(p. 57) Specialized Child and Family Interventions
Court-involved families involved around disputes around child custody and visitation present a conundrum for therapists. These are very special families that differ in substantial ways from the typical clients that therapists see (Association of Family and Conciliation Courts Task Force on Court-Involved Therapy, 2011; Drozd, Saini, & Olesen, 2016; Johnston, Roseby, & Kuehnle, 2009). Feelings are not just intense; they are often fully dysregulated. Developmental tasks are not completed in a timely way. Family structures enter a period of uncertainty. Children and others become triangulated into parental conflict. There often is lack of appropriate boundaries between parental conflict and children. Coparenting atrophies or never develops. Communication breaks down. Legal actions are particularly acrimonious. Families become involved in kin wars. New partners are often brought into relationships with children prematurely or in disruptive ways. The specter of violence is often present. One or more family members often present with personality disorder, personality challenges, or other significant psychopathology. Parent–child difficulties abound with a great deal of blame about who is at fault. Children often present with special difficulties and issues that are intrinsically difficult to negotiate between parents. The issues present are maintained and enhanced by pathogenic exchanges between family members and become interminable.
Psychotherapy in most contexts in which it is employed mostly works. Typically, three out of four cases presenting with the usual problems clients present in psychotherapy (depression, anxiety, relational problems) manifest clinically significant change1 (Datchi & Sexton, 2016; Wampold & Imel, 2015). Although there is substantial literature pointing to the superiority of some treatments in some contexts, for most clients, most therapy is effective. Certain core ingredients of therapy, such as establishing a good therapeutic alliance and generating a sense (p. 58) of hope, are typically enough to help most clients move toward both short-term and longer-term positive change (Norcross & Lambert, 2011), at least for many problems. In the context of the sorts of conflicts over child custody and visitation discussed in this chapter, such a broad nonspecific approach has little chance of being effective. These cases present with certain key properties that distinguish them from other cases, and there are several necessary ingredients in intervention with these cases. These are also cases that require the therapist to have a considerable therapeutic toolkit to work with them. It is not so much that there is one central crucial intervention, as much as that the therapist needs to have available a range of possibly effective interventions, which can be engaged to work with the often now chronic problems in these families.
Two key facts are essential to understanding treatment with these families and children. First, the damaging effects of living in the context of difficult separation and divorce are well known. Research has clearly demonstrated the toxic effects on children of high conflict in families that divorce (Emery & Dinescu, 2016; Johnston et al., 2009). Although a few resilient children may survive unimpeded, in this clinical context even those children who keep their grades up and do not show overt psychopathology, often show collateral damage of other kinds from these conflicts.2 The negative impact on most other family members is also apparent, as these family members simultaneously complain about the detrimental effects on them of the family conflict even as they engage in that conflict (Hetherington & Elmore, 2003). It is important to add the qualifier that some families engage in these conflicts for better reasons; for example, when there is a parent who is dangerous for children and who will not acknowledge that danger. However, the systemic problem remains, given that most of those who are engaged in dysfunctional conflicts incorporate a narrative that they are serving the best interest of their children.
Second, although it is fairly easy to distinguish these families from others who do not engage in such conflicts, what precisely makes a family expose children to intense conflict is not always clear. Families that look like these families in many external ways may harbor extreme negative feelings but find ways to negotiate differences or, at the very least, find ways for those differences to not have a pervasive effect on the everyday life of the family. Sometimes, very dysfunctional families can resolve differences, whereas sometimes more functional families cannot. Clearly, a systemic process, like a virus, spreads in these families that make for special difficulties. One stuck element can set off a process that spirals down (p. 59) into the morass of this kind of conflict. This spiral is potentiated by a variety of elements such as radically different visions of divorce and postdivorce life, deep senses of injury, poor communication processes, triangulation of children into the conflict, individual psychopathology, and neither partner having the ability to differentiate from the conflict (Lebow, 2019). Once very deeply into such conflict, it becomes quite difficult for either parents or children to extract themselves.
Given the absolute stuck quality of many of these cases and the out-of-control systemic processes often involved evident to everyone who encounters the family, courts look to therapists to be helpful in their treatment. Typically, these families breeze through typical court-ordered mediation without much of a pause or any success (Pruett & Johnston, 2004). This chapter summarizes a set of useful guidelines and strategies for working with these families. A longer exposition of the overall approach to these families can be found in Treating the Difficult Divorce: A Practical Guide for Psychotherapists (Lebow, 2019). Because there has been little research on treatment with these families, these guidelines are derived from clinical experience, observing the work of others who most successfully with these families, and building on strategies, which have acquired considerable evidence for the impact in other related contexts such as anger management and other high conflict relationships as well as the research about what is known about these families.
Establishing an Effective Frame for Therapy
Although most of this chapter focuses on strategies of intervention, the center of any successful work with these families or with members of these families resides in establishing an effective frame for the therapy. In my experience, not only is establishing such a frame a necessary condition for success, failure to do so is fraught with endless issues likely to result in early termination and/or significant difficulties in the treatment (Friedlander, Heatherington, & Escudero, 2016; Heatherington, Friedlander, Diamond, Escudero, & Pinsof, 2015).
