Overcoming Obstacles to Effective Intervention: Coherent Service Planning and

Practical Strategies 6th Annual AFCC Australian Conference

August 15-17th 2019 Lyn Greenberg, Ph.D., ABPP

Presenter Biography Lyn R. Greenberg, Ph.D, ABPP, specializes in work with court-involved children and

families. She provides parenting coordination, consultation, treatment and intervention services to children and families involved with the courts, as well as forensic expert and consultation services to attorneys and training/consultation services to mental health professionals. Specialty areas include assessment of child abuse allegations, child interviewing, and specialized interventions for complex child custody cases, including those involving children with special needs.

Dr. Greenberg has written and presented extensively on a variety of issues related to child custody, child abuse, professional ethics, interviewing children, and the professional practice of forensic psychology in child custody and juvenile dependency cases. She enjoys an international reputation for her expertise on treatment of court-involved children and families, early intervention, parenting coordination and other specialized services, and teaches frequently in the US and in several international venues. She and her coauthors were honored with the AFCC Meyer Elkins award for their model on early intervention with children and families. She served as the reporter and member of the Association of Family and Conciliation Courts Task Force on Court Involved Therapists, co-edited the Journal of Child Custody special issue on court-involved therapy, and has also been honored by the American Psychological Association for her work. She is one of a select group of authors invited to contribute to the APA Handbook of Family psychology, and currently serves on the APA Working Group on children’s exposure to parental conflict. She is the lead editor for the just-published edited volume, “Evidence- Informed Interventions for Court-Involved Children and Families,” just released by Oxford Academic Press, which includes an internationally acclaimed group of authors and innovative models for assisting families.

The Robinson Family

Thomas and Ginny Robinson were married for 15 years and have two children - Priscilla, age 11 and Bobby, age 13. The parents’ marriage ended two years ago when Ginny learned from a friend that Thomas had been having an extramarital affair with Jane, a colleague from his office. Ginny was devastated by the divorce and has initially had difficulty transitioning from being a stay-at-home mother to working. Both children were furious at their father and resisted spending time with him for several months after the parents separated. This was particularly difficult since Thomas had been an active participant in both children’s athletic teams.

Thomas agreed to participate in family therapy with the children to “help them get over their feelings” about the divorce. The therapy was limited to Thomas and the children. He describes these sessions as largely consisting of Priscilla and Bobby yelling at him. He states that there were some good sessions and that the children even appeared to enjoy spending time with him over Christmas, but that if their mother would call they would pretend to be unhappy. Although Priscilla is now largely compliant with transitions, Bobby intermittently fails to show up at the school activity or other location where the parenting transitions are to occur. He is also frequently rude to Jane. The therapy sessions ended after about 8 weeks when Ginny refused to transport the children and Priscilla complained that the therapy gave her a headache.

She has a history of stomach aches which were tied to school distress when she was younger but ultimately resolved. Her complaints of headaches have continued to increase since the therapy was stopped, often occurring on days when a parenting transition is to occur.

Jane has now moved in with Thomas. They plan to get married in three months and are expecting a child in six months. Thomas has told Ginny but has not yet told the children. He believes it is time for the children to accept the situation and resume a more normal relationship and increased parenting time with him.

Ginny refuses to require them to comply with the parenting plan. She states that they are old enough to make their own decisions and she can understand their problems trusting Thomas.

Thomas is requesting a resumption of family therapy, this time with everyone required to participate, and a step-up plan that would eventually have the parents share parenting time equally.

The Smith Family

• Janie and Howard Smith have been separated for two years. Their children are Herbie, age 9, and Tiffany, age 4. The parents live close to one another and the children spend half of their time in each parent’s care on a 2-2-5-5 schedule.

• Both parents have history of obesity. Janie left Howard after she became involved in a health club and lost 30 pounds. Howard remains 40 lbs overweight and has struggled with depression.

• Herbie was involved in soccer, and occasionally in swimming until the time of

his parents’ separation. After his parents separated, he became increasingly depressed and sedentary and rapidly gained weight. He is now at the 98th percentile of weight/BMI and states he doesn’t like to play soccer anymore. According to the pediatrician, Herbie is already borderline diabetic. Mother wants to enroll him in soccer, to which Herbie vociferously objects. He seems to be aware that Janie initiated the separation and was present during arguments between his parents near the time of separation.

• Janie expresses concern that Herbie will adopt his father’s health habits.

Herbie now spends most of his time playing video games and resists all forms of exercise. Howard recalls being horribly teased because of his weight as a child and refuses to force his son to do soccer or any kind of exercise. He believes that Herbie is overeating because he is upset that Mother moved out. Recently, Mother re-enrolled Herbie in a soccer team, without Father’s permission. Father refuses to require Herbie’s participation, although he has attended some practices that Herbie has attended at Mother’s insistence, on her custodial days. He has videotaped Herbie isolating himself, crying, resisting participation and being isolated or teased by peers. Mother contends that Herbie’s health is at risk and that he would adjust to participating in the soccer program if Father would support it. She is threatening to seek modification of the custody order so that Herbie will participate regularly, based on the allegation that Herbie’s obesity places him at medical risk and that her decision to enroll Herbie in soccer was based on the pediatrician’s recommendation.

• Howard contends that he spoke with the pediatrician about Herbie’s obesity, and his own concerns that Herbie is depressed at the parents’ separation, and that being forced into soccer only makes this worse. He states that the pediatrician endorsed Howard’s suggestion that Herbie be enrolled in psychological counseling. Howard also expresses concern that Janie is “fat shaming” Herbie and denying him any of the food he likes, while allowing Tiffany to eat what she likes in front of Herbie. He still gives Herbie occasional treats and states that he recently witnessed Tiffany pushing a cookie away from Herbie stating, “you can’t have that.” Herbie has begun to bully Tiffany.

• Three weeks ago, Herbie began to resist attending school on the day of the

parenting transition, stating that he did not want to go to his mother’s house. Mother went to Father’s home to retrieve Herbie, who had to be carried, crying, out to his mother’s car while his parents argued with each other about the situation. Father contends that Herbie resists going to his mother’s home because she is insensitive and obsessed with his appearance. Mother contends that Father is not taking the health risks to Herbie seriously and is undermining her as a parent. She further alleges that Father is slipping money to Herbie so that Herbie can buy whatever he wants at the school cafeteria, rather than eating the nutritious lunches she packs.

• The situation escalated recently when Herbie went in tears to the school

guidance counselor, begging to not be sent to his mother’s home and claiming that Mother says demeaning things to Herbie about his weight. Mother denies making these statements. Father reports that the alleged statements are similar to statements mother made to him toward the end of the marriage. The guidance counselor followed a report of suspected emotional abuse, which was dismissed after the parties agreed to seek psychological counseling for themselves and Herbie. Each parent has filed a motion in family court seeking sole legal and primary physical custody of Herbie. Each has requested a single expert report. Howard brought Herbie to a therapist who works with his own therapist, without Janie’s permission, and both believe that Herbie and the family need therapy. Howard believes that both children, particularly Herbie, are being placed at serious emotional risk by Janie. Janie is willing to have Herbie in counseling as long as both parents agree to comply with a weight management program for him.

• Both parents’ lawyers have attempted to contact the pediatrician, who has surrendered his records but been unavailable to speak with anyone on the phone. The records reveal that the pediatrician has discussed Herbie’s weight with both parents and both exercise and counseling have been discussed. One progress note includes the notation, “mo states enrolling in soccer.” Another documents Father’s concerns about teasing and psychological issues and his intention to seek counseling for Herbie.

1

Oxford University Press

Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping

and Development

Lyn R. Greenberg, Ph.D., ABPP Forensic and Clinical Psychology

Board Certified, Couple and Family Psychology 11340 W. Olympic Blvd., Suite 265

Los Angeles, CA 90064 Tel: (310) 399-3684 Fax: (310) 988-2706

lyn@lyngreenbergphd.com www.lyngreenbergphd.com

Barbara J. Fidler, Ph.D., C.Psych., Acc.FM Family Solutions

1709 Bathurst Street Toronto, ON M5P 3K2

Tel: (416) 481-2046 Fax: (416) 481-5957

Email: drbarbarafidler@sympatico.ca

Michael A. Saini, Ph.D., M.S.W., R.S.W. Factor-Inwentash Faculty of Social Work, University of Toronto

246 Bloor Street West Toronto, ON, M5S 1A1

Tel: 416-946-50277 Fax: 905-836-9455 Email: michael.saini@utoronto.ca

2

Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping

and Development

Table of Contents Lynda Doi Fick, MA, MFT- A dedication, November 11, 1948-February 19, 2017 Author: Kenneth P. Sherman, Esq. Part A – Integrating What We Know: Coping, Adjustment, and the Legal Context Chapter 1: Shifting Our Perspective – Focusing on Coping and Adjustment Author: Lyn R. Greenberg, Ph.D., ABPP Chapter 2: The Role of the Courts in Supporting Therapeutic Interventions Authors: Nicholas Bala, L.S.M, J.D., LL.M., & Hon. Marjorie A. Slabach (Ret.) Part B – Therapeutic Approaches and Strategies Chapter 3: Specialized Child and Family Interventions Author: Jay Lebow, Ph.D., APBB Chapter 4: Matching Parent Education Programs to Family Treatment Needs Authors: John A. Moran, Ph.D., David Weinstock, J.D., Ph.D., and Kolette Butler, J.D., Psy.D. Chapter 5: Parenting Coordination: Structures and Possibilities Authors: Barbara J. Fidler, Ph.D., C.Psych., Acc.FM, & Lyn R. Greenberg, Ph.D., ABPP Chapter 6: The Power of Group Dynamics: Strategies for Supporting Children and Adolescents in Groups Post Separation and Divorce Authors: Jeff Mintz, M.S.W., RSW, Michael Saini, Ph.D., M.S.W., R.S.W., & Shely Polak, Ph.D., M.S.W., R.S.W., Acc.FM Chapter 7: Understanding and Using Activities Authors: David R. Austin, Ph.D., CTRS, and Lyn R. Greenberg, Ph.D., ABPP Part C – Special Issues in Intervention with Children and Families

3

Chapter 8: Early intervention with Resistance Refusal Dynamics and Hybrid Cases Authors: Lyn R. Greenberg, Ph.D., ABPP, Hon. Robert Schnider (Ret.), & Julie Jackson, Director, Family Law Division, Legal Aid Western Australia Chapter 9: “How am I supposed to treat these cases?” Working with families struggling with entrenched parent-child contact problems: A hybrid case. Authors: Barbara Fidler, Ph.D., C.Psych., Acc.FM, Robin Deutsch, Ph.D., ABPP, & Shely Polak, Ph.D., M.S.W., RSW., Acc.FM Chapter 10: Trauma and Child Custody Disputes: Screening, Assessment, and Interventions Authors: Leslie Drozd, Ph.D., Michael Saini, Ph.D., M.S.W., R.S.W., Kristina Vellucci-Cook, Psy.D., M.F.T Chapter 11: Bringing the Previously Absent Father into the Family Authors: Kyle D. Pruett, M.D., Marsha Kline-Pruett, M.S., Ph.D., M.S.L., & Robin Deutsch, Ph.D., ABPP Chapter 12 – Treating Children Exposed to Intimate Partner Violence within the Context of Child Custody Disputes Authors: Michael Saini, Ph.D., M.S.W., R.S.W., Elisa Romano, Ph.D., C. Psych, Kelly Weegar, Ph.D Student in Psychology, Sarah Zak , B.A. in Psychology , Elena Gallitto, Ph.D. Student in Psychology Chapter 13 – The Special Needs Child After Separation or Divorce: Involving Both Parents in Treatment and Intervention Planning Authors: Daniel B. Pickar, Ph.D., ABPP, and Robert L. Kaufman, Ph.D., ABPP Part D – Best Practices and Future Directions Chapter 14: Building and Managing Collaborative Teams Author: Matthew J. Sullivan, Ph.D. Chapter 15: Professional Ethics in a Legal Context Authors: Paul C. Berman, Ph.D., & Katherine W. Killeen, Ph.D. Chapter 16: Concluding Thoughts and Future Directions Confirmed authors: Lyn R. Greenberg, Ph.D., ABPP, Barbara J. Fidler, Ph.D., C.Psych., Acc.FM, Michael Saini, Ph.D., M.S.W., R.S.W., Hon. Robert Schnider (Ret.), Ashley-Lauren Reyes, M.A.

4

© Lyn R. Greenberg, Ph.D., ABPP

LYN R. GREENBERG, PH.D., ABPP Forensic and Clinical Psychology

Board Certified, Couple and Family Psychology 11340 W. Olympic Blvd., Suite 265

Los Angeles, CA 90064 310/399-3684 * fax 310/988-2706

lyn@lyngreenbergphd.com * http://lyngreenbergphd.com/

Elements of Systematic Intervention Planning Identifying goals (focus on developmental tasks and behaviors)

• Treatment goals for children o What does each child need to learn/master

Individually? In family relationships? In other systems, settings, activities?

o What behaviors will demonstrate progress?

• Treatment goals for parents o What does each parent need to master

To shield the child from conflict? To use effective parenting skills and authority, so the child

can progress developmentally To support the child’s independent relationships? To manage daily routines and support normal activities for

the child? To create a safe and stable household? To accurately understand the child’s feelings, including

expressions of distress? To solve family problems effectively?

o What behaviors will demonstrate progress?

Identifying resources required • What activities or services can promote the desired changes? • Can the child participate in community or normative activities?

o If so, what activities will best promote treatment goals? o If not, what interventions are required to enable the child to

participate? o What structures are needed to shield the child from conflict during

activities? • Are psychoeducational resources available? • How do available services fit with parents’ schedules and daily stressors?

© Lyn R. Greenberg, Ph.D., ABPP

• How can the family be assisted in integrating and applying information and experiences from various settings?

• Is specialized treatment or a treatment team required? • Is it workable to combine some specialized services with community

activities/resources?

• Underlying structure o Detail in safety orders – establishing safety while promoting healthy

relationships and activities o Reducing conflict in parenting transitions o Structures for children’s activities and events

Procedures for selecting and supporting activities Support for children’s autonomy and parent-child

relationships Priorities among activities, and between activities and

therapeutic interventions A process to adapt procedures as needs change

• Structuring psychological interventions

o Consider each element in model orders and specialized treatment models

o Selection of therapists Sufficient qualifications, at least in the coordinating therapist Explain the differences to the court Realistic understanding of resources, and about the choices

parents make about using their resources Consider combining specialized and non-specialized

services, with coordination o Structure for coordinating therapeutic information o Balancing privacy and accountability o Clear path from the therapeutic approach to the desired change o Establishing accountability

Cooperation with treatment Payment Supportive transitions to and from services Shielding the child from conflict Use of parental authority to promote child’s cooperation Specific behavioral changes

o Is a parenting coordinator needed? If so – what skills or background should this person have? How should the rule be structured? What if the parents won’t stipulate?

© Lyn R. Greenberg, Ph.D., ABPP

• Anticipating and addressing sabotage and resistance

o If interventions haven’t worked in the past, what has gone wrong? o If past interventions were inappropriately selected or poorly

structured, differentiate the new intervention plan from what has been tried in the past

o If family members have frustrated or undermined progress, how? o Who is likely to disagree with the recommended plan?

How might resistance be manifest? Which parts of the recommendations will cause anxiety in

the child? o Establish procedures with clear expectations and enough detail to

prevent obvious sources of sabotage o If recommending a specialized provider, consider recommending

that person be involved in crafting the treatment order

• Measurement of progress and feedback mechanisms

Levels of Stress, Potential Outcomes

Healthy

Moderate

SevereToxic

AvoidanceRegression

Mastery

Unhealthy StressResponses

Support Resolution Resilience

Long-term dysfunctionRisks to physical and

mental health

Interventions, Treatment, Recovery,

Resilience

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1

Attorney for Petitioner 2

3

Attorney for Respondent 4

5

SUPERIOR COURT OF THE STATE OF CALIFORNIA 6

FOR THE COUNTY OF LOS ANGELES 7

8

In re the Marriage of: ) Case No. 9

Petitioner: ) STIPULATION AND ORDER FOR 10

) COUNSELING AND/OR PARENT 11

and ) EDUCATION 12

Respondent: ) 13

14

15

1. IT IS HEREBY STIPULATED by and between the parties, (insert 16

names)____________________________________________________________________ 17

_ 18

joined by their respective attorneys of record, to the appointment of 19

Lyn R. Greenberg, Ph.D. (CA Lic. Psychologist, #PSY11436) to conduct 20

counseling/psychotherapy with themselves and/or the minor child(ren) of the parties (insert 21

names and birth dates of minor children): _ ___ 22

_ 23 24

25

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1

2. OTHER PARTICIPANTS IN COUNSELING 2

Both parents will participate in counseling if requested by Dr. Greenberg. Dr. Greenberg 3

may request the involvement of other household or family members as she deems appropriate. 4

The parents acknowledge that, when a child is involved in counseling, the child is considered to 5

be Dr. Greenberg’s client/patient. Parents are adjunct/collateral participants in counseling 6

directed toward the welfare of the child. 7

3. DURATION OF COUNSELING 8

The parties and/or minor child(ren) and/or others will participate 9

in counseling for at least ____ months, not to exceed one year unless the parties stipulate 10

otherwise or the court so orders. The frequency, duration and structure of sessions will be 11

adjusted as Dr. Greenberg deems appropriate. Dr. Greenberg will determine the order of 12

appointments and who should be present at each. As consistent with other orders in this 13

matter, and if a child is involved in treatment then the parties agree to deviate from their usual 14

parenting time arrangements as appropriate to allow both parties to participate in transporting 15

the minor child to and from treatment. 16

4. COOPERATION WITH TREATMENT 17

Both parties are ordered to cooperate with Dr. Greenberg, including, but not limited to, 18

(1) paying for services in a timely manner in accordance with the fee agreement executed by 19

the parties with the Dr. Greenberg, (2) ensuring that the minor child(ren) are transported to and 20

from scheduled appointments in a timely manner; and (3) exercising parental authority to 21

require that the minor child(ren) attend(s) and cooperate(s) with treatment. 22

The parties have been advised that successful psychotherapy for children often requires 23

-3-

that parents make changes in their own behavior and parenting, to support their children’s 1

needs. Dr. Greenberg may request specific changes in such areas as setting appropriate limits 2

for children, encouraging children to express feelings and solve problems appropriately, 3

listening to children’s concerns, actively supporting children’s independent relationships, and 4

shielding the children from parental conflict. The parties agree to make reasonable efforts to 5

cooperate with Dr. Greenberg’s requests in these areas. If either parent disagrees with 6

requests or recommendations made by Dr. Greenberg, the parent will discuss those concerns 7

privately with Dr. Greenberg, and will not allow the child to witness or overhear such concerns. 8

Both parties acknowledge that they have had an opportunity to review this stipulation and Dr. 9

Greenberg’s consent agreement, and to ask any questions they may have concerning Dr. 10

Greenberg’s approach to treatment and other alternatives that may be available. The structure, 11

frequency, duration, and participants in therapy sessions will be determined by Dr. Greenberg. 12

Dr Greenberg will not make recommendations as to custody or parenting plans, nor determinations 13

regarding the child’s best interests, as these are outside the therapists’ role. She may make 14

recommendations to the parties regarding changes in the parent-child relationships that may be 15

helpful to the children in implementing the Court’s orders. When children are not directly 16

involved, but therapy is conducted for the benefit of the children parents may need to consider 17

similar behavior changes. 18

5. GOALS OF COUNSELING 19

The goals of counseling shall be following (check all boxes and describe specific issues): 20

[ ] Facilitate communication between the parties regarding their minor child(ren)'s 21

needs:_____________________________________________________________ 22

_____________________________________________________________________ 23

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[ ] Reduce conflict regarding parenting time schedules__________________________ 1

_____________________________________________________________________ 2

__________________________________________________________________ 3

[ ] Improve the quality of parenting skills of (Petitioner/Respondent/both parents), 4

_____________________________________________________________________ 5

_____________________________________________________________________ 6

[ ] Address emotional/behavioral problems of child(ren) 7

______________________________________________________________________ 8

[ ] Facilitate the relationship between child(ren) and 9

[ ] Petitioner [ ] Respondent [ ] both parents 10

[ ] Conjoint/family therapy for 11

[ ] both parents 12

[ ] both parents and the child(ren) 13

6. CONFIDENTIALITY 14

Except as authorized below, Dr. Greenberg will keep confidential all information obtained 15

in counseling except when mandated by law to report suspected child abuse and where a 16

person appears to be a danger to him/herself or others. If a child is in treatment, Dr. Greenberg 17

will require written authorizations from both parents to release any information not required by 18

law or addressed in this stipulation/order. Any authorizations to release and receive 19

information, as noted below, represent additional and full waivers of any privileges that may 20

apply to information provided to Dr. Greenberg. References to “any applicable privilege” herein 21

do not represent a legal determination by the therapist that a particular privilege applies in this 22

case. Such a determination would be the province of the Court if a dispute arises. The 23

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stipulation signed herein describes the intended conduct of the therapist with respect to these 1

issues, all of which may be subordinate to the orders or findings of the trial court. The parties 2

understand that the therapist is not an attorney and that he/she is required to obey the order of 3

the court and/or to bring to the attention of the court any possible conflicts between the court’s 4

orders and professional practice standards applicable to psychologists. By signing this 5

stipulation, both parents acknowledge that they have had an opportunity to review this 6

stipulation with counsel. Both parents agree to attempt to resolve any disputes over sharing of 7

information with Dr. Greenberg before taking legal action. If Dr. Greenberg is required to by 8

subpoena or ethical obligations to participate in a legal matter, the parties agree to reimburse 9

Dr. Greenberg for reasonable expenses including attorneys fees. 10

The parents also understand that, if Dr. Greenberg is permitted by waiver or required by 11

law or court order to provide information to anyone, including counsel, a child custody evaluator 12

and/or the Court, the information released may include information that might otherwise be 13

considered to be protected under the Health Insurance Portability and Accountability Act 14

(HIPAA). 15

Should any dispute arise as to whether a communication is privileged, Dr. Greenberg will 16

refer the issue to the court for resolution, and will refrain from disclosing the information in 17

dispute until directed by the Court. Dr. Greenberg will obey any order from the trial court 18

regarding release of treatment information provided by the parents or children. The parties 19

agree to hold Dr. Greenberg harmless regarding any release of information provided based on 20

good-faith adherence to a waiver or Court order, and for any delay resulting from a good faith 21

decision by Dr. Greenberg to seek direction from the Court before releasing information. 22

7. METADATA 23

The parties agree that, to the extent Dr. Greenberg is formally (e.g., pursuant to 24

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subpoena) or informally requested/required to produce her records, Dr. Greenberg may provide 1

records in paper form or on a flash drive. In either event, Dr. Greenberg will not be required to 2

produce electronic copies of her books and records or provide "metadata" relating to her books 3

and records. Dr. Greenberg's production of documents from her computer will be limited to 4

items Dr. Greenberg can print out. The parties will not have access to Dr. Greenberg's personal 5

devices. Dr. Greenberg will only provide records if all privilege issues have been resolved. 6

8. DIRECT COMMUNICATIONS TO THE COURT 7

If either party returns to court regarding custody or visitation issues, Dr. Greenberg: 8

______ will provide no information to the court, absent additional order and waivers 9

_______will provide a letter to the Court describing the parties’ and children’s progress 10

and cooperation in treatment. This may include specific statements and 11

behaviors which Dr. Greenberg deems necessary to adequately support other 12

content or statements in her letter. 13

_______will describe the type of additional services and/or treatment, if any, that would 14

be helpful for the children or family 15

______ will describe on other interventions that would be helpful to the children and 16

family 17

18

Authorization to provide a letter to the Court on any of these issues represents a full 19

waiver of any applicable privilege regarding this counseling/therapy, such a waiver also applies 20

to any testimony that Dr. Greenberg is required to provide about her letter. Any letter provided 21

by Dr. Greenberg will only address issues related to the counseling or therapy. Such a letter 22

does not substitute for a child custody evaluation, and Dr. Greenberg will not make any custody 23

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recommendations. Procedures in therapy are not equivalent to those provided in a child 1

custody evaluation. 2

Dr. Greenberg is authorized to notify the court, with copies of the communication to 3

counsel, if she is unable to proceed with court-ordered treatment due to non-cooperation of any 4

party, including non-payment of fees, or if significant obstacles are being encountered to 5

treatment. 6

The parties and counsel agree that all testimony provided by Dr. Greenberg, in any 7

matter related to this family, shall be considered expert testimony, paid for at Dr. Greenberg’s 8

regular fee, under the terms of Dr. Greenberg’s fee agreement. . No letter or testimony will be 9

provided by Dr. Greenberg without payment seven days in advance, from the parent or counsel 10

desiring such report or testimony, or from the party responsible for paying for treatment. Absent 11

receipt of such payment, Dr. Greenberg will be under no obligation to provide communications, 12

testimony, or services of any kind. 13

9. INFORMATION TO CUSTODY EVALUATORS 14

If either party returns to court regarding custody or visitation issues and a custody 15

evaluation is ordered, the parties may be asked to waive privilege so that Dr. Greenberg can 16

provide information to the child custody evaluator. If such waivers are provided, the content of 17

information provided to the evaluator will be at Dr. Greenberg’s discretion. Both parents agree 18

to execute any additional releases that may be necessary or convenient to document waiver of 19

privilege. If a child is in treatment, Dr. Greenberg must receive releases from both parents or 20

an order of the Court to disclose treatment information. 21

10. COMMUNICATION WITH OTHER PROFESSIONALS 22

To coordinate treatment, it may be helpful for Dr. Greenberg to communicate with other 23

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professionals (therapists, teachers, doctors, etc.). The parties hereby waive all applicable 1

privilege to allow Dr. Greenberg to receive information from and provide any and all treatment 2

information to the professionals listed below: 3

____________________________________________________________________________4

____________________________________________________________________________ 5

____________________________________________________________________________ 6

The parties agree to execute any additional releases that may be necessary or 7

convenient to allow such communication. If Dr. Greenberg believes that communication with 8

any other professionals would be helpful to treatment, additional releases may be requested 9

from the parties. If Dr. Greenberg requests communication with the parties’ individual treating 10

therapists, the parties may provide a one-way release, preserving the confidentiality of their 11

individual treatment information, if appropriate. 12

11. If Dr. Greenberg is ordered or requested to provide treatment information in a manner 13

that she believes raises risks to the welfare of the children, Dr. Greenberg is authorized to 14

provide this information to the Court, as well as to request any interventions (e.g.. appointment 15

of minor’s counsel) that she believes would mitigate this risk. 16

12. [ ] A review hearing is hereby set for __________, for the following purposes: 17

_ 18

_ 19

13. FEES 20

The cost of the counseling shall be paid as follows: 21

____________ Petitioner; ____________ Respondent; ______________ ½ by each party in 22

accordance with the terms of Dr. Greenberg’s fee agreement. 23

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1

Dr. Greenberg’s individual meetings with each parent will be paid for by: 2

the parent attending the session 3

½ by each party; 4

petitioner; 5

respondent. 6

Outside-session services (including but not limited to conference calls, correspondence, 7

and telephone calls), as described in Dr. Greenberg’s consent agreement, will be paid as 8

follows: ___ _ _ 9

_ 10

Each parent is to provide payment to Dr. Greenberg within ten days of receiving any 11

invoice or request for payment from Dr. Greenberg. 12

Each parent and counsel acknowledge that they have had an opportunity to review Dr. 13

Greenberg’s fee/consent agreement and this stipulation, and to consult with counsel concerning 14

it. The parents agree to abide by the terms of this agreement and Dr. Greenberg’s fee/consent 15

agreement, and agree to abide by the terms of those documents. Each parent and counsel 16

acknowledge that treatment services may be suspended if fees are not paid, and that Dr. 17

Greenberg has no responsibility to provide letters, testimony or other services if fees are not 18

paid. If treatment services are suspended due to nonpayment of fees by either party, Dr. 19

Greenberg is authorized to disclose this information to both parents, counsel and the Court. 20

21

A facsimile or photocopy of this stipulation/order shall be considered as valid as the original. 22

This Stipulation and Order may be signed in counterparts. 23

24

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IT IS SO STIPULATED. 1

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DATED: _____________________________________ Petitioner

DATED: ______________________________________ Respondent DATED: _______________________________________

Attorney for Minor (if applicable)

AGREED AS TO CONTENT AND FORM: DATED: __________________________________

Attorney for Petitioner DATED:

Attorney for Respondent

ORDER IT IS SO ORDERED. DATED: ___________________________________________ JUDGE OF THE SUPERIOR COURT

2/21/2018 National Child Traumatic Stress Network Empirically Supported Treatments and Promising Practices | National Child Traumatic Stress Network …

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National Child Traumatic Stress Network Empirically Supported Treatments and Promising Practices

The fact sheets linked from this page offer descriptive summaries of some of the clinical treatments, mental healthinterventions, and other trauma-informed service approaches that the National Child Traumatic Stress Network (NCTSN)and its various centers have developed and/or implemented as a means of promoting the Network’s mission of raising thestandard of care for traumatized youth and families. This list does not present a comprehensive list of all relevant interventions developed and available for treating childtraumatic stress. Nor do the fact sheets themselves offer a rigorous review of the evidence supporting each intervention.The NCTSN does not intend for this website to serve as a public notice or advertising space for interventions that its sitesare not implementing. Individuals who wish to know the evidence supporting an intervention may search online databases such as the NationalRegistry of Evidence-Based Programs and Practices (NREPP) and the California Evidence-Based Clearinghouse for ChildWelfare (CEBC). These websites offer a rigorous review of interventions—and the evidence supporting them—for a varietyof child and adolescent mental health problems. Those searching for an intervention to best match the needs of thepopulations they serve are encouraged to consider other interventions than those summarized here.

