We're Still Taking X‐Rays but the Patient is Dying: What Keeps us from Intervening More Quickly in Resist‐Refuse Cases?

Self Cite

Children and adolescents who are having difficulty coping with stress often present with complaints of physical discomfort. Effective treatment approaches exist for many of these issues. Among high-conflict parents, however, children's medical issues can become another canvas for conflict, with parents focused more on blaming one another for the child's distress than on options for assisting the child.Professionals can be drawn into the conflict to such a degree that they overlook essential steps for addressing and managing these issues. The authors present a researchinformed model for managing medical and psychophysiological issues amid parental conflict.

Section: Role Of the Courtmentioning

confidence: 99%

Managing children's and adolescents' medical complaints amid parent conflict: Strategies and tools for professionals

Greenberg,

McNamara,

Weisz

et al. 2023

Self Cite

“…In most cases, individual work and safe structured contact between a resisted parent and child are best when concurrent and synchronized. Holding off on contact results in increased anxiety and rigidly held, polarized perceptions and memories (Greenberg & Schnider, ). Except in those cases where the risks to the child's functioning include self‐harm or significant decompensation in functioning, seeing a rejected parent will be stressful, but not intolerable with the proper supports in place.…”

Section: Treatment Of Trauma Responsesmentioning

confidence: 99%

Trauma‐Informed Interventions in Parent–Child Contact Cases

Deutsch¹,

Drozd²,

Ajoku³

2020

Parent-child contact problems may arise in the context of high conflict separation/divorce dynamics between parents. In cases where there are parent-child contact problems and children resist or refuse contact with one of their parents, there may also be incidents of child maltreatment, intimate partner violence, or compromised parenting that can be experienced by a parent or child as traumatic. The circumstances around separation and/or post-divorce often result in intense stress for families. In this paper we distinguish between the stressful circumstances that may arise as a result of high interparental conflict and pulls for alignment from a parent, and the real or perceived trauma as a factor which contributes to resistance or refusal of a child to have contact with a parent. Interventions to address both trauma responses and the resist-refuse dynamics are differentiated and discussed. After screening and assessment, the intent is to treat trauma responses with short-term, evidence-based therapy, either before or concurrent with co-parent and family intervention. Key Points for the Family Court Community:Parent-child contact problems may have many causes. When children resist contact with a parent the multiple factors including trauma, that result in this problem must be explored.Assessing the impact and symptoms of interparental conflict and trauma on children and coparents, including emotional dysregulation resulting in feelings of being overwhelmed or needing to avoid is necessary to proceed with a family intervention For family intervention to be successful It is necessary for each family member to be able to manage distressing emotions without feeling overwhelmed or numb and to be able to process information accurately. These issues may result in one of the treatment components that can occur before or at the same time as the family intervention.Delaying contact with a parent generally results in more negative characterization, anxiety and polarization and is generally not recommended. Instead safe, structured contact to begin the process of desensitization should occur once the parent and child have basic skills of coping with and managing distressing thoughts and feelings.

“…With delay, the positions of the children and parents and in some cases their legal representatives, often become cemented during a custody evaluation. These concerns lead some to advocate for family system‐based interventions, including reunification therapies to begin before completion of the litigation process (Deutsch et al, ; Greenberg et al, ; Greenberg & Schnider, ). The efforts, including revealing the willingness and capacity of the family members to change, can inform the evaluation process.…”

Section: Expanding and Refining Interventionsmentioning

confidence: 99%

“…There is much potential for such early interventions, though like all interventions, this approach requires an initial screening for safety, child abuse and violence, and other risk factors such as untreated child and parent mental health problems or mental illness, substance use disorders, a pattern of noncompliance with court orders, severe personality disorders, previous failed intervention efforts, and each parent's readiness or willingness to engage and their responsiveness to change. If a case is found appropriate for the clinical intake and then early intervention, ongoing assessment is necessary to ensure continued safety for the child and victims and for any needed changes to the initial treatment plan (Deutsch et al, ; Fidler & Ward, ; Greenberg & Schnider, ; Marcus, ). Screening for violence and assessment of risk factors needs to continue throughout an intervention and be responded to appropriately, in some cases with a recommendation for the therapy to be modified or to end, combined with a report to child protection services or a recommendation for a comprehensive child custody evaluation, or another type of assessment such as that related to impulse control or substance use.…”

Section: Expanding and Refining Interventionsmentioning

confidence: 99%

Concepts, Controversies And Conundrums Of “Alienation:” Lessons Learned In A Decade And Reflections On Challenges Ahead

Fidler¹,

Bala²

2020

There have been significant advances in understandings and practice related parent-child contact problems (PCCPs), with a growing consensus about some issues and continuing controversy about others. It is widely acknowledged that PCCP cases are most fruitfully understood from a multi-factorial perspective. While some cases may be totally the "fault" of one parent (a parent perpetrating violence or abuse, or a parent exhibiting alienating behavior), in many situations both parents bear some responsibility: focusing on a single cause is rarely helpful. Most professionals and researchers agree that the challenge in practice is to distinguish between false positives and false negatives for both alienation (or unjustified rejection) and realistic estrangement (justified rejection). There is continuing controversy over whether the concept of "alienation" should be used, especially in court proceedings, and a related disagreement about the extent to which family courts are now failing to respond adequately to cases of intimate partner violence (IPV) or child abuse when alienation is also raised. Continuing education, intentional exploration of alternative hypotheses, and active perspective-taking will contribute to effective professional involvement. Increased parent education and prevention can play an important role, although for the more severe PCCP cases the family courts system will continue to play a critical role. While more research must be done, given the complexity of issues, conclusive findings are unlikely in the near future. Legislators and family justice professionals must make decisions based on a thorough analysis of each family's circumstances in the context of our present knowledge, taking account of the limits of the law. They will often face the conundrum of making decisions in the face of uncertainty. Key Points For The Family Court Community:There have been significant advances in understandings and practice related to parent-child contact problems (PCCPs), with a growing consensus about some issues and continuing controversy about others.It is widely acknowledged that PCCPs cases are best understood and addressed by relying on a multi-factorial perspective, a family-systems approach and coordinated professional services.Attention to false positives and false negatives for both alienation (unjustified rejection) and for realistic estrangement (justified rejection) is necessary. For either of these types of contact problems and for cases involving elements of both, it may be in the child's best interest to remedy the strained parent-child relationship and for the child to maintain contact with both parents.Legal and mental health professionals involved in decision making, forensic and clinical assessments, and psychoeducational and clinical interventions face challenges in fact finding and correcting for ubiquitous cognitive biases. Continuing education, intentional exploration of alternative hypotheses, and active dialogue with openness to different perspectives will contribute to effective profess...