First and foremost, experience suggests that on the list of essential characteristics in establishing an effective frame for therapy is the presence of a firm but patient attitude on the part of the therapist. Once in a very great while, some simple intervention may succeed in rapid movement toward therapeutic goals, but this is very much the exception. Clients in these families come to treatment with many complaints, a profound sense of helplessness, little sense of any ownership in the creation or maintenance of problems, and considerable trauma. They feel caught up in a Kafkaesque drama in which there is no solution other than to have the court intervene on their behalf. Therapists must come to these situations not only with a sense of caring and sufficient skill to help move the situation on but also able to frame solutions that may work over time and to patiently work toward those solutions. Communicating a sense that the therapist has seen situations like this (p. 60) one, which have moved toward successful resolution, and has a long-term sense of how to get there is a vital part of successful treatment. This is a sense communicated not so much at one moment in time, but as the therapy unfolds; there is a road to a better life even as the facts of the moment may challenge that sense.
Closely connected to this essential characteristic of successful therapy is forming a successful therapeutic alliance; a positive connection in the service of the tasks and goals of therapy with each member of the family (Pinsof, 1994). It goes without saying that therapies are effective to the extent that strong therapeutic alliances form (Norcross & Lambert, 2014), but in these cases, this is even more true than in others. And the challenges to forming alliances are considerable. Many clients are mandated to treatment, and while this may help with retention, it does not necessarily translate into alliance formation or high levels of cooperation. Rather to seek help, they may be seeking to present “better than the other” in the courts.
The therapist has the difficult tasks of helping move family members in a constructive direction, which in these cases almost invariably includes to some extent pushing against strong beliefs that family members have. Further, having a positive alliance with one family member is often experienced as a threat to an alliance with another. Alliance does not mean allying with client positions. It does mean working to find some core level of client engagement with the therapist and the treatment in the service of problem resolution.
Therefore, using all the relationship-building skills that therapists can manifest is crucial in these cases. Paths toward building alliance include allowing family members to have time to tell their stories, finding less controversial subjects to spend some of the time on, engaging in activities during some of the time together that help in alliance building, and finding that core Rogerian better part of each person to relate to. It also means working to use the motivation clients may have (perhaps to comply with the court or convince the court of their cooperation) in the service of building engagement with therapy.
It also must be added here that while the therapist may have a role with either the entire family or a part of the family, such as a child or the parents, building alliances with the entire family still matters. In fact, one way of reducing the chances of success is creating too strong an alliance with one family member that another family member experiences as threatening. As Pinsof (1994) describes, alliances are both with the direct patient system (those in therapy) and the indirect patient system (those in the family not in therapy who are affected). It is important in the work with clients directly to help all family members understand the therapist has an interest in a positive sense of connection with other family members, and this can be a crucial element in success. Most directly, this is manifested in work with children in the therapist being sure to maintain a good connection with parents even as the primary work is being done with one child or multiple children. Therapists who work with children and ignore their parents’ important feelings risk the success of the treatment.
(p. 61) Adding to the complexity of therapy with these families in difficult divorce is the substantial minority of families in which no effort by the therapist will engage certain family members in anything other than perfunctory attendance (if that). In these families, the therapist is left with complex decisions about when to move to the alternate frame of primarily focusing on working with those family members with some motivation to change and seeing whether this might benefit the system as a whole as well as those individuals. Here, first efforts must be to see whether there are ways to build alliance (e.g., around the client’s anger or sense of helplessness in the context of the dispute) or at least mandate attendance (through intervention of the court or attorneys), but when this does not succeed, the therapy algorithm moves to how to best help the system while seeing whether there is some way to limit extent of the negative alliance of the resistant client to the therapy.
Third on the list of essential ingredients in successful therapy lies in creating a positive connection with the representatives of the court around treatments that have court involvement. In these most difficult and complex cases, the aid of such entities as attorneys representing children and the court often is essential to attendance and constructively moving toward the goals of treatment. Working to ensure a positive relationship with the court’s representatives is also crucial to success. This is done both through establishing a working relationship with those in these roles and through cooperation with these individuals and entities in the course of the treatment. This working relationship is especially important when clients are resistant to therapy, where those in other roles such as a child’s attorney can be enlisted act in support of the therapeutic process. These issues are discussed further in Chapters 2, 8, and 9 of this volume.
Fourth, having a clear written therapeutic contract about what is going to occur during the treatment also is an essential underpinning (Greenberg, Martindale, Gould, & Gould-Saltman, 2004). This includes, for example, who is going to attend what sessions, who will pay for sessions, what are client rights in terms of participation and confidentiality, and who decides about the matters that are to be at the center of the therapeutic work. Clients in these cases often have a distorted sense of what is going to occur in therapy. Some even believe the therapy will be more of an evaluation than therapy. Clients also have many fears about confidentiality, some of which are realistic given the therapist may be expected to report to a custody evaluator, the court, or the attorney for the children. Therefore, clarifying in detail what is going to occur is essential to this work. Because everyone is so energized in these cases, it is essential that the parameters and rules of engagement to be in writing, not only for the clients’ own legal purposes but also so they can be sure to understand the process fully.