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Page Contents:How the Fact Sheets Were DevelopedHow to Use the Fact SheetsCore Components of InterventionsIntervention Descriptions

How the Fact Sheets Were Developed

These fact sheets were developed as part of the NCTSN Trauma-Informed Interventions: Clinical and Research Evidenceand Culture-Specific Information Project, a joint venture undertaken by the NCTSN and the National Crime VictimsResearch and Treatment Center at the Medical University of South Carolina. The aim of this project was to summarizevarious types of clinical and research evidence pertaining to trauma-informed interventions, especially as these interventionsrelate to diverse cultural groups (as defined by such factors as race, ethnicity, sexual orientation, socioeconomic status,spirituality, disability, and geography). Produced in close consultation with the developer of each treatment or service approach and replacing a set of fact sheetsdeveloped by the NCTSN in 2005, these documents include more up-to-date information and more culturally-relevantfeatures. The fact sheets not updated for the NCTSN Trauma-Informed Interventions: Clinical and Research Evidence andCulture-Specific Information Project remain in their original form.

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How to Use the Fact Sheets

In recognition of the diverse needs of the child and adolescent populations served by NCTSN sites across the country, theinterventions and treatments listed below span a continuum of evidence-based and evidence-supported interventionsranging from rigorously evaluated interventions to promising practices and newly-emerging practices. Readers areencouraged to review and consider these practices from a variety of perspectives including the following:

1. Consider not only the levels and types of evidence that support the use of the intervention in general, but also itsappropriateness for a given community and target population. For example, does it address the types of trauma andlosses that are prevalent within that population? Does it address their typical consequences, such as mental distress,functional impairment, risky behavior, or developmental disruption?

2. More generally, the needs, values, available resources, demographic characteristics, and informed preferences of aprovider's service population also influence the type of intervention needed. Factors to consider include these:

Local culture and values of the clientele and the surrounding communityDevelopmental factors, including age, cognitive, and social domainsSocioeconomic factorsLogistical and other barriers to help-seekingAvailability of individual/family/community strength-based resources that can be therapeutically leveragedSetting in which services are offered (school, residential, clinic, home)

3. Also consider such factors as training requirements, feasibility of adoption and implementation, and potential forsustainability. Readers should gather additional information on adoption readiness through discussions with thetreatment developers and other sites that have implemented the practices.

4. The NCTSN has developed a position statement on Prerequisite Clinical Competencies for Implementing Effective,Trauma-informed Intervention—that agency leaders, clinicians, trainers, and others can use to guide optimal serviceprovision to children and families affected by trauma—delineating the clinical knowledge and skills recommendedprior to training in or implementing an evidence-based treatment (EBT) both within and outside of the NCTSN. Avariety of NCTSN tools may be available to help build these foundational competencies, including the Core

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Secondary Traumatic StressSpecial Populations andTraumaFamily-Youth-ProviderPartnerships

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Curriculum on Childhood Trauma.5. Many existing trauma-focused interventions overlap in their content and approaches. These areas of overlap are

termed core components. Core components can be conceptualized as intervention objectives (what the therapistintends to achieve by intervening) or practice elements (actions the therapist undertakes toward achieving theintervention objective). Providers should consider: (1) Whether a given intervention targets or includes the desiredintervention objectives (outcomes valued by the clients), and (2) whether the practice elements used in theintervention can be realistically implemented by the therapist (e.g., specific skills-acquisition activities, homework,role-play, games). Taken together, agencies/clinicians should evaluate both intervention objectives and practiceelements in terms of their "fit" with the specific needs and preferences of the population the agency serves.):

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Core Components of Interventions

Motivational interviewing (to engage clients)Risk screening (to identify high-risk clients)Triage to different levels and types of intervention (to match clients to the interventions that will most likely benefitthem/they need)Systematic assessment, case conceptualization, and treatment planning (to tailor intervention to the needs, strengths,circumstances, and wishes of individual clients)Engagement/addressing barriers to service-seeking (to ensure clients receive an adequate dosage of treatment inorder to make sufficient therapeutic gains)Psychoeducation about trauma reminders and loss reminders (to strengthen coping skills)Psychoeducation about posttraumatic stress reactions and grief reactions (to strengthen coping skills)Teaching emotional regulation skills (to strengthen coping skills)Maintaining adaptive routines (to promote positive adjustment at home and at school)Parenting skills and behavior management (to improve parent-child relationships and to improve child behavior)Constructing a trauma narrative (to reduce posttraumatic stress reactions)Teaching safety skills (to promote safety)Advocacy on behalf of the client (to improve client support and functioning at school, in the juvenile justice system,and so forth)Teaching relapse prevention skills (to maintain treatment gains over time) Monitor client progress/response during treatment (to detect and correct insufficient therapeutic gains in timely ways)Evaluate treatment effectiveness (to ensure that treatment produces changes that matter to clients and otherstakeholders, such as the court system)

In contrast, interventions that do not include needed core components may be inappropriate for the population or mayrequire substantial adaptation.

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Intervention Descriptions

Click on each intervention fact sheet, culture specific sheet or training guideline to download detailed information on theintervention as well as where to obtain additional information. Interventions are listed in alphabetical order.

Name of Intervention Targeted Populations Modality Culture-Specific Fact

Sheet

TrainingGuidelines

Adapted Dialectical BehaviorTherapy for SpecialPopulations (DBT-SP) (2012)(PDF)

8-21; both males andfemales; for youthexperiencing a widerange of traumas

individual Yes --

Alternatives for Families - ACognitive Behavioral Therapy(AF-CBT) (2012) (PDF)

School-age children; foryouth experiencing awide range of traumas

individual, family Yes --

Assessment-BasedTreatment for TraumatizedChildren: TraumaAssessment Pathway (TAP)(2012) (PDF)

0-18; both males andfemales; for children whohave experienced a widerange of traumas

individual, family,systems

Yes Yes

Attachment andBiobehavioral Catch-up(ABC) (2012) (PDF)

Birth – 24 months; bothmales and females; forlow-income families whohave experiencedneglect, abuse, domesticviolence, placementinstability

individual, family No Yes

Attachment, Self-Regulation,and Competence (ARC): AComprehensive Frameworkfor Intervention withComplexly Traumatized Youth(2012) (PDF)

2-21; both males andfemales; for children,caregivers, and systemsthat have experienced awide range of traumas

individual, family,systems

Yes Yes

An Elementary SchoolIntervention for ChildhoodTrauma (Bounce Back)(2017) (PDF)

5-11;both males andfemales; for use inschools for youthexperiencing a widerange of traumas

individual, group,family

No --

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Child Adult RelationshipEnhancement (CARE) (2008)(PDF)

Children of all ages andtheir caregivers; bothmales and females

family, systems Yes --

Child and Family TraumaticStress Intervention (CFTSI)(2012) (PDF)

7-18; both males andfemales; for parents andchildren who may havecomplex trauma histories

individual, family,systems

No --

Child Development-Community Policing Program(2007) (PDF)

0-18+; both males andfemales; for children andfamilies in the aftermathof crime and violence.

individual, family,systems

No --

Child-Parent Psychotherapy(CPP) (2012) (PDF)

0-6; both males andfemales; for youth whohave experienced a widerange of traumas and parents with chronictrauma

individual, family,systems

Yes --

Cognitive BehavioralIntervention for Trauma inSchools (CBITS) (2012)(PDF)

10-15; both males andfemales; for children whohave experienced a widerange of traumas

individual, family,systems

Yes Yes

Combined Parent ChildCognitive-BehavioralApproach for Children andFamilies At-Risk for ChildPhysical Abuse (CPC-CBT)(2015) (PDF)

4-17; both male andfemale; for families with ahistory of physical abuseand inappropriatephysicaldiscipline/coerciveparenting strategies

individual, group,family

Yes --

COPE - Community OutreachProgram - Esperanza (2007)(PDF)

4-18; both males andfemales; for traumatizedchildren who arepresenting with behavioror social-emotionalproblems

individual, family No --

Culturally Modified Trauma-Focused Treatment (CM-TFT)(2008) (PDF)

4-18; both males andfemales; Latino/Hispanic;for youth who haveexperienced a widerange of traumas

individual, family Yes --

Early Pathways (EP) (2017)(PDF)

Child abuse and neglect,sexual abuse, intimatepartner abuse,community violence,multiple and prolongedtraumatic events, andcomplex trauma

family No --

Family Advocate Program(2005) (PDF)

18-70; both males andfemales; for youth whopresent with anxiety,depression, PTSDsymptoms, and/ortraumatic loss

family No --

Forensically-SensitiveTherapy (2005) (PDF)

4-17; predominantlyfemale; for youthpresenting problemsranging from anxiety anddepression to risk-takingbehaviors and functionalimpairment. Program isdesigned for a mentalhealth clinic.

individual, family No --

Group Treatment for ChildrenAffected by DomesticViolence (2007) (PDF)

5-no upper limit; bothmales and females; forchildren and theirnonoffending parentswho have been exposedto DV

group, family,systems

No --

Honoring Children, MakingRelatives (2007) (PDF)

3-7; both males andfemales; for AmericanIndian and Alaska Nativechildren

individual, family No --

Honoring Children, Mendingthe Circle (2007) (PDF)

3-18; both males andfemales; for AmericanIndian and Alaska Nativechildren

individual No --

Honoring Children,Respectful Ways (2007)(PDF)

3-12; both males andfemales; for AmericanIndian and Alaska Nativechildren

individual No --

Integrative Treatment ofComplex Trauma for

2-21; both males andfemales; for Hispanic-American, African-

individual, family,systems

Yes Yes

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Adolescents (ITCT-A) (2008)(PDF)

American, Caucasian,Asian-American; foryouth who may havecomplex trauma histories

Integrative Treatment ofComplex Trauma forAdolescents (ITCT-C) (2017)(PDF)

2-21; both males andfemales; for Hispanic-American, African-American, Caucasian,Asian-American; foryouth who may havecomplex trauma histories

individual, family,systems

No --

International Family Adult andChild Enhancement Services(IFACES) (2012) (PDF)

6-12; both males andfemales; for refugee andimmigrant children whohave experienced traumaas a result of war ordisplacement

individual Yes --

Let's Connect (LC) (2016)(PDF)

3-15; both males andfemales; for children whohave experienced a widerange of traumas

individual, family Yes --

Parent-Child InteractionTherapy (PCIT) (2008) (PDF)

2-12; both males andfemales

individual, family,systems

Yes Yes

Problematic Sexual Behavior-Cognitive-Behavioral Therapyfor School-Age Children(PSB-CBT-S) (2016) (PDF)

7-12; both males andfemales; for children withproblematic sexualbehavior may or may nothave a history of trauma

individual, family,systems

Yes No

Psychological First Aid (PFA)(2012) (PDF)

0-120; both males andfemales; for individualsimmediately followingdisasters, terrorism, andother emergencies

individual Yes --

Real Life Heroes (RLH)(2012) (PDF)

6-12, plus adolescents(13-19) with delays insocial, emotional orcognitive functioning;both males and females;for children who haveexperienced a widerange of traumas

individual, family,systems

Yes Yes

Risk Reduction throughFamily Therapy (RRTF)(2015) (PDF)

13-18, both males andfemales; for adolescentsand family; primarytrauma type is childhoodsexual abuse/sexualassault

family No --

Safe Harbor Program (2007)(PDF)

6-21; both males andfemales; provided inschools for children andadolescents exposed totrauma and violence whomay present with a rangeof problems andsymptoms

individual, group,family, systems

No --

Safety, Mentoring, Advocacy,Recovery, and Treatment(SMART) (2012) (PDF)

3-11; both males andfemales; to date themodel has beeneffectively used withprimarily African-American children;majority of families arelow income

individual, family,systems

No Yes

Sanctuary Model (2008)(PDF)

4-no upper limit; bothmales and females;evidence-supportedtemplate for systemchange based on theactive creation andmaintenance of anonviolent, democratic,productive community tohelp people heal fromtrauma

systems Yes Yes

Skills for PsychologicalRecovery (SPR) (2012)(PDF)

5-120; both males andfemales

individual, family Yes --

Skills Training in Affective andInterpersonalRegulation/Narrative Story-Telling (STAIR/NST) (2005)(PDF)

12-21; for females whohave experiencedsexual/physical abuseand a range of additionaltraumas, includingcommunity violence,

individual, group No Yes

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domestic violence, andsexual assault

Southeast Asian Teen Village(2005) (PDF)

adolescents; females,Southeast Asian (mostlyHmong)

group No --

Streetwork Project (2007)(PDF)

13-23; both males andfemales; harm reductionprogram good with awide variety ofethnic/racial groups,religious group, and theLGBTQ community

individual, group, systems

No --

Strengthening Family CopingResources (SFCR) (2008)(PDF)

0-no upper limit; bothmales and females; forfamilies experiencingeconomic hardship

family No Yes

Structured Psychotherapy forAdolescents Responding toChronic Stress (SPARCS)(2012) (PDF)

12-21; both males andfemales; for adolescentswith Complex Trauma,e.g. adolescents exposedto chronic interpersonaltrauma (such as ongoingphysical abuse) and/orseparate types of trauma(e.g. community violence,sexual assault).

group Yes --

Support for StudentsExposed to Trauma: SchoolSupport for Child hoodTrauma (SSET) (2017) (PDF)

10-16; both males andfemales; for use inschools for youthexperiencing a widerange of traumas

individual No --

Trauma Adapted FamilyConnections (TA-FC) (2012)(PDF)

0-18; both males andfemales; who reside inthe household; familiesexperiencing complexdevelopment trauma, atrisk of neglect

individual, family,group

No --

Trauma Affect Regulation:Guide for Education andTherapy (TARGET) (2012)(PDF)

10-18+; both males andfemales; for children andcaregivers experiencingtraumatic stress; veryfrequently with singleparents or with familieswhose children havelimited contact withbiological parents (e.g.,foster kids, residentialplacements), anddiversity of religiousaffiliations

individual, group,family, systems

Yes Yes

Trauma and Grief ComponentTherapy for Adolescents(TGCT-A) (2015) (PDF)

12-20; both males andfemales; for trauma-exposed or traumaticallybereaved older childrenand adolescents

individual, group,family, systems

Yes --

Trauma-Focused CognitiveBehavioral Therapy (TF-CBT)(2012) (PDF)

3-21; both males andfemales; for children withPosttraumatic StressDisorder (PTSD) or otherproblems related totraumatic lifeexperiences, and theirparents or primarycaregivers

individual, family Yes Yes

Trauma-Focused Coping inSchools (TFC) (AKA:Multimodality TraumaTreatment Trauma-FocusedCoping-MMTT) (2012) (PDF)

6-18; both males andfemales; for childrenexposed to singleincident trauma andtargets posttraumaticstress disorder (PTSD)and collateral symptomsof depression, anxiety,anger, and external locusof control

individual, group Yes --

Trauma-InformedOrganizational Self-Assessment (2008) (PDF)

6-19; both males andfemales; for children whohave experienced a widerange of traumas

individual,family,systems

Yes --

Trauma Systems Therapy(TST) (2016) (PDF)

6-19; both males andfemales; for youth whohave experienced a widerange of traumas

systems Yes --

Trauma Systems Therapy for 10-18; both males and systems Yes --

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Refugees (TST-R) (2016)(PDF)

females; newly arriving,recently resettled, and established refugeeyouth and communities

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Association of Family and Conciliation Courts

Guidelines for Court-Involved Therapy

© 2010 Association of Family and Conciliation Courts

Association of Family and Conciliation Courts

Guidelines for Court-Involved Therapy

Approved by the AFCC Board of Directors October 2010

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Table of Contents

Preamble ........................................................................................................................... 1 Introduction ...................................................................................................................... 1 Definitions ......................................................................................................................... 2

Definitions Regarding Professional Roles ............................................................. 2 Community Therapist ................................................................................ 2 Court-Involved Therapist (CIT) ................................................................. 2 Court-Appointed Therapist ........................................................................ 2 Court-Ordered Therapist ............................................................................ 2

Definitions Regarding Experts ............................................................................... 2

Expert ......................................................................................................... 2

General Definitions ................................................................................................ 3 Client/Patient.............................................................................................. 3 Collateral .................................................................................................... 3 Confidentiality ........................................................................................... 3 Privilege ..................................................................................................... 3 Conflict of Interest ..................................................................................... 3 Informed Consent....................................................................................... 3

Guideline 1: Assessing Levels of Court Involvement .................................................... 5

1.1 Court-involved treatment and the legal process ......................................... 5 1.2 Special considerations for court-involved roles with children .................. 6

Guideline 2: Professional Responsibilities ..................................................................... 7 2.1 Role boundaries ......................................................................................... 7

2.2 Respect for parties, families, the legal process .......................................... 7 2.3 Communication of observations and opinions to adult clients,

parents of child clients, and other professionals ....................................... 8 2.4 Professional objectivity .............................................................................. 8 2.5 Managing Relationships ............................................................................. 8 2.6 Accountability ............................................................................................ 9 Guideline 3: Competence ................................................................................................ 9 3.1 Competence for the specialized role of CIT .............................................. 9 3.2 Gaining and maintaining competence ........................................................ 9 3.3 Areas of competence ................................................................................ 10 3.4 Understanding professional roles and resources ...................................... 11 3.5 Representation of competence and professional knowledge ................... 11

3.6 Consideration of impact of personal beliefs and experiences .................. 11

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Guideline 4: Multiple Relationships ............................................................................. 12 4.1 Simultaneous and sequential role conflicts .............................................. 12 4.2 Disclosure of potential role conflicts ....................................................... 12

Guideline 5: Fee Arrangements .................................................................................... 13 5.1 Timing, documentation ............................................................................ 13 5.2 Components of fee agreements ................................................................ 13 Guideline 6: Informed Consent .................................................................................... 14

6.1 Components of informed consent ............................................................ 14 6.2 Special considerations for children .......................................................... 15 6.3 Third party requests for treatment............................................................ 15 6.4 Multiple treatment participants ................................................................ 16 6.5 Handling treatment information ............................................................... 16 6.6 Clients who are represented by attorneys ................................................ 16 6.7 Changes in the nature of the therapist’s Court involvement .................... 16 6.8 Providing feedback and Court testimony ................................................. 17 Guideline 7: Privacy, Confidentiality and Privilege ................................................... 17 7.1 Client/patient confidentiality and privilege ............................................. 17 7.2 Litigation and its impact on treatment information ................................. 18 7.3 Impact of limits of expertise on disclosure of treatment

information ............................................................................................... 18 7.4 Ongoing obligation to inform clients ....................................................... 18 7.5 Special issues in children’s treatment ...................................................... 19 7.6 Health Insurance Portability and Accountability Act (HIPAA)

considerations .......................................................................................... 19 7.7 Requests for treatment information from third parties ............................ 20 7.8 Responding to a subpoena ....................................................................... 20

7.9 Responding to a Court order for release of treatment information .......... 20 7.10 Appealing a Court order........................................................................... 21 Guideline 8: Methods and Procedures ......................................................................... 21

8.1 Adherence to professional standards, special considerations with Court involvement ........................................................................... 21

8.2 Obtaining necessary information ............................................................. 21 8.3 Therapeutic role and process ................................................................... 22 8.4 Distortions of treatment information ....................................................... 22 8.5 Selecting appropriate treatment methods ................................................. 23 8.6 Critical examination of treatment information ........................................ 23 8.7 Impact of release of treatment information on clients ............................. 24 8.8 Consultation about methods and procedures ........................................... 25

Guideline 9: Documentation ......................................................................................... 25 9.1 Sufficiency of documentation .................................................................. 25 9.2 Record keeping ........................................................................................ 25

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9.3 Organization and detail ............................................................................ 26 9.4 Confidentiality and security ..................................................................... 26 9.5 Ethical and statutory requirements ........................................................... 26 9.6 Communication of record keeping procedures to clients ........................ 26

Guideline 10: Professional Communication ................................................................ 27 10.1 Authorization to communicate ................................................................. 27 10.2 Accuracy in communication .................................................................... 27 10.3 Limits and distinctions ............................................................................. 27 10.4 Appropriate parties to include in communication .................................... 28 10.5 Testimony ................................................................................................ 28

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PREAMBLE

The Guidelines for Court-Involved Therapy have been formulated to assist members of the Association of Family and Conciliation Courts (AFCC) and others who provide treatment to court-involved children and families. The Guidelines are also intended to assist those who rely on mental health services or on the opinions of mental health professionals in promoting effective treatment and assessing the quality of treatment services. The Guidelines are also intended to assist the Courts to develop clear and effective Court orders and parenting plans that may be necessary for treatment to be effective. AFCC does not intend these Guidelines to define mandatory practice. They are a best-practice guide for therapists, attorneys, other professionals and judicial officers when there is a need for therapeutic interventions with court-involved children or parents. While available resources and local jurisdictional expectations may influence the types of therapeutic services provided by a Court-Involved Therapist (CIT), the purpose of these guidelines is to educate, highlight common concerns, and to apply relevant ethical and professional guidelines, standards, and research in handling court-involved families.

INTRODUCTION For the purposes of these guidelines, court-involved therapists are mental health professionals who provide therapeutic services to family members involved in child custody or juvenile dependency Court processes. Family and juvenile Court cases involving therapeutic services introduce unique factors and dynamics that require consideration in the treatment process. Both the treatment process and information provided to the therapist are likely to be influenced by the family’s involvement in a legal process. While appropriate treatment can offer considerable benefit to children and families, inappropriate treatment may escalate family conflict and cause significant damage. The Guidelines for Court-Involved Therapy are the product of the Court-Involved Therapist Task Force, appointed by AFCC President Robin Deutsch in 2009. Task force members were: Hon. Linda S. Fidnick, Co-Chair; Matthew Sullivan, Ph.D., Co-Chair; Lyn R. Greenberg, Ph.D., Reporter; Paul Berman, Ph.D.; Christopher Barrows, J.D.; Hon. R. John Harper; Hon. Anita Josey-Herring; Mindy Mitnick, M.Ed., M.A.; and Hon. Gail Perlman.

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DEFINITIONS

A. Definitions Regarding Professional Roles Community Therapist: Any mental health professional providing psychotherapeutic treatment of a parent, child, couple or family who is not involved with the legal system at any time during the treatment. Court-Involved Therapist (CIT): Any mental health professional providing psychotherapeutic treatment of a parent, child, couple or family who is, at any time during the treatment, involved with the legal system. Court-Appointed Therapist: Any mental health professional providing psychotherapeutic treatment of a parent, child, couple or family undertaken because the particular psychotherapist was ordered by a judge to provide treatment. The Court order designates the specific psychotherapist and may describe the expected treatment. Court-Ordered Therapist: Any mental health professional providing psychotherapeutic treatment of a parent, child, couple or family undertaken because it was ordered by a judge. The Court order does not designate a specific therapist and may describe the expected treatment. B. Definitions Regarding Experts Expert: The word expert generally refers to a person with specialized knowledge of a particular subject matter. In the legal context, the word “expert” refers to a witness who has been specifically qualified by the Court in a particular case to provide opinion evidence within a circumscribed subject matter determined by the Court. To qualify an expert, the Court first reviews evidence of the witness’s expertise of that subject matter, unless the admissibility of the professional’s opinion as an expert has been previously stipulated to by the parties or established by the Court.

(a) Treating Expert: A mental health professional, who currently serves or has served as the therapist for a parent, child, couple or family involved with the legal system. If the therapist is qualified by the Court as an expert, testimony should be limited to the therapist’s particular area of expertise and issues directly relevant to the treatment role. To the degree permitted by the Court in a specific case, the treating expert can provide expert opinion regarding a parent or child’s psychological functioning over time, progress, relationship dynamics, coping skills, development, co-parenting progress, or need for further treatment, as appropriate to the therapist’s role. In contrast to the forensic expert, the treating expert does not have the information base or objectivity necessary to make psycho-legal recommendations, such as specifying parenting plans, legal custody, or decision-making authority.

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(b) Mental Health Forensic Expert: A mental health professional hired by a party or appointed by a Court to answer a legal question through the application of psychological methods. A mental health forensic expert, for example, may perform a custody evaluation, a psychological evaluation to answer a particular question formulated by the Court, a competency evaluation, an evaluation to assist the Court in the decision-making process regarding custody and/or access. Their testimony might include psycho-legal issues such as recommendations about parenting plans, legal custody or decision-making authority.

