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Research Informed Early Intervention: Catching Them

Before Too Much Damage is Done

AFCC – Australian Chapter 3rd Annual Conference August 18th-20th, 2016

LYN R. GREENBERG – PH.D., ABPP

Today is about:

• Ques%oningsomeassump%ons

• Broadeningtherangeofknowledgeweconsider

• Viewingfrommul%plelenses

Today is about..

• Iden%fyingdysfunc%onearly

• Buildingthecaseforearlyinterven%on

• Prac%calstrategies

Myths, Truisms and other Nonsense

• Inordertointervene,wehavetofirstresolveeveryallega%onandassignblame

• Ifweassess/inves%gatelongenoughandthoroughlyenough,wewilllearn“thetruth”

• Extensiveassessmentsarealways(orevenusually)leadtobeGerinterven%ons

Myths about Therapy • Itmustbevoluntary

• Itmustbeverbalandleadto“insight”

• Confiden%alitymustbeabsolute

• Itisfundamentallydifferentfrompsychoeduca%on,coaching,orskill-building

• Ifparentsdon'tchange,there’snothingwecandoforkids

That we don’t have Perfect evidence doesn’t mean that there’s no evidence

• Therewillneverbeperfectcontrolledstudiesaboutanyoftheseinterven%onsasaunit

• Thereisconsiderableresearchoneffec%vementalhealthinterven%ononmanyoftheissueswetarget• Therearefewerexcusesfordoingwhatweknowdoesn’twork,butwecanbuildop%onsmorelikelytosucceed• Risksofdoingnothing

Degrees of Research Support • EvidenceBasedvs.• EvidenceInformedvs.

• Failingtoconsideravailableevidencevs.• Disregardingavailableevidencevs.• “Flyingbytheseatofourpants”

AdaptedfromSexton,T.,Gordon,K.C.,Gurman,A.,Lebow,J.,Holtzworth-Munroe,A.,&Johnson,S.(2011).Guidelinesforclassifyingevidencebasedtreatmentsincoupleandfamilytherapy.FamilyProcess,50,377–392.

Limits in our perspective come from…

• Explosionofliteratureanddivergenceofspeciali%es• Informa%onsilos

• Affilia%oneffectsandsubtleconfirmatorybias

• Observa%onsofpooroutcomeorpoorprac%ce

• Issuesfocusedonbyparentsandoeenthelegalsystem

• Powerfulpossibili%esandimportantinforma%onoeenmissed

• Oversellingofsomefindings,neglectofothers

The Case for Early, Systemic Intervention • Risksofdelay• Difficul%esofinterveningwhenproblemsbecomeentrenched

• Ini%altreatmentgoalsdifficulttoobjectto

• Availabletoolsinchildren’sac%vi%esanddailyrou%nes• Opportuni%estosendclear,earlymessagestoparentsandfollowthemupifli%ga%oncon%nues

• Interven%onversusevalua%on/assessment:whichismosthelpfulwhen?

Misconceptions Complicating Interventions • Improvingtherela%onshipofhighconflictco-parentsishopeless

• Thebestprac%ceforparent-childcontactproblemisreunifica%oncounselingfortherejectedparentandtheresis%ngchild

• Ifreunifica%oncounselingfortherejectedparentandthechildisineffec%ve,individualcounselingfortheparentand/orthechildisneeded

• Parentshavereasonablyaccurateunderstandingoftheadverseimpactofco-paren%ngconflictonchildren

Misconceptions Complicating Assessment and Treatment Planning

• Itisimportanttodiagnosepersonalitydysfunc%on

• Parentsandchildrenarecrediblereportersabouttheparen%ngcompetenceoftheresistedparent

• Ifthechildseemshappierorcalmeraeercontactisrestrictedwithoneparent,it’ssafetoconcludethattherestrictedparentistheproblem

• Afew‘headliner’examplesofpoorparen%ngareconclusiveofparen%ngskillsdeficit

Key Findings to Know..

• DetailedinGreenbergandLebow(2016)• Compellingconsistencyonkeyfindings

• Evidenceforinterven%onwithbehaviorswesee• Howmuchadapta%onisneeded

• Resourcesfromchild’sdailylives

Children’s Outcome is Related To • CopingEffec5veness(healthycopingskills)• CopingEfficacy(beliefthatwhatonesaysordoeswillwork)• Accesstohealthyrela%onships• Stability• Authorita%veparen%ng• Accesstonorma%veac%vi%es• Managementofdevelopmentalrisks

Pedro-Carroll,J.L.(2005).Fosteringresilienceintheaeermathofdivorce:Theroleofevidence-basedprogramsforchildren.FamilyCourtReview,43,52–64.