Fifth, therapists must coordinate with other therapists involved with the family. Multiple therapies can and often are effective, but rarely without active coordination between the therapists. Working with different sets of facts and foci with different clients can readily result in conflicting messages between (p. 62) therapists. Sometimes, therapists even become advocates for their respective clients and thereby become part of the tribal warfare (Johnston & Campbell, 1986). I have reached the point in this work that I decline cases if someone refuses to authorize any communication among therapists. It is important to explain to the clients (or counsel) that they can choose to rule out certain topics for therapist communication (e.g., the status of a new relationship) if the issue is one of privacy.
Finally, it is essential for the therapist to have realistic expectations. Goals can be accomplished, but difficult divorces rarely move toward resolution quickly. It is far better to begin with a frame of improving the situation for one’s client and the family and removing some threats to individual and collective functioning, rather than to imagine the family as fully transforming into a fully functioning divorced family. Such movement is in itself quite an accomplishment and may make the difference between some or all family members remaining mired in dysfunction and more positive outcomes.
An Integrative Framework
There are numerous approaches to psychotherapy. Nested within these approaches are specific strategies and methods for approaching implementing interventions and change. Proponents of various approaches argue about which approach is most effective and which strategies matter the most. Nevertheless, the pervasive nature of the problems in these cases, coupled with the ongoing systemic maintenance of the problems frequently encountered, suggests that these are cases in which various strategies are effective in various ways and that the best chance for resolution lies in bringing to bear those strategies that are most relevant or appropriate to the specific case.3 Which interventions to use, when, and with whom are best determined in relation to ongoing assessment as to what is occurring in a family, what has been effective thus far, any relevant research you can consider, and what might be most relevant to the issue and focus at the moment (Pinsof et al., 2018). I have described an integrative way of working with these cases originally called integrative family therapy for disputes over child custody and visitation and subsequently integrative therapy for difficult divorce (Lebow, 2015; Lebow & Rekart, 2007; Lebow & Slesinger, 2016; Lebow, 2019). Here, the focus is on the specific toolkit of interventions that has proved most useful in many of these cases.
(p. 63) There is much sameness among these cases. Nonetheless, the work in these cases varies considerably from case to case. Good practice is informed by a thorough assessment and formulation leading to a plan for treatment. Different specific interventions are called for in different cases. Given the degree of pathology in these cases, most interventions will have some positive impact, but parsimony in intervention strategy is especially important. There is ample opportunity for endless therapeutic goals inviting endless strategies, but given the inevitable limits of time and resources, careful choice of intervention strategy needs to be made in relation to the case formulation and treatment plan (Greenberg & Lebow, 2016), and what may be acceptable in the context of this family.
Strategies for Intervention
Several key intervention strategies lie at the core of most helpful psychotherapy with families, individual adults, or children experiencing the sorts of disputes over child custody and visitation that result in considerable involvement with the judicial system. Most all of these are active and directive strategies. Although a wide range of intervention may be used at times, the difficult to reach nature of those experiencing these family problems, coupled with the time limited nature of much of this work, points to the advisability of having the center of intervention be active and direct.
Having said that, active direct intervention is effective only to the extent it is presented in a context that allows clients to respond to directives, raise their questions about the concepts and methods involved, work through any doubts they may have about processing the particular therapeutic strategy, and practicing through whatever homework is involved. Gerald Patterson and colleagues (Patterson & Chamberlain, 1994) long ago showed that for directive cognitive behavioral interventions, directives were contraindicated if they were frequently followed by disregard or opposition to the directive. This points to the transcendent importance in working with these families or members of these families for considering each of their individual stages of change and adapting the chosen intervention strategy to that stage of change (Prochaska, Norcross, & DiClemente, 2013). As in good practice in relation to stage of change, useful intervention is targeted in helping clients move one stage of change: that is, to move from precontemplation where they do not see any problem to contemplation where at least they can see the problem although still unable to form a plan for doing anything about the problem or from contemplation where they can begin to see the difficulties they have become involved to action where they find some way to do something useful in relation to those difficulties.
Having said this, what follows is a summary of the what are typically the most useful intervention strategies in therapy with these families and/or the individual (p. 64) family members. These strategies are constituent parts of integrative therapy for difficult divorce (Lebow, 2019) but also represent the most prominent core ways of intervening outside the context of this model (Greenberg, Doi Fick, & Schnider, 2016; Greenberg & Lebow, 2016).
First on the list of intervention strategies must be the protection of clients’ personal safety. Most obvious is physical safety. A significant percentage of the cases of this kind present physical threats to clients and sometimes even to therapists, which need to be proactively dealt with early in the therapeutic process. Based in assessment and in terms of information acquired as the therapy moves forward, decisions need to be made about who is safe to be with whom and what measures need to be taken before and after meetings to protect the safety of those attending. Sometimes, a decision needs to be made to not meet with clients conjointly. Other times, the first stage of treatment must focus with individuals deemed to be dangerous on anger management and self-control.
Beyond questions of physical safety, certain family configurations may be psychologically injurious to family members, and similar safety planning and work with family members to enable conjoint meetings needs to occur around issues of psychological safety. Especially in the context of psychological safety, the therapist must be able to distinguish what truly is damaging from what is experienced as damaging. Skill in working with these issues involves dealing with real threats and engaging a process to help family members become more settled so they can distinguish between what they don’t like and what is actually threatening.