C. General Definitions Client/Patient: A parent, child, couple or family receiving psychotherapeutic treatment from any of the mental health professionals defined in this section Collateral: A person, not a client or patient, who has information bearing on the client or patient and whom a mental health professional, in any role defined in this section, interviews to obtain information or engages directly in the client or patient’s treatment. Confidentiality: An ethical duty, also established by statute, rules or case law in some jurisdictions, owed by a mental health professional to a client/patient, subject to some exceptions, to maintain the client/patient’s privacy by not revealing information received from the client/patient. Privilege: A legal right, conferred by statute in many jurisdictions and limited by exceptions, held by a mental health professional’s client/patient to prevent the mental health professional from disclosing confidential information in a legal proceeding. Some jurisdictions have a formal process for determining whether or not and under what circumstances the privilege will be waived by or on behalf of the client/patient to allow testimony by the mental health professional in a court-related matter. (Issues regarding privilege and confidentiality are described in Guideline 7.) Conflict of Interest: A situation in which personal, professional, legal or other interests or relationships have the potential to compromise or bias the mental health professional’s judgment, effectiveness or objectivity. A conflict of interest may also occur in some jurisdictions based on the establishment of an appearance of conflict standard rather than an actual conflict. Informed Consent:

(a) A client/patient’s decision to consent to a proposed treatment or a proposed release of confidential information by a mental health professional, after the client/patient has received reasonably full and accurate information from the mental health professional as to the risks, benefits and likely consequences of the decision to consent.

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(b) The term is used colloquially by mental health professionals to mean the process by which a client/patient receives the information needed to make an informed decision. The process usually includes discussion and a written agreement between the mental health professional and the client/patient as to the information provided and the client’s understanding of it. (See Guideline 6.)

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GUIDELINE 1: ASSESSING LEVELS OF COURT INVOLVEMENT 1.1 A CIT should assess the degree to which legal processes will impact the

treatment and consider issues that may impact the client or parent’s functioning in treatment, and the implications of treatment interventions on the legal processes

(a) The CIT should be aware that cases may have different degrees of Court

involvement, and may also change in their degree of Court involvement over time.

(b) The CIT should obtain information about how the decision to enter therapy

was made, who was involved in the decision, and what outcomes are expected from the treatment or the therapist by parents, other professionals, or the Court.

(c) The CIT should consider the variety of mechanisms through which court-

involved families can enter treatment, and the implications of each of those circumstances:

(1) A parent involved in a Court case recognizes his/her own or child’s

distress and seeks treatment. (2) A parent seeks therapy for him/herself or a child, in hopes of

improving his/her own position in the Court case and securing the therapist’s direct or indirect participation (report to a custody evaluator, etc.).

(3) Parents are ordered to obtain therapy for themselves or a child, but select from community practitioners with no specific agenda, reporting expectation or requirement.

(4) The Court orders therapy to address particular issues, such as child distress, high-conflict dynamics, reunification, etc. The order may include some degree of reporting requirement, or contingencies allowing reporting.

(d) The CIT should consider the potential impact of Court involvement on adults’ functioning in treatment. The stress of Court involvement and the importance of the outcome to those involved can generate conscious or unconscious distortion of information and changes in the clients’ or parents’ expectations of the therapist.

(e) The CIT should consider the impact of his/her natural working alliance

with the client. This may lead the therapist to align with the client’s position in the legal dispute, thus impairing the CIT’s ability to prepare the client to cope with likely outcomes and stresses in the legal process. While a client may equate his or her best interests with prevailing in the legal dispute, CITs must remain cognizant that their role is to promote successful psychological

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functioning in the client, not to serve as an advocate or a forensic expert or produce a particular outcome in the legal process.

1.2. Special considerations for court-involved roles with children

(a) Children’s behavior and statements may vary markedly based on the circumstances of treatment.

(b) The CIT has an enhanced obligation to consider multiple treatment hypotheses

and be knowledgeable about children’s developmental tasks and needs.

(c) The CIT should use particular caution to ensure that he/she has adequate data on which to base any opinions or assessments, and to form and express such opinions only within confines of the therapeutic role and available information, while remaining cognizant of the impact of Court involvement on the family and on treatment information.

(d) The CIT must, whenever possible, obtain each parent’s perspective in the

treatment process and maintain professional objectivity when interpreting statements and behaviors of children. The CIT should use particular caution in interpreting statements, play or drawings that appear to express positions on adult issues to avoid inaccurate or incomplete assessment of a child’s developmental needs, expressed thoughts and feelings.

(e) The CIT should be aware of the potential impact of parental needs and

expectations on treatment involving children or adolescents. The CIT should be particularly aware that:

(1) A parent may have a genuine desire to obtain treatment or provide it

to a child, but may also have expectations that the therapy will support the parent’s own goals in the legal conflict.

(2) A child or adolescent who is expressing a “position” regarding a contested issue in the legal conflict may have external influences on their perceptions, or that negatively impact their coping skills.

(f) While it is common in traditional treatment for one parent to be more involved

in child treatment than the other, this therapy structure creates a risk in court-involved treatment. A CIT should consider both parent-child relationships and each parent’s perspective in court-involved treatment.

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GUIDELINE 2: PROFESSIONAL RESPONSIBILITIES 2.1 A CIT should establish and maintain appropriate role boundaries

(a) A CIT should inform potential clients, and others who may be relying on the therapist’s opinion or services, of the nature of the services that can be offered by the therapist and the limits thereof. This includes providing thorough informed consent to clients/parents and appropriate information to others who may rely on the therapist’s information. (See Guideline 6 and Guideline 10.)

(b) A CIT should resist pressure from anyone to provide services beyond or

antithetical to the therapeutic role, as defined by recognized professional and ethical standards or guidelines.

(c) A CIT should explain to clients any decisions to decline to provide certain

services. If others (e.g., the Court guardian ad litem, minor’s counsel or agency) have requested services that the CIT considers inappropriate, the CIT should also explain decisions to decline these requests, to the degree that information provided is not privileged or privilege has been waived.

(d) A CIT should be prepared to modify elements of the therapeutic process, if

appropriate, and to explain the necessity for the modification. (e) A CIT should apprise the Court of any conflicts between the Court’s

expectations and the ethical and professional obligations, or role limitations, of the therapist.

2.2 A CIT should demonstrate respect for parties, families, the legal process and

its participants (a) A CIT should communicate respect for the legal system to clients, collaterals,

and others who may rely on the therapist’s work, information or opinions.

(b) A CIT should provide a thorough informed consent processes to parents, and age-appropriate explanations to children, as described in Guideline 6.

(c) A CIT should communicate, within the limits of any applicable privilege,

regarding the limits and responsibilities of the therapist’s role. (d) A CIT should respect each parent’s rights, as defined by relevant orders or

law, regarding knowledge of, consenting to, and/or participating in a child’s treatment.

(e) A CIT should be knowledgeable about appropriate expectations for

developmentally acceptable behavior in children while respecting their independent feelings, perceptions, and developmental needs.

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(f) A CIT should communicate with counsel in a balanced manner when in a

neutral role and authorized to do so.

2.3 A CIT should provide clear, non-technical communication of observations and opinions to adult clients, parents of child clients, and other professionals when appropriate and permitted by applicable privilege

2.4 A CIT should maintain professional objectivity

(a) A CIT should actively seek information that will provide the most thorough understanding of his/her client’s circumstances and issues, while remaining within the limits of the therapist’s assigned therapeutic role in the case.

(b) When children are involved in treatment, a CIT has an enhanced obligation to

consider multiple hypotheses, seek information and involvement from both parents and avoid the biasing effects of one-sided or limited information.

(c) A CIT should make efforts to consider and assess treatment issues from the

perspective of each involved individual. This does not preclude maintaining a strong therapeutic alliance with a parent client/patient in individual therapy, but may require exploring with the client how others may perceive the issues.

(d) To the degree possible in the given therapeutic role, the CIT should remain

aware of the information emerging in the legal process in order to assist the client in coping with it.

2.5 The CIT should manage relationships responsibly

(a) A CIT should recognize that the therapeutic relationship may change as a family’s involvement with the Court changes or as the therapist communicates to other professionals, collaterals or the Court.

(b) If a parent or family who has not previously been court-involved becomes

involved in a legal process and asks the therapist to continue services, the CIT should discuss with the relevant individuals and/or family members the potential effect of Court involvement on the therapy. This should include discussion of potential requests for release of therapeutic information to others including a child custody evaluator, parenting coordinator, other professionals, or the Court.

(c) If a CIT who has not previously been involved with a client’s ongoing

litigation is asked to provide information or have other involvement in the legal process, the CIT should notify the client and/or the client’s legal representative of such requests. If the CIT believes the release of information

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will adversely impact the client, the CIT should seek legal advice and notify the Court.

(d) The CIT should clearly document informed consent on the above issues.

2.6 A CIT should maintain accountability

(a) The therapist in a child-centered role should recognize that active intervention may result in the dissatisfaction of one or both parents, but should nevertheless maintain focus on the welfare of the child client.

(b) If disputes arise regarding interpretation of Court orders governing treatment,

the CIT should seek direction or clarification from the Court, or an authorized Court representative in the case.

(c) The CIT should recognize that others in the legal system (e.g., custody evaluator, parenting coordinator, child’s counsel or the Court) may have a role in monitoring or reviewing the therapeutic process.

(d) The CIT should recognize that his/her judgments, interventions, reports,

testimony and opinions may have a profound impact on outcomes for children and families. The CIT should remain objective at all times, should use caution in forming and expressing opinions, and should use particular caution in drawing conclusions from limited observations or sources of information.

(e) A CIT should recognize that the dynamics of a court-involved case may create

conflicts or disagreements with litigating parents or lead to demands that the therapist withdraw from the case. The CIT should recognize that therapeutic confrontation of a parent or a child, or a refusal to accede to the wishes of a parent or child, may frustrate that individual’s desires, but does not necessarily constitute a conflict of interest. Such therapeutic confrontation may be therapeutically appropriate or even essential. In such a situation, withdrawing from the case or abandoning the intervention, unless terminated by the client, may be antithetical to the interest of the child or family.

GUIDELINE 3: COMPETENCE 3.1 A CIT has a responsibility to develop and maintain specialized competence

sufficient for the roles they undertake 3.2 Gaining and maintaining competence

(a) A CIT has a responsibility to obtain education and training, and to maintain current knowledge, in areas including, but not limited to:

(1) Characteristics of divorcing/separated families and children

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(2) Family systems and other systems in which court-involved families interact

(3) The impact of high interparental conflict on post-separation custody arrangements

(4) Effective interventions with divorcing or separated families (5) Adaptations of traditional therapeutic approaches that may be

Necessary to work with divorcing or separated families (6) characteristics and needs of special populations who may be

Involved in treatment (7) Ethical issues and applicable local legal standards

(b) A CIT should utilize continuing education and professional development

resources to maintain current knowledge of issues relevant to court-involved treatment.

(c) A CIT may also gain some of the required knowledge through experience and

consultation with colleagues; however, clinical experience should not be asubstitute for knowledge of the underlying science, relevant research, legal issues and standards of practice.

3.3 Areas of competence

(a) The CIT should maintain knowledge and familiarity with current research related to psychological issues in areas including, but not limited to:

(1) Child development and coping, including developmental tasks (2) Child interviewing and suggestibility (3) Children’s decision-making ability, including appropriate means of

understanding children’s abilities and interpreting expressed preferences or opinions

(4) Factors in divorcing families that increase risk to children, or promote resilience in children

(5) Domestic violence (6) Child abuse and child welfare (7) High conflict dynamics, including risks to children from exposure

to parental conflict, parental undermining, alienation and estrangement

(8) Treatment approaches, including both traditional methods and adaptations for divorcing or separated families

(9) Parenting and behavioral interventions (10) Special needs issues, including medical issues, psychiatric

diagnoses, substance abuse, learning or educational problems, developmental delays, etc.

(11) Ethnic, cultural, and sexual orientation differences among families

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(b) The CIT should maintain knowledge and familiarity with legal information

and issues related to court-involved therapy, including, but not limited to: (1) Statutes and local Court rules in the therapist’s jurisdiction (2) Case precedents relevant to court-involved treatment (3) Interactions and potential conflicts between governing mental

health practice and family Court expectations or family law statues (4) Ethical and professional guidelines and standards applicable to the

role of the CIT, obtaining ethics consultation as appropriate (5) Circumstances under which it may be necessary or appropriate for

the therapist to consult an attorney

(c) The CIT should seek appropriate consultations when issues arise that are outside of the CIT’s expertise.

3.4 Understanding of professional roles and resources

(a) The CIT should be familiar with the roles of other professionals with whom the CIT may interface while providing therapy in a case.

(b) The CIT should understand the roles of the child custody evaluator and the parenting coordinator, and the impact that the appointment of such professionals may have on both the process of therapy and the privacy of therapeutic information.

(c) The CIT should understand the roles of the minor’s counsel or guardian ad

litem, and should be aware of the laws governing confidentiality of treatment information when one of these professionals is appointed.

3.5 Representation of competence, state of professional knowledge

(a) The CIT should accurately represent his/her areas of competence, advise clients/parents if an issue arises that is beyond the CIT’s knowledge and expertise, and initiate consultation and/or referral, when appropriate.

(b) The CIT should understand the limits of scientific knowledge and use caution

to avoid overstating the certainty or parameters of professional opinions. (See Guideline 10.)

3.6 Consideration of impact of personal beliefs and experiences

(a) The CIT should remain familiar with current research on the impact of personal bias, personal beliefs and cultural and value differences, factors that may contribute to bias, and efforts that may be undertaken to contain or manage potentially biasing conditions in the CIT’s work.

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(b) The CIT should recognize and acknowledge that powerful issues may arise in

court-related cases that generate personal reactions in the therapist or others, and take steps to counterbalance exposure to information or otherwise manage these issues.

(c) The CIT should obtain appropriate consultation to assist in maintaining

professional objectivity. GUIDELINE 4: MULTIPLE RELATIONSHIPS 4.1 The CIT should avoid serving simultaneously in multiple roles, particularly

if these create a conflict of interest. For example, the CIT should not serve simultaneously as therapist and evaluator or as therapist and friend. Similarly, the CIT is strongly discouraged from performing different roles sequentially, as, for example, a therapist who becomes an evaluator or a therapist who becomes a parenting coordinator.

4.2 The CIT should disclose to all relevant parties any multiple relationships that

cannot be avoided and the potential negative impact of such multiple roles.

(a) The CIT who discovers that he/she is performing multiple roles in a case should promptly seek to resolve any conflicts in a manner that is least harmful to the client and family. The CIT should clarify the expectations of each role and seek to avoid or minimize the negative impact of assuming multiple roles.

(b) The CIT should recognize that relationships with clients are not time limited

and that prior relationships, or the anticipation of future relationships, may have an adverse effect on the CIT’s ability to be objective.

(c) The CIT should attempt to avoid conflicts of interest and should address them

as soon as they arise, or the potential for conflict becomes known, by:

(1) Identifying a real or apparent conflict of interest as soon as it becomes known to the CIT

(2) Refusing to assume a therapeutic role if personal, professional, legal, financial or other interests or relationships could reasonably be expected to impair objectivity, competence or effectiveness in the provision of services

(3) Communicating with the client or potential client or counsel, and, if necessary, with the Court, about the existence of the conflict.

(4) Recognizing that the appearance of a conflict of interest, as well as an actual conflict of interest, can diminish public trust and confidence both in the therapeutic service and in the Court

(5) Differentiating between conflicts that require declining to assume or

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withdrawing from the therapeutic role, as opposed to multiple or sequential roles that may be undertaken with waivers from the client or parent

(6) Recognizing the risks of undertaking conflicting roles, even if the client or parent signs a waiver

(7) Clearly documenting the disclosure of any waived conflict, the client’s ability to understand it, and the client’s waiver. The client must receive a clear explanation of the conflict, and it may also be necessary to provide such explanations to other professionals or agencies relying on the therapist’s work or information

GUIDELINE 5: FEE ARRANGEMENTS 5.1 The CIT should establish a clear written fee agreement with the responsible

parties prior to commencing the treatment relationship

(a) A CIT may send a written fee agreement to the parties and/or client(s) prior to commencing treatment.

(b) If the case is not court-involved, a CIT may discuss the terms and fee

requirements of treatment directly with the parties and/or client. This discussion should be documented in the CIT’s record.

(c) If the case is already court-involved, or likely to be, a CIT may send the fee

and consent agreements to counsel. 5.2 The CIT should provide written documentation to each responsible party

(a) Documentation should include a description of the treatment services to be provided, including all of the elements of informed consent described in Guideline 6.

(b) A CIT should provide a fee agreement that contains, at a minimum:

(1) A description of all services and charges (2) Expectations regarding payment, including, if applicable:

(i) fees associated with missed or cancelled sessions, (ii) costs/fees generated by one parent, (iii) consequences of non-payment, including its potential impact on continued provision of services, (iv) the use of collection agencies or other legal measures that may be taken to collect the fee (see attached sample agreement).

(3) Policies with regard to insurance reimbursement, if any. This should include issues such as identifying the person responsible for submitting the insurance form, payment for covered and non-covered

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services, responsibility for submitting treatment plans (if required by the insurer) and the consequences of using insurance.

(4) Policies regarding advance payments, if any, for treatment services and the use of those payments

(5) A procedure for handling of disputes regarding payment

(c) If the therapy is court-ordered, the CIT should provide to the Court all information required to engage the CIT so that the Court can issue an appropriate and comprehensive order. The written fee agreement may be incorporated into the Court order that initiates the therapy. The therapist should request that the Court specify the party responsible for the payment or the specific apportionment between the parents or parties. In the event that the Court order fails to address the issue of fees adequately, the therapist should take appropriate steps to obtain clarification from the Court before providing services. Arrangements should be sufficiently clear to prevent or resolve most fee-related disputes, and for a future judicial officer or reviewer to be able to resolve any such disputes submitted to the Court.

(d) If treatment is terminated or suspended due to non-payment, the CIT should

conduct the termination or suspension in accordance with the order, fee agreement and ethical principles.

(e) The CIT should maintain complete and accurate written records of all

amounts billed and all amounts paid. GUIDELINE 6: INFORMED CONSENT 6.1 At the outset of therapy, the CIT should provide a thorough informed

consent process to adult clients and parents or legal guardians if the therapy involves the child

(a) A CIT has a professional obligation to inform the client of the limits of

confidentiality and privilege at the outset of the therapeutic relationship, to promote informed decision-making throughout treatment and to document such explanations in the CIT’s record. The CIT should clarify that these cautions do not constitute legal advice, and that the CIT will obey the Court’s orders regarding treatment information.

(b) The informed consent should use language that is understandable and

includes, at a minimum, information about the nature and anticipated course of the therapy, risks and benefits of the therapy, fees, the potential involvement of other individuals in the therapy, and a discussion of confidentiality.

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(c) The CIT should be aware of state laws that impact confidentiality and access to records and these should be incorporated in the informed consent.

(d) Clients or their counsel should have an opportunity to ask questions, obtain

answers, and discuss their concerns. These discussions should be documented in the CIT’s record.

6.2 If a child is to be involved in treatment, there are special considerations

(a) A CIT should generally avoid accepting a child into treatment without notifying or consulting with both parents.

(b) A CIT should request copies of Court orders or custody judgments

documenting each parent’s right/authority to make decisions regarding treatment and delineation of each parent’s access to treatment information.

(c) In rare and urgent cases, such as when there is strong reason to suspect a risk

to a child’s safety, a CIT may accept a child in treatment at the request of one parent. This should only occur if that parent has clear legal authority to consent and pending efforts to either notify the other parent or obtain permission from the Court; however, the CIT should be aware that such a decision may increase risk to the child, and to the CIT.

(d) A CIT should explain the nature and purpose of the treatment to a child in

age-appropriate language. It may be necessary to revisit these issues as treatment proceeds.

(e) A CIT should discuss the limits of parental involvement and confidentiality

with the parents or guardians of a child or adolescent involved in treatment. 6.3 When a CIT becomes involved in treatment at the request of a third party

such as the Court, an attorney, or a social service agency, the CIT should be especially attentive to informed consent issues

(a) The CIT should identify to the client the name of the person or agency that

requested the services and the potential impact this may have on the treatment. (b) If an adult client or parent does not sign the informed consent, or otherwise

has significant disagreements with the treatment process, the CIT should defer commencement of services and refer the client back to the third party agency or the Court for clarification.

(c) If the CIT has been appointed by the Court to provide treatment to one or

more adults and an adult refuses to sign consent documents, the CIT should defer commencement of services until consent is obtained or the Court takes action to resolve the issue.

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(d) If a CIT is asked by anyone to provide treatment to a child and one parent

supports treatment while the other refuses consent, the therapist should refer the parties back to the Court for resolution of the dispute between the parents, and then proceed as the Court directs.

(e) If the court-ordered treatment is to proceed, it is recommended that the CIT

require a treatment order, specifying the nature of the services to be provided and the parameters of treatment, before proceeding with treatment.

6.4 When more than one individual participates in the therapy, the CIT should

clarify with each person the nature of the relationship between the participants and between each participant and the therapist. The CIT should also clarify his/her roles and responsibilities, the anticipated use of information provided by each person, and the extent and limits of confidentiality and privilege

6.5 On a case-specific basis, the CIT should explain to the client the manner in

which treatment information will be handled. Issues to be clarified may include, but are not limited to:

(a) Whether the consent of one or both parents will be required to release

information from conjoint, co-parenting or marital therapy

(b) Whether information will be released to a custody evaluator, parenting coordinator, the Court, or any other individual, and the extent of the information to be released

(c) Whether, and how, the CIT will communicate to the Court in the event that

one or both parents do not cooperate with court-ordered treatment

(d) What will happen if the CIT is subpoenaed to give testimony in a court-related matter

(e) What information can be released to insurance companies, the Court, the other

parent, or other entities to enable the CIT to collect his/her fees. 6.6 The parent/client should be encouraged to consult with counsel before

signing a therapy/informed consent agreement, if the parent or client is represented

6.7 If the CIT’s level of Court involvement changes or requests are made to

change the CIT’s role, the CIT should inform the client of the risks, benefits and impact of any potential changes in treatment

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(a) The CIT should obtain consultation before contemplating a change in his/her role that might create a conflict of interest or alter therapeutic alliances.

(b) If the CIT becomes aware of potentially conflicting roles, he/she should take

reasonable steps to immediately disclose, clarify and discuss the potential conflicts and any potential adverse impact. The CIT should make best efforts to minimize any negative impact, including withdrawing from the case, if appropriate.

(c) If the parties consent to a change in the CIT’s role, the CIT should document

the revised informed consent process.

6.8 The CIT should be sensitive to the possibility of being asked to provide feedback to third parties or to testify as a witness. The CIT should inform the client of this potential at the beginning of the informed consent process and as necessary thereafter.

(a) The CIT should take reasonable steps to clarify the limits of the therapeutic

role, the potential scope of information to be released, and the potential implications of the release of information or the testimony for the client (see Guideline 7). In no case should the CIT attempt to provide legal advice to the client.

GUIDELINE 7: PRIVACY, CONFIDENTIALITY AND PRIVILEGE 7.1 The CIT should understand the principal issues that arise in court-related

therapy in regard to client/patient confidentiality and privilege.

(a) The CIT should be aware that laws and standards vary markedly among jurisdictions, and there may be conflicts in the law within a single jurisdiction. Issues that may vary among (and within) jurisdictions include, but are not limited to:

(1) The identified client (2) Assertion and waiver of the client’s privilege (3) Under what circumstances the mental health professional can or

must disclose confidential information

(b) The CIT should be aware that ethical, clinical, and legal issues related to confidentiality/privilege may differ depending on whether a parent, child, couple or family is in treatment.

(c) The CIT should be aware of clinical issues related to disclosure of confidential

information. (See Guideline 8.7.)

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7.2 The impact of litigation on decisions regarding use of treatment information.

(a) The CIT should also be aware that a client or parent’s legal case may be affected by the client’s decision to release or decline to release treatment information. The CIT should encourage the client/parent to seek appropriate legal consultation before making this decision.

(b) The CIT should consider the impact of the Court context on a client’s

decisions about the use of treatment information and should take precautions accordingly.

(c) The CIT should consider that situational pressures may affect the client or

parent’s judgment or authority on the issue of waiving the privilege regarding treatment information. These pressures may include requests from the Court or other professionals with influence on the legal proceedings (e.g., a custody evaluator or parenting coordinator) that the parent waive his/her own, or the child’s privilege as to the treatment relationship.

(d) The CIT should be aware that in some jurisdictions or situations, parents may

not hold the right to waive or assert the child’s privilege in court-involved treatment or treatment of the child. In some jurisdictions, a CIT has the option or duty to resist disclosure of information, or seek direction from the Court, if the CIT determines that disclosure of the information risks the welfare of the child. The CIT should be familiar with the appropriate procedures for his/her jurisdiction.

7.3 A CIT should recognize the limits of his/her expertise and, when in doubt as to

whether information requested about treatment can be released, seek legal advice or request direction from the Court

7.4 Ongoing obligation to inform clients

(a) A CIT should revisit the discussion of confidentiality with the client as

circumstances change, or as issues arise in therapy that may result in the disclosure of treatment information.

(b) If therapy is court-ordered and there is dispute regarding privacy,

confidentiality and privilege, the CIT should seek clarification from the Court prior to commencing services. If a dispute arises as to the interpretation of the Court order after services have begun, the CIT should seek direction from the Court before releasing information.

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7.5 Special issues in children’s treatment

(a) A CIT should be familiar with general provisions governing confidentiality of children’s treatment information in his/her jurisdiction, including:

(1) Who holds the child’s privilege and how a child’s privilege can be waived or asserted

(2) Under what circumstances a child or adolescent may have a role in this decision

(3) How the CIT should respond if he/she receives conflicting instructions from the parents

(4) How the CIT should respond if he/she believes that disclosure of treatment information poses a substantial risk of harm to the child

(b) At the outset of a child’s treatment, the CIT should clarify the provisions of

the order or therapy agreement regarding the child’s treatment information. These issues include, but are not limited to:

(1) How information about a child’s progress will be shared with

parents(2) Whether the consent of one or both parents will be required to

release information about the child’s progress (3) The role that the child’s thoughts and feelings will play in

determining what information is shared, and how it is shared (4) Circumstances in which the CIT may be required to release

information to the parent or other professionals (5) Circumstances that might require further discussion, clarification or

modification of the order or agreement as the treatment progresses

(c) A CIT should prepare the child client for the release of treatment information, address the child’s feelings about the issue, and assist the child in coping with any stressors that may result.

(d) The CIT should adapt explanations to the developmental and situational needs of each child.

(1) When working with a child client, the CIT should clarify the limits

of confidentiality in developmentally appropriate language (2) A CIT should not make blanket promises to a child that treatment

information will be confidential

7.6 Considerations for therapists covered under the Health Insurance Portability and Accountability Act (HIPAA) If the CIT is a HIPAA-covered entity, he/she must be aware of his/her obligations under the Act, and the how those obligations may change if the client or family

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becomes involved with the Court. When requirements under HIPAA appear to be in conflict with other laws or Court orders, the CIT should obtain legal consultation.

7.7 Responding to requests for treatment information from third parties

(a) The CIT should request a copy of the release signed by the client, former

client, parent, or other authorized person. The CIT should not communicate with a third party without an appropriate release or order of the Court authorizing disclosure.

(b) Prior to providing client information to a third party, the CIT should attempt

to inform the client or former client about the request for release of information.

(c) The CIT should inform the client or former client of the nature of the

information that may be released to a third party if the client waives the privilege. If appropriate, the CIT should also refer the client or former client to his/her attorney to assist the client in making this decision.

(d) A release does not supersede a Court order; therefore, prior to releasing

information to a third party, a CIT should consult any agreement or Court order that governs the treatment.

7.8 Responding to a subpoena

(a) A CIT should be aware of differences between subpoenas and Court orders.