Pedro-Carroll,J.L.,Sandler,I.N.,&Wolchik,S.A.(2005).Specialissueonpreven-%on:Research,policy,andevidence-basedprac%ce:Forginginterdisciplinarypart-nershipsinthecourtstopromotepreven%onini%a%veforchildrenandfamilies.FamilyCourtReview,43(1),18–21.

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Factors We Can Impact, That Are Related to Outcome (Adapted from Pedro-Carroll, 2005)

IndividualFactors• Ac%vecopingstyle• AccurateAGribu%ons• HopefortheFuture• Realis%cappraisalofcontrol• Effec%vecopingskills

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Factors We Can Impact, That Are Related to Outcome (Adapted from Pedro-Carroll, 2005)

FamilyFactors:• Protec%onfromInterparentalConflict

• Psychologicalwell-beingofChildren,• Solid,suppor%veparent-childrela%onships,• EconomicStability,

• Authorita%veParen%ng• HouseholdStabilityandStructure

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Factors We Can Impact, That Are Related to Outcome (Adapted from Pedro-Carroll, 2005)

ExtrafamilialFactors:

• Suppor%verela%onshipswithposi%veadultrolemodels

• Supportnetwork(family,school,community)

• Preventa%veInterven%onsprovidingsupportandskillstraining• Effec%veTherapy

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Importance of Daily Activities -Focusing Our Attention on the “Mundane” issues

•  Detailsofdailyrou%nesandorganizedac%vi%esoeenneglected,par%cularlyinearlystagesaeersepara%on

•  Informa%onontheseissuesisoeenlostwhenwedon’tinvolvechildrenininterven%ons(parents’percep%onsoeennotreliable)

• Outcomestudies(andclinicaldatafromchildren)suggestthatthesearethemostimportantissuestothemandtheirdevelopment

•  Researchfromfamilypsychology,recrea%ontherapyandotherdisciplinesisoeenhighlyrelevanttothispopula%onbutdoesn’talwaysreachus,asitisnotlabeledas“childcustody”research

•  Ac%vityissuesmaybeessen%alforresolvingotherproblems

Johnston,RosebyandKuehnle(2010);Dunn(2001);Reedetal(2013);Sandleretal(2010),Pedro-Carrol(2005),GreenbergandLebow(2016);Moran,SullivanandSullivan(2015)etc.

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Degrees of Research Support • EvidenceBasedvs.• EvidenceInformedvs.

• Failingtoconsideravailableevidencevs.• Disregardingavailableevidencevs.• “Flyingbytheseatofourpants”

AdaptedfromSexton,T.,Gordon,K.C.,Gurman,A.,Lebow,J.,Holtzworth-Munroe,A.,&Johnson,S.(2011).Guidelinesforclassifyingevidencebasedtreatmentsincoupleandfamilytherapy.FamilyProcess,50,377–392.

Additional Elements of Evidence-Informed Intervention

• Contextualrelevance• Behavioralspecificity• Integra%onintotheoverallplan• Disciplinedapplica%onofwhatweknow,informedinference

• Researchfromadjoiningdisciplinesorotherpartsofthesystem

• Developmentalanchoring

(Sextonetal2010,Greenberg,DoiFickandSchnider2012,GreenbergandLebow2016)

Discriminating What Applies

• Twogeneralapproachestofamilytherapywithempiricalsupport• BehavioralFamilyTherapy(includessomecogni%veandintegratedmodels)• Emo%on-focusedFamilyTherapy

• Whichisapplicabletoourpopula%on?

• Whichislikelytobeadisaster?

Risks to Children of Conflicted Parents “Whentheelephantsfight,thegrassgetstrampled.”

