Canadian Counselling & Psychotherapy Association, May 16, 2017

Working with Families of High Conflict Divorce: Conceptual Frames, Ethics, and Competencies
Canadian Counselling & Psychotherapy Association, May 16, 2017 Jeff Chang, PhD, R.Psych. Athabasca University & Calgary Family Therapy Centre Drjeffchang.webs.com

Acknowledgements Athabasca University Calgary Family Therapy Centre
The families who generously allowed me to share their experience

Background Professor at Athabasca University Master of Counselling Program 22 years of excitement working with high-conflict divorce and parenting in private practice Bilateral parenting evaluations Mediation Parenting coordination Litigation support for family lawyers

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

Background Information

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

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

High Conflict Divorce About one-third of former spouses have significant difficulty establishing a healthy relationship with each other after divorce 75% of divorces with children have no court appearances that are not “by agreement” Another 10 to 15% require one contested application between 5 to 15% have what can be described as high conflict relationships

High Conflict Divorce Emotional reactivity
Immediate blamefulness and attribution of intentionality for parenting slip-ups Exaggeration of parenting differences Court applications to restrict the parenting time of the other parent, and to manage issues that most former couples can manage on a month-to-month or season-by-season basis

High Conflict Divorce Four levels of problems/one level of intensity:
Conduct that would require a report to child protection Inadequate parenting that does not require a report to child protection Big disagreements about generally adequate parenting Problems that arise simply because parents cannot communicate productively

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

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

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

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

Football Shoes and Camping Gear: Mom Responds
… As for standby items John. I think it is long long overdue for you to get a job and contribute to supporting your children. And yes fill your home with clothes and shoes and toys and bikes and helmets and scooters and sport equipment and pay for some of their education and activities. That would be amazing!! It's funny but Chris says in the U.S. people who don't pay child support go to jail. DEAD BEAT DAD

The Professionals Invitations to pathologize
Hard work and heart-breaking for us Scares many practitioners off Area of practice drawing the most ethical complaints Practitioners feel threatened by high conflict-parents, and “fire” children as clients to minimize risk.

And the toll it takes on us….
The Professionals And the toll it takes on us….

Competence: Knowledge, Skills, and Attitudes
Supervisees should have better than basic proficiency with: Case conceptualization and treatment planning Typical child development Ethical reasoning Dual roles and relationships Informed consent and access to information

Family systems conceptualization Seeing things in patterns and in terms of social organization is essential for avoiding aligning too much with one parent Family life cycle Divorce process and dynamics of high- conflict divorce Dynamics of abuse -- “subclinical”

Executing basic interventions Balancing support with confrontation Managing the working alliance with multiple clients simultaneously Engaging and interviewing children

Managing highly conflictual interactions Maintaining even emotional demeanor in the face of provocative and blameful statements (“poker face”) Acknowledging without endorsing truth (“accurate” empathy) “When he does X, you experience that as an effort at control.” “You interpret her asking the kids about the time they spent as monitoring you.”

Therapeutic neutrality Best interests of the children = effective parental decision-making Patience: the long view

Self of the Therapist Issues
Countertransference Avoiding triangulation Dealing with helplessness Parallel process/isomorphism Dealing with professional attack – sometimes via complaint to regulatory bodies

High Conflict Divorce Hard work and heart-breaking for us
Scares us many practitioners off Area of practice drawing the most ethical complaints Some therapists’ risk management strategy of firing kids when their parents are too conflictual

Operating Principles

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

Operating Principles Children are resilient. Safety first.
Keep the big picture in mind and take a long view. Acknowledge problems, while focusing on possibilities, strengths, and resources.