(b) A CIT who has received a subpoena should consider consulting an attorney familiar with both legal issues in the jurisdiction related to mental health law and the requirements of the Court in which the family is involved. Procedures, requirements, and the CIT’s options will vary depending on the jurisdiction, whether the case is being heard in a family Court or juvenile dependency Court, and many other issues.

(c) A CIT should not automatically respond to a subpoena by disclosing written

or oral information.

(d) A CIT should not ignore a subpoena.

(e) The CIT may wish to consider the additional guidance provided in Appendix A regarding specific steps that may be helpful in responding to a subpoena.

7.9 Responding to a Court order for release of treatment information

(a) If the CIT is ordered by the Court to release information, particularly over the

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objection of one of the parties, the CIT should request a written order specifying the parameters of information to be released.

(b) If there are outstanding legal questions regarding what information can be

released (such as whether the CIT can release information from other agencies or child protective services), the CIT may wish to obtain the assistance of an attorney who can bring these issues to attention of the Court and obtain clarification or direction.

7.10 Appealing a Court order

There are some circumstances in which a CIT may believe that disclosing information may violate ethical or professional practice guidelines applicableto mental health practice. In such a case, the CIT may wish to consult anattorney familiar with the laws of mental health privilege/confidentiality in that jurisdiction.

GUIDELINE 8: METHODS AND PROCEDURES 8.1 The CIT should adhere to the methods and procedures generally accepted in

his/her particular discipline. In addition, the CIT should maintain methods and procedures consistent with being involved in situations, which may include litigation, testimony, and the reporting of various matters to Court, parties, or their attorneys.

8.2 Obtaining necessary information if the therapy is court-ordered

(a) The CIT should attempt to obtain all information necessary to conduct the court-ordered therapy and should discuss the goals of the court-ordered therapy with the client.

(b) As appropriate to the specific case, the CIT should request information that

may be necessary for effective treatment. This may include permission to speak to a prior therapist or other involved professionals, copies of prior Court orders, therapy records, and reports from child custody evaluators, child protective services, or a guardian ad litem.

(c) The CIT should obtain necessary information, including copies of relevant

Court orders, to confirm that his/her role is clearly defined and consistent with the therapeutic role and the CIT’s expertise.

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(d) If the CIT is unable to obtain information from the parties or counsel that is necessary to conduct treatment, the CIT may apply to the Court for further direction if the CIT has obtained appropriate releases. Application to the Court should be preceded by proper notice to the parties and counsel.

8.3 Therapeutic role and process

(a) The CIT has a responsibility to identify both the intended clients and any others intended to be the beneficiaries of the intervention.

(b) When the intended beneficiary of the intervention is an individual client, the

primary focus of the therapist is the client’s welfare and treatment is implemented for the benefit of the client. Therapists with different treatment orientations may identify different treatment goals, but all focus on improving client’s functioning.

(c) In other cases, a relationship or family unit may be the identified client or may

be the participants in counseling, but the goal may be to reduce conflict or promote behavior change for the benefit of the child (e.g., co-parenting or conjoint/reunification therapy).

(d) The CIT should clearly identify the goals, procedures and beneficiaries based

on any relevant orders and in collaboration with the client(s) and other professionals as appropriate, and should clearly communicate this information to participants in the therapy.

8.4 The CIT should understand that the information provided by the client during the course of the treatment is based upon the client’s experience and perspective, which may sometimes be distorted or lacking balance and comprehensiveness

(a) The CIT should strive to maintain professional objectivity, and to remain

aware of the impact of the therapeutic alliance on the therapist’s information and perspective.

(b) The CIT should actively consider alternative hypotheses regarding the

information (i.e., data) he/she is receiving in the treatment. (c) The CIT should strive to be aware of societal and personal biases and

continuously monitor his/her actions for evidence of potential bias. Awareness of research and focus on the treatment data inform the CIT and help limit the potential for bias. The CIT should consider withdrawing from a case when he/she is unable to manage a known bias and/or is unable to maintain objectivity.

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(d) The CIT should be aware that the treatment may be influenced by the client or family’s involvement in legal processes, and that the legal process may be influenced by the actions of the therapist.

(e) The CIT must constantly guard against/protect his or her work from threats to

professional objectivity and role boundaries. 8.5 Selecting appropriate treatment methods

(a) A CIT should not exceed the bounds of his/her professional competence in

his/her diagnosis, treatment planning and treatment of clients. (b) A CIT should use methods or interventions that are generally accepted within

the professional communities and literature, and should apply methods or interventions appropriate to the situations and characteristics of court-involved families.

(c) A CIT should be able to justify and explain the choice of methods based upon

the current state of professional knowledge and research. (d) The CIT should select treatment methods or approaches that minimize the

potential for biased or inappropriate interpretations of client’s statements and behaviors or perceptions of others’ behavior. This may include deliberate balance in asking questions, challenging assumptions, and supplementing behavioral observations with other methods of inquiry.

(e) A CIT should exercise caution in forming opinions or structuring therapy

based on limited or one-sided information. (f) A CIT should maintain current knowledge about the validity (or lack of

validity) of using specific behaviors as a basis for diagnosis or treatment, and should employ treatment methods that allow the therapist to gather information from a variety of methods and observations.

8.6 Critical examination of information

(a) A CIT should critically examine information received from a client before formulating or offering a clinical opinion. This is especially important in light of the possibility that a therapeutic alliance may produce a bias toward the client.

(b) A CIT should recognize that loss of therapeutic objectivity may harm a child

or family, whether or not the therapist reports or testifies about the therapy. Therapists should avoid inappropriate bias by actively considering, and exploring, rival hypotheses about a client’s difficulties.

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8.7 A CIT should consider the clinical implications of actions taken when the CIT is asked to release treatment information, and should endeavor to minimize risks in these areas

(a) The therapist should be aware that an adult client requesting the release of

information may not fully attend to, or understand, the risks and benefits of such a decision. This may lead to distress in the client or damage to the therapeutic alliance, if the client is surprised by the therapist’s information or opinion.

(b) The therapist should assist the client in understanding:

(1) The risks and benefits of releasing information (2) The nature of the information in the client’s records (3) The CIT’s obligation to provide complete answers when questioned

under oath and to avoid misleading other professionals or the Court (4) Other potential factors that may lead to distress in the client or

damage to the therapeutic relationship due to the release of information

(c) When a child is involved in treatment and the CIT is asked to release

treatment information, the CIT should consider and address issues to minimize disruption of treatment and avoid distress in the child. Issues to consider may include:

(1) Appreciation of the parent’s right to information and any concerns

that he or she may have about the child or the therapy (2) Protection of the child’s treatment progress and privacy (3) Potential for disruption of the therapeutic relationship if the parent

feels excluded or resorts to litigation in order to obtain information (4) Possibilities for negotiating the parent’s involvement and managing

the sharing of information without violation of the child’s privacy, wholesale release of treatment information, or litigation

(d) The CIT should consider and address the various clinical possibilities in

children’s expressed preferences about disclosure of information. The CIT should consider the potential implications of whatever action the CIT takes, and should utilize available therapeutic options for dealing with the child’s information. Issues to consider and address may include:

(1) Treatment goals related to the children’s resolving of issues with

parents (2) A child’s realistic or unrealistic fears about the parent’s response to

the information (3) The child’s own emotional issues or difficulty in expressing feelings

directly

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(4) Whether the child will ultimately be empowered or protected by having the CIT share information on the child’s behalf

(5) Whether the child needs protective measures to prevent harm resulting from the sharing of therapeutic information

(6) Whether information can be disclosed in a therapeutic rather than legal setting

(e) The CIT should prepare both adult and child clients for the sharing of information and endeavor to anticipate any problems the client may experience as a result.

8.8 A CIT should seek appropriate advice

When in doubt about an appropriate course of action, the CIT should consider seeking legal advice or professional consultation. Such advice may protect both the clients/participants in therapy and the CIT.

GUIDELINE 9: DOCUMENTATION 9.1 A CIT should create documentation so that the Court can understand the

treatment process, progress and financial arrangements 9.2 A CIT should establish and maintain a system of record keeping that is

consistent with applicable law, rules, and regulations and that safeguards applicable privacy, confidentiality, and legal privilege. A CIT should create and maintain records reasonably contemporaneously with the provision of services.

(a) In deciding what to include in the record, the CIT may determine what is

necessary in order to:

(1) Provide competent care (2) Assist collaborating professionals in delivery of care (3) Provide documentation required for reimbursement or required

administratively under contracts or laws (4) Effectively document any decision making, especially in high-risk

situations (5) Allow the CIT to effectively answer a legal or regulatory complaint

(b) If a client, parent or third party requests limited record keeping as a condition

of treatment the CIT should explain that record keeping must meet professional standards.

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9.3 Records should be organized and sufficiently detailed

A CIT should maintain records that facilitate the provision of future services by the CIT and by other professionals, ensure accuracy of billing and payments, and ensure compliance with ethical requirements and laws. Records should be sufficiently detailed, legible and readily available for reproduction upon receipt of appropriate releases or Court orders.

9.4 Confidentiality and security of records A CIT should make all reasonable efforts to maintain confidentiality in creating, storing, accessing, transferring and disposing of records under his/her control. A CIT should maintain active control of records, provide appropriate training to any support staff, and take reasonable care to prevent the loss or destruction of records. 9.5 Ethical and statutory requirements

(a) A CIT should be cognizant of and follow relevant ethical and statutory requirements regarding maintaining records.

9.6 Communicate and clarify recordkeeping with the client and/or parents

(a) When the client is a child, the CIT should request any orders establishing who has the authority to consent to release of records. A minor may have the legal prerogative to consent to treatment, but the parent may nevertheless seek access to the records. A CIT should verify parents’ statements of having the sole authority to consent to or block release of records by requesting relevant documents.

(b) When the CIT has multiple clients, such as when a parent participates in

therapy with the child, the CIT should clarify as part of the informed consent procedure how the records are kept and who can authorize their release.

(c) A CIT should clarify any costs associated with providing copies of records

and follow relevant statutes regarding fee arrangements. A CIT should not refuse to release records needed for emergency treatment because a client has not paid for services.

(d) Even when clients are participating in therapy pursuant to a Court order, the

CIT should clarify policies, procedures and fees associated with the release of records and confidentiality.

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GUIDELINE 10: PROFESSIONAL COMMUNICATION Communication from a CIT to another therapist, the client, parents, counsel, or the Court carries with it an obligation to ensure that the communication is authorized, clear, and accurate. A CIT should recognize the adversarial nature of the legal system and the potential impact of the therapist’s observations and opinions. 10.1 Authorization to communicate

A CIT should take reasonable steps to ensure that he/she is authorized to communicate with a third party, as described in Guideline 7.

10.2 Accuracy in communication

(a) In communication with others, a CIT should take reasonable steps to ensure that he/she is accurate in communicating:

(1) The nature of the service provided (2) His or her opinions on diagnosis, prognosis, and/or progress in

treatment (3) His or her opinions on appropriate actions that would support the

therapy (4) His or her understanding of the role the therapist has with the family

and in the Court process (5) Reports or observations of parents’ or children’s behavior

(b) The CIT should make reasonable efforts to ensure that information regarding his or her services, including treatment, reports and testimony is communicated in language that can be understood by consumers and minimizes potential for misuse of the therapist’s information.

10.3 Communicating limits and distinctions

A CIT should communicate the bases and limitations of observations and opinions.

(a) In all communications, especially in reports or testimony, the CIT should distinguish between observations, verbatim statements, inferences derived from his or her sources of information and conclusions or assessments reached.

(b) A CIT should articulate the limits of any communications. A CIT should

decline to communicate opinions, recommendations, or information requested:

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(1) When there is insufficient data on which to form a reliable opinion (2) When there is no authorization to do so (3) When the opinion requested is inconsistent with the role of the CIT

(c) Where the information available to the CIT might support more than one therapeutic assessment or opinion, the CIT should present and acknowledge the alternate possibilities and any treatment data or research supporting them.

(d) When necessary and appropriate, a CIT should be prepared to explain the

limits of the CIT’s role and the reasons it is inappropriate to give testimony or opinions in violation of that role.

10.4 Appropriate parties to include in communication

A CIT should carefully consider who should be aware of and involved in each professional communication.

(a) The CIT should consider whether one or both counsel, a guardian ad litem,

child’s counsel, other CITs, or parenting coordinator should be included in the communication.

(b) The CIT should respond with caution if an adult client’s attorney requests a

treatment report, particularly if the request comes through the client. The CIT should discuss with the client the potential content and implications of such a report, as discussed in Guidelines 7 and 8. With an appropriate release, the CIT may also wish to consider consulting with the adult client’s attorney to ensure that the attorney is aware of the potential content and implications of a report from the therapist.

(c) The CIT in a neutral role, such as that of child’s therapist, co-parenting

therapist or conjoint/reunification therapist, should avoid unilateral communication with either parent’s attorney in order to avoid appearance of bias and to contain the potential for actual bias.

10.5 Testimony

(a) A CIT should recognize the limits of his/her knowledge, and the potential impact that testifying in Court may have on the client and on treatment. Prior to testifying, a CIT should thoroughly discuss these issues with adult clients, and should engage in age-appropriate preparation of child clients.

(b) A CIT should comply with any limits on the scope of his/her testimony, which

have been specified by a judicial officer in conjunction with any applicable ethical code.

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(c) A CIT should anticipate that clients, attorneys, and the Court may ask the CIT to testify beyond the limits of his or her knowledge and role. The CIT should respectfully decline to provide information or opinions that exceed the treatment role or the CIT’s knowledge base.

(d) A CIT should seek to clarify any conflicts between the testimony requested by

the Court or counsel and any limitations imposed by professional ethics codes or licensing regulations.

(e) When the CIT is designated as an Expert Witness by the Court he or she may

offer relevant clinical opinions within the role of the treating expert.

(1) The CIT may offer opinions on issues such as diagnosis, changes or behaviors observed in treatment, treatment plan, prognosis, coping and developmental abilities, conditions necessary for effective treatment, etc.

(2) The CIT should not render opinions on psycho-legal issues (e.g., parental capacity, child custody, validity of an abuse allegation, joint or sole custody), as these are beyond the scope of the treatment role and properly the province of other professionals and the Court

APPENDIX A

RESPONDING TO A SUBPOENA

This material is intended to supplement the information in Guidelines 7 and 8.7 regarding privilege and confidentiality issues, and the clinical management of requests for treatment records or information. 1. A subpoena is not a Court order. It is a formal request from an attorney to summon a

witness or require a witness to bring documents to a hearing. The hearing might be a deposition (oral testimony taken under oath in preparation for a formal trial or to preserve the evidence) or a trial itself.

2. A CIT should never ignore a subpoena. 3. A CIT should not assume that a subpoena requires him or her to automatically disclose

all requested information 4. Some jurisdictions have detailed statutes regarding psychotherapist privilege. These may

include specific statutorily-mandated steps the CIT can take in response to receipt of a subpoena. In other jurisdictions, a CIT may want to obtain legal advice from an attorney familiar with (1) the privacy law in that jurisdiction; (2) the requirements specific to family court cases or the laws governing the CIT’s role; and (3) the ethical obligations of mental health professionals. It is important for each CIT to know the state of the law in his or her jurisdiction on this issue and for the CIT to provide his/her counsel with any specific orders governing the CIT’s role in the particular case.

5. The requirements for responding to a subpoena may be different in a juvenile or

dependency court, a family court, a general civil court and a criminal court. When obtaining legal counsel with regard to a subpoena, the CIT should know which type of court is the setting for the case that generated the subpoena and should provide legal counsel with all relevant orders and documents.

6. If a CIT receives a subpoena regarding an adult client’s treatment, he or she should make

and document best efforts to notify the client or former client that the subpoena was served. The CIT should let the client know the scope of the information sought in the subpoena and that the client has a right to consult counsel to determine how best to respond to the subpoena.

7. If the subpoena was sent by the client’s attorney, the CIT may, with the written consent

of the client, cooperate with the attorney. 8. If the subpoena was sent by opposing counsel, the CIT may, with the written consent of

the client, cooperate with the client’s attorney to design a strategy for response to the subpoena.

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9. In working with the client’s attorney, it is important for the CIT to learn what the attorney

hopes to gain from the CIT’s involvement in (or exclusion from) the case, the issues being litigated, and the information and/or opinions that the lawyer will ask the CIT to reveal. The CIT should also attempt to learn what the opposing side is trying to achieve and whether and in what way the opposing lawyer may attempt to discredit the CIT’s information and/or opinions.

10. Upon receipt of the subpoena, the CIT should carefully review his or her own records

regarding the client and be prepared to discuss with the client and his or her attorney the following:

A. Whether the record contains outdated material; B. Whether the record contains highly personal material;

C. Whether the record contains information that could help the client achieve the goals described by the client’s attorney;

D. Whether the record contains information that could harm the client’s goals. 11. If the subpoena was sent by the opposing attorney, the CIT should discuss with the

client’s attorney whether or not it would be useful to attempt to negotiate with opposing attorney to limit the scope of the subpoena, e.g., to redact outdated material, the names of third parties not important to the litigation or highly personal information.

12. The CIT should discuss with the client’s attorney whether or not it would be wise to bring

a Motion to Quash the subpoena, i.e., a request of the Court that the CIT be relieved of the obligation to provide testimony or produce records. The Motion to Quash must be grounded in some legally-cognizable rationale. For example, the material known to the CIT may not be relevant to the litigation. Or the opposition might be able to obtain the information known by the CIT from other sources, which would be less invasive to the client than obtaining information from the CIT. Or in some jurisdictions it will be possible to argue that, even though the CIT has information bearing on the case, it is more important that the client’s privacy be maintained than that the information be disclosed.

13. If a child is the CIT’s client and the child’s records are subpoenaed, the CIT should

consider whether or not the potential consequences to the child warrant opposing release of the information, requesting that an independent advocate be appointed, or warning the involved parties about risks to the child from release of the information. The CIT should be familiar with the procedures in his or her jurisdiction that are used to protect or consider the child’s treatment information. In most jurisdictions, under ordinary circumstances, the parents or the person with legal custody of the child or the legal guardian has the power to determine whether or not to allow a child’s private information to be released. However, if the parents are themselves in conflict in the litigation, the jurisdiction may have a special process for determining the child’s privacy rights (as the parents are in a conflict of interest position about the child’s privacy rights). Some jurisdictions will have a procedure by which a specially appointed person will decide,

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after learning more about the litigation and the effects on the child, whether to waive or to assert the child’s privilege. In some jurisdictions the decision of that appointee is decisive; in other jurisdictions, the person’s decision is a recommendation to the Court, which has the final say.

14. If the CIT is asked to give information or an opinion about the effect on the child client of

release of treatment information, the CIT should be prepared to explain the potential impact on the child of releasing the information and, conversely, the potential impact of withholding the information and the risks and benefits of each. Relevant factors might include the child’s wishes, the impact of the decision on the child’s ability to trust therapy and the CIT following a disclosure, the child’s needs or ability to have his or her voice heard in the litigation, and whether or not there are other, less intrusive sources for obtaining the information.

15. The CIT should be aware that ultimate decisions regarding release of treatment

information may not be the province of the therapist. Properly informed adults, and their attorneys, may have the right to control their treatment information. Those charged with protecting the child, such a minor’s counsel, Guardian Ad Litem or the Court, may need to weigh and determine the best means of protecting the child’s interests.

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For supplemental information, please see the following documents: Sample client-therapist contract: http://www.afccnet.org/pdfs/Client-therapist%20contract.pdf Sample stipulation and order for counseling: http://www.afccnet.org/pdfs/Stipulation%20and%20order%20for%20Counseling.pdf Sample order for counseling: http://www.afccnet.org/pdfs/Order%20for%20Counseling.pdf Suggested references: http://www.afccnet.org/pdfs/Suggested%20references.pdf

CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE: EARLY

INTERVENTION WITH RESISTANCE-REFUSAL DYNAMICS

Lyn R. Greenberg, Lynda Doi Fick, and Hon. Robert A. Schnider

Children often need help before their parents are ready to stop fighting. Children at the center of high-conflict disputes, particu-larly those who resist contact with a parent, face extraordinary risks of maladjustment. Years of investigation and litigationmay precede any meaningful attempt at intervention, based on the questionable belief that all elements of causality (or blame)must be established before any effective treatment can occur. Children’s functioning may continue to deteriorate during thistime, undermining their future adjustment and reducing the chance of successful intervention later. We illustrate the applicationof the coping-focused, multisystemic Child Centered Conjoint Therapy model to assisting these families. Methods to assistchildren without compromising external investigations are discussed.

Key Points for the Family Court Community:� Children at the center of conflict often exhibit dysfunction early, failing to master developmental tasks or developing

other symptoms.� Trained professionals can identify problem behaviors and intervene early, before problems become entrenched.� It is not always necessary to conclusively assign blame or the causes of dysfunction in order to assist the child.� Early intervention allows better integration with the child’s natural world and activities.� With disciplined procedures, effective treatment can occur without tainting or interfering with external investigations

or evaluations.

Keywords: Child Abuse; Child-Centered Conjoint Therapy; Court-Involved Therapy; Domestic Violence; High-Conflict

Divorce; Resistance–Refusal Dynamics; Reunification; and Visitation Resistance.

ADJUSTING OUR THINKING TO FOCUS ON COPING

The risks to children at the center of conflict have been well established in the professional litera-ture, but there is less agreement as to the best way to support or assist families before too much dam-age is done to children’s development. Children at the center of conflict exhibit dysfunctionalpatterns early, failing to master essential developmental skills or demonstrating regressive or inap-propriate behavior (Kelly, 2012). Older children may begin to alter their behavior based on their per-ception of parents’ needs, rather than developing independent relationship skills. Younger childrenare extremely vulnerable to anxiety or anger in adults or older siblings, and may demonstrate regres-sive behavior, anxiety, or resistance to parenting transitions. All of these behaviors can be caused bya variety of factors, but are also associated with difficulties in future adjustment. Some children canmaintain developmentally appropriate behavior in neutral settings, at least early on, but demonstratemore difficulty when exposed directly to the parenting conflict or subjected to it for a longer periodof time. Although behaviorally focused therapies exist in many areas of psychology, the process oflitigation may prioritize blame over assisting the child. As described below, the Child-Centered Con-joint Therapy (CCCT) model is designed to provide immediate assistance by supporting essentialdevelopmental skills. Even while parents argue about the root cause of the problem, a skilled familytherapist or therapeutic team can focus on preventing deterioration and giving the child some oppor-tunity and permission for normative experiences while other issues in the case are pending.

As described by Greenberg and Lebow (2016), there is an expanding research base underscoringthe importance of children’s development of effective coping abilities, as well as a greater

Correspondence: lyn@lyngreenbergphd.com

FAMILY COURT REVIEW, Vol. 00 No. 00, Month 2016 00–00VC 2016 Association of Family and Conciliation Courts

appreciation of the variety of venues for supporting these abilities. Other studies underscore commonelements in successful outcomes for children of divorce (Dunn, Davies, O’Connor, & Sturgess,2001; Pedro-Carroll, 2005; Pedro-Carroll, Sandler, & Wolchik, 2005; Sandler, Tein, Mehta,Wolchik, & Ayers, 2000). These include both coping abilities and coping efficacy, as well as accessto the normal peer and developmental activities that other children enjoy (Pedro-Carroll, 2005). Cop-ing abilities include, but are not limited to, the ability to differentiate one’s own feelings from some-one else’s, appropriately express independent needs and feelings, regulate emotions, managedistress, recognize danger, know the difference between anxiety or discomfort and danger, ask forhelp, and form healthy relationships with others.

Critical among these abilities is that the child actively engages with others, in an appropriate way,to get his/her needs met. Coping efficacy reflects the child’s confidence that, if s/he uses healthy cop-ing skills, someone in the environment will respond. Pedro-Carroll (2005) notes the importance ofchildren having a realistic appraisal of control, recognizing what they can and cannot change andwhich decisions are ultimately made by adults. Both the general developmental literature and out-come investigations with children of divorce underscore the importance of children having access tothe activities that other children enjoy (Johnston, Roseby, & Kuehnle, 2009, pp. 152–153). This isalso consistent with literature from other disciplines recognizing the importance of various activitiesto children’s development and management of difficulties in both adults and children (Austin, 2013;Austin, 1982; Moran, Sullivan, & Sullivan, 2015).

For the child’s adjustment, these issues are considerably more important than the subjects, such asexact timeshare, that often preoccupy adults. With early intervention, many children can have arespite from dysfunctional family dynamics, develop or maintain healthy social and relationship-building skills, learn healthy coping abilities, and benefit from safer venues for resolving conflict ormaintaining connections with a parent.

THE Child-Centered Conjont Therapy (CCCT) MODEL

CCCT (Greenberg, Doi Fick, & Schnider, 2012; Greenberg et al., 2008; Greenberg & Doi Fick,2005; Greenberg, Gould, Gould-Saltman, & Stahl, 2003) is an adaptive, coping-focused, multisyste-mic approach useful for children of preschool age and above. Adapted interventions can be donewith even younger children, with focus on the parenting behaviors that support development. Asdescribed below, the therapist maintains discretion as to who is involved in each session. CCCT isfocused on developmental tasks that a child needs to achieve in order to function successfully infuture relationships. Drawing on research from developmental and family psychology, recreationtherapy, and other disciplines, the approach is designed to consider the full tapestry of a child’s activ-ities and relationships as resources for both supporting healthy development and resolving parent–child contact problems. Family discussion of emotionally loaded history may be an ultimate compo-nent, but the intervention rarely begins there; rather, the focus is on establishing healthy, pro-socialbehavior in the child, as well as protection and support for the child’s emotional independence. Themodel is designed to be coordinated by a highly skilled family therapist, or a designated child’s ther-apist, who maintains a systemic approach but a clear focus on the child’s independent needs andinvolves family members as appropriate.

The model is designed to give the therapist flexibility with who attends sessions and the interven-tions used. Initially, “family therapy” may consist of separate sessions with the therapist serving as aconduit for communication, or conjoint sessions focused on daily issues and skill building. The mod-el provides an opportunity for parents to implement and practice the skills they were taught inpsycho-educational settings. Other elements of the intervention may include establishing detailedprotocols for management of the child’s activities, engaging with other professionals and communityresources, and promoting normalization of the child’s behavior and experiences. Parent–child rela-tionship issues are addressed in a variety of venues. The model is not limited to within-session

2 FAMILY COURT REVIEW

contact and may include interfacing with other systems, phone call or e-mail boosters, or other serv-ices. The focus of the model on daily activities and behavior makes it easily adaptable to youngchildren.

Interventions are highly structured. They focus on basic components of emotional developmentsuch as identifying and expressing independent feelings, promoting safety and security, establishingboundaries, identifying and making distinctions among family members’ perceptions and emotions,encouraging discussion about specific behaviors and problems while shielding the child from theparental conflict, establishing healthy routines, and altering both parents’ and children’s behavior topromote healthy adjustment in the child. Parents are taught to apply healthier parenting skills andheld accountable if they persist in parenting patterns that undermine or cause continued distress tothe child or violate therapeutic agreements or court orders. All of these issues can be addressed whilefocusing on daily issues and coping skills, without interfering with external investigations. Mecha-nisms for establishing and maintaining accountability are discussed in greater detail below.