•  Impairedabilitytohandlefrustra%on

•  Poorsocialinterac%onandcopingskills

•  Poorabilitytomodulateaffect

•  Avoidance,internalizingdisorders

•  Impairedrealitytes%ngandsocialjudgment

Fidler,B.J.,Bala,N.andSaini,M.A.(2013),Kelly,J.S.(2012)

The Child’s Tapestry is Smaller, and Larger, Than Ours

• Dailyrou%nesandac%vi%es• Developmentaltasks• Survivingtheparentalconflictinallserngs• Maintainingaccesstofriendsandorganizedac%vi%es• Establishingindependentrela%onshipsandtheabilitytomaintainthem

• AGen%ontotheseissuesateverylevelmaybothpreventproblemsandprovidebeGermeansofaddressingthem

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Changing our Thinking in Light of Research and Experience

• Thechild’sabilitytocopeeffec%velyover%meIStheul%mateissue,ifourtrueinterestisinprotec%ngthechild

• Skillsandstrategiesaremodifiable,“insight”canfollowbehaviorchange

• Childrencanbetaughtskillsandhaveaccesstoopportuni%esforotherhealthyrela%onships,iftheseissuesareaddressedsoonenough

• Oncedysfunc%onalbehaviorsbecomeentrenched,interven%onismuchmoredifficult

• Focusoncopingskillsanddevelopmentopportuni%esmaygivechildrenopportuni%esformoreemo%onalindependence,orcreateclear,behavioralevidence(thatthecourtcanunderstand)aboutriskstothechildandparentalcoopera%on

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How are these children coping?

hGps://www.youtube.com/watch?v=Edb9plpHO7k

And here’s the most recent comment…

• WhenmyparentsgotdivorcedIwasfouranditwasmybirthdaytheydidn'ttellmemydadjustpackedupleeandtomeandmysisterandmybrotherwithhimnowImTensirngathomecryingbecausemydadneverspeakstousatallonlywhenheisgoingsomewhereIhavenotseenmymotherin1Yearand4monthsIcatcallortalktomymomIhaveparanoiaIonlyhaveonefriendandIrarelytalkwithherI'mbulliedatschoolformyhairmylifemyclothesmyshoesmybodyandthingshappentomethatshouldhappenyearslater….

Comment continued..

…lastyearinDecembermydadsoldmydogshewastheonlythingthatmademefeelhappyIhaveastuffedanimalfrommymombutitjustmakesmecrybecauseImissmymomIhavehadthoughtsaboutkillingmyselfbeforeIcrymyselftosleepatnightandwhenpeoplemen%onmy"parents"IsayyoumeanmydadmyparentsaredivorcedandtheyarelikeomgsorryIdidn'tknowIpretendlikeit'sokaybuteverydayIfeellikeI'mdyinginsidemydadsaysbadthingsaboutmymomandhowsheishorriblenastymeanuglydumbandawitchandsheismymotherthatmeansI'mrelatedtohersothatswhatIamiguessdidImen%onthatmymothergotmarriedagaintosomeoneMDandmybrotherhatenowmymomhashadanotherchildheismyhalfbrotherandI'mgonnastopwri%ngknowbecauseI'mactuallysobbingasIwritethissoI'mgonnastopbeforeIdehydratemyself😖Thisishowmyheartfeelsalldayeveryday

Interventions for Parents

*Note:Severalslidesinthissec%onhavebeenprovidedoradaptedcourtesyofJohnMoran(oneofmyco-presentersfromourAFCCSeaGle2016presenta%on)orhavebeen

adaptedfromyearsofcollabora%veworkwithMaGhewSullivan.

Creating a Positive Therapeutic (and Legal) Bind

Theore5cally,parentsareunitedbytheirdesiresthatchildrenhave:• Safety• Lovinghomeenvironments

• Protec%onfromtheharmfuleffectsofthedivorce

• Anopportunitytodevelopintohealthyadolescentsandadults• Thebestresourcestosupportchildren‘smutualdesiretoprotectandnurturethechild

Descriptors and Frequency of the Problem

• 3typesofco-paren%ngrela%onships:coopera%veco-paren%ng(15%);parallelco-paren%ng(70%);andhighconflictco-paren%ng(15%)• 85%offamiliesarestrugglingwithco-paren%ngconflict,eitherlowgradetensionwithoccasionalflare-ups,orchronicconflictwithoccasionalinstancesofsuccessfullynego%a%ngaparen%ngproblem

Kelly,J.S.(2012)RiskandProtec%veFactorsAssociatedwithChildandAdolescentAdjustmentfollowingSepara%onandDivorce;SocialScienceApplica%ons.InKuehnle,K.&Drozd,L.(Eds.)Paren%ngPlanaEvalua%ons;AppliedresearchfortheFamilyCourt.OxfordUniversityPress.

