Steven Friedlander, Ph.D. - Guest
Dr. Friedlander is a clinical psychologist with a special expertise working with families when a child is refusing or resisting contact with a parent. His most recent publications have focused on post-divorce disruption of family relationships, and interventions designed to resolve those problems. Dr. Friedlander facilitates consultation groups for other professionals which focus on interventions with families when a child resists/refuses contact with a parent, and parent coordination in high conflict families. He previously served on the Board of Directors of the California chapter of the Association of Family and Conciliation Courts (AFCC-CA) from 2005-2014. Dr. Friedlander is Clinical Professor Emeritus in the Department of Psychiatry, University of California San Francisco |
W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Dr. Keith Sutton: (00:22)
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area and the Director of the Institute for the Advancement of Psychotherapy. Today, I'll be speaking with Steven Friedlander PhD, who is a licensed clinical psychologist with special expertise in working with families when a child is refusing or resisting contact with a parent. His most recent publications have focused on post-divorce disruption of family relationships, and interventions designed to resolve those problems. Steven facilitates consultation groups for other professionals, which focus on interventions with families when a child resists or refuses contact with a parent, and parent coordination in high conflict families. He previously served on the board of directors of the California Chapter of the Association of Family and Conciliatory Courts, and is currently Clinical Professor Emeritus in the Department of Psychiatry at University of California, San Francisco. Let's listen to the interview.
Dr. Keith Sutton: (01:23)
Welcome Steven. Thanks for joining us today.
Dr. Steven Friedlander: (01:26)
Pleasure to be here. Thanks for inviting me.
Dr. Keith Sutton: (01:29)
Yeah. So I got your contact information from Marjorie Ganz Walter, who I have gotten consultation from in the past. I had been in her consult group on high conflict divorce, and, you know, I'm really interested in this area. I actually don't do, kind of, more high conflict divorce, kind of court ordered work. Although I work with many families, children, adolescents, adults, couples, where divorce is involved either, you know, they're going through that process or have gone or thinking about going through that process. So I know that you have expertise in this area and before we even kind of get to that, I'd love to hear about your career and how you got into this area of specialty.
Dr. Steven Friedlander: (02:12)
That's a, that's a great question. My career started out pretty traditionally in terms of an interest in psychotherapy. I did two and a half years of teaching in a special service elementary school in New York City and the South Bronx of New York. And that was while I was in graduate school. And that experience was a really transformational one for me in terms of focusing on children and families. So when I finished some graduate, I got my master's degree from the University of New York and headed to graduate school and was really embarked on, what in my mind was a traditional career, doing psychotherapy. I had been steeped in psychoanalytic kind of thinking and psychodynamic thinking, and when I got to graduate school, I was confronted with the whole burgeoning behavioral and social learning theory. And it was a dramatic challenge for me to sort of combine the two. And I went ahead and trained at Langley Porter at UCSF, did my preclinical training there then did a post-doc at UC Berkeley. And then I was invited onto the faculty at UCSF. And I was there for a full-time faculty there for 11 years in the child and adolescent psychiatry program, really working with families. We were studying childhood depression, I was teaching in the clinical psychology program and the child psychiatry program. And after being there for 11 years, for a combination of factors, I left my full-time position and continued teaching up until just a few years ago. And shortly after I left, I was asked to do a child sexual abuse evaluation. I had been indirectly involved in one of the big headline child sexual abuse issues back then in the eighties. And so I did this child sexual abuse evaluation, and the judge kind of liked the report, and so shortly after that asked me if I was interested in doing a custody evaluation, and I had no training or interest, no work, no knowledge about that, but I agreed to do it. And so I did a few custody evaluations and it was around that time that a group of us you know, really icons in the field...Joan Kelly and Jan Johnston sort of convened what we thought of at the time as a study group. And there was a group of us in this study group, many of whom, almost all of whom have become sort of luminaries in the field at this point. But it was to study what had been labeled parental alienation, a situation where post divorce, a child resists or refuses to spend time with the parent. And there's no logical, justifiable reason. And Richard Gardner had written, identified the issue, and labeled it the parental alienation syndrome, and it created a lot of controversy.
Dr. Steven Friedlander: (05:52)
So while we had convened to do this study group, and we were going to rethink this concept of parental alienation. And at the same time I was getting more and more involved in the family law aspect of working as a psychologist. And I did some training in mediation, I did training in what we called then special master or parenting coordination. And my practice started growing where I was doing a lot of work with children of divorce and families of divorce and working also as a parenting coordinator working with parents and helping them make decisions in these very high conflict divorce cases. And after several years of this study group, we all kind of rethought the whole concept of parental alienation. And out of that study group came four papers, four publications, which really had a significant impact, I think, on the field. And the main one was by Joan Kelly and Jan Johnson called the Reformulation of the Parental Alienation Hypothesis, where the focus was on the child. And then the rest of us did sort of offshoots of that. So several people wrote about the assessment of how to assess parental alienation. Several people wrote about the legal aspects of it. And Jan Johnston, Marjorie Walters, and I wrote about treatment. So in 2001, the paper came out about treatment, and Marjorie and I developed a very, very close working relationship, and we continued to work together and to share our experiences, trying to help these families. And, let's see, so that paper came out, the original paper came out in 2001, so nine years later after quite a bit of clinical experience Marjorie and I published our first paper, which was a follow-up to that first paper with Jan Johnson. And it was just an elaboration and extension based on our clinical experience over those eight or nine years. And we tried to refine the intervention. And intervening with these families, and trying to help these families is a very, very challenging situation. They're in the family court. The traditional adversarial system is not suited for helping most families of divorce, but certainly these families. And what we're talking about is we've got high conflict, we have divorce, and we have high conflict divorce, which is maybe 10 to 20%, depends on what data you're looking at.
Dr. Keith Sutton: (09:30)
And that's one thing actually I'm interested in this area because I think that both myself and other clinicians that I've worked with end up working with families, there are many families of course that have experienced separation, divorce, and remarriage. But some of these situations like this, where I guess they would be termed high conflict divorce, they're really kind of a separate situation that oftentimes needs some special training. And really there's a number of different roles. Actually I don't know if you know David Friedman, but he's actually doing a training for one of the organizations locally on those different roles, because you know that there's the special master role, there's a co-parenting role, there's the custody evaluation, evaluation role. And, you know, also then the therapist, and really for many therapists, they're terrified of working with these types of situations, especially with court involvement, because those are one of the highest situations where there's reports to licensing boards, potential of getting attempts at being sued and these kinds of things. And so I think that that's a big concern, I would love to hear about your thoughts on these different roles and what therapists need to know in working with these situations, on how to navigate that or get consultation or so on, or to think about it.
Dr. Steven Friedlander: (10:50)
Right. Well, I think this is probably an instance in which, I don't know if therapists should be terrified, but I think that therapists should be appropriately cautious about getting involved with these cases, especially court involved cases, unless they have some special training or expertise in it. And it's certainly the case when we're talking about families where a child has resisted or refused contact with a parent. You have to have very specialized knowledge and training to work with these families. And if you don't, that's an invitation to become involved in a potentially negative way, in a way that's not helpful at all in spite of the best of intentions. And the various roles that one can serve with these high conflict divorce cases are all intertwined in some way. So in very high conflict cases, these are people who wound up in court regularly, and so at some point, the idea emerged that maybe there's a way to keep these people out of court.
Dr. Steven Friedlander: (12:17)
And that was to import the idea of a special master, which had been operative in industry, and the NFL, and in negotiations between ownership and workers, et cetera, to resolve differences, alternative dispute resolution, how to resolve a difference of opinion in a less contentious way. So the concept of the special master was imported into family law. And I remember one of the judges saying it's not a good use of court time to make a decision about whether Johnny should wear a blue shirt or a red shirt. We need some other way of making these decisions. And so the concept of the special master was born, where the court transfers some of its authority to make decisions, binding decisions on families, to the special master, so that a special master can make a decision that has the same force as a court order. That has evolved now, because there was a case in which a family objected and the Supreme Court held, I think it was the Supreme Court, held that the court could not force people to use a special master because they lost their right to a day in court.