As described elsewhere (Greenberg, Doi Fick, & Schnider, 2012; Greenberg et al., 2008;Greenberg & Doi Fick, 2005; Greenberg et al., 2003), the CCCT model was developed with carefulattention to relevant ethical codes and professional practice guidelines (American PsychologicalAssociation, 2002). Although it preceded the Association of Family and Conciliation Courts (AFCC)Guidelines for Court-Involved Therapy, the procedures in the model are consistent with the Guide-lines and designed to limit bias and remain consistent with relevant research. As the model is devel-opmentally based and adaptive, we have found it to be applicable to a variety of issues faced bycourt-involved families.

Our focus in this article is on the application of the CCCT model to families in which a childresists or refuses contact with a parent, resists transitions between parents, or demonstrates regressivebehavior that either or both parents associate with parenting transitions. Our use of the term“resistance-refusal dynamics” is a generic one, referring to a variety of families in which such phe-nomena are observed. A number of authors have addressed families in which children resist contactwith a parent, with or without a reasonable basis for their objections (Fidler, Bala, & Saini, 2012;Kelly & Johnston, 2001; Friedlander & Walters, 2010; Warshak, 2001; Drozd & Olesen, 2004;Garber, 2011). Various authors have described treatment or psychoeducation approaches for familiesin which these patterns have become established, generally focused on children aged 8 and above(Sullivan, Ward, & Deutsch, 2010; Sullivan & Kelly, 2001; Warshak, 2001; Friedlander & Walters,2010). Prior to this age, most children do not independently produce hostile narratives about a parent.Nevertheless, as described below, a variety of developmentally regressive and unhealthy copingbehaviors may be evident in much younger children. In most children, these issues are more likely tobe more amenable to intervention when addressed early. Our focus in this article is on application ofCCCT to early intervention with these challenging families.

ADDRESSING A HOLE IN THE CONTINUUM—THE CASE FOR EARLYINTERVENTION

CCCT is designed to assist families who often go unserved or who receive attention too late.Many of these are families who did not sufficiently benefit from group classes for separating parentsor from general parenting classes. Some parents resolve global issues (such as general timeshare)through mediation or settlement, but continue to expose their children to instability and conflictregarding daily routines, activities, parenting transitions, rules, and other issues of daily life. Whiletheir children remain at psychological risk, these families may not receive further services unlessthey return to court to resolve a dispute or their children demonstrate emotional or behavioral prob-lems. If the children’s behavior violates school rules or laws, it may be treated as a disciplinary issuewithout addressing the family dynamics causing or maintaining the problem. Older children may beless responsive to treatment or fail to elicit the sympathy of authority figures. This underscores anadditional risk of failing to intervene when children are in distress.

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 3

In contrast to traditional verbal approaches to therapy, the clear targets in CCCT are coping skillsand behavior. As others have written (Sullivan, 2008), parents in the highest-conflict families aremore likely to exhibit long-term patterns of acting-out behavior and relationship difficulties (Fidler &Bala, 2010; Sullivan, 2008; Sullivan et al., 2010), and model dysfunctional behavior for their chil-dren. Litigation processes and long delays between court hearings further compound the difficulty inconnecting behavior to consequences, even when all parties clearly understand the court orders.Thus, parents (and children) may have violated court orders and normal rules of conduct for extendedperiods of time without really experiencing any specific consequences for their behavior. For thesereasons, professionals may believe that these families cannot benefit from therapeutic help (Johnston,Walters, & Olesen, 2005; Walters & Friedlander, 2010). Conversely, as others have noted, even seri-ously dysfunctional families can be helped if treatment methods are adapted to fit this population(Gershater-Molko, Lutzker, & Wesch, 2002).

The work of Pruett, Cowan, Cowan, and Diamond (2012) underscores both the complexity of thispopulation and the potential benefits of attending to their problems early. Pruett et al. (2012) havedeveloped and demonstrated the effectiveness of time-limited, psychoeducational group interventionsaimed at increasing father involvement, reducing restrictive gatekeeping, and facilitating parentalcooperation (Austin, 2012). While they describe their intervention as a primary prevention strategy,it offers more services than more limited court-based parenting programs. Chief among them is theengagement of case managers who assist families struggling with other daily issues.

Children who resist contact with a parent may be more likely to come to the attention of the court,as the excluded parent may seek orders to enforce the parenting plan, provide counseling, a child custo-dy evaluation, or an order for some of the more specialized milieu programs that address disrupted rela-tionships. Many of these families are also poorly served, as they may initially be referred to therapythat is not adequately structured or specialized for this situation. Outmoded and often demonstrablyineffective treatment approaches, such as counseling that is limited to the rejected parent and child, areoften among the first to be attempted. (This is a common structure when courts order “reunificationtherapy,” but a one-sided approach is rarely successful and may exacerbate the problem.) Traditionally,therapy has often focused exclusively or excessively on issues in the parenting conflict, without ade-quate attention to the rest of the child’s life or other developmental needs. Parents who are in dispute asto the cause of the disrupted relationship may choose to litigate this issue or request extensive evalua-tions, with children receiving little effective help or intervention for months or years.

When a child has not mastered age-appropriate developmental abilities, this may be quicklyapparent to a trained observer. Thus, these types of issues can be addressed with very young childrenand their parents, and can begin long before a dynamic of restrictive gatekeeping, estrangement, oravoidance becomes truly entrenched in the child. Mastery of these abilities is critical to the child’sfuture, transcending immediate issues in the family conflict. If resistance-refusal dynamics becomeentrenched, however, the older child or adolescent may begin to exhibit regressed or dysfunctionalbehavior in front of peers, such as crying, tantrums or rudeness to a parent. The adolescent may thenbecome increasingly socially marginalized, as both peers and other parents react to the inappropriate-ness of the child’s or adolescent’s behavior. This, in turn, robs the adolescent of the emotionalresources and healthy relationships that s/he may need to achieve successful adjustment and indepen-dent relationships.

A core concept in the CCCT model is the recognition that resistance-refusal dynamics, like all ofthe problems in court-involved families, occur against a broader systemic and developmental back-ground. In addition to the stresses of family conflict, children may have emotional, medical, educa-tional, or behavioral issues that need prompt intervention to avoid a lifetime of disability ordysfunction. In some children, these vulnerabilities exist before the parents separate and are a factorin the separation. In others, these conditions arise independently after the separation or become morevisible as stress increases. For example, a child may receive a diagnosis of attention deficit/hyperac-tivity disorder or a learning disability, which was at a subclinical level while the child was in the ear-ly grades but became more disabling as the child entered third grade and the parents separated.Obesity in children may reach a level of clinical concern as a child gets older or in response to a

4 FAMILY COURT REVIEW

sudden, marked weight gain or other deterioration. Other children have medical conditions that areunrelated to the parenting conflict but are either neglected or become a focus of conflict once theparents separate. Parents who blame one another for the child’s difficulties may fail to focus onassisting the child, advocating for the child’s educational needs, cooperating with medical or mentalhealth treatment, or establishing other resources for the child. The child’s condition may then deterio-rate, and depression or a sense of helplessness may compound the original problems. All of theseconditions may reflect a combination of developmental, genetic, psychological, and environmentalfactors and may need or be responsive to a variety of kinds of intervention.

While judicial determination of some allegations (such as allegations of abuse or danger to thechild) must precede therapy regarding those issues, families exhibiting resistance-refusal dynamicsoften present a host of other deficits and problems. Many have trouble maintaining an emotionallystable or healthy environment, access to peer activities and healthy relationships, or the other devel-opmental experiences children need for healthy adjustment. These issues can be addressed withoutcompromising external investigations or evaluations, and addressing them may be crucial for the ulti-mate health of the family and children. Allowing dysfunctional behaviors to become entrenchedthrough years of litigation and investigation may seriously impair children’s functioning, diminishingthe chance that any intervention will be successful when a conclusion is finally reached.

Even if it is determined that there is a traumatic history to be resolved, the interventions described here-in will provide tools necessary to address those issues. Toward that end, a protective structure is estab-lished for therapeutic sessions; children are expected to treat parents with the respect accorded to anyadult. Parents are not required to agree with their children’s perceptions but are prohibited from anybehavior that could be perceived as intimidating or denying children’s feelings. Practicing on noncon-tested or daily issues, both are taught skills for discussing and resolving problems. Specialized resourcesand parenting materials can also be reviewed and practiced with parents separately, so that expectationsare more realistic and time with the child more productive. Moran, Sullivan, and Sullivan (2015) have pro-vided a very useful handbook for parents addressing some of these issues. In the therapeutic context, wehave provided these rules to parents in advance and requested that therapists practice with their clientsusing examples of distressing things that the children might say. These can be tailored to the case, oftengleaned from legal documents or the parents’ experiences with the child.

REQUIRING DEVELOPMENTALLY APPROPRIATE PARENTING AND DEALINGWITH CONFLICTING EXPECTATIONS

Therapy is structured to require children to exhibit behavior that would normally be expected of achild the same age in any setting where the child is expected to follow rules and treat others withrespect. This may require giving directions to parents as to the best ways to promote the child’s coop-eration. For example, a 4-year-old is expected to walk into the session rather than be carried by anadult, unless the child needs physical assistance from the parent. If the child is capable of walkinginto his preschool, a birthday party, or his karate class, he is capable of walking into the therapist’soffice or getting into the other parent’s car. These parent–child interactions will provide data regard-ing the quality of the parenting and the child’s responsiveness to each parent’s style, which can thenform the basis for further intervention.

Particularly in the initial stages, this process may require constantly refocusing the parents onwhat they can do to help the child, rather than assigning blame for the problem. Children from con-flicted families often feel caught between parents’ opposing needs and expectations. Parental conflictmay have long predated the separation, and the child may align with one parent for a variety of rea-sons. Some children have a natural affinity for one parent’s style, while others have aligned with oneparent due to exposure to adult information or the belief that one parent is more needy or vulnerable.One parent may have better parenting skills or sensitivity to the child. In some situations, this reflectslimitations in the less-preferred parent. Alternatively, the less-preferred parent may not have had asmuch time or opportunity to parent.

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 5

This can become an escalating cycle if either parent, or the child, resists opportunities to improvethe relationship between the child and the nonpreferred parent. Avoidance is a powerful, if extremelyunhealthy coping strategy and in court-involved families there may be an even greater impetus toresist change. Parents may perceive threats to their legal positions or an unwelcome focus on bothparents’ contribution to problems. Children may have become accustomed to avoiding problemsrather than dealing with them and may never have developed the active coping skills that are so criti-cal to development. At least one parent may be indulging the child’s regressive or acting-out behav-ior. The child may be avoiding dealing with his/her own feelings by taking sides or producingstatements that each parent wants to hear (Fidler & Bala, 2010). Although both parents and childrenmay ultimately find that better coping skills make life easier, it is not uncommon for them to initiallyattempt to avoid the work, and uncertainty, of change.

The therapist may be able to defuse this issue by focusing on the routines, rules, and structure ofeach household, exploring this issue with each parent and with the child. Often, children can speakmore freely and descriptively about these issues than about the contested issues that are the focus oflitigation, and these daily issues are often developmentally critical. Parents are quick to blame oneanother for children’s problems or even for minor variations in behavior. The therapist should workwith each parent to realistically review his/her observations while making parenting suggestions toalter the child’s behavior and promote healthy development. An evenhanded approach on theseissues is helpful, particularly if one parent has felt overly criticized by the other. It is essential thatthe therapist explore issues common to conflicted households prior to considering anxiety or traumaas a cause of the child’s behavior. For example, the therapist should explore differences in the rou-tines and rules between households, sources of fatigue, practical stressors surrounding bed and meal-times, or other variables that may lead to tantrum behavior or other distress in the child. In theprocess, parents may learn to consider a variety of possible explanations for their children’s behavior,rather than immediately blaming the other parent. It is also important for parents and children to learnthat parents may have different rules or practices on some issues (Smart, 2002), just as differentteachers have different rules.

It is helpful to explore messages the child perceives from either parent about the meanings ofimportant concepts and the acceptability of the child’s feelings. Is there a special definition of “truth”in one household or the other? How do parents respond to the child’s various feelings in everydayinteractions, as well as around parenting transitions or disputed issues? Does the household differenti-ate between feelings of anger and inappropriate behavior? Careful and systematic exploration oftenreveals the enormous cognitive and emotional binds impacting children.

Initial procedures can be adopted around school events or organized activities, where the activity islargely under the direction of a third adult. Organized or externally based activities lend themselves tocommon expectations. If the less-preferred parent has some deficits, this is an opportunity for him/herto demonstrate that s/he can rise to the occasion, follow others’ rules, and avoid embarrassing the child.Activities can also be selected and structured to support the strengths of each parent–child relationship(Austin, 1982, 2013; Moran et al., 2015) with behavioral expectations adjusted according to theparents’ and child’s abilities. If the preferred parent truly is not undermining the other parent–child rela-tionship, s/he can demonstrate this by supporting these activities, setting clear limits with the child, andintervening promptly if the child demonstrates inappropriate behavior toward the other parent—just asthe preferred parent would do if the child behaved that way toward any other adult. The child gainspractice in being polite to someone that s/he may not like at the moment, a common skill taught to chil-dren, and avoids being marginalized by peers. If the child grumpily acknowledges that the rejected par-ent “didn’t embarrass me this time,” therapeutic movement has occurred and can be built upon.

A child’s conflicted loyalty or a parent’s attitude toward the other parent may distort the informa-tion that the child provides about his/her time with the other parent. Ultimately, the most successfultherapy process will help the child to feel freer to tell each parent about positive time with the otherparent, and to express in an appropriate way the child’s concerns about each parent. Many parentsfall short of these goals, but by establishing behavioral rules that promote these abilities in the childand allow engagement in all aspects of the child’s life, communication patterns can be established

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that carve out a safer space, at least in external environments, for the child’s healthy development.Even if the parent does not share the goal or wish to cooperate, the parent’s own attorney, therapist,or consultants may advise that it is both better for the child and better for the parent’s ultimate legalposition to cooperate with providing some normalcy for the child. Other methods for promotingparental cooperation are detailed below.

This model requires contracting with parents, providing written notes, or confirming by e-mail toencourage parents to be accountable for their behavior. The therapist must clearly state expectationswithout ambiguity. If a parent’s cooperation decreases, the therapist must review contracts and orderswith the parent, explore the parent’s reactions, and document clearly. The therapist should emphasizeto the parent that the child’s stress will decrease when conflicted parents change their behavior, andthat cooperation might even make life easier for the parents. The therapist must emphasize that theparent is not just being asked to alter behavior to benefit the other parent—cooperation is importantto all of the child’s current and future relationships. Ultimately, the therapist may need to rely on thecourt’s underlying orders to promote cooperation in treatment. Components of effective therapyorders/stipulations are extensively discussed in Greenberg, Doi Fick, and Schnider (2012) and theAFCC Guidelines (2011).

ILLUSTRATIVE CASE EXAMPLES

Joe Brown and Patti White are the parents of Janie, age 41=2, who is a pre-kindergarten student. Theyhave each presented a video showing the following: Janie was clutched in Mother’s arms while Mothercarried her to Father’s waiting car. Mother’s face was close to Janie’s as she cried and Mother said, “Iknow it’s scary, Janie, but Daddy is here to pick you up.” Father cheerfully greeted Janie but said nothingto Mother, other than, “put her down please Patti.” Janie began to cry as Mother said to Father, “I toldyou she’s too scared to go with you. She knows you’re still a dangerous alcoholic. Why doesn’t anyonelisten to me.” Father responded with hostility, “You’re alienating her. She’s fine when she’s not aroundyou. This is why I should have custody.” The parents continued to execute the exchange for 15 minutesin the same manner while Janie’s distress escalated. This occurred 1 day before Father was scheduled totake Janie to perform in a program at her school. Janie is substantially overweight and has delays in grossmotor skills, issues which are impeding her participation with peers. Her pediatrician has urged the parentsto address these issues immediately by increasing Janie’s physical activity and promoting healthier foodchoices. He suggests structured but noncompetitive programs such as a local kiddie gym. Mother hasreluctantly chosen a program, although she believes this issue can wait because Janie is so distressed anddislikes physical activity. Father has chosen a different kiddie gym program with which he thinks Mothershould comply. Mother cites this as another reason for Janie’s distress at parenting transitions. Father hasfiled an ex parte motion seeking to have his parenting time extended so that he always transitions Janie toand from school. Mother wants Father’s parenting time monitored. Each is seeking sole custody and acustody evaluation has been ordered.

This is a complex scenario, but not really more complex than what we often see in our daily pro-fessional practice. Children often present with multiple and overlapping issues that pose risks to theirfuture development, particularly if exacerbated by stress or neglected due to the parenting conflict.While the parents pursue their disagreement about the causes of the problems, the child’s deteriora-tion continues. Without intervention, children in these situations may have seriously entrenchedproblems by the time evaluations or litigation is concluded. Effective intervention is possible withoutinterfering with a custody evaluation, although the family therapist may also generate data that willbe useful to understanding the problems.

In this case, the therapist might provide highly structured procedures to facilitate any parentingtransitions involving both parents, although it may reduce stress to use natural transitions at neutralsettings. For any parenting exchanges that involve both parents, Father may be instructed to wait inthe car while Mother facilitates the transition. The level of detail can seem excruciating to the normalobserver. For example, Mother might be instructed to (1) help Janie into her car seat; (2) buckle Janie

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 7

in; (3) say, “Bye, Janie, have a good time with Dad, and I will see you when you get back”; (4) smile,wave, close the car door, and walk away. Father would be instructed to leave the curb without hesita-tion while engaging Janie in cheerful conversation. Similar procedures will likely be needed toencourage each parent to support (or at least not undermine) Janie’s activities with the other parent.Treatment goals include promoting Janie’s independent skills, avoiding more developmental delay,and allowing as many issues as possible to be addressed in community settings with help to strength-en her peer relationships. An early focus on the medical recommendations and Janie’s developmentalneeds may help parents to build some habits for separating medical issues from the conflict, but thisis certainly not guaranteed. Either way, the early intervention may delay the need for more medicalservices and promote success for Janie.

The selection of Janie’s activities may gradually include her desires and preferences, particularlyif she has a protected space for describing her likes and dislikes, which activities her friends are in,and other child-centered concerns. All of this takes place in the context of developmentally appropri-ate limits and structure—that is, Janie does not have the choice to avoid exercise entirely, refuse totransition to either parent, or indulge in regressive behavior. Through counseling procedures such asthose described below, she could earn the right to have some voice in selecting the activities she par-ticipates in. Such procedures also send reassuring messages to children that they do not have tochoose between their parents. At best, this provides support for healthier behavior by both parentsand support for Janie. At worst, it provides a record of developmentally focused suggestions, whichcan be used to hold a parent accountable if s/he refuses to cooperate and Janie’s behavior worsens.

A developmentally based rapid intervention does not require the parent to agree with the court’s orderor to change his/her opinion of the other parent; it is intended to bring immediate relief to the child. Ananxious parent might also be reminded that specific, conflict-reducing procedures will also help professio-nals to “see the real problem.” Thus, both of Janie’s parents can be assured that the therapist is remainingalert for signs of problems in the other parent’s relationship with Janie so that assistance can be offered.Each parent’s attorney might remind them of the potential consequences of refusing to cooperate withcommon-sense suggestions such as reducing Janie’s distress and supporting recommended activities.Teachers may be helpful in reinforcing “big girl” behavior in Janie, modeling effective behavior for theparents, and giving Janie access to healthy relationships. By reinforcing appropriate behavior across Jan-ie’s settings and activities, Janie may be strengthened even if the parents remain in conflict.

Content may emerge in counseling sessions that does not entirely support either parent’s perceptionsbut rather the complexity of Janie’s distress, which can then be addressed in a structured way by the fami-ly therapist. The parents can also be referred for appropriate services as their deficits become clearer. Rap-id change can be promoted with an emphasis on Janie’s medical risks, coordination with medicalprofessionals, and the need for cooperation from both parents with uncomfortable behavioral changes.

As the multisystemic plan is created and implemented, the therapist may be able to identifystrengths and deficits that inform future service planning. For example, while some parents fail to setlimits as part of the parental conflict, others have more general difficulty establishing routines andsetting limits with their children. This difficulty may be temporary, if the crisis of divorce forceschanges in the household and temporarily overwhelms the parent. Other parents need more generalassistance (i.e., a parenting skills class) to better manage their children’s behavior. In some cases, thechildren’s behavior has become difficult to manage due to their independent issues, not arising fromeither parent or the divorce. Parents are often not alert to these factors; therapists should have a sys-tematic process for considering them.

CLINICAL INTERVENTIONS

BUILDING A LANGUAGE OF FEELINGS

Many children and parents in conflicted families are unable to identify or articulate their indepen-dent feelings (Johnston , Walters, & Friedlander 2001), or to separate their own feelings from those

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of others. Developmentally, these are critical abilities. Many materials are available that expose chil-dren to depictions of feelings in daily experiences, matching them to common feeling words. Thesematerials are often used in early childhood education and are not focused on divorce or parentingconflict. The therapist may review these materials with children and ask children to identify occa-sions when they have had similar feelings. As children describe events about their daily lives, thetherapist can help them use the materials to find pictures or words that match their experience. Thesecan later be used in discussions with parents, on content that starts with the mundane and builds incomplexity.

Many children of conflicted parents struggle with powerfully ambivalent feelings that either theyor their parents are unable to identify or tolerate. It is helpful to both parent and child to use concreteterms to define confusing or conflicting emotional experiences. Nonloaded examples can also beused to teach these skills, and neutral source materials are available for that purpose (often from edu-cation outlets). Age-appropriate language with a young child, for example, might include, “I’m hav-ing two feelings at the same time. I’m happy to go to Disneyland but sorry to miss my friend’sbirthday party.” With appropriate parental and therapeutic support, this may be expanded to family-centered content, such as, “I’m happy to go camping with Daddy but sad that Mommy will bealone.” It should be noted that the ability to tolerate ambivalence is often severely impaired in chil-dren of conflict, which impairs their ability to tolerate complex emotions and form healthy relation-ships. One often finds that children have failed to master emotional abilities characteristic of muchyounger children, making exploration of these issues a challenging and delicate aspect of therapy.

The focus is on assisting the child to build an independent vocabulary of emotions that hopefullycan be shared with parents. Practicing with daily activities, the parent’s task is to empathize with thechild’s perceptions, acknowledge an understanding of these emotions, and praise the child for self-expression. A bonus occurs when a parent apologizes to the child for contributing to the child’s stressor works with the child to find a more comfortable routine or practice. Even when parents cannotaccept ambivalence or achieve higher-level change, children can discuss the issues in their individualsessions, and the skills practiced will be useful to the child in coping with the parents’ conflict and inbuilding other relationships.

A TRAUMA-SENSITIVE BUT NONSUGGESTIVE APPROACH

Many high-conflict families arrive amid allegations of trauma, and children may make statementsor exhibit behavioral signs that may represent trauma. Children may be traumatized by specificevents with parents, chronic conflict, perceived threats of abandonment, and/or external events.These issues are often the subject of external investigations and thus may not be specifically dis-cussed in therapy until those investigations are concluded. Nevertheless, this model is designed to beboth trauma sensitive and nonsuggestive, as the interventions help build a foundation of coping andcommunication abilities that will help children address any traumatic issues.

The “language of feelings” intervention supports these abilities, with the therapist maintainingtherapeutic objectivity by systematically eliciting the child’s perceptions on a variety of nonloadedissues and how various feeling words apply to them (Greenberg et al., 2003; Kent & Doi Fick,2001). Traumatic memories may be expressed by the child, but are more likely to be understood cor-rectly if grounded in basic skills and everyday experience. Therapeutic knowledge about the effectsof trauma can be a source of bias for the therapist, who may unwittingly make assumptions aboutwhat has happened to the child and how the child has responded. These biases may then influencechildren’s perceptions. It is critical to remember that symptoms can have multiple meanings, and iftrauma exists, it may be more complex than either parent’s perception. Systematic exploration of pos-sibilities is essential. Therapists may need more advanced training to manage these complex cases,and disciplined procedures are also essential. The AFCC Guidelines (2011) outline some of theessential areas of training, which must be combined with a therapist’s willingness to constantly ques-tion one’s own assumptions and explore alternate possibilities.

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 9

Children who resist contact with a parent may be unusually direct about raising allegations oftrauma with an appointed family therapist or with the nonpreferred parent. To avoid tainting externalinvestigations, therapists may need to acknowledge the importance of the child’s feelings but gentlyredirect the topic to another time or to the professional who has been designated to investigate theallegations. For example, a therapist might say, “That sounds like really important stuff to talk about.But you know, the court has set some rules about what we do, and it sounds like the judge wants (thesocial worker or evaluator) to be the ones to talk to you about that for now. That doesn’t mean wecan never talk about it, but for right now it would be good to just get to know each other and give mea chance to catch up on all of the papers they sent me.”

The therapist can explore whether there is anything making the child feel unsafe “right now”because the therapist might be able to help with those issues. This could lead to useful discussion ofhow to make any ordered visitation manageable for the child and also permit the therapist to explorethe reasonableness of any fears expressed by the child. Is either parent making inappropriate com-ments to the child? Is either of them discussing the allegations? Is the child expressing unrealisticfears, such as a concern that a parent’s presence at a school concert will somehow cause the child tobe unable to sing at the performance? How could the parent do that?

This exploration enables the therapist to focus on techniques that assist the child with stress man-agement and empower the child to enjoy his/her own school performance regardless of what hisparents are doing or saying. Along the way, the therapist is reinforcing healthy coping abilities suchas a realistic appraisal of control, enhancing the child’s independent ability to manage his emotions,and assisting the child to derive support from age appropriate activities. If the child resists discussingany subject other than the allegations, this behavior is noteworthy and hazardous to the child’s func-tioning. The therapist should help the child to engage with child-centered elements of his/her life.The therapist can request healthy messages from both parents that support the child in focusing onactivities outside of the parenting conflict and should assist the child with skills for doing so. If thetherapist is unable to gain cooperation in this endeavor, it is noteworthy information to be consideredin any assessment of the child and family.

In this hypothetical situation, an initial protocol may require the disfavored parent to sit fartheraway from the child and have no interaction with the child other than a friendly wave and an oppor-tunity to praise the child’s performance via subsequent message or at a therapy session. To the degreethat the preferred parent is conveying anxiety to the child, such protective structures may reassureboth parent and child or demonstrate that the parent’s or child’s expressed concerns are not realistic.The restricted parent has an opportunity to demonstrate his/her ability to cooperate (or not). As a gen-eral rule, these interventions are easier with younger children who may be impacted by adult anxietyor anger, but can be helped to overcome their anxiety with structure and the support of independentadults. (Preschool teachers are often particularly adept at this.) It is often necessary to review the pro-posed activity in detail with both the preferred parent and the child, discussing each step in the pro-posed activity, a realistic appraisal of risks and benefits, and specific steps or protocols to manageany anxiety the child expresses. This is best done separately with the parent and child, as their feel-ings may not be the same.

This approach also allows time to establish an adequate foundation in communication beforemore emotionally loaded content is discussed. Parents can be taught specific language that empa-thizes with the child’s feelings, avoids denying their memories, and commits to plans for the futurethat address concerns such as management of anger. Specific discussion of past allegations may needto be delayed, but the child’s feelings or fears can be addressed in planning for the child’s expectedtime with the parent. The same skills can be reinforced in discussion of the outside activities thatparents are attending and in discussions with the preferred parent.

The preferred parent’s task is to support the child in exercising healthy coping skills, includingusing language to express independent feelings and participating in independent activities as permit-ted/ordered by the court. This may require setting limits with regressive behavior.