Parent reactions that impede progress

• Emo%onalresponsestothedivorce• Anxiety/defensivenessaboutparen%ngdifficul%es

• Catastophizing,jumpingtotheworstconclusions

• Mergingofissueso Thecoparent’sperceivedbetrayalintheadultrela%onshipbecomesanassump%onofuntrustworthinessinparen%ng

o Adultemo%onalresponsesprojectedontochildren

• Skep%cismabouttheabilityofmentalhealthproviderstohelp

• Resentmentathavingtochangeone’sownbehavior

Factors Related to Parent-Child Contact Problems

Matching Level of Parent-Child Contact Problem to Level of Intervention

• Mild–Psychoeduca%on,family-systeminterven%onwithadequatelytrainedprofessionals,indirectaccountability,directcoordina%on

• Moderate–Useofteamwithadvancedtraining,clinicalandjudicialcasemanagement,directaccountability,coordina%on

• Moderate/Severe–mul%-day‘intensive’tojumpstartreintegra%onofrela%onships,followupcoordinatedtreatmentessen%al

• Severe–Changeofresidenceofchild,legal-decisionmakingauthority,interruptcontactbetweenchildandalignedparent,coordinatedfollowuptreatment

Interventions for Children Who Complain, Gossip About a Parent

• SampleCo-paren5ngAgreementforwhenChildrenComplainAboutTheirCo-ParenttobeReadtotheChildrenItisourdivorce.Youshouldnothavetogothroughit,feelresponsibleforit,hearaboutit,orprovideemo%onalsupportforusaswegothroughitorensurethateitherofusisbehavingproperlyaboutit.Hereareourrules:1. NeitherMomnorDadisallowedtomakecri%calstatementsaboutoneanother;

2. Ifyouhearusmakeacri%calstatementaboutoneanother,pleasepointoutthatwearebreakingtherule,andyoumaytelltheotherparentwhatyouheardsaid,ifyouwish.

Moran,J.A.,Sullivan,T&Sullivan,M.(2015)OvercomingtheCo-Paren5ngTrap:Essen5alParen5ngSkillsWhenaChildResistsaParent.OvercomingBarriers,Inc.

Sample Co-parenting Agreement (cont’d)

3.Youarenotallowedtoreadcourtdocuments,readourtextmessagesoremailstooneanother,oroverhearourconversa%onswithotheradultsaboutdivorce-relatedmaGers.ItisyourresponsibilityaswellashourstoensurethatyouarenotexposedtosuchmaGers.

4.Ifoneofusseemsangryorupsetaboutthedivorce,pleasedon’taskustotalkaboutit;instead,giveus%meandspace.Wearecompetentadultsandcantakecareofourownbusinessalthoughsome%mesweneeda“%meout”toseGleouremo%ons.

Sample Co-parenting Agreement (cont’d)

5.Ifyouhaveacomplaintabouteitherofus,bringitdirectlytotheparentyouhavethecomplaintaboutratherthantheotherparent.Everyonehastolearntoaddressrela%onshipproblems.Weknowitcanbetoughforakidtobedirectwithaparent;wewillhelpyoualongifyoustartthetalk.Butgoingforward,ifyoucomplaintomeaboutMom/Dad,Iwilllistenpolitely,andaskyoutobringtheissuetoMom/Dad;Iwon’tjumpinforyou.

Sample Co-parenting Agreement (cont’d)

6.However,ifyoutelloneofusthatyouhaveanissuewithyourotherparentandarenotcomfortabletotalktoyourotherparentdirectly,wecanallmeettogether,andIwilldomybesttohelpyoutalkaboutyourissueswithouttalkingforyou.

And in a less than ideal world..

• Parentsdon’tfollowthrough• Bothchildrenandparentslackthecopingskillstofollowthecontract• Childrenseetheirparentsasoverwhelmedsodon’taskforhelp

• Parentsfindwaystounderminetheotherparentwithoutdirectlyviola%ngthecontract;childrenenactthatemo%onalagenda

• Nofeedbackfromthechildastowhetherit’sworking

• Problemgoesundergroundun%lexhibitedinchildren’ssymptomsorbehavior

Systemic Intervention Planning

• Whatdoesthechildneedtolearn/master?• Whatac%vi%esorcondi%onscanhelpthechildgetthere?