Dr. Steven Friedlander: (13:54)
So now the term that we use is parenting coordinator and it is not something the court can order, but it is something that the parents can agree to and stipulate to. And usually the parenting coordinator, can, there's a stipulation that outlines here are the areas in which the parenting coordinator can make a decision that has the effect of a court order. And then there are additional areas where the parenting coordinator can make a recommendation. And if the recommendation is not accepted by both parents, it can go to court. And then the judge makes a determination. So that's the parenting coordinator role. And it's been very, very helpful and very useful, that has also evolved the roll, which sometimes is confused with the parenting coordinator, called a co-parent counselor, which is a very different kind of endeavor.
Dr. Steven Friedlander: (15:03)
This is where you meet with both parents post separation or divorce. And the job is really to help them develop a working relationship so that they can raise their children together. In spite of the fact that they are divorced. And in spite of the fact that they may not get along at all, and the co-parent counselor does not have any authority to make any decisions, but it's a combination of counseling mediation education you'll often explain to parents, well, this is not good for kids for this reason, or, you know, your child is in this particular developmental stage. That's why he's acting out in this way.
Dr. Keith Sutton: (15:53)
Yeah, that's what I've thought about, or what I know, you know, co-parenting folks they oftentimes are speaking on behalf of the child, like this is what the child needs at this developmental, which might be a little different than kind of as a family therapist, you might be kind of balancing all the relationships and working with each kind of person and keeping the rapport. Not that they're not keeping rapport, but they're more saying like here's the information that's needed and how do we work together to help that child, even if it's maybe not what the parent wants to hear or one parents or so on.
Dr. Steven Friedlander: (16:26)
Right. It's very different. It is different from family therapy and it's different in several ways. First of all, it's not therapy, although, you know, you hope it can be therapeutic, it's not therapy. And one of the hallmarks of co-parent counseling is we try to be a historical. Parents, want to come in and talk about what's happened in the past. And what we try to do is help them focus on moving forward. You've got a five-year-old kid you're going to have to have a relationship with each other for the next 15 years where you're going to be raising this child and making decisions together. Let's see if we can build a relationship that helps you do that. And of course, the goal is to make the co-parent counselor, it's kind of like raising a child, to make the co-parent counselor unnecessary. So you build a relationship. And many times what's done is a parenting plan is written so that it becomes the basis on which decisions get made and how vacations are shared and how medical decisions are made and educational decisions are made. So it can be very, very helpful. I sometimes tell parents and co-parent counseling, I say, I wish that I could have a picture of your kids kind of on my shoulders so that when you're looking at me, you're seeing your kids, because that's who I'm representing in this process. I'm doing what I think, I'm trying to help you do what's best for your kids.
Dr. Keith Sutton: (18:09)
Yeah. And I think it was Anne Basso, a therapist in Marin who had said that, it's more that we're asking the parents, we're not going to unpack all the baggage, but more how do we get that baggage across the street to help your child? And I'm wondering too, I had overheard somebody say at one point that the ideal is co-parenting where things are equal at both homes. But the reality is parallel parenting often where the nuances of what time bedtime is and all those kinds of things are more kind of akin to the different home and personality and so on. But the kids, just as they transition to a different set of circumstances and rules and expectations at school, they also kind of transition between the different homes, if there's consistency, even if they're not identical.
Dr. Steven Friedlander: (19:01)
Right. So when we do co-parenting and when we think about a parenting plan, we genuinely do aspire to have a situation where there's as many similarities as possible. If parents can agree on bedtimes, diet, some disciplinary, how to handle discipline, the more consistency there is between homes, the easier it is for the child, generally speaking. And we want that child to feel comfortable moving back and forth. When parents separate and divorce, we ask the child to do the most difficult. To bear the biggest consequence, which is to live in two separate homes. And so what we want to do is to make that work as smoothly as possible, and for the child to feel as secure as possible. So I often tell parents in co-parent counseling, I use the metaphor, I say, I want you to imagine that you're in a 7-47 flying over the Atlantic ocean. And all of a sudden you hit the worst turbulence you've ever hit, and you're sure you're going down, and the pilot comes on the Intercom. What do you want to hear? You want to hear a calm, reassuring voice, we've run into a little turbulence, sit back, relax, we'll take care of it. What don't you want to hear? You don't want to hear the pilot and co-pilot arguing about what the best thing to do is. You don't want to hear them fighting. You want to know that they're in charge and they're in control, and they're going to take care of that airplane. So I tell them, you are the copilots of your child's 7-47, and they have to see you working together, cooperating, calm, making decisions, and leaving your conflict and all the anger, et cetera, we have to set it aside. We have to find a place for it so that you can do what's best for your kids.
Dr. Keith Sutton: (21:18)
Yeah. I'm wondering too about, and we'll get specifically into the kind of parental alienation, refusal type of situations, but in the more average kind of divorce or bordering on high conflict divorce, what is the role of the therapist, maybe working with the child or particularly for myself, I work systemically. So I'm working with the kids sometimes individually, sometimes I'm working with the parents, oftentimes when I'm working with a divorce or separated or non married couple, having some sessions with the kids and one parent, and the kid and the other parents. Do you have any thoughts or advice for therapists on how to kind of balance within that and work with, say a co-parenting specialist, or work with a special master or so on and what their roles might be within that kind of aspect?
Dr. Steven Friedlander: (22:12)
Yeah, that's a great question. So in addition to whatever goals you might have as a therapist, just independent of whether the family is divorced or not divorced, for children there are a couple of things that I think are very important. One is to, and this is the message I give to parents as well, and that is, we want the child to feel that it's okay to love both parents. And we want the child to experience each parent being supportive of his or her relationship with the other parent. And so we want the therapist and in terms of the question you're asking, to have a similar perspective, to be facilitating and helping the child have a good relationship with both parents. And in your collateral work with parents, to be conveying that message also. To be conveying to the parent that it's important. It's a gift to the child if you are supportive of the other parent. When you say something positive to your child about the other parent, you not only are helping the child in the relationship with the other parent, but you are strengthening your relationship with the child. And so the same can be held for the therapist. If the therapist is seen as supporting the child and experienced by the child as supporting the child's relationship with both parents, and understanding the difficulties of going back and forth, this gets back to your earlier question, because when there is not a lot of commonality between the two homes, we do see a parallel parenting, which is somewhat more disengaged, where the parents are more disengaged, and there's only communication around necessary decisions. And the two homes may be quite different. And so when the child goes back and forth... children are capable of discrimination learning; they know it's okay to eat potato chips at dad's house, but not at mom's house, they can do that. It's harder for them, but they can do it. So these are the kids that we sometimes see who, when they go to mom's house, they don't ever mention dad. And when they go to dad's house, they don't have ever mentioned mom. Now in one of our papers, Marjorie, Ganz, Walters and I talked about what we call the middle space, the tenable middle space. And that was, ideally there's a place between the homes where the child feels held and comfortable with both parents. That's what we aspire to, but we may not get there.
Dr. Keith Sutton: (25:26)
Kind of like that attachment piece. Please talk more about the parental alienation and parental rejection and these kinds of nuances.
Dr. Steven Friedlander: (25:35)
So we have the high conflict cases, and then a very small percentage of those high conflict cases we see children who either resist or refuse, downright refuse to spend time with a parent. And when that refusal appears to be unjustified, when it appears not to be based on the child's actual experience with the parent, then we start to be concerned about what is causing the refusal or the resistance. And Gardner's approach was to say that this is a function... And he did a great job of delineating what these kids look like. They openly express hatred for the rejected parent, and they give trivial reasons. I worked with a kid once, eight years old, who said he never wanted to have anything at all to do with his father again. And when I asked him if he could explain, help me understand why he felt that way he said that his dad was a taker-backer. I said, well, I've never heard of a taker-backer, what's that? He says my dad goes to Costco, and he buys something and then he takes it back. And that was his reason for never wanting to see his dad again. So this is what Gardner called trivial reasons. And usually we hear repetitive kind of phrases, and they don't sound genuine, they don't sound real. And they may sound rehearsed, and they may sound like the other parents speaking, child has no ambivalence at all even though there may be lots of evidence of a good relationship with that parent in the past, they are totally on ambivalent and totally rejecting. They seem rehearsed, and a real hallmark of this is that the rejection kind of seeps into the extended family of the rejected parent.