The goal of all of these interventions is to support active coping and continued mastery of devel-opmental skills, so that any trauma that does exist will not be so disabling to the child. When

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avoidance becomes entrenched, the child’s behavior may more closely resemble a tantrum andshould be dealt with as such. Some form of parent accountability, as described below, may be neces-sary for such interventions to be successful. Detailed, specific plans facilitate this, as specific behav-iors are suggested for each parent that the parent either will or will not comply with.

It is worth noting that current research on treatment of trauma emphasizes the use of cognitive-behavioral approaches and other methods that reduce arousal or hyper-reactivity (Silverman et al.,2008) and promote effective coping abilities. This orientation is consistent with the plans suggestedabove. Careful selection of activities (Austin, 2013) may reinforce these abilities in children (Silver-man et al., 2008). Activities such as martial arts, yoga, or other activities that focus on self-control,mindfulness, calming oneself, and breathing may be supportive to any future efforts to treat trauma,without presupposing any conclusions on the issue. Where issues of self-control have been raised,these activities may provide an opportunity for both parent and child to learn and demonstrate skillsthat address these issues.

Families can also develop signal words that are unusual in everyday conversation but provide away for a child to tell a parent that s/he is becoming distressed or overwhelmed. (Some childrenchoose words with literal connotations of chaos or disruption, such as “volcano” or “earthquake.”) Atherapeutic contract between parent and child would allow the child to notify the therapist if use ofthese words did not alter the parent’s behavior or conversation. The child will require explicit permis-sion from parents to allow this intervention to be successful, and therapists can observe whetherparents are willing or able to do this credibly. Sessions can focus on whether the tool is being usedappropriately or simply to avoid unpleasant tasks—again, a foundation for future work.

We underscore here that these hypothetical interventions are only examples; they must be adjust-ed to the clinical situation at hand and often require that the therapist have advanced training. Theyare not intended to in any way deny the importance of traumatic events; rather, they are intended toprovide options for supporting the child’s emotional survival and development without taintingexternal investigations.

Once the court has made its findings, therapists may need to revisit the process of helping childrenresolve traumatic memories, discordant perceptions of events, or fears about future contact with theirparents. A brief, age-appropriate explanation of the court’s findings can begin the shift to complywith adult decisions. Specific procedures for this process are beyond the scope of this article but aredescribed in Greenberg, Doi Fick, and Schnider (2012) and will also be addressed in a futurepublication.

THE IMPORTANCE OF ACCOUNTABILITY

Effective intervention often requires a backdrop of accountability. In some cases this accountabili-ty is indirect, such as when a child custody evaluation is underway and the parents expect that theevaluator will ultimately seek information from the therapist. The court may create the context fortreatment by issuing orders about the behavioral changes it wants to see, such as peaceableexchanges, improvement in the child’s behavior, the child’s access to extracurricular activities withappropriate conduct by parents, attention to a child’s educational or medical needs, adherence to theparenting plan, and so on. A therapeutic plan may be a necessary element of those goals (Greenberget al, 2008). Family court professionals disagree about how specific the court can be in orderinginterventions, and jurisdictional differences abound. The involvement of a parenting coordinator andcollaborative team is ideal (Greenberg & Sullivan, 2012). Whatever the form of accountability, it isessential that the court clearly convey the expectation that parents cooperate.

Therapists should assist families in establishing specific behaviors or dialogue to comply withcourt orders, addressing nonverbal and indirect as well as direct behaviors. As Fidler and Bala(2010) and others have noted, high-conflict parents are often characterized by what they do not do,as well as by what they do. The therapist may need to establish therapeutic contracts outlining spe-cific, active procedures to promote compliance and reduce stress on the child. For example, if the

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 11

parenting plan includes telephonic or Web visits, the therapist should obtain detailed informationabout how these occur and recommend detailed protocols, including eliminating distractions (Walters& Friedlander, 2010). Detailed follow-up is essential. For example, with appropriate discussion andconsent, Web visits can be recorded and reviewed with parents and children. Such recordings mayprovide a wealth of information and discussion material for the child and parents, reinforcing bothappropriate behavior and the ability of the child and parents to discuss their different perceptions ofevents. Parents’ strengths and deficiencies often emerge during these discussions, giving the therapistan opportunity to make appropriate interventions or referrals.

MANAGEMENT OF THERAPEUTIC INFORMATION

Accountability may also be promoted by clarity about the information that therapists may be per-mitted or required to disclose. Jurisdictions differ markedly in their treatment of these issues, and afull exploration of this issue is beyond the scope of this article. The AFCC Guidelines address thisissue in detail, both in the main document and in sample materials, orders, and consents in the appen-dices. For purposes of the present article, however, it is important to note that the issue need not bebinary. As we have emphasized throughout this article, part of the focus in CCCT is for children tolearn to express feelings appropriately and for parents to learn to better understand their children’sneeds. Thus, to the degree that it is safe to do so, parents should be learning more about their childrenthroughout the therapy process. Some therapeutic finesse is required in making these decisions whenthey are part of a clinical intervention, as parents and children build the skills necessary to listen toone another.

With higher-conflict families or if problems become more entrenched, interventions withoutaccountability are less likely to succeed. Courts (and parents) may have a variety of options availableto them, but therapists must also honestly assess whether the structure being established for treatmentis adequate to the task they are expected to accomplish. Failed therapy also has consequences forchildren. It is also important to consider the situations in which children want certain information toreach their parents or others with the ability to protect them. When, for example, a therapist will bespeaking to an evaluator, children can be given an opportunity to select information that should beshared, as well as to express any concerns they may have about the reaction of their parents wheninformation is disclosed. This also provides the therapist with an opportunity to equip the child withcoping skills for these situations.

Each of us has had cases in which (1) no reporting was permitted; (2) disclosure was limited tocertain circumstances, such as renewed litigation or the request of a child custody evaluator; (3) wehave been required to testify; or (4) reports were limited to overall descriptions of the coping abilitiesbeing focused on and/or parents’ cooperation and a variety of other scenarios. We have had situationsin which parents threaten to file new litigation and demand reports from us, only to change courseonce we advise them of what we would have to say in such a report. We generally request permissionto use our discretion in sharing information with parents or in the type of information shared aboutthe child’s statements, to promote treatment goals and avoid surprises.

While it is often assumed that sharing of therapeutic information necessarily involves a breach oftrust, we have found that this is often not the case if the issue is managed appropriately. Balancingprivacy and accountability is a difficult issue in these cases and is best viewed as an issue to be man-aged, on an ongoing basis, as part of the therapy.

CLEAR UNDERLYING ORDERS HELP

Ultimately, there is considerable power in the therapist being able to say, “The judge decided; I’mjust here to make it work.” It is therefore useful to have clear, detailed orders addressing therapy,including an order that details the court’s expectations on issues such as parenting time, review

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hearings, and the extent of each parent’s participation in the child’s life as therapy progresses(Martinson, 2010).

While children’s safety must always be the first priority, we have found that it is useful, whensafe, to have underlying orders that allow both parents to have access to common childhood experi-ences such as attendance at athletic events, school performances, and other child-focused activities.For example, the court may consider ordering that a monitored parent may attend athletic and schoolevents—allowing the parent to greet the child but avoid engaging with the other parent—and direct-ing the parents to work with a therapist to develop detailed protocols for such events. Such structurescan also be applied to other parenting activities such as assisting with homework, attending parent–teacher conferences and other common parenting activities. This creates a structure that is lessdemeaning for the restricted parent and underscores the complexity of the parental role and the varie-ty of ways that parents can support their children. In therapy, therapists can assist parents with skillsfor asking the child relevant questions and responding to a child’s cues and behavior. Interventionsthat reduce the parent’s isolation from the child will facilitate the normal conversations that underliemost important relationships. This is often an essential element of resolving resistance-refusaldynamics.

Such experiences also allow the child to view the parent in the context of activities that are outsideof the allegations or parenting conflict. Of course, such a structure cannot be utilized where the courthas determined that there is danger in such areas such as stalking, violence, or child abduction. Nev-ertheless, progress in therapy is likely to be enhanced by maintaining parental roles as much as possi-ble without endangering the child.

Creative use of available options is essential. If a parent cannot attend a school or athletic event,can the other parent be expected to post a video of the event online for the other parent to see? A par-ent who cannot attend a joint parent–teacher conference may need help asserting his/her need for aseparate opportunity to talk to the teacher. Specificity in orders may be necessary to obtain the coop-eration necessary for these interventions to succeed, and this is an instance in which managed sharingof therapeutic information may help. For example, a therapist may send an email to both parentssummarizing his suggestions for ensuring that a restricted or distant parent can view his son’s basket-ball game online, including the suggestion that the nonrestricted parent videotape the game andmake it available on a specified web site, and that the restricted or distant parent view the game with-in 48 hours and communicate with the child about it. This would not require that the therapist dis-close any of the child’s statements. Either parent could then use the e-mail as an exhibit, along withwhatever verification exists that the other parent did or did not comply. (Web sites such as Our Fami-ly Wizard are already set up for this purpose.)

Specificity is also important on issues such as transportation for therapy and activities, parentingtransitions, limits and specifics in restraining orders, telephone access, and the responsibility of theparents to cooperate with the therapist and exercise their parental authority to promote the child’scooperation. Orders can be drafted that specifically prevent similar conflicts that have arisen in thepast for each specific family (e.g., late exchanges, conflict at public events, missed telephone calls).Financial arrangements should reflect the reality that therapists may be providing a broader range oftherapeutic services than is the case in traditional treatment and that this intervention, while moreexpensive than “bargain basement” therapy, is hugely less expensive than extensive evaluations orlitigation. Detailed discussion of therapy consents and orders can be found in Greenberg, Doi Fick,and Schnider (2012) and the AFCC Guidelines for Court-Involved Therapy.

Legal professionals disagree about what courts can directly order parents to do versus encouragingtheir cooperation or signing stipulations arrived at through mediation or other processes. The timepressures on judicial officers may also result in them settling what are perceived to be the “big” issuesand leaving the therapist to sort out the rest. While a full exploration of the obstacles and possibilitiesis beyond the scope of this article, we would observe that a number of commonly used tools, legalstrategies, and standard orders could be adapted to address many of the types of accountabilityrequired by this model. Forms can be developed that list common elements seen in conflicting fami-lies, so that mediators, attorneys or hearing officers can check and/or modify relevant orders for each

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 13

family. Many of the elements in these orders may appear to be minutiae to the busy hearing officerand may ultimately need modification as therapy progresses. The involvement of a parenting coordi-nator and collaborative team (Greenberg & Sullivan, 2012) is an ideal and sometimes necessary solu-tion, but not available to all families.

CONCLUSION

CCCT is a systemic, coping-focused, trauma-sensitive model targeting court-involved families.The model is most effective when supported by expectations of parental cooperation, mechanismsfor accountability, parenting structures, and specific orders that allow therapeutic intervention toimpact children’s everyday experiences. In this article, our focus has been on application of the mod-el to resistance-refusal dynamics or the deteriorations in the child’s emotional development that pre-cede them. The interventions are designed to facilitate the child’s healthy engagement in dailyactivities and independent relationships, promoting the coping and emotional abilities critical to suc-cessful adjustment. Specific behavioral interventions target immediate solutions, with hope that inter-nalized change may follow, but the child will be exposed to or learn different coping responsesregardless. Even if parents never achieve what a therapist would describe as “insight,” the changes inbehavior can provide the opportunity for children to have a healthier future.

The financial challenges facing family courts, and the risks of delayed intervention, underscorethe need for interventions that promote immediate relief to children and families while hopefullyreducing the need for ongoing litigation. Just as critically, CCCT is designed to address the varietyof systems and activities that interact with families. In families, many activities happen simultaneous-ly. Emotional challenges and developmental tasks do not necessarily arise in a carefully definedsequence. Both challenges and opportunities arise for children as part of the family’s daily life,impacted by the parental conflict and other factors related to the litigation. If intervention occurs ear-ly enough, available community resources and professionals (i.e., school events, recreational activi-ties, and other professionals involved with the child) may still be available to the child andsupportive to treatment. This enhances the relevance of therapy to the child’s daily life and may ulti-mately both enhance benefits and reduce costs.

CCCT will not be effective with every family. Therapy procedures and goals must be adapted tothe individual family. Parents who represent a danger to their children may always be limited in theirtime with the child, and appropriately so. Other parents will never be able to truly tolerate a child’sengagement with the other parent. The aim is to promote sufficient emotional and coping abilities tosupport the child in resolving issues to the degree possible with parents, while engaging in healthyrelationships outside of the family.

An additional strength of the model is the focus on concrete and behavioral issues that are under-standable to those outside the mental health professions. Thus, if the family does return to litigationor a custody evaluation is ordered, the therapist may be able to provide specific data that will assistdecision makers in making necessary modifications to parenting plans. Some of the relevant data willalso emerge in nonprivileged settings, such as the child’s activities, which may allow relevant infor-mation to emerge without compromising the child’s privacy.

CCCT should be considered an evidence-informed model. While there has been clinical successwith its methods and it is based in the social science literature, controlled studies of its effectivenessas a unit have not been possible.

REFERENCES

Association of Family and Conciliation Courts Task Force on Court-Involved Therapy. (2011). Guidelines for court-involvedtherapy. Family Court Review, 49, 564–581.

14 FAMILY COURT REVIEW

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,57, 1060–1073.

Austin, D. R. (1982). Therapeutic recreation: Processes and techniques. New York: Wiley.Austin, D. R. (2013). Therapeutic recreation: Processes and techniques (7th ed.). Urbana, IL: Sagamore Publishing.Austin, W. G. (2012). Parental gatekeeping in custody disputes: Mutual parental support in divorce. American Journal of Fam-

ily Law, 25, 148–153.Drozd, L. M., & Olesen, N. W. (2004). Is it abuse, alienation, and/or estrangement? A decision tree. Journal of Child Custody,

1(3), 65–106.Dunn, J., Davies, L. C., O’Connor, T. G., & Sturgess, W. (2001). Family lives and friendships: The perspectives of children in

step-, single-parent, and nonstep families. Journal of Family Psychology, 15, 272–287.Fidler, B. J., & Bala, N. (2010). Children resisting postseparation contact with a parent: Concepts, controversies, and conun-

drums. Family Court Review, 48, 10–47.Fidler, B. J., Bala, N., & Saini, M. (2012). Children who resist postseparation parental contact: A differential approach for

legal and mental health professionals. New York: Oxford University Press.Friedlander, S., & Walters, M. G. (2010). When a child rejects a parent: Tailoring the intervention to fit the problem. Family

Court Review, 48, 98–111.Garber, B. D. (2011). Parental alienation and the dynamics of the enmeshed parent-child dyad: Adultification, parentification

and infantilization. Family Court Review, 49, 322–335.Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2002). Using recidivism data to evaluate project safecare: Teaching

bonding, safety, and health care skills to parents. Child Maltreatment: Journal of the American Professional Society on theAbuse of Children, 7, 277–285.

Greenberg, L. R., Doi Fick, L., & Levanas, M. I. (2008, February). Therapeutic interventions. Rebuilding relationships: Child-centered conjoint therapy in high conflict cases. Presentation conducted at the Association of Family Conciliation Courts,California Chapter, California Annual Conference, Santa Monica, CA.

Greenberg, L. R., Gould, J. W., Gould-Saltman, D. J., & Stahl, P. (2003). Is the child’s therapist part of the problem? Whatjudges, attorneys and mental health professionals need to know about court-related treatment for children. Family LawQuarterly, 37, 241–271.

Greenberg, L. R., & Sullivan, M. J. (2012). Parenting coordinator and therapist collaboration in high conflict shared custodycases. Journal of Child Custody, 9, 85–107.

Greenberg, L. R., Doi Fick, L., & Schnider, R. (2012). Keeping the developmental frame: Child-centered conjoint therapy.Journal of Child Custody, 9(1–2).

Greenberg, L. R., & Lebow, J. (2016). Putting it all together: Effective intervention planning for children and families. In L.Drozd, M. Saini, & N. Olesen (Eds.), Parenting Plan Evaluations: Applied Research for the Family Court (2nd ed.).Oxford, NY: Oxford University Press.

Johnston, J. R., Walters, M. G., & Friedlander, S. (2001). Therapeutic work with alienated children and their families. FamilyCourt Review, 39, 316–333.

Johnston, J. R., Walters, M. G., & Olesen, N. W. (2005). The psychological functioning of alienated children in custody dis-puting families: An exploratory study. American Journal of Forensic Psychology, 23(3), 39–64.

Johnston, J., Roseby, V., & Kuehnle, K. (2009). In the name of the child: A developmental approach to understanding andhelping children of conflicted and violent divorce (2nd ed.; pp. 129–154). New York: Springer.

Kent, J., & Doi Fick, L. (2001). Court-dependent children. In M. Winterstein & S. Scribner (Eds.), Mental health care for childcrime victims: Standards of care task force guidelines (pp. 68–78). Sacramento, CA: California Victim Compensation andGovernment Claims Board.

Kelly, J. B., & Johnston, J. R. (2001). The alienated child: A reformulation of parental alienation syndrome. Family CourtReview, 39, 249–266.

Kelly, J. B. (2012). Risk and protective factors associated with child and adolescent adjustment following separation anddivorce: Social science applications. In K. Kuehnle & L. Drozd (Eds.), Parenting plan evaluations: Applied research forthe family court (pp. 49–84). New York: Oxford University Press.

Martinson, D. J. (2010). One case—one specialized judge: Why courts have an obligation to manage alienation and otherhigh-conflict cases. Family Court Review, 48, 180–189.

Moran, J. A., Sullivan, T., & Sullivan, M. (2015). Overcoming the co-parenting trap: Essential parenting skills when a childresists a parent. Natick, MA: Overcoming Barriers Inc.

Pedro-Carroll, J. L. (2005). Fostering resilience in the aftermath of divorce: The role of evidence-based programs for children.Family Court Review, 43, 52–64.

Pedro-Carroll, J. L., Sandler, I. N., & Wolchik, S. A. (2005). Special issue on prevention: Research, policy, and evidence-based practice: Forging interdisciplinary partnerships in the courts to promote prevention initiative for children and fami-lies. Family Court Review, 43, 18–21.

Pruett, M. K., Cowan, C. P., Cowan, P. A., & Diamond, J. S. (2012). Supporting father involvement in the context of separa-tion and divorce. In K. Kuehnle & L. Drozd (Eds.), Parenting plan evaluations: Applied research for the family court (pp.123–155). New York: Oxford University Press.

Sandler, I. N., Tein, J. Y., Mehta, P., Wolchik, S., & Ayers, T. (2000). Coping efficacy and psychological problems of childrenof divorce. Child Development, 71, 1099–1118.

Greenberg et al./CATCHING THEM BEFORE TOO MUCH DAMAGE IS DONE 15

Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., et al. (2008). Evidence-based psy-chosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psy-chology, 37, 156–183.

Smart, C. (2002). From children’s shoes to children’s voices. Family Court Review, 40, 307–319.Sullivan, M. J. (2008). Coparenting and the parenting coordination process. Journal of Child Custody, 5, 4–24.Sullivan, M. J., & Kelly, J. B. (2001). Special issue: Alienated children in divorce: Legal and psychological management of

cases with an alienated child. Family Court Review, 39, 299–315.Sullivan, M. J., Ward, P. A., & Deutsch, R. M. (2010). Overcoming barriers family camp: A program for high-conflict

divorced families where a child is resisting contact with a parent. Family Court Review, 48, 116–135.Walters, M. G., & Friedlander, S. (2010). Finding a tenable middle space: Understanding the role of clinical interventions

when a child refuses contact with a parent. Journal of Child Custody, 7, 287–328.Warshak, R. A. (2001). Divorce poison: Protecting the parent/child bond from a vindictive ex. New York: HarperCollins.

Lyn R. Greenberg, Ph.D., ABPP, specializes in work with court-involved children and families. She providesparenting plan coordination, specialized treatment, consultation, training, and expert witness services. She haswritten and presented extensively on issues related to divorce, child abuse, professional ethics, high-conflictdynamics, and family forensic psychology. She has served as the reporter and member of the AFCC TaskForce on Court-Involved Therapy and is a Fellow of APA Division 43.

Lynda Doi Fick, M.A., M.F.T., is a member of the Los Angeles Superior Court, Juvenile Dependency 730Expert Panel and has performed child custody evaluations in the family law court for the past 25 years.The focus of her practice is court-involved treatment on cases with historical elements of child abuse, trau-ma, high-conflict divorce, and/or abduction. She is a contributor to the 2001 Mental Health Care for ChildCrime Victims, Standards of Care Task Force Guidelines.

Hon. Robert A. Schnider received his A.B. degree from the University of California at Berkeley in 1967 andhis J.D. degree from the University of California at Berkeley, Boalt Hall School of Law in 1970. He was apartner in the law firm Schnider & Schnider from 1971 and was a Certified Family Law Specialist. He waselected as commissioner of the Los Angeles County Superior Court in 1981 and assigned to the Family LawDepartment. In 2002, he was appointed judge of the superior court. From 2005 to 2007, he was the super-vising judge of the Family Law Department. He retired from the bench at the end of 2008 and now worksas a private neutral. He has lectured and taught extensively to both lawyers and judicial officers and hasreceived several awards including Judicial Officer of the Year in 1997 from the Family Law Section of theState Bar of California, the ACFLS Special Recognition Award in 2008, and the Outstanding Jurist Awardin 2000 from the Los Angeles County Bar Association.

16 FAMILY COURT REVIEW

ADAPTIVE AND MALADAPTIVE GATEKEEPING BEHAVIORS AND ATTITUDES: IMPLICATIONS FOR CHILD OUTCOMES AFTER SEPARATION AND DIVORCE

Michael Saini, Leslie M. Drozd and Nancy W. Olesen

Gatekeeping has been used as a theory and a measure to describe and assess family dynamics within the context of separation and divorce. Although originally focused on maternal gatekeeping behaviors that either facilitate or restrict the father’s involvement with the child, recent attention has expanded gatekeeping to a gender-neutral framework for assessing the ways in which both parents’ behaviors and attitudes can impact the involvement and the quality of the child’s relationship with the other parent. While gatekeeping intersects with interparental conflict, parent alliance, and parent-child relationships, gatekeeping provides a unique perspective for assessing and measuring behaviors and attitudes that facilitate or restrict the other parent’s relationship with the child. In this paper, we explore adaptive and maladaptive gatekeeping behaviors and attitudes that can affect the other parent’s relationship with the child. Implications are presented for connecting adaptive and maladaptive gatekeeping responses to child outcomes of safety, wellbeing, and positive parent-child relationships following separation and divorce. We build on the recent attention to gatekeeping as a potential framework within the child custody context. Key points for Family Court Community:

• Gatekeeping is a useful framework for assessing parental behaviors and attitudes that can facilitate, protect or restrict the involvement of the other parent with the child.

• Gatekeeping originally focused on maternal behaviors that facilitate or restrict the involvement of fathers with the children,

• Attention has shifted toward a more gender neutral framework for assessing how parents’ attitudes and actions affect the involvement and quality of the relationship between the other parent and child.

• Rather than a set of hardline rules that govern behaviors, gatekeeping requires working hypotheses to consider the various factors that may contribute to both adaptive and maladaptive gatekeeping responses.

Keywords: Separation and divorce; Parent-child relationships; Gatekeeping; Adaptive; and Maladaptive

Case Study Rob (age 38) and Anne (age 37) were married for 7 years and have one child named Emily (age 4) from their union. Nearing the end of the marriage, Anne became increasingly dissatisfied with Rob’s substance use (both in the presence of Emily and outside the matrimonial home). Rob’s use of alcohol and crack cocaine created strain on the family. Anne filed for divorce when she found out that Rob was involved in an affair with her best friend. Following the separation, Rob did not have contact with Emily for a period of four months. He attended a 30-day addiction program and he began doing random drug testing once a week (where Anne received emails from the drug clinic indicating the outcome of the test) in order to regain contact with Emily. Since being drug-free, Rob has been visiting with Emily every other weekend supervised at his parents’ home. Rob has recently purchased a home in close proximity to Anne’s home and he is wanting more contact with Emily. He said he eventually wants to share parenting time but at this time, he wants more time with Emily and he wants the opportunity to have unsupervised visits in his new home. Anne wants to support the time that Rob spends with Emily but is concerned about his past substance use and his overall consistency as a parent.

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Preliminary assessment of the case study

Gatekeeping has been used as a theory to describe family dynamics within the context of

separation and divorce (Drozd, Olesen & Saini, 2014). Although gatekeeping alone should not be

the sole basis for making decisions regarding child custody disputes, it can nevertheless provide

a useful framework for generating hypotheses regarding the parents’ behaviors and attitudes

about the child’s relationship with the other parent and the impact of gatekeeping on the child’s

overall safety and wellbeing. Some preliminary questions based on the above case study may

include:

• What attitudes and behaviors demonstrated by the parents facilitate or interfere with the other parent’s involvement with Emily?

• Anne has concerns that Rob may abuse drugs while Emily is in his care, are these concerns warranted (protective gatekeeping) or unwarranted (unjustified restrictive gatekeeping)?

• Why was it important for Anne to receive Rob’s drug testing results by email? • How does Rob view Anne’s concerns about Emily spending time in his care? • What were Anne’s reasons for restricting Rob’s contact with Emily for the first four

months after the separation? • Does Rob support Emily’s relationship with Anne? What are some examples of this? • Do either parent’s behavior during the exchanges have an impact on Emily’s relationship

with the other parent? • What strategies could be put in place to limit the safety concerns so that Anne supports

more contact between Rob and Emily? • How can the concept of gatekeeping inform our understanding of this case?

In this paper, we will build on a growing body of literature on gatekeeping (Allen & Hawkins,

1999; Austin, Pruett, Kirkpatrick, Flens, & Gould, 2013b; Ganong, Coleman, & Chapman, 2016;

Pruett, Arthur, & Ebling, 2007; Trinder, 2008) to explore these questions by considering

facilitative and restrictive gatekeeping behaviors and attitudes. We will also extend the concept

of gatekeeping to consider whether facilitative and restrictive gatekeeping is adaptive or

maladaptive to the child’s overall safety and wellbeing. Gatekeeping can complement other

3

factors that should be included in a comprehensive assessment of family dynamics post

separation, including parental attunement, parent competency, parent-child attachment, parent-

child conflict, age, special needs, and development of the child, to name a few.

Introduction to Gatekeeping

Gatekeeping is a set of beliefs, behaviors, and attitudes about the child’s relationship with

the other parent that can influence the amount of time a child spends with that parent, the quality

of that relationship, and the other parent’s overall involvement (Trinder, 2008). Allen and

Hawkins (1999) originally defined maternal gatekeeping within intact families as a “mother's

reluctance to relinquish responsibility for family matters setting rigid standards, wanting to be

ultimately accountable for domestic labor to confirm to others and to herself that she has a

valued maternal identity, and expecting that family work is truly a woman's domain” (p. 205). In

metaphoric terms, gatekeeping involves leveraging control of the other parent’s influence and

access to the child by either opening the gate to support the other parent’s relationship with the

child or closing the gate to restrict the other parent’s relationship with the child (Austin et al.,

2013b; Trinder, 2008). Gatekeeping develops throughout parental relationships in both intact and

separated families and can define parental roles and tasks according to parent’s availability and

expertise and how the other parent perceives these roles (Austin et al., 2013b).