Witnessing (Weingarten, 2016) involves the most basic listening techniques and the therapist empathically responding. Clients often enter these treatments highly traumatized, and the simple act of therapist attending and empathically responding to client concerns not only has value in establishing alliance but also may promote the client experiencing some sense of relief. However, while witnessing is a powerful technique with most individual problems, impact on the kinds of difficulties in highly entrenched cases tends to be limited. In part, this is because clients have told their stories many times over to empathic listeners, who in no way challenge the narrative of the client. These stories often are closely interwoven with creating a narrative that may be better suited to winning a court case than setting a foundation for possible therapeutic gains. Therefore, witnessing is often most useful as an entrée into treatment, rather than as a potent ingredient in behavior change.
(p. 65) Establishing and Maintaining a Solution-Oriented Focus
Families in difficult divorce are caught up in problematic sequences in which feelings are strong and constant. One antidote for this progression is a solution-oriented focus. Best represented in the context of solution-oriented therapy (O’Hanlon & Weiner-Davis, 1989) and narrative therapy (Freedman & Combs, 2015), this focus shifts attention from problems to possible solutions.
In creating the focus on solutions, the therapist first explicitly describes the value of focusing on future behavior changes and then actively and persistently intervenes in ways to recast problem statements into possibilities for finding possible solutions. The therapist reframes statements about problems in forms that are less provocative and have the possibility of being addressed through action. For example, if one former partner obsessively centers on the other’s behavior, the therapist refocuses attention onto what might be done to reduce those concerns or how to better live with the problem in a less damaging way. Statements such as “he is always out of control” are responded to by creating a focus on what specifically might lead to some useful action. The therapist might ask how the client to identify a step necessary toward having fewer angry outbursts or finding a way toward the other’s behavior not affecting them as much. Again, as with the other interventions described here, it is essential for the therapist to keep their focus on impact over the long run, rather than looking to simple attempts to dramatically refocus clients.
Psychoeducation involves the presentation of information about typical psychological reactions to common presenting situations and helpful ways of approaching specific life circumstances. Psychoeducation numbers among best established evidence-based intervention strategies with couples and families (McFarlane, 2016; Pedro-Carroll, 2010).
It is striking in work with families involved in child custody and visitation disputes how limited their information is about the life circumstances in which they find themselves. The reasons for this are straightforward. In the tumult and trauma of this life circumstance, it is hard to seek out objective information about this life circumstance. Furthermore, this is a very special life circumstance, such that some of the most objective information about larger arcs of life does not especially apply (e.g., to believe what your children tell you when they tell you a story about what is occurring in the other parent’s home during an interparental conflict). This is a life circumstance in which people seek out information most consistent with their world view. In the 21st century, the Internet is filled with websites that point to exaggerated concerns about divorce, over-the-top pronouncements about men’s and women’s rights, and postings that relate the most frequently encountered behaviors to extreme psychopathology on the part (p. 66) of a family member. In this world of alternate facts, it is easy for those involved to come away from their “research” with a sense that can support almost any wrong-headed action. In years of the clinical experience, I have yet to find a parent who presented psychoeducational information from the Internet that did not perfectly mirror their own perspective. For example, it is not uncommon to hear one parent “diagnosing” the other as having a narcissistic or personality disorder, while noting that he or she is not a mental health professional but knows this to be true.
Thus, finding a way to present the most important and relevant psychoeducational information in a way that is accessible to clients is an outstanding challenge in this work. Therapist skill mostly here depends on pairing psychoeducation with witnessing, alliance building, motivational interviewing, and various calming interventions so that the information can be integrated. Delivering psychoeducation is often a process of presenting information, encountering client resistance to absorbing that information, and revisiting that information at various moments where it is especially applicable in the context of other work designed to enhance client receptivity. It also depends on sequencing psychoeducation to enhance its assimilation. For example, information that adult conflict is harmful to children is more easily incorporated than information that challenges a parent’s view of how custody is best allocated to two working parents.
There are many potential foci for psychoeducation. The one in which there is the most universal agreement among experts, and the one most frequently presented by the court, focuses on the deleterious effects of adult conflict and toxic stress on children (Emery & Dinescu, 2016). Bringing that information into focus in some salient way, particularly in relation to specific behaviors emerging on the part of children, is an essential part of work with the parents. An attribution often made by parents is that the damage being experienced is either inevitable in divorce or specifically due to the other parent’s behavior. Citing the statistics on the deleterious effects of interparental conflict on children and the triangulation of children in separating/divorcing families can help refocus parental attention on what parents can do to help their children. In many instances, once the research is made plain, they can more fully appreciate that if they want their children to be reasonably well-adjusted, the parents have no choice but to develop strategies to protect their children from the adult conflict.
A second major psychoeducational topic is skillful parenting. In many of these conflicts, one or both parents have major deficits in parenting. One of the most frequent ways this comes to occur is that one or the other parent comes to the divorce with little experience as a parent (usually in the context of the traditional family arrangement where one parent does most of the parenting). This leaves the second parent with the dilemma of now having time with children without having developed an adequate parental skill set. Offering these parents information about how to parent more successfully is enormously helpful, both in increasing their skill and helping allay the other parent’s fears. For more skillful parents, helping them better understand that developing such skills is a developmental process (which (p. 67) most less-involved parents do eventually master) is also helpful. Additionally, for all parents, parenting needs to occur in a new context and one that is often highly stressed around time. Information about how single or repartnered parents do this more successfully is also enormously helpful.