Dr. Steven Friedlander: (27:52)
So all of a sudden, I don't want to have anything to do with my grandparents, my aunts, my uncles, my cousins. So when we see that we get concerned, and then what Gardner called our attention to is that usually the aligned parent, or the favorite parent, has in those cases has been saying things or doing things that undermine the relationship with that parent. Sometimes it's intentional, sometimes it's not. I worked with a family where, worked with a little girl. I was the girl's therapist and the girl was resisting time with her dad. This was actually very early before I fully understood all about parent alienation. It was on the internet, and we were reading about it, but the dad kept saying that the mom was alienating the girl, and the mom says, I don't know what he's talking about. And then she called me one day and she said, I need to talk to you. And the mom came in and she said, you know, I looked up this thing about alienation and he's right, I'm doing it. I didn't realize I was doing it, but I am. So sometimes parents do it and they're not even aware of it.
Dr. Keith Sutton: (29:17)
Yeah. And I'm wondering too, I mean, cause I think that I've worked with some families where this was the case and sometimes the parents were saying, oh my child doesn't want to see me anymore, it's due to alienation or rejection, but the parent themselves had some difficulties with, I wouldn't necessarily say narcissistic, but you know, that were unaware of what the kids' needs were, and we're very kind of frustrated. And in these kinds of situations where the kids could point and I like how you're differentiating between things that make sense of why they would reject, versus not because oftentimes it was these situations where the parent was acting in a way that was not good for the relationship with the child. And eventually they didn't want to see them anymore. But then the parent, rather than looking at any of their behavior, identified it as parental rejection or alienation because they could never be doing anything wrong, and maybe the other parent who is doing and really struggling to see any of their side.
Dr. Steven Friedlander: (30:21)
Right. So you're very astutely putting your finger on a number of characteristics of these families. First of all, the keyword is polarization. These cases are dramatically polarized and they characterized by all or nothing or black and white thinking. It's either this or it's either that. And so the paper that, the first paper that Marjorie and I wrote was, I can't remember the exact time, but something like tailoring the intervention to fit the problem. And we identified multiple factors that contribute is not only what the favorite parent is doing, but there are times when the child is resisting or re rejecting a parent because of what that parent has done. And this gets to a point that I should make. And that is when Gardner came out with this idea, it was a lot of sort of political upheaval about it because advocacy groups got very involved.
Dr. Steven Friedlander: (31:22)
Yeah. So, there had been a trend from the tender years doctrine where mothers were assumed to be, you know, the appropriate caretaker. To a more recent phase when fathers were recognized as being important, equally important to the child and the kids need both parents. So fathers were becoming more and more involved. And when Gardner came out with this parental alienation idea, women's groups, and especially domestic violence groups became upset because some fathers were using parental alienation as a way of blaming the mother. And they were seen as potentially abusive parents who were trying to blame the mother for the child's behavior,
Dr. Keith Sutton: (32:18)
Like power and control.
Dr. Steven Friedlander: (32:19)
Right? Exactly. So then father's rights groups got involved and then later the voice of the child got involved. So these three different kinds of sociopolitical movements converged. So what it comes down to is you have to evaluate in every case, what are the factors that are contributing? It's not one or the other. Marjorie and I called them hybrid cases where there may be some alienating behavior on the part of one parent, but there may be some inappropriate parenting, not abuse, or if there is abuse or domestic violence going on, we don't look at, we don't even, it doesn't even enter. And shouldn't enter the refuse, resist dynamic. Marjorie and I got away from calling it parental alienation, developed the concept of our RRD, the refuse resist dynamic. It's a combination of factors relating to the parents, their parenting styles, their parenting skills and abilities, the child vulnerabilities in the child, the nature of the separation and divorce was a traumatic, you know, was it expected?
Dr. Steven Friedlander: (33:48)
Was it planned? All of these factors, converge Dan Johnson and John Kelly put together a very, very beautiful complex model, all the different factors that converge on this. And when we evaluate, we've got to evaluate for every single one of them alienation that the kind of behaviors that we're talking about, what is called estrangement or justified estrangement, where the parent who's being resisted or rejected is harsh or punitive or narcissistic and not attuned, not well attuned to the child. So the child is not that comfortable with that parent, there's enmeshment with the preferred parent, which sort of cuts across these cases, which is always something that's very, very important to pay attention to. And in family therapy, you're familiar with that as an important concept. And some people think that if there is significant and measurement, that's gotta be addressed separately.
Dr. Keith Sutton: (34:50)
Yeah. Okay. And what is the work that's being done when it is identified as a rejection refusal situation, that's not due to kind of a proof of use or inappropriateness of the other parent? They're not having the significant reasons for the rejection. How, what is the model that you use in working with those families clinically?
Dr. Steven Friedlander: (35:15)
So that's the model that Marjorie Walters and I presented in our paper, we call it the MMFI, multi-faith multifactorial family intervention, modal family intervention. And it was a family systems based intervention in which after a thorough assessment, we would meet with various entire family, had to be involved, not just child and the rejected parent favorite or aligned parent as well, and any other siblings. And we would work with them in various combinations. You know, sometimes the individual meetings, sometimes the rejected parent and the child, sometimes the rejected parent and the aligned parent, whatever seemed to be the most appropriate at that moment clinically to address whatever the issues were in an effort to address all of the issues. And there have been a proliferation now of different ways of intervening with these cases since 200. When this, these papers, came out and even since 2010, when we presented our model, there are lots of similar outpatient models.
Dr. Steven Friedlander: (36:43)
There are some intensive models now that have been used where children and the whole family goes to a camp, or in a tent spends an intensive weekend together in a structured setting. And various kinds of therapeutic interventions are done along with recreational interventions. And probably the most prominent one was called overcoming barriers, which were for years having these family camps mostly on the west coast, I'm sorry, on the east coast. They have recently suspended doing these interventions, just focusing on research now. And my understanding is that the reason for that is that these cases, these families are extremely difficult to have any kind of meaningful impact with. Yeah, I, you know, we see some success so that intermittent reinforcement keeps us going, or there's so much focus these days, as you well know, on evidence-based treatment and having search support for the efficacy of an intervention.
Dr. Steven Friedlander: (38:05)
And we don't have anything like that in this field. We don't, we haven't even been able to do any kind of meaningful, sophisticated research on it. People have to do some outcome studies on their own intervention. Marjorie and I tried to do that and we weren't able actually to do it for an interesting reason. When we called the parents, one parent was absolutely gung ho and participating, and that was the rejected parent or yes, and the aligned parent, no interest at all. So we couldn't get agreement. We couldn't get permission to use the data.
Dr. Keith Sutton: (38:45)
Because it's often probably just court ordered. Right? So there may not seem to be agreeing to the, for the data collection.
Dr. Steven Friedlander: (38:53)
That's one of the important evolutions in this work. And that is when we first started, we were just doing voluntary clinical family therapy. But very quickly became clear that because typically the favorite parent of the aligned parent is not motivated at all, and the child is not motivated at all, that we need something to provide incentive or motivation. And that has evolved into a closer and closer collaboration between the mental health professional and the mental health field and the family law field. So one of the later papers that we wrote had to do with that collaboration with the court and what we needed the court to do in order to help sort of encourage, and provide incentive for these families to participate in therapy. And even then, it's very, very difficult. One of the most controversial aspects of working with these families is that many people believe that if you have a clear case where a parent is undermining the relationship with the child, many people are now thinking of that as abuse.