• Whatdevelopmentallyregressiveinfluencesdoweneedtoaddress,orprotectthechildfrom?

• Howdowebuildresilienceinthechild?• Whatassessmentques%ons

• MUSTbeansweredbeforehand• Canbeaddressedwhileinterven%onisongoing

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Systematic Intervention Planning (cont.)

• Useofrecrea%onandexternalac%vi%es• Ac%vityanalysis(Aus%n,2012)• Detailedprocedures• Organizedac%vi%eslendthemselvestocommonexpecta%ons

• Focusonbehavior• Aretherejointac%vi%esthatallowthechildtoaccessthestrengthsofaparentwhileminimizingnega%veexposure?

• AGen%onateverylevel–media%on,collabora%ve,evalua%onandtreatmentintake

• Accountabilitycanbedirectorindirect

Attorney Interests in Early Intervention

• ClientAssessmentandManagement• Turningglobaldistressintoconcreteissues• Iden%fyingweaknessesbeforethecourtoranassessordoes• Theposi%veimpressionofsincere,verifiableeffort

• Andifyoumustli%gate–gatheringbehavioraldataontheresponseoftheopposingparty

Resistance-Refusal Dynamics

• Don’talwaysstartasfull-blownrestric%vegatekeeping• Canseverelydistortordelayemo%onaldevelopment

• Canimpactchildrenlongintothefuture

• Regressivesymptomsareoeenevidentearly

Resistance-Refusal Dynamics (Young children) • Youngerchildren:

• Typicallydon’trepeathos%lenarra%vesaboutaparentindependently• Areeasilyaffectedbyanxietyandangerconveyedbyothers• Presentagreaterpatchworkofstrengthsandweaknesses

• Rapiddecisionsaboutpreschoolmaybecri%cal

• Developmentalregression(oeentothenonverbal)

• Abili%esthatsupportparen%ngtransi%onsarealsogloballyadap%ve

Resistance-Refusal Dynamics (cont.)

• Schoolagechildren:• Accustomedtocomplyingwithexternaldemands• Canrespondtoclearlimits• Oeeninvolvedinexternalac%vi%es• Closertopeersinsocialbehaviorifproblemnotentrenched

Resistance-Refusal Dynamics (cont.)

• Adolescents(notentrenched):• Irreconcilabletensionbetweenfamilyconflictandnormaldevelopment

• Canrespondtoclearlimitsandappropriatefamilytherapy• Externalac%vi%esarearesource• Preferavoidancebutmaybeabletoengageeffec%vecopingskills• Promptinterven%oncri%cal

• Ifdynamicsbecomeentrenched,effec%veinterven%onmaybeenormouslycostlyandmarginallyeffec%ve

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Progression in treatment..

• Behavioralexpecta%ons• Languageoffeelings,descrip%ons

• Usenon-loaded.generalizedmaterials• Mul%plehypotheses,constantly• Cau%onsretargetedques%ons• Protocolforexploringalternatepossibili%es• Rememberthechild’soutsidelife!

• Ini%alprac%cewithparentsinnon-contestedinterac%ons• Parent’sknowledgeofchild’sac%vi%eshelpful

Progression in Interventions

• Supportparen%ngac%vi%esoutsideofcontestedissues(schoolevents,etc.)

• Graduatedprac%cemayallowformoresuccessfulresolu%onofconflictedissues

• Paren%ngskillsgearedtospecificgoals• Coordina%onamongprofessionals

• Ifcontactwithparentremainstoxictothechild,supportappropriateresolu%on

Maximizing Resources • Asinglespecialistinaneutralrole(i.e.child-centeredconjointtherapistorideallyaPC)cancoordinate(andteach)lessexperiencedprofessionals

• Wheninterven%onisearlyenough•  Nonprofessionalresourcescanaidtreatment•  Externalprofessionalscanaddressspecificissues

• Comparethecostsoftreatmentandli%ga%on

• Poorqualitytreatmentul%matelycostsmorethanengagingqualifiedprofessionals

•  Judicialofficerserngfinancialpriori%es

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“The judge decided, I’m here to help you make it work…” Clear underlying orders aid treatment •  Detailsandlimitsinrestrainingorders

• Maintainparentalroleswherepossible(i.e.publicandschooleventsifsafe)

• Ordersregardingtravelorremovingchildfromarea

•  Structuredtelephoneaccess(oeennecessaryforbothsides),structureforwebvisits

•  Detailedorderreexchangecondi%ons,includingholidays,andproceduresaroundthechild’sac%vi%es

•  Expecta%onsrecoopera%onwithtreatment,cleartreatmentorders

•  Areasofparentalauthority

Therapeutic Interventions versus Parenting Plan Assessments

• Whatques%onscanonlybeansweredwithanassessment?• Howextensivedoestheassessmentneedtobe?