This readily also segues into considerations about the importance of coparenting as one means of removing children from parental conflict and how some minimal mode of coparenting might develop. Parents who have a strong aversion to coparenting often do not use or even know about different models for coparenting. In the context of these disputes, we are not talking about highly involved or cooperative coparenting, but how to establish that being collectively on the same page about fundamentals of parenting and avoiding major conflicts has value to the welfare of not only the children but also to the parents. Through psychoeducation, the therapist can present ways that similar families with similar histories manage to establish a disengaged business-like model of coparenting.
Closely linked here is the important psychoeducational information about bringing new parent figures into children’s lives. These families often do this poorly, principally through not allowing sufficient time to adapt to the first transition of divorce or through too rapidly assigning new stepparents major parenting functions. Providing a sense of how families successfully move through the transition to divorce and into the further transition many experience in new stepfamilies can help provide guidelines for approaching these transitions in a more constructive way.
Another major focus of psychoeducation is the treacherous nature of being in these conflicts, particularly when in the legal system. Like being in a theater of war, predictable and expected things will happen that will be experienced negatively. For example, one well-known scenario is when family members find better ways to work together, only to be followed by one parent receiving a threatening document prepared by attorneys based on earlier circumstances that then comes to be received as an act of betrayal. Understanding how things work in processes such as the adversarial process that many clients find themselves in can help provide additional room for coping with these circumstances.
Psychoeducation is also crucial in work directly with children. Most often, children have nowhere to learn about divorce other than from the dysfunctional processes occurring within the family and the often-distorted communications about the divorce from family members. Simple and clear communication that not only incorporates the sense of loss involved in divorce but also speaks to this being a transition that can be mastered can be enormously helpful in reassuring and redirecting children. Identifying specific coping skills, including how to differentiate from interparental conflict, goes a long way to helping children and adolescents negotiate this transition. There are a variety of books and materials that are available for children of different ages and in various family situations. Some examples include What in the World Do You Do When Your (p. 68) Parents Divorce? A Survival Guide for Kids (Winchester & Beyer, 2001), Divorce Is Not the End of the World (Stern & Stern, 2008), and It’s Not Your Fault, Koko Bear (Lansky, 1998).
Motivational interviewing developed by William Miller consist of a set of techniques designed to increase client motivation to change (Miller & Rollnick, 2002). These methods are a natural fit when working with this population, so many of whom, be they adults or children, do not believe they have any aspect of their own lives to change. In the special variation on precontemplation in these individuals, there clearly is a sense of problem, but it is seen as fully located in others, not in self. Motivational interviewing consists of establishing an empathic connection and looking for ways to engage the clients to increase motivation. Techniques involved include helping clients to clarify their values, consider possible differences between their values and behavior, examine their views of the future, and what it will be like if things continue as they are and actively raising the question about whether there might be value in not changing at all. For those who show reluctance to engage in positive steps toward change, assuming such a stance can help reduce the sense of reactivity to the therapist or the legal system. Further, it allows for exploration of whether within the client there might be some parts that may be able to move toward at least some change. It goes without saying here that for many clients presenting with this kind of difficulty, the differences between how a people might want to see themselves and how they are acting is often massive. It is a considerable breakthrough if clients can come to find some degree of greater objectivity in considering their own role in their present situation.
Behavioral strategies are derived from principles of classical conditioning, operant conditioning, and social learning theory (Barlow, Conklin, & Bentley, 2015; Dattilio & Epstein, 2016; Goldfried, 1994). They mostly involve either teaching and practicing how to do various psychosocial behaviors or arranging contingencies so the principles of classical and operant conditioning can be invoked to help clients display more effective repertoires of behaviors.
The intervention strategy most frequently employed that draws on classical conditioning in these cases is exposure. Just as clients come to associate stimuli such as heights or airplanes with fear and distress, adults and children in these families often have similar visceral reactions to other family members. Exposure in the context of preparation that promotes relaxation and other coping responses can help reduce the sense of distress in the presence of these other family members. However, the preparation involved and creation of a holding environment that can (p. 69) reduce reactivity must be highlighted; exposure alone is usually experienced with flooding that only reinforces the internal sense of distress.
One place operant and social learning strategies are particularly relevant is to help enable more authoritative parenting. These methods are at the core of parenting programs regardless of the target symptoms or behavior. In such work, therapists teach and model to parents the regular and dependable use of rewards and consequences and a parallel set of positive warm and connected behaviors to build attachment. Parents then apply these methods with their children, with the result processed in sessions involving both parents and children. All the behavioral methods are predicated on considerable practice outside of meetings, followed by feedback about how that practice has gone, and further shaping of the behaviors and focus in relation to that feedback.