Dr. Steven Friedlander: (40:22)
And they are thinking of it as requiring that the child be taken away from that parent for a period of time and placed with the other parent after an assessment, then it's found that that other parent is a good parent and the child will be safe. And I can see the look on your face, and I can imagine how people are responding to this. It is a very controversial, and there were efforts to do that early on, and as you can imagine, they didn't go well because those children didn't go along and some of them tried to hurt themselves or ran away or something. So because these children have ideas about the other parent that are not accurate, they are distorted, but they are deeply held. And I sometimes worry that the word indelible is the right word to use because that's one of the reasons why we don't want to get into litigating. Did this happen, or didn't it happen, even in this therapy, in the work with the refused resist families, you can't litigate reality. You want to fight about whether something happened. You're not going to get anywhere.
Dr. Keith Sutton: (41:45)
Yeah. The approach that I use is kind of an integrative approach that my colleague, Jamie, James Kim, and I put together, a kind of a four stage model where first we're assessing and figuring out what's going on. And this is for various diagnosing, sort of so on. The second stage is then doing some preparation work meeting with the kids, doing some work with the parents, helping with co-regulation, if that's a difficulty in the family, if there's escalation. And then the third stage is really kind of some structural rules, consequences, kind of create helping parents have tools, which sets us up for them. The fourth stage, which is the attachment work, kind of based on attachment based family therapy, guide diamonds model, can you talk to your parent when you're feeling bad or upset about whatever it might be, if not, what gets in the way and preparing them to talk and the parents to listen.
Dr. Keith Sutton: (42:36)
And I've had a couple of situations where I've had this, that it was not a full on severe conflict court involvement, but where the one parent needed some help. And once they got some of the tools, they were parenting with more integrity, it's less chaotic. And fortunately, in this one situation, I'm thinking of the mother was really wanting her daughter to have relationship with the father, although she was refusing to go to his home and kind of encouraging and really addressing some of the loyalty buy-ins. But what ended up, we finally got to a place where she could talk about her issues with the dad, both the issues she had with them. And also a feeling of that Dad had hurt mom, he left mom and she was, you know, young at the time she was nine.
Dr. Keith Sutton: (43:19)
And she saw mom very upset and dad was able to really listen and hear and kind of sit with her emotions and also talk to her about that. He very much cared for her mom also and they had worked for 11 years, trying to get help and him working on, but the relationship didn't work out. And it was such a shift to be able to have that conversation and open conversation, which had never been had. And she was 13 at the time. And for four years, this conversation never really happened that often times I've found that situation where if I can help the parents who maybe need some of that help and is open to feedback to shift, then they can feel like a better parent. And then oftentimes create that container to then hear the kid's pain or hurt from the past or resentment at what had happened between the parents or so on.
Dr. Keith Sutton: (44:11)
And oftentimes that can heal that attachment bond and then kind of restore that balance. But of course that ends up being dependent on one, if the one parent is able to hear feedback on how the other child felt hurt, and two, that support from the other parent encouraging the relationship, which again, like you're saying, particularly at least that piece of these cases, it's not there so much. And that's sort of the hallmarks of this, right? The mental alienation, I guess. I don't know if it would be particularly of the rejection also, but I guess when there is a non-issue with the other parent,
Dr. Steven Friedlander: (44:45)
Yeah. That's a lovely example of how doing that sort of work. And especially that dad's ability to sit with those feelings of her, of his daughter, and be responsive and empathic and understanding. So he had significant strengths that he was able to do that.
Dr. Keith Sutton: (45:09)
We figure we'll work to get there, but-
Dr. Steven Friedlander: (45:11)
Yeah, I'll bet, I'll bet.
Dr. Keith Sutton: (45:12)
Couple months of work, but he got there eventually.
Dr. Steven Friedlander: (45:15)
Right. You know, one of the hallmarks of these cases is the externalization of blame and it's all the other person, and it's very difficult to look at what I did as a parent, what I can do. And that's a big hurdle to try to get over is you can get over that. You can make progress, but it's very difficult. Sounds like you did a great job with that.
Dr. Keith Sutton: (45:47)
Yeah. With some of those other families, whereas I wouldn't necessarily labeled narcissistic, but that situation where it is so much blame and not being able to take any responsibility are those situations where I found here, are the least successful because the parent can't really attune to the kids' needs because they're so focused on their own. So it ends up, the kids don't end up feeling safe, so they don't want to continue that relationship.
Dr. Steven Friedlander: (46:12)
And it highlights another issue. And that is in this complex model where there's multiple factors contributing any one or two factors is enough to bring the case to a more positive outcome, what to do in that, to not being able to move. So you don't have to address every single one of them. So if a parent is able to do that as your dad did in that case, that can make a difference. Even if some other factors are mitigating against the change. And the other piece of it is the child. And that is there some kids who are not, you know, a parent can, we can see parental alienating behaviors in kids don't get alienated because the kid is resilient, the kid, you know, so you need sort of the perfect storm. Emergence of multiple factors create the problem. It's not just one factor. It's multiple factors.
Dr. Keith Sutton: (47:19)
I think one of the hardest situations that I worked in was where there was one parent that had a lot more financial means than the other parents. And oftentimes they, their lawyer, you know, they had a lawyer who was able to help them through the court process where the other one didn't and the other one really struggled. And I think that for me, that was really hard and we were court ordered to continue therapy, and I was able to make some conversations that the mother couldn't afford anymore. It was a heterosexual couple. And I guess that, I think those situations are the toughest is when both parents are having a hard time being in the therapy and being on the same goals, of course the ideal of family therapy, even if they're divorced, that we're all kind of on the same page of what the goals are for the kids.
Dr. Keith Sutton: (48:07)
But sometimes there's such a dynamic with so much conflict. It becomes hard. And some of their old stuff ends up getting in the way and just even the imbalance of power, whether financial or whatever it might be. And so that I think that was hitting it home for me. And I was getting some consultation with Marjorie regarding this family. And really just, again, how specialized this is. And especially for these families where there are going to be issues of power imbalance and so on where the court is both needed, but at some times it can also create difficulty.
Dr. Steven Friedlander: (48:45)
Yeah. What you were describing, reminded me of something I wanted to say, when you asked about what the child's therapist can do. And one of the issues when we're talking about imbalance is when a child comes in and is rejecting a parent, and you're the child's therapist, it's really important not to join with the child in agreeing that that parents should be rejected, find the right, the sweet spot between understanding and being empathic to the child's feelings, but not taking the position that this parent should be rejected. Unless of course the parents has been abusive or for some reason for it, but always keeping an open mind and always holding space, psychological space for the child to have both parents in his or her life. And that's important.
Dr. Keith Sutton: (49:51)
Yeah. And sometimes I talk about what the kids do as that. I oftentimes would like them to give the person a chance to create some of the changes that they feel needs to be made. Because if you know, God forbid the person passed away or something like that, they would feel, at least I had given some effort in that and allowed them the opportunity to make these changes, to make our relationship better or safe or whatever it might be. And they may or may not be able to do that, but at least they, on their side of the street, were able to create that opportunity whether or not their parent rises to that opportunity. Another thing. And again, there might be confounding of the whole larger system, which even if the other parent is making changes or are showing up in a way it's still not going to work, but at least giving a chance of engagement.
Dr. Steven Friedlander: (50:40)
Right. Yeah. It's, that's true.
Dr. Keith Sutton: (50:44)
Thank you so much for your time today. This is really great. And I think this is such an important subject and I will definitely link the work that you've done on our website for others that want to check this out. And there is, I don't know if you're involved with it, but I know there's a number of different trainings that folks can take to better understand the co-parenting or get training in that area or the special master type of work or the custody because this is a complex area. And I think that as I've talked to others some people are terrified and won't go near it. But that, you know, again, with some clear understanding and tools and structures around and working with other professionals can create that support. And I know that especially this area is always often, I'm looking for more clinicians to get more of that training with specialists.
Dr. Steven Friedlander: (51:35)
I run a consultation group with a bunch of experienced clinicians. And we've been discussing these kinds of cases for years. And the number of referrals that we get far exceeds what anybody is able to do. So we would welcome people who are interested in learning how to do this because we need fresh young blood.
Dr. Keith Sutton: (52:03)
Definitely. Yeah. Well, thank you so much for your time today. I really appreciate it.
Dr. Steven Friedlander: (52:07)
Thanks my pleasure. Thanks. Thanks for inviting me. Take care.