• Whatbehavioraldatacanbegatheredthroughtreatmentfocusedondailyissues?

• Canassessmentbeconcurrentwithinterven%on?

• Financialresources–whereshouldthemoneybespent?

Structure and Interventions Children and Families

• Cleartreatmentorders/consents•  (Sourcesforsamplelanguage)• Resistpressurestoproceedwithoutone

• Conferencecallwithcounsel• Clearprotocol,methodicalprocedures

• Logicalconnec%onbetweentheorderandgoals• Clarityreboundariesoftherapist’srole• Declinecasesthataresetuptofail

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Therapist can (and should) assist with specific behaviors to comply with orders… • Specificdialogue• Structuredrou%nes,decision-making

• Rulesandcontracts,emailconfirma%on,detail

• Recommenda%onstoparentsforbeGersuppor%ngchild

• Feedbackrewhatisandisn’tworking• Abilitytoar%culatelimitsofrole

• Combiningtreatmentresourceswithcommunityinvolvement–whichmayalsogeneratenon-privilegeddata

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Preparation of parents…. • Direc%onfromtheCourttocooperatemayhelp–applytobothparents

• Givethereluctantparentachancetobeheard,butcleardirec%onforcoopera%on

• Clearrulesforeachparentintherapy• Assessfor“specialrules”vs.poorlimitserngoverall

• Centralspecialistcoordina%ngwithothertherapists;one-wayreleasesmaybeanop%on

Create developmentally-appropriate therapeutic tasks

• Withinandoutsideoftherapy• Createtasksthataredifficultfortheparent(orchild)toreasonablyobjectto

• Useopportuni%escreatedbyschooloroutsideac%vi%es• Workthroughthedetailsofobjec%ons

• Protec%vestructurewhereanxietyisanissue• Recognizeandsetlimitswithtantrumbehaviors

• Realitytes%ngrehowotherswillreacttothechild’sabnormalbehavior

Analyzing and selecting activities • Whatdevelopmentaltaskswillithelpthechildachieve?

• Whatlevelofinterac%onisrequiredorpermiGed?Howdoesitmatchwith

• Parents’skills• Childskills•  Statusofrela%onship• Availableresources,ac%vitystructure

• Isthecourtwillingtohelp?• Establishingcon%ngencies

Moran,J.,Sullivan,T.,&Sullivan,M.(2015).Overcomingtheco-paren5ngtrap:Essen5alparen5ngskillswhenachildresistsaparent.Natnik,MA:OvercomingBarriers.;Greenberg,DoiFickandSchnider,2012;alsoinpress;D.Aus%n1982,2012

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How does a parent accept responsibility? • Discussionofcontestedissues(i.e.abuseallega%ons)mayneedtobedeferredwhileinves%ga%ons/evalua%onsarecompleted

• Supportofhealthychildbehavior• Childrenneedtoknowtheirpercep%onsareacceptedandtakenseriously,butmaynotbeliteralmemory

• Contrac%ngforfuturebehavior• Permissionfrombothparentstotelltherapistwhatdidanddidnotwork

• Coordina%onwithparent’sprovider

Practice and follow-through on non-contested issues

• Requiresthatparenthaveaccesstomaterialaboutchild’sdailylifeandac%vi%es

• Tailoringrestrainingordersandresponsibili%esofalignedparent• Regularcontactbetweenbothparentsandtherapist• Spendpartofeachchild’ssessiondiscussingdailylifeandissues• Discussionandtherapeu%ccontractsreissuesineachparent-childrela%onship

• Detailed,carefulfollow-through

More unity may serve us well.. • IfeveryoneaGendstotheseissues,thatinforma%onmayfilterbacktothecourt;

• AdvocateforinclusionofthisissueintrainingsthatjudgesaGend• Expecta%onsfortreatmentorders,notaccep%ngcasesthataresetuptofail