Difficult divorce often involves family units that have become stuck in moving to new (typically single-parent) structures in the context of disputes over child custody and parenting time. Effective coparenting is notably absent or highly conflictual in these families. Structural family therapy interventions focus on establishing the core necessities for a functional family structure (Minuchin, 1974). These include creating flexible but permeable boundaries, flexible but stable alliances between family members that are not pathogenic, and an equitable distribution of power between family members. Directive intervention suggests and helps facilitate movement to create such boundaries, alliances, and distribution of power. Particularly important for these cases is to find ways to, at the very least, have the parental coalition not be fully dysfunctional and to rein in overly strong child–parent alliances that can become dominant in these families (Kelly & Johnston, 2001).
Establishing Reliable, Rule-Driven Methods of Communication and Good Enough Coordination
Communication training is a core aspect of couple and family therapy (Dattilio & Epstein, 2016). In court-involved families characterized by significant levels of conflict, frequently communication has fully broken down and successful vehicles for the sharing of essential information are unavailable. Part of this work lies in introducing a speaker–listener technique, such that speakers practice speaking clearly, and listeners practice listening well (Stanley, Markman, Blumberg, & Eckstein, 1997). The speaker–listener technique needs to be simplified further beyond its use in more traditional couple/family therapy, such that it is reduced to being sure information about topics such as coparenting is communicated and heard with a minimum of exchange (Diamond & Lebow, 2016) Further, for many of these families any kind of verbal communication is problematic and, at least at the beginning of the work, aims to find some form of communication that can (p. 70) allow for the successful passage of information. Thus, texting, email, and divorce communication websites, such as Our Family Wizard, are utilized. However, the communication training in this context is no less complex, especially given the frequent realistic fear that written communication will be used as evidence in the litigation. Whether verbal or written, the goal is to find a safe and secure simple minimal system for communication both between parents and between parents and children. Success typically lies in keeping goals limited to just enough communication to allow for the minimal needed coparenting
Negotiation and Problem-Solving
Negotiation is a central intervention in couple and family therapy (Baucom, Epstein, Kirby, & LaTaillade, 2015; Dattilio & Epstein, 2016; Jacobson & Margolin, 1979). In therapy with members of these families finding some basis for negotiation between parents and even between parents and children is an important goal.4 Efforts in negotiation in therapy involve a highly structured process much different to that in some stereotypes of talking therapy. In this process, family members are encouraged to brainstorm about possible solutions, to communicate their preferred solutions, and then to see whether there can be some way to at least compromise toward resolution. Negotiation about principal issues in the divorce conflict, such as who will have the children when, is left to those in the legal process. Here, the negotiation focuses on the sorts of issues that appear frequently and inevitably need to be resolved but do not rise to the level of the major foci of the legal dispute, such as how pick-ups/drop-offs, diets, bedtimes, and homework are handled. Such issues not being worked out between parents can be highly disruptive for children and have major effects on their functioning (Greenberg & Lebow, 2016; Johnston, Roseby, & Kuehnle, 2009). The hope is that by developing such minimal negotiation skills clients will be able to carry those skills forward beyond the time of the legal dispute therapy. Again, as with the development of communication, the goals for negotiation are best kept at a realistic level, with the hope that a simple application of principles for negotiation can ultimately transfer to conversations between the parents (see Chapters 5 and 8 of this volume).
Mindful Practice and Radical Acceptance Strategies
Mindful practice is become a very popular focus of skill development in therapy, just as it has become common practice in the lay world. It is now a well-established evidence-based method for helping reduce tension, anxiety, and depression, and anger (Kabat-Zinn, 2012) and is becoming increasingly used with children and (p. 71) adolescents (e.g., http://www.stressedteens.com; Kabat-Zinn, 2012). All these problematic behaviors are very prevalent in high conflict divorce, and, thus, it is a natural fit in this context. Furthermore, mindful practice carries with it the virtue that it is hard to conceive of this specific method as serving one client over another and thus is well suited to these cases in helping move the frame away from one person being viewed as the problem. In fact, I have found one of the most successful frames for employing mindful practice in high conflict divorce is for the mindful practice not to be solely targeted at one person, even though there may be a person in the family who might be particularly suited to the technique, but to the entire family. Mindful practice requires considerable practice before it can be useful in the high conflict environments that characterize these families. There are highly structured methods for teaching mindful practice, such as that of Kabat-Zinn (2012). One option is to engage in such a series of structured meetings with family members, though it often is more parsimonious (particularly with more motivated clients) to introduce mindful practice and outsource the actual practice to a series of tapes, an app, or a class in mindful practice. The therapist’s goal is to provide a sufficient base for practice that the skill can actually be applied in a way that might impact on behavior. Austin and Greenberg (Chapter 10 of this volume) provide more detailed material on understanding and selecting activities to support therapeutic goals.
In a related vein, third-wave behavioral strategies based on radical acceptance (Christensen, Doss, & Jacobson, 2014; Hayes, Strosahl, & Wilson, 2012) are extremely useful in these cases. Here, the therapy aim is on acceptance of that which is beyond a person’s control, a good fit with so many of these clients who center on changing the behavior of others.