Dr. Keith Sutton: (52:12)
Thank you for joining us. If you're wanting to use this podcast, earn continuing education credits. Please go to our website at therapyonthecuttingedge.com. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, providing in-person and remote therapy in the San Francisco Bay Area. IAP provides screening for licensed clinicians through our in-person and online programs, as well as our treatment for children, adolescents, families, couples, and individual adults. For more information, go to sfiap.com or call 415-617-5932. Also, we really appreciate feedback. And if you have something you're interested in, something that's on the cutting edge of the field of therapy, and think clinicians should know about it, send us an email or call us. We're always looking for the advancements in the field of psychotherapy to help in creating lasting changes for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area and the Director of the Institute for the Advancement of Psychotherapy. Today, I'll be speaking with Steven Friedlander PhD, who is a licensed clinical psychologist with special expertise in working with families when a child is refusing or resisting contact with a parent. His most recent publications have focused on post-divorce disruption of family relationships, and interventions designed to resolve those problems. Steven facilitates consultation groups for other professionals, which focus on interventions with families when a child resists or refuses contact with a parent, and parent coordination in high conflict families. He previously served on the board of directors of the California Chapter of the Association of Family and Conciliatory Courts, and is currently Clinical Professor Emeritus in the Department of Psychiatry at University of California, San Francisco. Let's listen to the interview.
Dr. Keith Sutton: (01:23)
Welcome Steven. Thanks for joining us today.
Dr. Steven Friedlander: (01:26)
Pleasure to be here. Thanks for inviting me.
Dr. Keith Sutton: (01:29)
Yeah. So I got your contact information from Marjorie Ganz Walter, who I have gotten consultation from in the past. I had been in her consult group on high conflict divorce, and, you know, I'm really interested in this area. I actually don't do, kind of, more high conflict divorce, kind of court ordered work. Although I work with many families, children, adolescents, adults, couples, where divorce is involved either, you know, they're going through that process or have gone or thinking about going through that process. So I know that you have expertise in this area and before we even kind of get to that, I'd love to hear about your career and how you got into this area of specialty.
Dr. Steven Friedlander: (02:12)
That's a, that's a great question. My career started out pretty traditionally in terms of an interest in psychotherapy. I did two and a half years of teaching in a special service elementary school in New York City and the South Bronx of New York. And that was while I was in graduate school. And that experience was a really transformational one for me in terms of focusing on children and families. So when I finished some graduate, I got my master's degree from the University of New York and headed to graduate school and was really embarked on, what in my mind was a traditional career, doing psychotherapy. I had been steeped in psychoanalytic kind of thinking and psychodynamic thinking, and when I got to graduate school, I was confronted with the whole burgeoning behavioral and social learning theory. And it was a dramatic challenge for me to sort of combine the two. And I went ahead and trained at Langley Porter at UCSF, did my preclinical training there then did a post-doc at UC Berkeley. And then I was invited onto the faculty at UCSF. And I was there for a full-time faculty there for 11 years in the child and adolescent psychiatry program, really working with families. We were studying childhood depression, I was teaching in the clinical psychology program and the child psychiatry program. And after being there for 11 years, for a combination of factors, I left my full-time position and continued teaching up until just a few years ago. And shortly after I left, I was asked to do a child sexual abuse evaluation. I had been indirectly involved in one of the big headline child sexual abuse issues back then in the eighties. And so I did this child sexual abuse evaluation, and the judge kind of liked the report, and so shortly after that asked me if I was interested in doing a custody evaluation, and I had no training or interest, no work, no knowledge about that, but I agreed to do it. And so I did a few custody evaluations and it was around that time that a group of us you know, really icons in the field...Joan Kelly and Jan Johnston sort of convened what we thought of at the time as a study group. And there was a group of us in this study group, many of whom, almost all of whom have become sort of luminaries in the field at this point. But it was to study what had been labeled parental alienation, a situation where post divorce, a child resists or refuses to spend time with the parent. And there's no logical, justifiable reason. And Richard Gardner had written, identified the issue, and labeled it the parental alienation syndrome, and it created a lot of controversy.
Dr. Steven Friedlander: (05:52)
So while we had convened to do this study group, and we were going to rethink this concept of parental alienation. And at the same time I was getting more and more involved in the family law aspect of working as a psychologist. And I did some training in mediation, I did training in what we called then special master or parenting coordination. And my practice started growing where I was doing a lot of work with children of divorce and families of divorce and working also as a parenting coordinator working with parents and helping them make decisions in these very high conflict divorce cases. And after several years of this study group, we all kind of rethought the whole concept of parental alienation. And out of that study group came four papers, four publications, which really had a significant impact, I think, on the field. And the main one was by Joan Kelly and Jan Johnson called the Reformulation of the Parental Alienation Hypothesis, where the focus was on the child. And then the rest of us did sort of offshoots of that. So several people wrote about the assessment of how to assess parental alienation. Several people wrote about the legal aspects of it. And Jan Johnston, Marjorie Walters, and I wrote about treatment. So in 2001, the paper came out about treatment, and Marjorie and I developed a very, very close working relationship, and we continued to work together and to share our experiences, trying to help these families. And, let's see, so that paper came out, the original paper came out in 2001, so nine years later after quite a bit of clinical experience Marjorie and I published our first paper, which was a follow-up to that first paper with Jan Johnson. And it was just an elaboration and extension based on our clinical experience over those eight or nine years. And we tried to refine the intervention. And intervening with these families, and trying to help these families is a very, very challenging situation. They're in the family court. The traditional adversarial system is not suited for helping most families of divorce, but certainly these families. And what we're talking about is we've got high conflict, we have divorce, and we have high conflict divorce, which is maybe 10 to 20%, depends on what data you're looking at.
Dr. Keith Sutton: (09:30)
And that's one thing actually I'm interested in this area because I think that both myself and other clinicians that I've worked with end up working with families, there are many families of course that have experienced separation, divorce, and remarriage. But some of these situations like this, where I guess they would be termed high conflict divorce, they're really kind of a separate situation that oftentimes needs some special training. And really there's a number of different roles. Actually I don't know if you know David Friedman, but he's actually doing a training for one of the organizations locally on those different roles, because you know that there's the special master role, there's a co-parenting role, there's the custody evaluation, evaluation role. And, you know, also then the therapist, and really for many therapists, they're terrified of working with these types of situations, especially with court involvement, because those are one of the highest situations where there's reports to licensing boards, potential of getting attempts at being sued and these kinds of things. And so I think that that's a big concern, I would love to hear about your thoughts on these different roles and what therapists need to know in working with these situations, on how to navigate that or get consultation or so on, or to think about it.
Dr. Steven Friedlander: (10:50)
Right. Well, I think this is probably an instance in which, I don't know if therapists should be terrified, but I think that therapists should be appropriately cautious about getting involved with these cases, especially court involved cases, unless they have some special training or expertise in it. And it's certainly the case when we're talking about families where a child has resisted or refused contact with a parent. You have to have very specialized knowledge and training to work with these families. And if you don't, that's an invitation to become involved in a potentially negative way, in a way that's not helpful at all in spite of the best of intentions. And the various roles that one can serve with these high conflict divorce cases are all intertwined in some way. So in very high conflict cases, these are people who wound up in court regularly, and so at some point, the idea emerged that maybe there's a way to keep these people out of court.
Dr. Steven Friedlander: (12:17)
And that was to import the idea of a special master, which had been operative in industry, and the NFL, and in negotiations between ownership and workers, et cetera, to resolve differences, alternative dispute resolution, how to resolve a difference of opinion in a less contentious way. So the concept of the special master was imported into family law. And I remember one of the judges saying it's not a good use of court time to make a decision about whether Johnny should wear a blue shirt or a red shirt. We need some other way of making these decisions. And so the concept of the special master was born, where the court transfers some of its authority to make decisions, binding decisions on families, to the special master, so that a special master can make a decision that has the same force as a court order. That has evolved now, because there was a case in which a family objected and the Supreme Court held, I think it was the Supreme Court, held that the court could not force people to use a special master because they lost their right to a day in court.