The conceptualization of gatekeeping has sparked a growing body of research that has

explored mothers’ beliefs and attitudes about fathers’ role in the family and the involvement of

fathers with the children in intact families (Holmes, Dunn, Harper, Dyer, & Day, 2013; McBride

et al., 2005; Trinden, 2008). McBride et al., (2005) for example, studied intact families and

found an association between mothers’ support of the fathers’ involvement and fathers’ positive

self-perception of themselves as parents and their physical presence with their children. Likewise,

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Cannon, Schoppe-Sullivan, Mangelsdorf, Brown, & Sokolowski (2008) found a correlation

between mothers’ expressions of progressive beliefs about the equal distribution of household

chores and parenting duties and parents reporting greater father involvement. Further, Cannon et

al., (2008) found an association between fathers’ progressive beliefs about their role and their

reported feelings of competency in their interactions with their children. In contrast, Holmes et

al., (2013) found a relationship between mothers who exhibited restrictive gatekeeping (e.g., not

permitting the father to take part in child care duties) and adolescents reporting that their mothers

as psychologically controlling and less involved with them. Maternal gatekeeping and maternal

interference with father-child relationships can harm mother-child relationship as well (Holmes

et al., 2013; Walper, Kruse, Noack, & Schwarz, 2005).

Parental identity and implications for gatekeeping

According to Allen and Hawkins (1999), maternal gatekeeping has been understood as a

means of mothers limiting the father’s involvement of both childcare responsibilities and

household chores as a way to maintain control of family work and remain at the center of family

life. Likewise, Gaunt (2008) highlighted the conceptual association between gatekeeping and

traditional women’s identity by suggesting that women can gain power from family work

because it reinforces their maternal identity.

More recently, Pedersen (2012) studied married couples and found that fathers and

mothers view themselves differently in their roles within the family. Mothers often perceive

good parenting as being reliable, providing a predictable structure, and consistent discipline,

whereas fathers tend to perceive good parenting as participating in family life and spending time

with children. At the same time, mothers also tend to feel pressure from the demands placed on

them to comfort and nurture the children. Feinberg and Kan (2008) found that when fathers are

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supportive of the mothers, mothers can feel more competent as parents. Kulik and Tsoref (2010)

also found that when mothers are more educated, wealthier, hold more liberal gender role

ideologies, and perceive more support from extended family, they are significantly less likely to

restrict the fathers’ time with the children.

Fathers have been found to view the importance of their role as providing an alternative

to the mothers’ roles (Pedersen, 2012). Fathers have described their roles as being more logical

whereas they tend to view the mothers’ role as more emotional. Fathers tend to perceive

themselves as providing support to mothers, but often do not perceive child rearing as their main

responsibility (Pedersen, 2012), but this perception of gender roles tends to be changing with

more fathers involved in instrumental parenting duties (e.g., changing diapers, making meals,

doing laundry, etc.).

Research on fathers’ involvement has also found a link between the fathers’ identity as a

parent and the amount of time they are in the physical presence of their children (McBride et al.,

2005). In a study of 30 two-parent families, McBride et al. (2005) found that the more fathers

spend time in their children’s presence, the better fathers felt about their role as a parent and this

was related to whether mothers believed that the fathers should be involved. When mothers were

more supportive, fathers tended to be closer to their children and feel more competent as parents.

Men in intact relationships are typically more likely to be involved and interested in their

roles as fathers when the coparenting relationship is satisfying. In a study of intact families,

Brown, Schoppe-Sullivan, Mangelsdorf, and Neff (2010) defined supportive coparenting as

parents’ ability to respect the other parent, recognize the other parents’ abilities, while also

cooperating with the other parent when parenting issues arise. When parents believed that their

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coparenting relationship is positive, fathers tended to cite greater encouragement and less

criticism from the mothers.

In summary, the growing body of research about parental relationships with their children

in intact families seems to suggest that parental roles and their availability of the parents with the

children tend to be associated and influenced by the other parent’s views and perceptions of the

potential benefits of the involvement of the other parent. When a parent supports the contribution

of the other parent, this seems to influence the amount of time and the quality of the relationship

with the children. Gatekeeping develops throughout parental relationships and it defines roles

and tasks according to parent’s availability and expertise. An understudied aspect of gatekeeping

is the potential influence of context specific factors, such as culture, religion, and attitudes

toward perceived gender differences.

Gatekeeping in the context of separation and divorce

The concept of gatekeeping has expanded to include: 1) both mothers and fathers as

gatekeepers; 2) gatekeeping as a continuum that varies in degrees; and 4) a growing attention of

gatekeeping in the separation and divorce literature (Austin et al., 2013b; Austin, Fieldstone, &

Pruett, 2013a; Austin, 2011; Austin, 2005a; Austin, 2005b; Pruett et al., 2007).

Mothers have been found to have a significant contribution to facilitating father-child

relationships post-separation (Cannon et al., 2008; Moore, 2012). Fagan and Barnett (2003)

studied both residential and non-residential fathers and found that greater restrictive maternal

gatekeeping behaviors were reported with non-residential fathers than with residential fathers.

They found that mothers reported non-residential fathers as less competent, thus increasing the

likelihood that mothers would choose to restrict the time the father spends with the children.

Sano, Richards, and Zvonkovik (2008) found that 20% of the separated mothers interviewed did

7

not trust the fathers and maintained control over access to the children because the mothers were

concerned with their children’s safety when the children were in the care of their fathers,

including concerns about the father’s substance abuse, violence, abuse, and criminal activities.

By introducing a gender neutral conceptualization of gatekeeping, Pruett, Williams,

Insabella, & Little (2003) opined that the level of mutual support and regard for the other parent

are important determinants for assessing gatekeeping behaviors. They found that if mothers and

fathers experienced positive feelings towards the other parent, there was an increased chance that

the other parent would be involved with the children. Similarly, in a study among fathers one-

year after divorce proceedings, Madden-Derdich and Leonard (2000) found that fathers who felt

supported by their ex-partners in maintaining their relationship with their children also reported

being able to positively interact with their ex-spouses on issues of childrearing and decision-

making. Likewise, Whiteside and Becker (2000) found that the prior relationship between

parents before the separation can influence the time the parents spend with their children after

the separation. Therefore, it appears that gatekeeping is context specific and depends on the

quality of the prior relationship between parents, the reasons for and events surrounding the

separation (e.g., violence, traumatic separation, feelings of betrayal), the time passed since

separation, ages of the children, and any special needs of the children, to name a few.

Gatekeeping continuum in child custody disputes

Austin et al. (2013b) described a gatekeeping continuum in the context of custody

disputes, ranging from facilitative to restrictive. In custody dispute situations, parents who

engage in facilitative gatekeeping behaviors and attitudes are more likely to demonstrate

flexibility in the parenting plan arrangements, such as exchanging the children between homes

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and maintaining telephone contact. They may also support the child’s relationship with the other

parent, allow for a symbolic representation (photos) of the other parent in each home and are

more likely to speak positively about the other parent and actively encourage the child’s

relationship with the parent (Austin et al., 2013b; Austin et al., 2013a; Pruett et al., 2007).

Restrictive gatekeeping practices in custody disputes often involve higher conflict

situations that result in numerous court appearances, limiting children’s contact with the other

parent, interfering with ongoing contact, and/or a rigid compliance with the parenting plan orders

or agreements (Austin et al., 2013a). They may also not permit the child to have photographs of

the other parent, they may ask the child to keep secrets from the other parent and may withhold

information about the child to the other parent (Austin et al., 2013b; Austin et al., 2013a; Pruett

et al., 2007).

Pruett et al. (2007) interviewed fathers and mothers going through the process of divorce

and both parents described facilitative behaviors to include being flexible regarding the parenting

schedule and encouraging contact with the other parent. In contrast, restrictive behaviors were

described as rigidity in the parenting schedule and not allowing children to communicate with

the other parent by telephone.

Scholars have also separated restrictive gatekeeping as either unjustified or justified

(Austin et al., 2013a). Unjustified gatekeeping has been referred to as behaviors and attitudes

that interfere with the child’s relationship with the other parent without foundation for these

interferences, such as a parent’s questioning the competence of the other parent to appropriately

parent without basis for the concerns and parent’s anger that contributes to the parent wanting to

punish the other parent by interfering with the child’s time with that parent. In contrast, justified

restrictive gatekeeping involves attitudes, actions, and/or legal positions designed to limit the

9

other parent’s access, contact, or involvement with child based on stated reasons that such

involvement would place the child at risk for harm, emotional distress, behavioral problems,

adjustment difficulties, or negative developmental impact (Drozd et al., 2014). Justified

restrictive gatekeeping may occur when a parent acts to limit the other parent’s involvement

because of concern about possible harm to the child or when a parent believes the inhibitory

behaviors serve a protective function (see Austin et al., 2013a, for a discussion about justified

versus unjustified restrictive gatekeeping).

Assessing for gatekeeping

Despite the growing attention in the published literature and conference proceedings on

gatekeeping, there remains little attention on the assessment of gatekeeping behaviors and

attitudes. Further, no studies have distinguished gatekeeping from other constructs, such as

parental alliance, interparental conflict, alienation, and justified estrangement (Austin, 2011;

Drozd et al., 2014; Ganong et al., 2016; Pruett et al., 2007). Ganong, Coleman, and McCaulley

(2012) stated the “lack of measures of gatekeeping behaviors is of a concern” (p. 391) and they

encourage the field to develop operational definitions of gatekeeping behaviors.

A search for published literature on gatekeeping has found four measures of gatekeeping

(Allen & Hawkins, 1999; Fagan & Barnett, 2003; Pruett et al., 2007; Puhlman, 2013). Allen and

Hawkins (1999) developed a measure to assess mothers’ perceptions of standards and

responsibilities, maternal identity, and differentiated family roles. Fagan and Barnett (2003)

developed the Gatekeeping Behaviors Measurement to assess the degree to which mothers

restrict access of their children to the father. Puhlman (2013) developed a three dimensional tool

to measure gatekeeping, including control, encouragement, and discouragement to represent the

maternal gatekeeping construct. Rather than exclusively targeting maternal gatekeeping, Pruett et

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al. (2007) developed a gatekeeping questionnaire to examine gatekeeping within the dynamics of

the family, which included nineteen statements about past and present couple, parent-child, and

triadic (parent-parent-child) dynamics. Likewise, Austin et al. (2013a) developed a Bench Book

for judges to assess parental gatekeeping in parenting disputes along a continuum of facilitative

to restrictive gatekeeping behaviors and attitudes.

With the exception of Pruett et al. (2007) and Austin et al. (2013a) gatekeeping measures

primarily focus on maternal gatekeeping to assess the degree to which mothers restrict access of

their children to their father. It is important to assess for facilitative and restrictive gatekeeping

by both parents (Austin et al., 2013a; Pruett et al., 2007).

Gatekeeping is only part of a larger coparenting process. Several proxy measures of

gatekeeping have been used in the literature (e.g., father involvement, parent alliance,

interparental conflict, etc.) suggesting that gatekeeping is a dyadic and complex process, and

therefore, gatekeeping should not be considered in isolation (Drozd et al., 2014). Further

research should also explore the connection of these coparenting dynamics with this emerging

understanding of adaptive and maladaptive gatekeeping framework.

Impact of gatekeeping on children

Austin et al. (2013b) discussed social capital as a way to describe the impact that

gatekeeping and coparenting relationships have on limiting children’s access to the other parent.

“Social capital refers to the benefit a child derives from the social and psychological resources

available to him or her in a particular living environment, community, or family, especially in the

most significant relationships for the child” (p. 490). Therefore, when both parents practice

facilitative gatekeeping, this enables children to benefit from the resources that are within their

parents’ environment. On the other hand, when parents use restrictive gatekeeping tactics,

11

children cannot benefit from these resources. Limiting the child’s relationship with the other

parent can weaken the parent-child relationship and can hinder the children’s ability to develop

with the positive influences of social resources found in the other parent’s environment.

Although there remains a lack of research specific to the impact of gatekeeping on

children, studies have suggested that parents who are able to disentangle from hostility after

separation are generally more focused on the safety and wellbeing of their children, more

sensitive and responsive to their children’s needs, less likely to use parenting techniques based

on their own states, wishes, and general ideas, and more likely to have positive feelings of

efficacy in their parenting roles (Amato & Gilbreth, 1999; Amato & Keith, 1991; Sandler, Miles,

Cookston, & Braver, 2008; Saini, 2012; Simons, Lin, Gordon, Conger, & Lorenz, 1999).

Protecting children from the negative consequences of separation and divorce can help to reduce

levels of stress due to effects of the family breakdown (Amato & Keith, 1991), as well as reduce

externalizing problems (Sandler et al., 2008). Sandler et al. (2008) found that lower levels of

conflict between the parents and the warmth of the relationship of each parent with the child

were associated with decreased levels of internalizing problems, such as depression and anxiety.

Neither gender nor child age was correlated with child reports of warmth by their mother or

father. Children had the fewest internalizing problems when they had positive and warm

relationships with both parents, suggesting that children do best when their parents are able to

shelter them from the presence of conflict, and meet their needs for warmth, attention, affection,

support, and affirming parent-child relationships.

Adaptive and Maladaptive Gatekeeping

Some parents are able to prioritize their children’s needs to have a positive relationship

with both parents, despite their own emotional difficulties with adjusting to the separation of the

12

adult relationship. Other parents seem to limit the children’s relationship with the other parent

because of their own struggles with separating their feelings towards the other parent. There are

also some parents who seem to restrict the other parent due to their belief they need to protect the

child from the other parent’s behaviors (e.g., use of drugs, inconsistency of spending time with

the child, previous and ongoing violence, etc.) (Saini, Drozd, & Olesen, 2016).

Given the conceptual connection between gatekeeping behaviors and attitudes with the

impact of gatekeeping on the children’s sense of safety and wellbeing, we suggest that

gatekeeping should be assessed based on the nexus between the gatekeeping behaviors

(facilitative or restrictive) and the consequences (either positive or negative) on the impact of

children’s sense of safety, wellbeing and the quality and time they spend with each parent.

Within this conceptual model, the paramount focus is the impact of gatekeeping

behaviors and attitudes on the child’s safety and wellbeing. The child’s safety includes protection

against physical, psychological, emotional, social, spiritual, or other types of harm or non-

desirable consequences. The child’s wellbeing includes the dynamic state of the child that is

enhanced when the child can fulfill his/her personal, relationship and social goals. Based on the

focus of the child’s safety and wellbeing, we define adaptive and maladaptive gatekeeping as the

degree to which gatekeeping either promotes a healthy child or fails to consider the impact on a

child’s safety and wellbeing.

Figure 1 – Adaptive and Maladaptive Gatekeeping Typologies

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The more the parent considers the child’s safety and wellbeing, the higher the parent

would be on the left side of the diagram (Adaptive Gatekeeping). A parent who falls on the right

side of the diagram (Maladaptive Gatekeeping) is not necessarily promoting unsafe conditions;

however, they are not as likely to be considering the importance of safety and wellbeing in

gatekeeping decision making.

Adaptive gatekeeping is related to either “facilitative – supportive” (behaviors and

attitudes that promoted the child’s relationship with the other parent that seemed to benefit the

child) or “restrictive – protective” (behaviors and attitudes that restricted the child’s relationship

with the other parent with respect to the child safety and wellbeing).

Contrarily, maladaptive gatekeeping is related to either “facilitative - abdicating”

(resigning to allow the child to be with the other parent but failing to consider the impact on the

child’s overall sense of safety, wellbeing, and feelings about the quality of the other parent’s

14

relationship) or “restrictive – unjustified” (behaviors and attitudes that interfered with the child’s

relationship with the other parent based on the parent’s inability to separate his/her own struggles,

feelings of anger, and/or betrayal resulting from the family breakdown.

Adaptive Gatekeeping

Adaptive gatekeeping occurs when parents seek to encourage and support the child’s

sense of safety and wellbeing, by either encouraging the child’s relationship with the other parent

in a safe situation, or protecting the child if they need to be protected from the other parent.

Facilitative - Supportive Gatekeeping Facilitative – supportive approaches to gatekeeping include: acknowledging other parent’s

strengths; flexibility and accommodation in supporting the time that the child spends with the

other parent; actively supporting the child’s relationship with the other parent; focusing on the

child’s wellbeing; and encouraging supportive coparenting relationships (Pruett et al., 2007).

Being flexible, accommodating, and supportive of the other parent is considered central

to facilitative- supportive gatekeeping. Flexibility in the schedule is related to parents supporting

the child to contact the other parent, and allowing the child to contact the other parent (e.g.,

telephone, email, text messages) when the child is away from them and in the other parent’s care.

Acknowledging the strengths of the other parent and speaking to children in positive

terms about the other parent can also have a positive impact on the child’s relationship with both

parents. Being able to separate the marital relationship from the interests of the child is another

important characteristic of facilitative-positive gatekeeping.

Restrictive - Protective Gatekeeping Restrictive – protective actions are described as attempts to limit the child’s contact with the

15

other parent arising out of concerns about the child being harmed by the other parent. These

rational motivations to restrict the time with the other parent may benefit the child, such as in

situations of intimate partner violence, child abuse and neglect and in cases of parental substance

abuse (Austin, 2008). The term “protective gatekeeping” was first coined by Leslie Drozd (as

cited in Austin, 2008) to explain the benefits of limiting or monitoring the other parent’s time

with a child to shield the child from potential harm due to dangerous and unsafe parenting

practices and/or the risk of harm due to the risk of abuse. In these situations, concern about

safety takes precedence over the desire to help the child maintain ties with the other parent

(Ganong et al., 2016). In cases of previous intimate partner violence, Hardesty and Ganong

(2006) found that even when mothers encourage the child with the father, the mother is more

likely to monitor the interactions of the child with the other parent to ensure the child remains

safe while in contact with the other parent.

Maladaptive Gatekeeping

Maladaptive gatekeeping emerges as behaviors and attitudes that fail to consider the

impact on the children’s safety and wellbeing while spending time with the other parent or that

interferes with the child’s relationship with the other parent based on the gatekeeper parent’s

own struggles with separating his/her feelings towards the other parent. Gatekeeping in these

situations seem to be based on the parent’s own needs (e.g., to get revenge against the other

parent, difficulties in coping with the family breakdown, mental health issues, etc.).

Facilitative - Apathetic Gatekeeping Some parents may appear uncaring, apathetic or disengaged to adequately protect the child from

risk of harm with the other parent due their own struggles to cope with the family breakdown,

mental health problems, unresolved trauma, fear of being harmed by the other parent or the fear

16

of being blamed for not supporting the child’s relationship with the other parent. A parent who

ignores, either directly or indirectly, the signs that the child may not be benefiting from the

contact with the other parent may facilitate access to the other parent despite the signs that the

contact with the other parent may pose risk to the child.

Another form of apathetic gatekeeping is when a parent does not adequately prepare the

child for the contact with the other parent (e.g., not advising the child of the scheduled pick up,

not assisting the child to pack a travel bag, etc.) because of their own discomfort with interacting

with other parent or dealing with the other parent during transitions, which can result in the child

not feeling prepared to engage with the other parent. Although on the surface the parent appears

to be facilitating the child’s relationship with the other parent (e.g., compliant with the court

order for access, not speaking negatively about the other parent in front of the child, etc.) the

parent’s lack of supportive gatekeeping may further strain the child’s relationship with the other

parent and may impact the child’s overall wellbeing.

Abdicating the sole decision making powers to the child in deciding whether to have

contact with the other parent is another strategy used by some parents when they do not want to

support the child’s relationship with the other parent but do not want to appear as though they are

restricting the child’s relationship with the other parent. Although children generally want to

share their perspectives in the parenting plan arrangements (Birnbaum & Saini, 2012), placing

the child in the sole decision making role without without parent input may not be helpful for

child’s overall sense of wellbeing as they attempt to navigate complex parent-child relationships.

Restrictive / Unjustified Gatekeeping

Restrictive –unjustified gatekeeping is as a strategy to interfere with the child’s relationship with

the other parent or to become overly rigid in the parenting plan so as to limit the child’s time

17

with the other parent. A parent’s dislike of the other parent and ongoing interparental conflict

may be contributing factors for not supporting the child’s relationship with that parent. Similar to

alienating behaviors, restrictive -unjustified gatekeeping may also be related to a parent’s own

mental health problems and psychological disturbances (Fidler, Bala, & Saini, 2012). This

prevents the parent from considering the potential value of the other parent’s relationship to the

child.

There are numerous examples of how parents attempt to interfere with the child’s

relationship with the other parent, including denigrating the other parent by communicating

extremely negative views about the other parent to the child; disclosing private information to

the child in hopes that the parent would be perceived as the better parent; being routinely late for

scheduled exchanges; not answering the telephone during scheduled telephone contact with the

child and the other parent; not respecting the other parent’s contribution to the child; and not

informing the other parent about information pertinent to the child.

Inconsistent Gatekeeping Inconsistent gatekeeping refers to the lack of an organized pattern of gatekeeping

(facilitative or restrictive). In these situations, decisions may not be based solely on the child’s

safety and wellbeing. Instead, parents may vacillate between non-protection and appropriate

protection and overprotection. With the desire to support the other parent’s relationship while

still struggling with the emotional turmoil of the separation, attempts to facilitate the relationship

with the other parent may be interrupted by interparental conflict, hostility and sabotaging

behaviors. These inconsistent interactions might be characterized by a high degree of boundary

ambiguity (Madden-Derdich, Leonard, & Christopher, 1999) about the perceived roles of each

parent as the family reorganizes itself post separation. As Cole and Cole (1999), suggest the

18

“ghosts of the past fade in and out at both expected and unexpected times in the lives of both the

formerly married and their children” (p. 271). As parents struggle to support the child’s

relationship with the other parent, they may also be struggling to see the value of the coparent

relationship. The uncertainty about the other parent’s motives can create inconsistent feelings

about whether to support the child’s relationship with the other parent or whether to restrict that

relationship.

Discussion Gatekeeping has its roots in efforts to explain maternal behaviors that either facilitate or

restrict a father’s involvement with the children. Scholars expanded the concept of gatekeeping

to include a gender-neutral framework for assessing how parents’ (both mothers and fathers)

attitudes and actions impact the involvement and quality of the other parent’s relationship with

the child (Austin et al., 2013a; Drozd et al., 2014; Pruett et al., 2007; Trinder, 2008).

There are factors that need to be considered when assessing for gatekeeping within

separated families. These factors include gatekeeping patterns formed in the parental relationship

prior to the family breakdown, the parents’ adaptation to the separation and extent to which a

parent can separate their negative feelings about the other parent and separation from the

children and; a parent’s perception of the other parent’s ability to care for the children after

separation, parents’ concerns regarding the children’s needs for safety and wellbeing, and the

degree that a parent accepts and supports the contribution of the other parent for the children

(Austin et al., 2013b; Austin et al., 2013a; Pruett et al., 2007).

Gatekeeping can be assessed on a continuum that varies in degrees from facilitative to

restrictive on the issue of supporting the other parent-child relationship (Austin et al., 2013a;

19

Pruett et al, 2007) and can also be assessed based on adaptive and maladaptive gatekeeping

behaviors and attitudes, which are distinctly different dimensions regarding whether the

behaviors and attitudes protect or hinder the child’s safety and overall wellbeing. Focusing on

adaptive and maladaptive gatekeeping emphasizes that not all facilitative gatekeeping supports

and protects the child’s safety and wellbeing, and not all restrictive gatekeeping should be

considered maladaptive. Ganong et al. (2016) identified certain safety concerns, such as

domestic violence and substance abuse, when a parent’s restricting behaviors to limit the child’s

time with the other parent may be assessed as protective and not maladaptive. Conversely, the

results suggest that not limiting the child’s time with the other parent may also be considered

maladaptive, especially when non-interference can fail to protect the child from the risk of harm.

Strategies for Assessing Adaptive and Maladaptive Gatekeeping

The case study of Rob and Anne, presented at the beginning of this paper, provides an

example to explore adaptive and maladaptive gatekeeping behaviors and attitudes. Anne’s

concerns about Rob’s previous drug abuse can be viewed within a restrictive-protective

gatekeeping lens due to her concerns regarding Emily’s safety and wellbeing while in Rob’s

care. Her concern for the child’s ongoing safety may explain Anne’s request to continue

receiving Rob’s drug test results. Viewed as a restrictive-protective gatekeeping strategy, this

hypothesis suggests that Anne is attempting to manage boundaries and regulate Rob’s access and

involvement with Emily. Despite Anne’s intention to protect the child, Rob may view Anne’s

monitoring as a reflection of Anne not encouraging his relationship with Emily, and as an

attempt to interfere with his relationships by discouraging, or being critical, of his involvement

with Emily. Rob may view Anne’s restricting behaviors as evidence that she is upset about his

affair and her continued hurt feelings regarding the family’s breakdown.

20

These contrary hypotheses can be a starting place for a mental health professional (e.g.,

mediators, parenting coordinators, therapists, etc.) working with a family to best understand both

positions and interests of the parties. Connecting intentions, attitudes, and actions of the parents

may assist in uncovering fears and concerns each party shares to help them come up with

mutually satisfying parenting plans to address the child’s overall feelings of safety and wellbeing.

Both parents can be encouraged to move towards more positive feelings about the

involvement of the other parent and to build a facilitative-supportive gatekeeping approach that

supports the other parent. Consequently, both parents can participate in childrearing

responsibilities. Both parents can be encouraged to increase the level of the other parent’s

participation and involvement with the child by equally supporting the child’s safety and

wellbeing, but must do so in a manner that protects the child from risk of future harm.

Future Directions

Gatekeeping is part of a larger analysis of the coparenting process, but it provides a

unique contribution to understanding coparental dynamics (Puhlman, 2013). Although both

mothers and fathers can express facilitative and restrictive gatekeeping behaviors and attitudes,

the family systems theory suggests that reciprocity is a major factor in understanding family

functioning (Cox & Paley, 1997). Accordingly, further research should explore gender

differences in meanings assigned to both fathers and mothers and the potential impact of these

differences for the children involved (Puhlman, 2013).

The new conceptual model of considering adaptive and maladaptive gatekeeping is the

first step in making better connections between gatekeeping behaviors and attitudes, the

perceived and actual impact of gatekeeping on children’s outcomes of safety, and a child’s

21

wellbeing and the quality of his or her relationship with both parents. Future studies should

consider how children themselves experience parental gatekeeping and the impact of

gatekeeping based on these experiences. Under a family systems approach, gatekeeping should

not be considered in isolation, but should be part of a comprehensive assessment of the multiple

factors that can influence parent-child relationships, can impact a child’s safety, can impact a

child’s wellbeing, and foster positive relationships with both parents.

References Allen, S. M., & Hawkins, A. J. (1999). Maternal gatekeeping: Mothers' beliefs and behaviors

that inhibit greater father involvement in family work. Journal of Marriage and Family,

61(1), 199-212.

Amato, P. R., & Gilbreth, J. G. (1999). Nonresident fathers and children's well-being: Meta-

Analysis. Journal of Marriage and Family, 61(3), 557-573.

Amato, P. R., & Keith, B. (1991). Parental divorce and the well-being of children: A meta-

analysis. Psychological Bulletin, 110(1), 26-46.