Disengagement Skills and Anger Management
In high conflict family dynamics, the ability to disengage is as important as the ability to engage. Given the powerful underlying affects in these families, coupled with personality characteristics or traits that may cause individuals to be prone to rage, sequences of small disagreements leading to affective discharge and angry outbursts are common. Thus, anger management skill training is a crucial strategy. Fortunately, there is a very well-developed technology for teaching and practicing anger management skills and considerable evidence for its efficacy (Karam & Lebow, 2006; Moran, Weinstock, & Butler, in press; Saini, 2009). Clients are taught and practice how to respectfully disengage from conflict that includes ways of emotional self-regulation, responding to challenging behaviors and statements, and selective appropriate use of taking time outs that pause the conflict. Time-out arrangements are not only the product of individual anger management but also a major shared strategy toward anger management in conflictual dyads, be they divorcing couples or parents and children. Dyads also benefit from being helped to see the sequence of behaviors that lead up to conflict and the steps that can be taken to reduce conflict at each of those steps.
(p. 72) Reattribution and Narrative Change
Cognitions play an important role in relational functioning. Particularly central in difficult divorce are negative attributions about others; this is where one family interprets the actions of another in the worst possible way. Negative sentiment override is frequently dominant, in which even the best intended behaviors are interpreted negatively (Gottman & Gottman, 2015). In a more benign divorce context, such attributions help create distance, reaffirm any positive meanings of ending the relationship, and mitigate a sense of loss. However, in these difficult divorces, my observation is that such cognitions become an essential ingredient in the maintenance of intractable conflict. Problematic actions of one person are invariably viewed as evidence of character flaws in the other, whereas positive behaviors and intent are minimized.
As noted, there are very well-established evidence-based methods for helping work with such cognitions. Strategies from cognitive, rational emotive, and the narrative therapies all specifically target such attributions (Beck, 2011). Most common is to employ Socratic questioning in relation to strong and often inflexible belief systems. What is the evidence for the beliefs? Is there evidence that might question the belief? What are the pros and the cons of assuming one’s present position toward one’s former spouse or one’s child or parent? Adapting this to work with parents, one might explore what their underlying cognitions and schemas are about gendered roles of parents, distinguishing more objective information about parenting that is occurring from other thoughts about their former partner, and differentiating their own thoughts from those of their children. Reattribution can help family members consider at least the possibility there may be an upside to looking at the behaviors in question in a different way: that is, to be able to consider multiple perspectives and the possibility that the two or more different ways of viewing a situation may each have merit. At the very least, it may be that even if cognitions themselves cannot be challenged, at a pragmatic level the client can engage in a dialogue about the benefits of bringing such a provocative vantage point into interactions. Closely related, it may be that clients, even without changing their cognitions, can learn the wisdom of not contaminating their children with those thoughts. Clearly, there are few circumstances in which holding and freely expressing such a vantage point is functional.
Exploring Underlying Emotion
Family members experiencing divorce typically feel traumatized and injured (Hetherington & Kelly, 2002). Therapy can be a safe place to share strong feelings and can yield considerable benefits, particularly in individual meetings with therapist. Sometimes clients discover that the strong feelings on the surface actually mask a deeper more painful feeling. For example, sometimes anger is what is evident, but shame and hurt lie beneath (Greenberg, 2011). Clearly, those in these disputes are in a great deal of pain, and, with the right client, accessing and (p. 73) working with that feeling can provide a sense of relief and even, at times, emotional transformation.
However, my sense is that such exploration of underlying emotion is in most instances less useful in conjoint therapy contexts with these families. In fact, the access to surface emotion often preoccupies clients. The responsibilities of the conjoint therapist, however, mostly reside in finding ways to work toward constructive ends even with such emotion underlying. Furthermore, most clients and these families are highly sensitive to the expression of strong negative feeling by others, leaving the distinct possibility of a negative reaction to what may even be a constructive accessing of emotion. Therefore, while such explorations may be useful in a client’s individual therapy or individual sessions with clients, caution and a great deal of preparation must be undertaken to deal with such emotions together. In individual meetings, accessing underlying hurt is a complex project but at times can help enable major shifts in behavior.
Exploring Individual Psychodynamics
Addressing the individual histories of parents and children and the internal conflicts that are present similarly represents a complicated territory in divorce therapy. Few clients enter such a therapy looking to do this kind of work as other issues predominate. In my view, and given the needed emphasis on direct problem-solving, such work may be most appropriate for the client’s individual therapy or in brief forays into this territory in occasional individual sessions with clients unless more direct efforts to work with the problems in the divorce are not successful and a parent’s individual dynamics significantly impede progress (Pinsof et al., 2018). As with the exploration of emotion, work centered on exploring individual psychodynamics is best reserved for individual therapy or individual sessions in the context of a conjoint therapy. There, with the therapist fully focused on that one client, and less sense of threat from others, such exploration into underlying meanings can be beneficial.
Combining strategies is the art of effective treatment. Largely, when to do what is best the product of what emerges as essential in the case formulation. It also must be informed by the extent to which various therapy strategies are acceptable to and productive with the clients. Doing more of what works is usually indicated, while (p. 74) recognizing what may not be working well and then adjusting the approach accordingly. Assessment, case formulation, and intervention are ongoing processes that mutually inform one another.