Dr. Steven Friedlander: (13:54)
So now the term that we use is parenting coordinator and it is not something the court can order, but it is something that the parents can agree to and stipulate to. And usually the parenting coordinator, can, there's a stipulation that outlines here are the areas in which the parenting coordinator can make a decision that has the effect of a court order. And then there are additional areas where the parenting coordinator can make a recommendation. And if the recommendation is not accepted by both parents, it can go to court. And then the judge makes a determination. So that's the parenting coordinator role. And it's been very, very helpful and very useful, that has also evolved the roll, which sometimes is confused with the parenting coordinator, called a co-parent counselor, which is a very different kind of endeavor.
Dr. Steven Friedlander: (15:03)
This is where you meet with both parents post separation or divorce. And the job is really to help them develop a working relationship so that they can raise their children together. In spite of the fact that they are divorced. And in spite of the fact that they may not get along at all, and the co-parent counselor does not have any authority to make any decisions, but it's a combination of counseling mediation education you'll often explain to parents, well, this is not good for kids for this reason, or, you know, your child is in this particular developmental stage. That's why he's acting out in this way.
Dr. Keith Sutton: (15:53)
Yeah, that's what I've thought about, or what I know, you know, co-parenting folks they oftentimes are speaking on behalf of the child, like this is what the child needs at this developmental, which might be a little different than kind of as a family therapist, you might be kind of balancing all the relationships and working with each kind of person and keeping the rapport. Not that they're not keeping rapport, but they're more saying like here's the information that's needed and how do we work together to help that child, even if it's maybe not what the parent wants to hear or one parents or so on.
Dr. Steven Friedlander: (16:26)
Right. It's very different. It is different from family therapy and it's different in several ways. First of all, it's not therapy, although, you know, you hope it can be therapeutic, it's not therapy. And one of the hallmarks of co-parent counseling is we try to be a historical. Parents, want to come in and talk about what's happened in the past. And what we try to do is help them focus on moving forward. You've got a five-year-old kid you're going to have to have a relationship with each other for the next 15 years where you're going to be raising this child and making decisions together. Let's see if we can build a relationship that helps you do that. And of course, the goal is to make the co-parent counselor, it's kind of like raising a child, to make the co-parent counselor unnecessary. So you build a relationship. And many times what's done is a parenting plan is written so that it becomes the basis on which decisions get made and how vacations are shared and how medical decisions are made and educational decisions are made. So it can be very, very helpful. I sometimes tell parents and co-parent counseling, I say, I wish that I could have a picture of your kids kind of on my shoulders so that when you're looking at me, you're seeing your kids, because that's who I'm representing in this process. I'm doing what I think, I'm trying to help you do what's best for your kids.
Dr. Keith Sutton: (18:09)
Yeah. And I think it was Anne Basso, a therapist in Marin who had said that, it's more that we're asking the parents, we're not going to unpack all the baggage, but more how do we get that baggage across the street to help your child? And I'm wondering too, I had overheard somebody say at one point that the ideal is co-parenting where things are equal at both homes. But the reality is parallel parenting often where the nuances of what time bedtime is and all those kinds of things are more kind of akin to the different home and personality and so on. But the kids, just as they transition to a different set of circumstances and rules and expectations at school, they also kind of transition between the different homes, if there's consistency, even if they're not identical.
Dr. Steven Friedlander: (19:01)
Right. So when we do co-parenting and when we think about a parenting plan, we genuinely do aspire to have a situation where there's as many similarities as possible. If parents can agree on bedtimes, diet, some disciplinary, how to handle discipline, the more consistency there is between homes, the easier it is for the child, generally speaking. And we want that child to feel comfortable moving back and forth. When parents separate and divorce, we ask the child to do the most difficult. To bear the biggest consequence, which is to live in two separate homes. And so what we want to do is to make that work as smoothly as possible, and for the child to feel as secure as possible. So I often tell parents in co-parent counseling, I use the metaphor, I say, I want you to imagine that you're in a 7-47 flying over the Atlantic ocean. And all of a sudden you hit the worst turbulence you've ever hit, and you're sure you're going down, and the pilot comes on the Intercom. What do you want to hear? You want to hear a calm, reassuring voice, we've run into a little turbulence, sit back, relax, we'll take care of it. What don't you want to hear? You don't want to hear the pilot and co-pilot arguing about what the best thing to do is. You don't want to hear them fighting. You want to know that they're in charge and they're in control, and they're going to take care of that airplane. So I tell them, you are the copilots of your child's 7-47, and they have to see you working together, cooperating, calm, making decisions, and leaving your conflict and all the anger, et cetera, we have to set it aside. We have to find a place for it so that you can do what's best for your kids.
Dr. Keith Sutton: (21:18)
Yeah. I'm wondering too about, and we'll get specifically into the kind of parental alienation, refusal type of situations, but in the more average kind of divorce or bordering on high conflict divorce, what is the role of the therapist, maybe working with the child or particularly for myself, I work systemically. So I'm working with the kids sometimes individually, sometimes I'm working with the parents, oftentimes when I'm working with a divorce or separated or non married couple, having some sessions with the kids and one parent, and the kid and the other parents. Do you have any thoughts or advice for therapists on how to kind of balance within that and work with, say a co-parenting specialist, or work with a special master or so on and what their roles might be within that kind of aspect?
Dr. Steven Friedlander: (22:12)
Yeah, that's a great question. So in addition to whatever goals you might have as a therapist, just independent of whether the family is divorced or not divorced, for children there are a couple of things that I think are very important. One is to, and this is the message I give to parents as well, and that is, we want the child to feel that it's okay to love both parents. And we want the child to experience each parent being supportive of his or her relationship with the other parent. And so we want the therapist and in terms of the question you're asking, to have a similar perspective, to be facilitating and helping the child have a good relationship with both parents. And in your collateral work with parents, to be conveying that message also. To be conveying to the parent that it's important. It's a gift to the child if you are supportive of the other parent. When you say something positive to your child about the other parent, you not only are helping the child in the relationship with the other parent, but you are strengthening your relationship with the child. And so the same can be held for the therapist. If the therapist is seen as supporting the child and experienced by the child as supporting the child's relationship with both parents, and understanding the difficulties of going back and forth, this gets back to your earlier question, because when there is not a lot of commonality between the two homes, we do see a parallel parenting, which is somewhat more disengaged, where the parents are more disengaged, and there's only communication around necessary decisions. And the two homes may be quite different. And so when the child goes back and forth... children are capable of discrimination learning; they know it's okay to eat potato chips at dad's house, but not at mom's house, they can do that. It's harder for them, but they can do it. So these are the kids that we sometimes see who, when they go to mom's house, they don't ever mention dad. And when they go to dad's house, they don't have ever mentioned mom. Now in one of our papers, Marjorie, Ganz, Walters and I talked about what we call the middle space, the tenable middle space. And that was, ideally there's a place between the homes where the child feels held and comfortable with both parents. That's what we aspire to, but we may not get there.
Dr. Keith Sutton: (25:26)
Kind of like that attachment piece. Please talk more about the parental alienation and parental rejection and these kinds of nuances.
Dr. Steven Friedlander: (25:35)
So we have the high conflict cases, and then a very small percentage of those high conflict cases we see children who either resist or refuse, downright refuse to spend time with a parent. And when that refusal appears to be unjustified, when it appears not to be based on the child's actual experience with the parent, then we start to be concerned about what is causing the refusal or the resistance. And Gardner's approach was to say that this is a function... And he did a great job of delineating what these kids look like. They openly express hatred for the rejected parent, and they give trivial reasons. I worked with a kid once, eight years old, who said he never wanted to have anything at all to do with his father again. And when I asked him if he could explain, help me understand why he felt that way he said that his dad was a taker-backer. I said, well, I've never heard of a taker-backer, what's that? He says my dad goes to Costco, and he buys something and then he takes it back. And that was his reason for never wanting to see his dad again. So this is what Gardner called trivial reasons. And usually we hear repetitive kind of phrases, and they don't sound genuine, they don't sound real. And they may sound rehearsed, and they may sound like the other parents speaking, child has no ambivalence at all even though there may be lots of evidence of a good relationship with that parent in the past, they are totally on ambivalent and totally rejecting. They seem rehearsed, and a real hallmark of this is that the rejection kind of seeps into the extended family of the rejected parent.