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

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

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

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

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

HIPs and PIPs Dr. Karl Tomm and colleagues at Calgary developed the ipScope: “IP”=interpersonal patterns PIPs= “pathologizing interpersonal patterns” HIPs= “healing interpersonal patterns”

HIPs and PIPs In pairs, the speaker describes two typical recurrent interactions between you and a loved one – one positive and one negative The listening takes notes about the interactions. Discuss the situation with the goal of expressing the interaction in at least one set of coupled behaviors

HIPs and PIPs Express it the “gerund” (--ing) form of the verb
These “vicious cycles” can amplify pre- existing problems

Individual pathology…
It is possible to be engaged in a PIP when you are not in the same room, in the same house, or in the same city An individual problem is exacerbated by a PIP and can be deescalated by a HIP Unfortunately, these family systems are predisposed PIPs

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

Safety first OBVIOUSLY
…. but understand the effects of interpersonal interactional patterns on behaviors that threaten safety Therapists require sophisticated knowledge of intimate partner violence – not all IPV is created equal Sandra Stith, MFT Program at Kansas State

Keep the big picture in mind and take a long view
A systemic approach helps us see the big picture – in a situation where, in all likelihood, no one else does If your setting allows it, be prepared for a long-term, if intermittent, relationship

Acknowledge problems, while focusing on possibilities, strengths, and resources.
Empathize carefully and purposefully when parents are discussing the problems of the other parent Don’t try to convince, teach, or lecture

Acknowledgement… possibilities…
Listen carefully for openings when someone is describing changes or differences Start by asking about descriptions and speculation, and coping. Be careful about asking for commitments for change SFBT: Visiting relationship, complainant relationship, customer relationship

So What to Do?

Intervention

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

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

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

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

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

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

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

Consider the relationship pattern as per solution-focused brief therapy: Visiting: no complaint – give compliments Complainant: complaint, but no sense of contributing to solution – give tasks of observation or prediction Customer: can articulate how to contribute to solutions – give tasks of action Usually, since they blame the other party, use tasks of observation and prediction: “Keep on the look-out for when things are better.”

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

Working with the parental subsystem
Get them together when they think that they can – do not do prematurely Agenda and ground rules: Focused on present and future, not past: “I will be very focused on managing the session.” Describe some PIPs and discuss antidotes Feedback on what they do well -- compliments Outcome: presenting a joint message to the child(ren)

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

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

Intervention and Reevaluation Cycles
Setting and maintaining the relational foundation Listening for clients’ world view, strengths, and preferences Negotiating a solvable problem or an achievable project Opening meaningful experiences of difference Within session Between sessions Circulating these experiences of difference

Setting and maintaining the relational foundation
Play with children before you work with them Be a therapeutic “uncle” or “aunt,” or…

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

Setting and maintaining the relational foundation
The relationship must support everything Who is concerned or involved with the problem? Include others in a non-blameful way Spend lots of time connecting with everyone, especially if the family is polarized Therapeutic relationship and problem definition/goal are interrelated – how you talk about it matters

Listening for clients’ world view, strengths, and preferences
Getting to know the child apart from the problem What are the parents' beliefs about this problem? and about parenting? What is the child good at? How did he/she get that way? “wonderfulness conversations”

Listening for clients’ world view, strengths, and preferences
Sometimes you can find something to utilize… The child’s experience will give you ideas about how the child acquires skills, useful “character traits,” good habits, etc. … or sometimes not…

Negotiating a solvable problem or an achievable project
Elicit a problem description that everyone can buy into – at least “sort of” Minimize blame and create space for respectful disagreement beware of clashing problem definitions/ beliefs child vs. parent parent vs. school therapist vs. parent

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

Opening meaningful experiences of difference… within session
“Inter-Viewing” What’s different? Behavioral sequence: Emotion Cognition Behavior Sensation Interpersonal Past real-life exceptions may be more accessible than hypothetical ones: “Can you remember…?”

Opening meaningful experiences of difference
the highlight package using drawings to elicit exceptions scaling drawings miracle drawings exception/new story drawings rehearsal in sessions

A Miracle…

A Good Time With Dad…

Find, elicit, or create meaningful experiences of difference
Contradiction/contrasts Identity and preferences What kind of person do you want to be?