In general, beginning with the simpler, most direct intervention strategies is advisable. Also, interventions that address urgent matters (such as containing the possibility of violence) have the highest priority. Typically, mindfulness and behavioral control strategies are easiest to learn and can bring some initial effect on the problems in focus quickly. The strategies that focus on working with thoughts and emotion readily follow. Still, such choices always must be filtered through the wildcard of which intervention strategies are most acceptable to clients, and the vital information gathered as therapy proceeds about which strategies best connect with clients and show early results of helping move the problem along (Lambert & Shimokawa, 2016; Pinsof et al., 2018).
Choosing Session Formats
The best therapy when working with difficult divorce combines individual, dyadic, and family treatment formats. Nonetheless, in the practical world, the most appropriate treatment formats chosen in a specific case are derived from a number of factors. One is the nature of the referral. The court and those connected to the court often have clear goals when making a referral, and it is important to be responsive to those goals. For example, the court may be most concerned about the individual functioning of a child or chaotic parent arguments. At the same time, the therapist has the best expertise to assess what format is likely to be helpful in what way and toward what end. For example, a child may be referred for individual therapy, when there is almost no likelihood that therapy for the child alone will have much impact at all on the problem in focus, given that so much of the difficulty resides in interaction between the parents or between a parent and a child. Therefore, a three-way conversation between the referral source, therapist, and clients is needed to ascertain what may be the best formats for treatment. As already noted in these very difficult cases, a strong argument can be made for every person being in every format of treatment. Because this is not often feasible, parsimonious choices need to be made about what resources to bring to bear with whom and toward what ends. Much of what is essential in therapy with such a family or members of such a family resides in identifying unambiguous goals in terms of both the process and the outcomes. These choices also require the therapist to adjust formats and session structure based on client needs and client progress. This is an inexact science, based on a combination of available research, clinical experience, and careful observation of the family. To be responsive to families’ needs, it is essential that the consent process empower the therapist to make those adjustments.
Having said all this, different therapy formats are most conducive to different sorts of process goals in treatment. Family formats are most useful in meetings (p. 75) in helping new family units organize more successfully and work together better. Only rarely does it prove useful to assemble the entire predivorce constellation, given the many possibilities for problems arising in such meetings, such as major conflicts and triangulation of children. The one instance where that format tends to be most helpful is when two parents share a set of concerns about one or more children and are prepared to work together toward helping that child or children. At times, when extended family play prominent roles in the conflict (especially often the case with young parents), their inclusion in meetings with the parent to whom they are related may make the major difference in therapy.
The dyadic format is most useful in dealing with conflicts between family members, most especially, between two parents with one another and when there are conflicts between a parent and a child. That format allows for dialogue, and especially if these meetings can be supplemented with some time with each individual, such conjoint meetings can provide opportunities for joint problem-solving and a lessening of the difficulties.
The individual format is most useful for working with adults or children, on their respective involvement in and responses to the difficulties. For example, a child may be helped to work on their feelings of efficacy in the context of a family conflict (Greenberg & Lebow, 2016; also see Chapter 1 in this volume). Alternately, if a parent has anger control issues, it may be better to approach these problems in a therapeutic context separate from the child (i.e., individual session or a separate anger management intervention). Once the parent has improved their skill set sufficiently, it will be emotionally safer to address these issues in the presence of a child (see Chapters 8 and 11 in this volume for further information). This could occur via separate but coordinated therapies, a referral to an appropriate group program or a single family therapist who conducts individual, dyadic, or family meetings aimed at comprehensively dealing with the problems at issue.
The Interface with the Judicial System
A major unique factor in these cases is that the judicial system is involved. This both presents challenges and adds possibilities. The challenges include dealing with clients’ reactivity to the legal system, their concerns about confidentiality, the possible need for reporting on progress, and the frequent presence of mandated clients without personal motivation. On the positive side, court involvement enhances accountability and the possibilities for continued involvement even among those who are reluctant and often means that others with therapeutic goals in mind are present and active in interactions with the clients. Therapists who work with these cases learn how to collaborate well with and leverage support from those in the judicial system. Chapters 2, 8, and 9 in this volume elaborate on the interface between work with these families and the judicial system.
(p. 76) Coda
This chapter has provided a tour of the major therapeutic methods involved in working with court-involved families involved in child custody and parenting time disputes. Given space limitations, it has remained focused on the larger picture. There are specific literatures and manuals that cover each of the intervention strategies described (consult the citations in each section for further reading). There also are a variety of tools, including books, plays, videos, and games for helping children of various ages engage with the therapeutic strategies described. Additionally, specific versions of these strategies need to be tailored to the more specific problems encountered in these cases, such as interparental conflict, child–parent conflict, child–parent estrangement, kin wars, and individual psychopathology that may be present in adults or children. As noted earlier, it is helpful for therapists to have broad-ranging tool kits for working with the varied problems that frequently appear, as well as outside resources to refer clients to when they require more specialized service.
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2 Here it important to note we are not discussing the impact of divorce on the general divorcing population, where the effects tend to be less pronounced, but living in the treacherous territory of families with the sorts of issues that present in difficult divorce. It also should be added that these toxic effects are equally prevalent when similar conflict patterns occur between partners who have never been married.
3 Some therapy methods are almost always a poor fit with work with this population. These include methods that highlight the direct expression of unprocessed emotion; passive reflective methods, which allow much space for clients to perceive the therapist as being in support of destructive behavior; and very indirect methods such as interpretative play therapy with children.