• Educa%onateverylevel• Addressingtheissuesearly• Remindingourselvesthatthelifeofthechildandfamilyinterfaceswithmanyothersystems,whichmayprovidecrucialresourcestothechildandanopportunityforparentstodemonstratehealthybehavior

• Mosttherapytakesplaceinthecontextofreallife☺

Adaptations for Special issues

Commoncomplica%ngissues:

• Childrenwithspecialneeds• Allega%onsofTrauma

• Parenthistoryofmentalillness

• Militaryserviceorothersepara%on

Trauma-sensitive, non suggestive approach

• Childrenoeenexhibitbehaviorsthatmayresultfromtrauma• Whileallega%onsareunderinves%ga%on,therapist’sroleistosupporthealthycopingskills

• Traumamaycomefrommul%plesources

• Ac%veconsidera%onofmul%plehypotheses

• Educa%ontoparentsremul%plemeaningsofchildren’sbehavior

• Specificinstruc%onsfortherapeu%ctasks

Potential Sources of Trauma

• Domes%cviolence• Childabuse• Chronicparentalconflict• Perceivedthreatsofabandonment

• Frequentrepe%%onofremindersofallegedevents

• Parentemo%onaloverload

• Externalevents

Additional complications

• Traumaimpactsmemory• Peoplemayrememberthingsdifferentlyevenifnooneislying

• Criminalvulnerabilitymayexist

• Insomecases(post-militaryPTSD),everyoneistrauma%zed

Coping-focused approach is trauma sensitive

• Strengthenschild’sindependentabili%es• Helpschildtodevelopindependentemo%onalresources

• Languageoffeelings• Graduatedprac%ceonnon-contestedissues• Opportuni%esforearlyinterven%onbytherapist• Groundingindailyac%vi%esaidsaccurateunderstanding• Consistentwithcurrentapproachestotreatmentoftrauma

Responding to Children’s Statements

• Maybeunusuallydirectandearlyintherela%onship• Ifinves%ga%onsongoing,mayneedtoredirecttoanother%meoradifferentprofessional

• Explorecurrentsourcesofanxietyandstress• Equipwithskillsforcurrentvisita%onstructure• Explorereasonablenessofanyfearsexpressed• Structurefortherapeu%ctasks• Reinforceage-appropriatebehavior

Children with Special Needs

• Parentsmaydisagreeaboutexistenceorseverity• Engagementwithothersystemscri%cal

• Medical• Educa%onal• Therapeu%crecrea%on• Otherservicesandrehab

• Languagedifferences–i.e.meaningof“consistency”

Parents’ Issues in Special Needs Cases

• Similardisabili%es• Self-esteemissues

• Fa%gue,stress,overload• Demandsofspecialeduca%onorotherserviceplans

• Gatekeepingissue?

Structured Information Gathering • Structureandaccountabilityfortheini%alprocess• Manageprocedures

• Professionalsinotherdisciplinesmaynotbefamiliarwithourpopula%on• Ensurebalancedinforma%ongathering• Bothparents’accesstoIEP’sandotherteammee%ngs• Avoidassump%onsaboutreasonsforaparent’slevelofasser%venessorinvolvement

• Iden%fyques%onstobeasked,havebothparentsreportbackandprocessinforma%on

• Structuredexperimenta%onwithinterven%ons

Application to Resistance/Refusal Dynamics

• Symptomsofthedisabilitymaybeconfusedwithresistance/refusaldynamics

• Childmayresisttransi%ontotheparentwhosetslimits

• Childisgerngrespitecaresomewhere

• Engagementinexternalac%vi%esoeencri%cal

• Ac5veplansfor“readiness”

Additional Handouts & Resources • Associa%onofFamilyandConcilia%onCourtsGuidelineswww.afccnet.org

• Addi%onalar%clesavailableat:• hGp://lyngreenbergphd.com/publica%ons-and-presenta%ons/

• hGp://lyngreenbergphd.com/resources-for-professionals/

• hGp://lyngreenbergphd.com/resources-for-parents/

• Addi%onalHandouts• Oremailadmin@lyngreenbergphd.com

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Contact Information LynR.Greenberg,Ph.D.,ABPPForensicandClinicalPsychology

BoardCer%fied,CoupleandFamilyPsychology11340W.OlympicBlvd.,Suite265

LosAngeles,CA90064Phone:(310)399-3684Fax:(310)988-2706

lyn@lyngreenbergphd.comwww.lyngreenbergphd.com