Using numerical or visual means to track progress Scaling for: Progress Confidence Motivation What is different between a 3 and a 4? Detailed description of pattern, sequences, and modalities

Connecting themes Eliciting a past instance: An actual Macro-description Skimming the surface of exceptions and joining them Developing an attributional description Micro-description Detailed sequential description of: Actions Thoughts Emotions Sensations interpersonal

Between sessions (end of session interventions) observational tasks for parents and teachers practicing one or two things bragging meetings reading a new story together

Amplify, anchor, and maintain new experiences
rituals and celebrations certificates and letters reflecting teams

Therapeutic Letters Offer commendations to individual family members and/or to the family as a whole, highlighting strengths and competencies Acknowledge problems and their effect Highlight particular words, ideas, or recommendations that stood out from the therapy session. Pose questions about future directions how to keep changes going what developments or new insights will follow Highlight what you are learning from the client(s) or from your work with them.

Reflecting Teams Observing team exchanges positions with the client(s)
The team presents mulitple perspectives tentatively Process: Physical separation Not addressing the clients directly Owning one’s own perspective Expressing observations tentatively This permits clients to take or leave the team’s perspective, and for the therapist to interview the lcient(s) about what they noticed

“Termination” and intermittent meetings
Active treatment versus maintenance “How long can you keep up these changes without any coaching?” Keeping the file open as long as your organization permits you. Expect to see them recurrently

Overcoming Lawyer- and Court-Phobia

Most therapists enter the field to be altruistic and conciliatory, not adversarial Lawyers are obligated to advocate for their clients Some have not “gotten the memo” about adversarial process not being helpful for children

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

Remember – the author of any document placed in evidence can be examined and cross-examined Fact witness Only “direct knowledge” What you have actually seen or heard Expert witness Qualified by experience and training Required when knowledge is outside of the scope of the general public

May give opinion evidence May use hearsay “There is no property in a witness” CCPA has an excellent brochure on responding to subpoenas You may be required to turn over a file, but you can often negotiate to release less information

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

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

Developing a School-Based Response
Focus on the big picture Use the core business of education as the entry point Be on the same page and have a go-to person Interact purposefully with the parents and stepparents Create a safe neutral space for the child Provide supportive and skill-based counselling for students

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

Use the core business of education as the entry point
Make it clear to each parent that your role is to educate the child, and that you are happy to do whatever it takes to do that Chair meetings assertively to keep on topic Use the child’s academic development as an opening to motivate the parents

Be on the same page and have a go-to person
Have one person or a team (counsellor and/or AP/VP) to: Be the “big-picture” guide Think about the patterns Be the school’s institutional memory Coach the rest of the staff Take responsibility for including high-conflict parenting situations for discussion in the School Resource Group meetings In accord with legislation and district policy, share information equally (and if possible simultaneously).

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

Interact purposefully with parents and step-parents
Focus on supporting the child’s academics Listen supportively but set boundaries Listen for when, somehow, things are better, or when things are not as bad….. If you hear something, ask for a description (not what the parent can do to make it better) Keep the PIPs in mind – listen for both sides of the loop Make suggestions tentatively and give parents lots of room to not take up a suggestion

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

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

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

Supervision (optional – time permitting)

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

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

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

Setting up for Success: Ethics
Consent of one parent or two? What’s legal vs. what’s wise? Clarify informed consent (age of consent) and access to information.

Ethical standards – advanced knowledge Case conceptualization and treatment planning Typical child development Family systems conceptualization Family life cycle Divorce process Dynamics of abuse -- “subclinical”

Executing basic interventions Balancing support with confrontation Managing the working alliance with multiple clients simultaneously Engaging and interviewing children

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

Therapeutic neutrality Best interests of the children = effective parental decision-making Patience: the long view

Self of the Therapist Issues
Countertransference Dealing with helplessness Dealing with professional attack – sometimes via complaint to regulatory bodies Parallel process/isomorphism

Contact me: Web: drjeffchang.webs.com Voice: Chang, J. (2016). Postdivorce counselling and dispute resolution: Services, ethics, and competencies. Canadian Journal of Counselling and Psychotherapy, 50(3S), S23–S42.

Canadian Counselling & Psychotherapy Association, May 16, 2017

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