Dr. Steven Friedlander: (27:52)
So all of a sudden, I don't want to have anything to do with my grandparents, my aunts, my uncles, my cousins. So when we see that we get concerned, and then what Gardner called our attention to is that usually the aligned parent, or the favorite parent, has in those cases has been saying things or doing things that undermine the relationship with that parent. Sometimes it's intentional, sometimes it's not. I worked with a family where, worked with a little girl. I was the girl's therapist and the girl was resisting time with her dad. This was actually very early before I fully understood all about parent alienation. It was on the internet, and we were reading about it, but the dad kept saying that the mom was alienating the girl, and the mom says, I don't know what he's talking about. And then she called me one day and she said, I need to talk to you. And the mom came in and she said, you know, I looked up this thing about alienation and he's right, I'm doing it. I didn't realize I was doing it, but I am. So sometimes parents do it and they're not even aware of it.
Dr. Keith Sutton: (29:17)
Yeah. And I'm wondering too, I mean, cause I think that I've worked with some families where this was the case and sometimes the parents were saying, oh my child doesn't want to see me anymore, it's due to alienation or rejection, but the parent themselves had some difficulties with, I wouldn't necessarily say narcissistic, but you know, that were unaware of what the kids' needs were, and we're very kind of frustrated. And in these kinds of situations where the kids could point and I like how you're differentiating between things that make sense of why they would reject, versus not because oftentimes it was these situations where the parent was acting in a way that was not good for the relationship with the child. And eventually they didn't want to see them anymore. But then the parent, rather than looking at any of their behavior, identified it as parental rejection or alienation because they could never be doing anything wrong, and maybe the other parent who is doing and really struggling to see any of their side.
Dr. Steven Friedlander: (30:21)
Right. So you're very astutely putting your finger on a number of characteristics of these families. First of all, the keyword is polarization. These cases are dramatically polarized and they characterized by all or nothing or black and white thinking. It's either this or it's either that. And so the paper that, the first paper that Marjorie and I wrote was, I can't remember the exact time, but something like tailoring the intervention to fit the problem. And we identified multiple factors that contribute is not only what the favorite parent is doing, but there are times when the child is resisting or re rejecting a parent because of what that parent has done. And this gets to a point that I should make. And that is when Gardner came out with this idea, it was a lot of sort of political upheaval about it because advocacy groups got very involved.
Dr. Steven Friedlander: (31:22)
Yeah. So, there had been a trend from the tender years doctrine where mothers were assumed to be, you know, the appropriate caretaker. To a more recent phase when fathers were recognized as being important, equally important to the child and the kids need both parents. So fathers were becoming more and more involved. And when Gardner came out with this parental alienation idea, women's groups, and especially domestic violence groups became upset because some fathers were using parental alienation as a way of blaming the mother. And they were seen as potentially abusive parents who were trying to blame the mother for the child's behavior,
Dr. Keith Sutton: (32:18)
Like power and control.
Dr. Steven Friedlander: (32:19)
Right? Exactly. So then father's rights groups got involved and then later the voice of the child got involved. So these three different kinds of sociopolitical movements converged. So what it comes down to is you have to evaluate in every case, what are the factors that are contributing? It's not one or the other. Marjorie and I called them hybrid cases where there may be some alienating behavior on the part of one parent, but there may be some inappropriate parenting, not abuse, or if there is abuse or domestic violence going on, we don't look at, we don't even, it doesn't even enter. And shouldn't enter the refuse, resist dynamic. Marjorie and I got away from calling it parental alienation, developed the concept of our RRD, the refuse resist dynamic. It's a combination of factors relating to the parents, their parenting styles, their parenting skills and abilities, the child vulnerabilities in the child, the nature of the separation and divorce was a traumatic, you know, was it expected?
Dr. Steven Friedlander: (33:48)
Was it planned? All of these factors, converge Dan Johnson and John Kelly put together a very, very beautiful complex model, all the different factors that converge on this. And when we evaluate, we've got to evaluate for every single one of them alienation that the kind of behaviors that we're talking about, what is called estrangement or justified estrangement, where the parent who's being resisted or rejected is harsh or punitive or narcissistic and not attuned, not well attuned to the child. So the child is not that comfortable with that parent, there's enmeshment with the preferred parent, which sort of cuts across these cases, which is always something that's very, very important to pay attention to. And in family therapy, you're familiar with that as an important concept. And some people think that if there is significant and measurement, that's gotta be addressed separately.
Dr. Keith Sutton: (34:50)
Yeah. Okay. And what is the work that's being done when it is identified as a rejection refusal situation, that's not due to kind of a proof of use or inappropriateness of the other parent? They're not having the significant reasons for the rejection. How, what is the model that you use in working with those families clinically?
Dr. Steven Friedlander: (35:15)
So that's the model that Marjorie Walters and I presented in our paper, we call it the MMFI, multi-faith multifactorial family intervention, modal family intervention. And it was a family systems based intervention in which after a thorough assessment, we would meet with various entire family, had to be involved, not just child and the rejected parent favorite or aligned parent as well, and any other siblings. And we would work with them in various combinations. You know, sometimes the individual meetings, sometimes the rejected parent and the child, sometimes the rejected parent and the aligned parent, whatever seemed to be the most appropriate at that moment clinically to address whatever the issues were in an effort to address all of the issues. And there have been a proliferation now of different ways of intervening with these cases since 200. When this, these papers, came out and even since 2010, when we presented our model, there are lots of similar outpatient models.
Dr. Steven Friedlander: (36:43)
There are some intensive models now that have been used where children and the whole family goes to a camp, or in a tent spends an intensive weekend together in a structured setting. And various kinds of therapeutic interventions are done along with recreational interventions. And probably the most prominent one was called overcoming barriers, which were for years having these family camps mostly on the west coast, I'm sorry, on the east coast. They have recently suspended doing these interventions, just focusing on research now. And my understanding is that the reason for that is that these cases, these families are extremely difficult to have any kind of meaningful impact with. Yeah, I, you know, we see some success so that intermittent reinforcement keeps us going, or there's so much focus these days, as you well know, on evidence-based treatment and having search support for the efficacy of an intervention.
Dr. Steven Friedlander: (38:05)
And we don't have anything like that in this field. We don't, we haven't even been able to do any kind of meaningful, sophisticated research on it. People have to do some outcome studies on their own intervention. Marjorie and I tried to do that and we weren't able actually to do it for an interesting reason. When we called the parents, one parent was absolutely gung ho and participating, and that was the rejected parent or yes, and the aligned parent, no interest at all. So we couldn't get agreement. We couldn't get permission to use the data.
Dr. Keith Sutton: (38:45)
Because it's often probably just court ordered. Right? So there may not seem to be agreeing to the, for the data collection.
Dr. Steven Friedlander: (38:53)
That's one of the important evolutions in this work. And that is when we first started, we were just doing voluntary clinical family therapy. But very quickly became clear that because typically the favorite parent of the aligned parent is not motivated at all, and the child is not motivated at all, that we need something to provide incentive or motivation. And that has evolved into a closer and closer collaboration between the mental health professional and the mental health field and the family law field. So one of the later papers that we wrote had to do with that collaboration with the court and what we needed the court to do in order to help sort of encourage, and provide incentive for these families to participate in therapy. And even then, it's very, very difficult. One of the most controversial aspects of working with these families is that many people believe that if you have a clear case where a parent is undermining the relationship with the child, many people are now thinking of that as abuse.
Dr. Steven Friedlander: (40:22)
And they are thinking of it as requiring that the child be taken away from that parent for a period of time and placed with the other parent after an assessment, then it's found that that other parent is a good parent and the child will be safe. And I can see the look on your face, and I can imagine how people are responding to this. It is a very controversial, and there were efforts to do that early on, and as you can imagine, they didn't go well because those children didn't go along and some of them tried to hurt themselves or ran away or something. So because these children have ideas about the other parent that are not accurate, they are distorted, but they are deeply held. And I sometimes worry that the word indelible is the right word to use because that's one of the reasons why we don't want to get into litigating. Did this happen, or didn't it happen, even in this therapy, in the work with the refused resist families, you can't litigate reality. You want to fight about whether something happened. You're not going to get anywhere.