Austin, W. G. (2005a). Considering the process of support for the other parent and

gatekeeping in parenting evaluations. Colorado IDC News, 7(1), 10-13. Retrieved from

http://www.child-custody-services.com/pdf/Gatekeeping-CIDC-2005.pdf

Austin, W. G. (2005b). The child and family investigator’s evaluation for the relocation case. In

R. M. Smith (Ed.), The role of the child and family investigator and the child’s legal

representative in Colorado (pp. C9-1 – C9-28). Denver, CO: Colorado Bar Association.

Austin, W. G. (2008). Relocation, research, and forensic evaluation: Part II: Research support for

22

the relocation risk assessment model. Family Court Review, 46(2), 347-365.

Austin, W. G. (2011). Parental gatekeeping in custody disputes: Mutual parental support in

divorce. American Journal of Family Law, 25(4), 148-153.

Austin, W. G., Fieldstone, L., & Pruett, M. K. (2013a). Bench book for assessing parental

gatekeeping in parenting disputes: Understanding the dynamics of gate closing and

opening for the best interests of children. Journal of Child Custody, 10(1), 1-16.

Austin, W. G., Pruett, M. K., Kirkpatrick, H. D., Flens, J. R., & Gould, J. W. (2013b). Parental

gatekeeping and child custody/child access evaluation: Part I: Conceptual framework,

research, and application. Family Court Review, 51(3), 485-501.

Birnbaum, R. & Saini, M. (2012). A scoping review of qualitative studies on the voice of the

child in child custody disputes. Childhood. 20(2), 260-282. doi:

10.1177/0907568212454148

Brown, G. L., Schoppe-Sullivan, S., Mangelsdorf, S. C., & Neff, C. (2010). Observed and

reported supportive coparenting as predictors of infant-mother and infant-father

attachment security. Early Child Development and Care, 180(1-2), 121-137.

doi:10.1080/03004430903415015

Cannon, E. A., Schoppe-Sullivan, S. J., Mangelsdorf, S. C., Brown, G. L., & Sokolowski, M. S.,

(2008). Parent characteristics as antecedents of maternal gatekeeping and fathering

behavior. Family Process, 47(4), 501-519.

Cole, C. L., & Cole, A. L. (1999). Boundary ambiguities that bind former spouses

together after the children leave home in post-divorce families. Family Relations, 48(3),

271-272.

Cox, M. J., & Paley, B. (1997). Families as systems. Annual Review of Psychology, 48, 243-267.

23

Drozd, L., Olesen, N. W., & Saini, M. (2014, February 7-9). Adaptive and maladaptive

motivational patterns for gatekeeping behaviors after separation and divorce: The

decision tree approach. Presentation at the Association of Family Conciliation and the

Courts California Chapter Annual Conference. San Francisco, CA.

Fagan, J., & Barnett, M. (2003). The relationship between maternal gatekeeping, paternal

competence, mothers' attitudes about the father role, and father involvement. Journal of

Family Issues, 24(8), 1020-1043. doi: 10.1177/0192513X03256397

Feinberg, M. E., & Kan, M. L. (2008). Establishing family foundations: Intervention effects on

coparenting, parent/infant well-being, and parent-child relations. Journal of Family

Psychology, 22(2), 253–263.

Fidler, B. J., Bala, N., & Saini, M. A. (2012). Children who resist postseparation parental

contact: A differential approach for legal and mental health professionals. New York,

NY: Oxford University Press.

Ganong, L., Coleman, M., & McCaulley, G. (2012). Gatekeeping after separation and divorce. In

K. Kuehnle and L. Drozd (Eds.), Parenting plan evaluations: Applied research for the

family court (pp. 369-398). New York, NY: Oxford University Press.

Ganong, L., Coleman, M., & Chapman, A. (2016). Gatekeeping after separation and divorce. In

L. Drozd, M. Saini & N. Olesen (Eds.), Parenting plan evaluations: Applied research for

the family court (2nd ed.). (pp. 308-345). New York, NY: Oxford University Press.

Gaunt, R. (2008). Maternal gatekeeping: Antecedents and consequences. Journal of Family

Issues, 29(3), 373-395.

Hardesty, J. L., & Ganong, L. H. (2006). How women make custody decisions and manage co-

parenting with abusive former husbands. Journal of Social and Personal Relationships,

24

23(4), 543–563.

Holmes, E. K., Dunn, K. C., Harper, J., Dyer, W. J., & Day, R. D. (2013). Mother knows best?

Inhibitory maternal gatekeeping, psychological control, and the mother-adolescent

relationship. Journal of Adolescence, 36(1), 91-101.

Madden-Derdich, D. A., & Leonard, S. A. (2000). Parental role identity and fathers' involvement

in coparental interaction after divorce: Fathers' perspectives. Family Relations, 49(3),

311-318.

Madden-Derdich, D.A., Leonard, S. A. & Christopher, F.S. (1999). Boundary ambiguity and

coparental conflict after divorce: An empirical test of a family systems model of the

divorce process. Journal of Marriage and Family, 61(3), 588-598.

McBride, B. A., Brown, G. L., Bost, K. K., Shin, N., Vaughn, B., & Korth, B. (2005). Paternal

identity, maternal gatekeeping, and father involvement. Family Relations, 54(3), 360-372.

Moore, E. (2012). Paternal banking and maternal gatekeeping in postdivorce families. Journal of

Family Issues, 33(6), 745-772.

Pedersen, D. E. (2012). The good mother, the good father, and the good parent: Gendered

definitions of parenting. Journal of Feminist Family Therapy, 24(3), 230-246.

Pruett, M. K., Arthur, L. A., & Ebling, R. (2007). The hand that rocks the cradle: Maternal

gatekeeping after divorce. Pace Law Review, 27(4), 709-739.

Pruett, M. K., Williams, T. Y., Insabella, G., & Little, T. D. (2003). Family and legal indicators

of child adjustment to divorce among families with young children. Journal of Family

Psychology, 17(2), 169-180.

Puhlman, D. T. (2013). Developing and testing a comprehensive measure of maternal

gatekeeping (Doctoral dissertation). Retrieved from DigiNole: FSU’s Digitial Repository.

25

(Paper 7559)

Saini, M. (2012). Reconceptualizing high-conflict divorce as a maladaptive adult attachment

response. Families in Society: The Journal of Contemporary Social Services, 93(3), 173-

180. doi:10.1606/1044-3894.4218

Saini, M. A., Drozd, L. M., & Olesen, N. W. (2016). Les comportements et attitudes de veille

parentale adaptés ou mal adaptés à la suite de séparation et de divorce: conséquences

chez les enfants. In M.-C. Saint-Jacques, C. Robitaille, A. St-Amand, & S. Lévesque

(Eds.), Séparation parentale, recomposition familiale: Enjeux contemporains (pp.113-

134).Quebec,CA:Pressesdel’UniversitéduQuébec.

Sandler, I., Miles, J., Cookston, J., & Braver, S. (2008). Effects of father and mother parenting

on children’s mental health in high- and low-conflict divorces. Family Court Review,

46(2), 282-296.

Sano, Y., Richards, L. N., & Zvonkovic, A. M. (2008). Are mothers really "gatekeepers" of

children? Rural mothers' perceptions of nonresident fathers' involvement in low-income

families. Journal of Family Issues, 29(12), 1701-1723.

Simons, R. L., Lin, K.-H., Gordon, L. C., Conger, R. D., & Lorenz, F. O. (1999). Explaining the

higher incidence of adjustment problems among children of divorce compared with those

in two-parent families. Journal of Marriage and the Family, 61(4), 1020-1033.

Trinder, L. (2008). Maternal gate closing and gate opening in postdivorce families. Journal of

Family Issues, 29(10), 1298-1324.

Walper, S., Kruse, J., Noack, P., & Schwarz, B. (2004). Parental separation and adolescents' felt

insecurity with mothers: Effects of financial hardship, interparental conflict, and maternal

parenting in east and west germany. Marriage & Family Review, 36(3-4), 115-145. doi:

26

10.1300/J002v36n03_07

Whiteside, M. F., & Becker, B. J. (2000). Parental factors and the young child's post divorce

adjustment: A meta-analysis with implications for parenting arrangements. Journal of

Family Psychology, 14(1), 5-26. doi: 10.1037//0893-3200.14.1.5

1

Overcoming Obstacles to Effective Intervention: Coherent Service Planning and Practical Strategies

6th Annual AFCC Australian Conference

August 15-17th 2019

Lyn Greenberg, Ph.D., ABPP Altman, M., & Wilfley, D. E. (2015). Evidence update on the treatment of overweight and

obesity in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 44(4), 521-537. doi:10.1080/15374416.2014.963854

Association of Family and Conciliation Courts (AFCC). Task Force on Court-Involved Therapy.

(2011). Guidelines for court-involved therapy. Family Court Review,49, 564–581. Austin, D. R. (1982). Therapeutic recreation: Processes and techniques. New York, NY: John

Wiley & Sons, Inc. Austin, W. and Drozd, L. (2012 and 2013). Intimate Partner Violence and Child Custody Evaluation,

Part I: Theoretical Framework, Forensic Model, and Assessment Issues (2012) & Part II: Judges’ bench book of the integrated framework for the assessment of intimate partner violence in child custody disputes, Journal of Child Custody, IX (4) & X (2).

Austin, D. R. (2013). Therapeutic recreation: Processes and techniques, (7th ed.). Urbana, IL:

Sagamore Publishing. Austin, W. G., Fieldstone, L., & Pruett, M. K. (2013). Bench book for assessing parental

gatekeeping in parenting disputes: Understanding the dynamics of gate closing and opening for the best Interests of children. Journal of Child Custody, 10, 1-16.

Banyard, V.L., Williams, L.M., Siegel, J.A. (2003). The Impact of complex trauma and

depression on parenting. Child Maltreatment, 8 (4), 334, 349. Barber, B. K., Bean, R. L., & Erickson, L. D. (2002). Expanding the study and understanding of

psychological control. In B.K.Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents (pp. 263-289). Washington, DC, US: American Psychological Association.

Barger, M. M., Kim, E. M., Kuncel, N. R., & Pomerantz, E. M. (2019). The relation between

parents’ involvement in children’s schooling and children’s adjustment: A meta-analysis. Psychological Bulletin, No Pagination Specified-No Pagination Specified. doi:10.1037/bul0000201

Bigelow, K. M. & Lutzker, J. R. (2000). Training parents reported for or at risk for child abuse

and neglect to identify and treat their children's illnesses. Journal of Family Violence. 15[4], 311-330. Germany, Springer.

2

Chaffin, M., Wherry, J. N., & Dykman, R. (1997). School age children's coping with sexual

abuse: Abuse stresses and symptoms associated with four coping strategies. Child Abuse & Neglect, 21, 227-240.

Christensen, A., Dimidjian, S., & Martell, C. R. (2015). Integrative behavioral couple therapy. In

A. S. Gurman, J. L.Lebow, D. K. Snyder, A. S. Gurman, J. L. Lebow, & D. K. Snyder (Eds.), Clinical handbook of couple therapy (5th ed.). (pp. 61–94). New York, NY, US: Guilford Press.

Cohen, JA, Mannarino, AP & and Deblinger, E. (2006). Treating Trauma and

Traumatic Grief in Children and Adolescents. The Guilford Press. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005).

Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398. Deutsch, R. (2012). The Process of Parenting Coordination. In S. A. Higuchi and S.J. Lally

(Eds.), Parenting Coordination Handbook, Washington DC: American Psychological Association

Deutsch, R. & Pruett, M.K. (2009). Child adjustment and high conflict divorce. In R.M.

Galatzer-Levy & L. Kraus (Eds.) The Scientific Basis of Child Custody Decisions (2nd Ed.). New York: John Wiley & Sons, 353-375.

Drozd, L.M., Olesen, N.W. (2004). Is it abuse, alienation, and/or estrangement? A Decision Tree. Journal of Child Custody, 1, 65-106. Drozd, L. (2008). Assessing Domestic Violence & Alienation, book chapter: Innovations in

Interventions with High Conflict Families, AFCC, 2008. Drozd, L. (2009). Rejection in Cases of Abuse and Alienation in Divorcing Families, book

chapter: Scientific Basis of Child Custody Decisions, editor Robert Galatzer-Levy. Drozd, L. M. and Olesen, N.W. (2010). Abuse and Alienation are Real: A Response to Meier’s Critique

of the Decision Tree. Drozd & Olesen (2010). Drozd, Olesen, & Saini, (2013). Parenting Plan & Child Custody Evaluations: Using Decision Trees

to Increase Evaluator Competence & Avoid Preventable Errors. Sarasota, FL: PRP. Drozd, L, Saini, M., & Olesen, N. (2016). Parenting Plan Evaluations: Applied Research for the

Family Court, Oxford University Press, 2nd edition. Drozd, L. and Bala, N. (2017). Introduction in A.M. Judge and R.B. Deutsch (Eds.), Overcoming

parent-child contact problems: Family-based interventions for resistance, rejection, and alienation. Oxford University Press.

3

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

Drozd, L. & Saini, M. (2019). Domestic violence/Intimate partner violence & child custody,

book chapter in Psychological Experts in Divorce Actions, 7th edition. Editors: Marc Ackerman & Jonathan Gould, Wolters Kluwer.

Drozd, L., Saini, M., Fidler, B., Gans Walters, M., and Deutsch, R. (in press). Changes in Resist-Refuse

Dynamics Checklist (CRDC). *Greenberg, L.R., & Lebow, J. (2016). Putting it all together: Effective intervention planning for

children and families. In L. Drozd, M. Saini, & N. Olesen (Eds.), Parenting Plan Evaluations: Applied Research for the Family Court, (2nd ed.).Oxford, NY: Oxford University Press.

Fidler, B. J. & Bala, N. (2010). Children resisting postseparation contact with a parent: Concepts,

controversies, and conundrums. Family Court Review, 48, 10-47. Fidler, B. J., Bala, N., & Saini, M. A. (2013). Children who resist post separation parental

contact: A differential approach for legal and mental health professionals. New York, NY: Oxford University Press.

Fidler, Barbara J., Greenberg, Lyn R. (2019). Parenting Coordination: Structures and

Possibilities. In L. Greenberg, B. Fidler, & M. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. 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. Fidnick, L., Koch, K., Greenberg, L. R., & Sullivan, M. J. (2011). Guidelines for court-involved

therapy: A best practice approach for mental health professionals. Family Court Review, 49, 564–581.

Fields, L. & Prinz, R. J. (1997). Coping and adjustment during childhood and adolescence.

Clinical Psychology Review, 17, 937-976. Friedlander, S. & Walters, M. G. (2010). When a child rejects a parent: Tailoring the

intervention to fit the problem. Family Court Review, 48, 98-111. Gershater-Molko, R. M., Lutzker, J. R., & Sherman, J. A. (2002). Intervention in child neglect:

An applied behavioral perspective. Aggression and Violent Behavior. 7(2), 103-124. Netherlands, Elsevier Science.

4

Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2003). Project SafeCare: Improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18, 377-386.

Gilliam, W. (2005). Prekindergarteners left behind: Expulsion rates in state prekindergarten

programs. FCD Policy Brief, (3) Greenberg, Lyn R. (2019). Shifting Our Perspective – Focusing on Coping and Adjustment. In L.

Greenberg, B. Fidler, & M. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

Greenberg, Lyn R., Austin, David R. (2019). Understanding and Using Activities. In L.

Greenberg, B. Fidler, & M. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

Greenberg, L. R., Deutsch, R. M., Gould-Saltman, D. J., & Judge Cunningham, D. (2013, May).

Poor planning produces (predictably) poor results: Systematic intervention planning. (Newsletter). Association of Family and Conciliation Courts California Chapter (AFCCCA).

Greenberg, L. R., Doi Fick, L., & Levanas, M. I. (2008, February). Therapeutic interventions.

Rebuilding relationships: Child-centered conjoint therapy in high conflict cases. Presentation conducted at the Association of Family Conciliation Courts, California Chapter, California Annual Conference, Santa Monica, CA.

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. 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.

Greenberg, Lyn R., Fidler, Barbara J., Saini, Michael A., Schnider, Robert, Reyes, Ashley-

Lauren. (2019). Concluding Thoughts and Future Directions. In L. Greenberg, B. Fidler, & M. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

Greenberg, L. R., Gould-Saltman, D. J., & Gottlieb, M. C. (2008). Playing in their sandbox:

Professional obligations of mental health professionals in custody cases. Journal of Child Custody: Research, Issues, and Practices, 5, 192-216.

Greenberg, L. R., & Lebow, J. (2016). Putting it all together: Effective intervention planning for

children and families. In L. Drozd, M. Saini, & N. Olesen (Eds.), Parenting Plan

5

Evaluations: Applied Research for the Family Court, (2nd ed.).Oxford, NY: Oxford University Press.

Greenberg, Lyn R., Schnider, Robert., Jackson, Julie. (2019). Early intervention with Resistance

Refusal Dynamics and Hybrid Cases. In L. Greenberg, B. Fidler, & M. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

Greenberg, L. R., & Sullivan, M. J. (2012). Parenting coordinator and therapist collaboration in

high-conflict shared custody cases. Journal of Child Custody, 9(1-2), 85-107. Guttentag, C. L., Landry, S. H., Williams, J. M., Baggett, K. M., Noria, C. W., Borkowski, J. G.,

& Ramey, S. L. (2014). My baby & me: Effects of an early, comprehensive parenting intervention on at-risk mothers and their children. Developmental Psychology, 50, 1482–1496.

Harold, G. T., Shelton, K. H., Goeke-Morey, M. C., & Cummings, E. M. (2004). Marital

Conflict, Child Emotional Security about Family Relationships and Child Adjustment. Social Development, 13, 350-376.

Hembree-Kigin, McNeil, CB, & Eyberg, S. (2007). Parent-Child Interaction Therapy,

Springer Johnson, T. C. (2006). Young children's problematic sexual behaviors, unsubstantiated

allegations of child sexual abuse, and family boundaries in child custody disputes. Journal of Child Custody: Research, Issues, and Practices, 2,111-126.

Johnston, J., Roseby, V., & Kuehnle, K. (2009). In the name of the child: A developmental

approach to understanding and helping children of conflicted and violent divorce (2nd ed.). New York, NY, US: Springer Publishing Co.

Johnston, J. R., Walters, M. G., & Friedlander, S. (2001). Therapeutic work with alienated

children and their families. Family Court Review, 39, 316-333. Judge, A. M., & Deutsch, R. M. (Eds.). (2016). Overcoming Parent-Child Contact Problems:

Family-Based Interventions for Resistance, Rejection, and Alienation (1st ed.). New York, NY: Oxford University Press.

Kelly, J. B. & Johnston, J. R. (2001). The Alienated Child : A Reformulation of Parental

Alienation Syndrome. Family Court Review, 39, 249-266. Kelly, J. B. & Johnson, M. P. (2008). Differentiation among types of intimate partner violence:

Research update and implications for interventions. Family Court Review, 46, 476-499. Kelly, J.S. (2012). Risk and Protective Factors Associated with Child and Adolescent

Adjustment following Separation and Divorce; Social Science Applications. In Kuehnle,

6

K. & Drozd, L. (Eds.) Parenting Plan Evaluations; Applied Research for the Family Court. New York, NY, US: Oxford University Press.

Kline-Pruett, Deutsch, & Drozd (2016). Step-up Parenting Plans: Grounded in Research, book

chapter. Parenting Plan Evaluations: Applied Research for the Family Court, Oxford University Press, 2nd edition.

Kline-Pruett, M. & Drozd, L.M. (2018). Ask the Experts: Ten Things to Know About Step-Up Planning: When and How to Determine The Right Time, Association of Family

and Conciliation Courts, Volume 13, No. 4, April 2018 E-News. Kinniburgh, K, Blaustein, M, Spinazzola, J & van der Kolk, B. (2005). Attachment,

self-regulation and competency. Psychiatric Annals, 35, 424-430.

Lamb, M. E., Hershkowitz, I., Orbach, Y., & Esplin, P. W. Tell me what happened: Structured investigative interviews of child victims and witnesses. Chichester, UK and Hoboken, NJ: Wiley, 2008.

Lebow, J. L. (2005). Integrative family therapy for families experiencing high-conflict divorce.

In J. L. Lebow (Ed.), Handbook of clinical family therapy (pp. 516–542). Hoboken, NJ: Wiley.

Lebow, J. L., & Black, D. A. (2012). Considerations in court-involved therapy with parents.

Journal of Child Custody: Research, Issues, and Practices, 9(1–2), 11–38.

Lindahl, M. W. & Hunt, L. A. (2016). Reunification in intrafamilial child abuse cases: A model for intervention. Family Court Review, 54(2), 288-299.

Lutzker, J. R., & Merrick, J. (2009). Editorial. Extending evidence-based practice in child

maltreatment: Training trainers, understanding implementation and cultural adaptations. International Journal of Child Health and Human Development, 2(1), 1–4.

Lutzker, J. R., & Edwards, A. (2009). SafeCare: Towards wide—scale implementation of child maltreatment prevention program. International Journal of Child Health and Human Development, 2(1), 7–16. Reprinted in J. Merrick (Ed.). (2009). Child health and human development yearbook 2009 (pp. 3–13). New York, NY: Nova.

Moran, J., Sullivan, T., & Sullivan, M. (2015). Overcoming the co-parenting trap: Essential

parenting skills when a child resists a parent. Natnik, MA: Overcoming Barriers. National Scientific Council on the Developing Child. (2015). Supportive

Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper 13. http://www.developingchild.harvard.edu

O'Hara, K. L., Sandler, I. N., Wolchik, S. A., Tein, J.-Y., & Rhodes, C. A. (2019). Parenting

time, parenting quality, interparental conflict, and mental health problems of children in

7

high-conflict divorce. Journal of Family Psychology, No Pagination Specified-No Pagination Specified. doi:10.1037/fam0000556

Olesen, N., & Drozd, L. (2012). Prudent therapy in high conflict cases: With and without

allegations of intimate partner violence or child abuse. Journal of Child Custody, 9(1), 69.

Pedro-Carroll, J. L. (2005). Fostering resilience in the aftermath of divorce: The role of

evidence-based programs for children. Family Court Review, 43, 52–64. Pedro-Carroll, J. L., Sandler, I. N., & Wolchik, S. A. (2005). Special issue on prevention:

Research, policy, and evidence-based practice: Forging interdisciplinary partnerships in the courts to promote prevention initiative for children and families. Family Court Review, 43(1), 18–21.

Pezdek, K. and Roe, C. (1997). The suggestibility of children's memory for being touched:

Planting, erasing, and changing memories. Law and Human Behavior, Vol 21(1), Feb 1997, 95-106.

Pezdek, K., & Hodge, D. (1999). Planting false childhood memories in children: The role of

event plausibility. Child Development, 70(4), 887-895. Pipe M.E., Lamb M.E., Orbach Y. & Cederborg A.C. (Eds.), Child sexual abuse: Disclosure,

delay, and denial. Mahwah, NJ: Lawrence Erlbaum Associates, 2007 Pruett, M. K., Cowan, C. P., Cowan, P. A., Diamond, J. S. (2012). Supporting father

involvement in the context of separation and divorce. In K. Kuehnle & L. Drozd, (Eds), Parenting plan evaluations: Applied research for the family court (pp. 123-151). New York, NY, US: Oxford University Press.

Pruett, M.K., Deutsch, R.M., & Drozd, L. (2016). Considerations for Step-Up parenting. In L.

Drozd, M. Saini, & N. Olesen (Eds). Parenting Plan Evaluations: Applied Research for the Family Courts. New York: Oxford University Press.

Reed, A., Snyder, J., Staats, S., Forgatch, M., DeGarmo, D., Patterson, G., … Schmidt, N.

(2013). Duration and mutual entertainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers. Journal of Family Psychology, 27(3), 343–352.

Saini, M.A., Drozd, L.M., and Olesen, N.W. (2016). Behaviors and attitudes of adaptive or

maladaptive gatekeeping following separation and divorce: Effects on children (2016). In M.C. Saint-Jacques, C. Robitaille, A. St-Amand, & S. Levesque (Eds.), Parental separation, family reintegration: Current issues (pp. 113–134). Quebec City, QC: University of Quebec.

8

Saini, M., Drozd, L., Olesen, N. (2017). Adaptive and maladaptive gatekeeping behaviors and attitudes: Implications for child outcomes after separation and divorce. April 2017. Family Court Review, Association of Family and Conciliation Courts.

Saini, M. A., Drozd, L.M., & Deutsch, R.M. (2018). A trauma-informed approach for the

assessment and intervention of resist/ refusal cases. Family Law: News & Views, AFCC, New York.

Sandler, I. N., Tein, J.-Y., Mehta, P., Wolchik, S. A., & Ayers, T. (2000). Coping efficacy and

Psychological problems of children of divorce. Child Development, 71, 1099 –1118. Saxe, G.N., Ellis, B.H. & Kaplow, J. (2006). Collaborative care for traumatized children

and teens: A Trauma Systems Therapy approach. Guilford Press, NY Sexton, T., Gordon, K. C., Gurman, A., Lebow, J., Holtzworth-Munroe, A., & Johnson, S.

(2011). Guidelines for classifying evidence based treatments in couple and family therapy. Family Process, 50, 377–392.

Shelton, K. H., Harold, G. T., Goeke-Morey, M. C., & Cummings, E. M. (2006). Children's

Coping with Marital Conflict: The Role of Conflict Expression and Gender. Social Development, 15, 232-247.

Shonkoff, J. P., Garner, A.S. et. Al. (2012). The lifelong effects of early childhood

adversity and Toxic stress. Pediatrics, 129, 232-246. Society of Clinical Child and Adolescent Psychology. Effectivechildtherapy.org. Retrieved from

https://sccap53.org/resources/education-resources/effective-child-therapy/ Stolberg, A. L., & Mahler, J. (1994). Enhancing treatment gains in a school-based intervention

for children of divorce through skill training, parental involvement, and transfer procedures. Journal of Consulting and Clinical Psychology, 62, 147–156.

Swan, A. J., Kagan, E. R., Frank, H. E., Crawford, E., & Kendall, P. C. (2016). Collateral

support: Involving parents and schools in treatment for youth anxiety. Evidence-Based Practice in Child and Adolescent Mental Health, 1(1), 3-15.

Tishelman, A. C. , Haney, P. , O'Brien, J. G. and Blaustein, M. E.(2010) ’A Framework

for School-Based Psychological Evaluations: Utilizing a 'Trauma Lens’, Journal of Child & Adolescent Trauma, 3: 4, 279 — 302.

Zilberstein, K. (2016). Parenting in families of low socioeconomic status: A review with

implications for child welfare practice. Family Court Review, 54(2), 221-231. WEBSITES

• http://www.nctsnet.org/nctsn_assets/pdfs/promising_practices/tfcbt_general.pdf

9

• http://www.nctsnet.org/nctsn_assets/pdfs/promising_practices/AF_CBT_fact_sheet_2_11_05.pdf

• http://pcit.phhp.ufl.edu/ • http://www.nctsnet.org/nctsn_assets/pdfs/promising_practices/pcit_general.pdf • http://www.nctsnet.org/nctsn_assets/pdfs/promising_practices/tst_general.pdf • http://www.nctsnet.org/nctsn_assets/pdfs/promising_practices/arc_general.pdf • http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/nc_manual_psyfirstaid.html

[Psychological First Aid: Field Operations Manual] • https://www.nctsn.org/treatments-and-practices/treatments-that-

work/interventions • https://www.nctsn.org/trauma-informed-care/creating-trauma-informed-systems