Dr. Keith Sutton: (41:45)
Yeah. The approach that I use is kind of an integrative approach that my colleague, Jamie, James Kim, and I put together, a kind of a four stage model where first we're assessing and figuring out what's going on. And this is for various diagnosing, sort of so on. The second stage is then doing some preparation work meeting with the kids, doing some work with the parents, helping with co-regulation, if that's a difficulty in the family, if there's escalation. And then the third stage is really kind of some structural rules, consequences, kind of create helping parents have tools, which sets us up for them. The fourth stage, which is the attachment work, kind of based on attachment based family therapy, guide diamonds model, can you talk to your parent when you're feeling bad or upset about whatever it might be, if not, what gets in the way and preparing them to talk and the parents to listen.
Dr. Keith Sutton: (42:36)
And I've had a couple of situations where I've had this, that it was not a full on severe conflict court involvement, but where the one parent needed some help. And once they got some of the tools, they were parenting with more integrity, it's less chaotic. And fortunately, in this one situation, I'm thinking of the mother was really wanting her daughter to have relationship with the father, although she was refusing to go to his home and kind of encouraging and really addressing some of the loyalty buy-ins. But what ended up, we finally got to a place where she could talk about her issues with the dad, both the issues she had with them. And also a feeling of that Dad had hurt mom, he left mom and she was, you know, young at the time she was nine.
Dr. Keith Sutton: (43:19)
And she saw mom very upset and dad was able to really listen and hear and kind of sit with her emotions and also talk to her about that. He very much cared for her mom also and they had worked for 11 years, trying to get help and him working on, but the relationship didn't work out. And it was such a shift to be able to have that conversation and open conversation, which had never been had. And she was 13 at the time. And for four years, this conversation never really happened that often times I've found that situation where if I can help the parents who maybe need some of that help and is open to feedback to shift, then they can feel like a better parent. And then oftentimes create that container to then hear the kid's pain or hurt from the past or resentment at what had happened between the parents or so on.
Dr. Keith Sutton: (44:11)
And oftentimes that can heal that attachment bond and then kind of restore that balance. But of course that ends up being dependent on one, if the one parent is able to hear feedback on how the other child felt hurt, and two, that support from the other parent encouraging the relationship, which again, like you're saying, particularly at least that piece of these cases, it's not there so much. And that's sort of the hallmarks of this, right? The mental alienation, I guess. I don't know if it would be particularly of the rejection also, but I guess when there is a non-issue with the other parent,
Dr. Steven Friedlander: (44:45)
Yeah. That's a lovely example of how doing that sort of work. And especially that dad's ability to sit with those feelings of her, of his daughter, and be responsive and empathic and understanding. So he had significant strengths that he was able to do that.
Dr. Keith Sutton: (45:09)
We figure we'll work to get there, but-
Dr. Steven Friedlander: (45:11)
Yeah, I'll bet, I'll bet.
Dr. Keith Sutton: (45:12)
Couple months of work, but he got there eventually.
Dr. Steven Friedlander: (45:15)
Right. You know, one of the hallmarks of these cases is the externalization of blame and it's all the other person, and it's very difficult to look at what I did as a parent, what I can do. And that's a big hurdle to try to get over is you can get over that. You can make progress, but it's very difficult. Sounds like you did a great job with that.
Dr. Keith Sutton: (45:47)
Yeah. With some of those other families, whereas I wouldn't necessarily labeled narcissistic, but that situation where it is so much blame and not being able to take any responsibility are those situations where I found here, are the least successful because the parent can't really attune to the kids' needs because they're so focused on their own. So it ends up, the kids don't end up feeling safe, so they don't want to continue that relationship.
Dr. Steven Friedlander: (46:12)
And it highlights another issue. And that is in this complex model where there's multiple factors contributing any one or two factors is enough to bring the case to a more positive outcome, what to do in that, to not being able to move. So you don't have to address every single one of them. So if a parent is able to do that as your dad did in that case, that can make a difference. Even if some other factors are mitigating against the change. And the other piece of it is the child. And that is there some kids who are not, you know, a parent can, we can see parental alienating behaviors in kids don't get alienated because the kid is resilient, the kid, you know, so you need sort of the perfect storm. Emergence of multiple factors create the problem. It's not just one factor. It's multiple factors.
Dr. Keith Sutton: (47:19)
I think one of the hardest situations that I worked in was where there was one parent that had a lot more financial means than the other parents. And oftentimes they, their lawyer, you know, they had a lawyer who was able to help them through the court process where the other one didn't and the other one really struggled. And I think that for me, that was really hard and we were court ordered to continue therapy, and I was able to make some conversations that the mother couldn't afford anymore. It was a heterosexual couple. And I guess that, I think those situations are the toughest is when both parents are having a hard time being in the therapy and being on the same goals, of course the ideal of family therapy, even if they're divorced, that we're all kind of on the same page of what the goals are for the kids.
Dr. Keith Sutton: (48:07)
But sometimes there's such a dynamic with so much conflict. It becomes hard. And some of their old stuff ends up getting in the way and just even the imbalance of power, whether financial or whatever it might be. And so that I think that was hitting it home for me. And I was getting some consultation with Marjorie regarding this family. And really just, again, how specialized this is. And especially for these families where there are going to be issues of power imbalance and so on where the court is both needed, but at some times it can also create difficulty.
Dr. Steven Friedlander: (48:45)
Yeah. What you were describing, reminded me of something I wanted to say, when you asked about what the child's therapist can do. And one of the issues when we're talking about imbalance is when a child comes in and is rejecting a parent, and you're the child's therapist, it's really important not to join with the child in agreeing that that parents should be rejected, find the right, the sweet spot between understanding and being empathic to the child's feelings, but not taking the position that this parent should be rejected. Unless of course the parents has been abusive or for some reason for it, but always keeping an open mind and always holding space, psychological space for the child to have both parents in his or her life. And that's important.
Dr. Keith Sutton: (49:51)
Yeah. And sometimes I talk about what the kids do as that. I oftentimes would like them to give the person a chance to create some of the changes that they feel needs to be made. Because if you know, God forbid the person passed away or something like that, they would feel, at least I had given some effort in that and allowed them the opportunity to make these changes, to make our relationship better or safe or whatever it might be. And they may or may not be able to do that, but at least they, on their side of the street, were able to create that opportunity whether or not their parent rises to that opportunity. Another thing. And again, there might be confounding of the whole larger system, which even if the other parent is making changes or are showing up in a way it's still not going to work, but at least giving a chance of engagement.
Dr. Steven Friedlander: (50:40)
Right. Yeah. It's, that's true.
Dr. Keith Sutton: (50:44)
Thank you so much for your time today. This is really great. And I think this is such an important subject and I will definitely link the work that you've done on our website for others that want to check this out. And there is, I don't know if you're involved with it, but I know there's a number of different trainings that folks can take to better understand the co-parenting or get training in that area or the special master type of work or the custody because this is a complex area. And I think that as I've talked to others some people are terrified and won't go near it. But that, you know, again, with some clear understanding and tools and structures around and working with other professionals can create that support. And I know that especially this area is always often, I'm looking for more clinicians to get more of that training with specialists.
Dr. Steven Friedlander: (51:35)
I run a consultation group with a bunch of experienced clinicians. And we've been discussing these kinds of cases for years. And the number of referrals that we get far exceeds what anybody is able to do. So we would welcome people who are interested in learning how to do this because we need fresh young blood.
Dr. Keith Sutton: (52:03)
Definitely. Yeah. Well, thank you so much for your time today. I really appreciate it.
Dr. Steven Friedlander: (52:07)
Thanks my pleasure. Thanks. Thanks for inviting me. Take care.
Dr. Keith Sutton: (52:12)
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