I met with a dad during my first of the month week of general public consults. I just completed a second meeting with the dad and his attorney.
The father and his attorney seemingly want my involvement in consultation to the involved mental health professionals – both current professionals and potentially future professionals.
I can consult with any involved MH professionals anywhere in a one-off consultation. They can simply schedule a time on my online Scheduling Calendar on my website. I’ll bill them and you’ll reimburse them. If they want a consult, they can schedule a consult.
If I don’t know who their client is, then there is no release of information issues since confidentiality is maintained if I don’t know who the person is. Besides, I know what they’re going to say, the pathology is pattern, I don’t need details. I’ll be the one talking.
But in this case there’s ins-and-outs with the mental health people that may keep me involved for a while, and the parent seemed eager to have me on a retainer for a small scope consultation package. I bill to the scope of service package – small, medium, large – not to my hours. You couldn’t afford me at my hourly rate.
Plus I want to give parents a solid number they can budget into their budget for Dr. Childress. What do you want me to do? Large, medium, small? Then I focus on what needs to be done.
I work for the child. As a clinical psychologist, the child is always my client. When the Court is involved, I get a second client, the Court. I’m mindful of my obligations to both.
The parent and attorney in this matter will discuss their options and needs, which is how it should be. You’re vulnerable to exploitation because you’re in desperate need in trying to save your children. It would be relatively easy to take advantage of you. So you should get a second opinion regarding my potential involvement – typically from your attorney.
I do what I do. Do you need what I do? I dunno, that’s not my decision. That’s yours, and you should talk it over with your attorney.
When I complete a scope of service consultation with a parent and their attorney and it seems like we have an agreement, I will send out a confirming email regarding what we discussed. I want everything to be clear.
Angry clients are vengeful clients. The best risk management is to have happy clients. I want happy clients. Everything needs to be clear from the start.
I also cc my case manager, Maggie, on this scope of service email and she then helps me keep track of clients, dates, reports, testimony, and scheduling everyone for everything. Thank you, Maggie.
I thought you might find the opening portion and closing portion of this Confirmation of Consultation letter interesting. I’ll skip the specifics of the scope of service. Notice it is nothing more than I say every day here on my Facebook page. This is not just my concern and recommendation for this parent – it’s my concern and recommendation for all parents.
I’m also aware that I’m putting something into the attorney’s hand. I call it documentation. Researchers call it data. Attorneys call it evidence. They seem to like evidence.
Here’s my opening part and my closing part, I’m taking out the middle part regarding the specifics of this scope of service agreement.
Based on our consultation, I am concerned about several possible diagnoses within the family, 1) possible Child Psychological Abuse (DSM-5 V995.51), 2) a possible shared persecutory delusion potentially created by the mother’s distorted parenting practices, and 3) a possible false (factitious) attachment pathology being imposed on the child by the mother’s pathogenic parenting (Factitious Disorder Imposed on Another; 300.19).
Possible Child Psychological Abuse
The only cause of severe attachment pathology is child abuse by one parent or the other. Either the targeted parent is abusing the child, creating the child’s attachment pathology toward that parent (a two-person attribution of causality), or the allied parent is psychologically abusing the child by creating a shared persecutory delusion and false (factitious) attachment pathology for the secondary gain to the parent of manipulating the court’s decisions regarding child custody, and to meet the parent’s own emotional and psychological needs (a three person triangle attribution of causality).
Whenever there is any concern about possible child abuse for any reason, a proper risk assessment to the possible child abuse concern needs to be conducted. This is my recommendation in your matter. An accurate diagnosis is needed to guide the Court’s decision-making and the treatment plan. Diagnosis guides treatment (the treatment for cancer is different than the treatment for diabetes).
All mental health professionals have duty to protect obligations (see Risk Assessment Handout). All currently involved mental health professionals should have conducted a proper risk assessment for possible child abuse to the appropriate differential diagnoses for each parent. Any future treatment should begin with the diagnostic process since the subsequent treatment will depend on the diagnosis.
Based on your description of the situation, the clinical concern is for a possible encapsulated persecutory delusion with the mother that is then being imposed on the child through the mother’s distorted parenting practices. The American Psychiatric Association provides the definition for a persecutory delusion:
From the APA: “Persecutory Type: Delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.” (American Psychiatric Association, 2000).
The presence of either a shared persecutory delusion and/or false (factitious) attachment pathology imposed on the child would represent a DSM-5 diagnosis of Child Psychological Abuse (V995.51), and a child protection response would be warranted. Based on your concerns and descriptions of the situation in your family, I recommend that a proper risk assessment for possible child abuse be conducted to the appropriate differential diagnosis for each parent.
Second-Opinion Consultation
I recommend that the involved mental health professionals obtain additional consultation regarding the diagnostic assessment of delusional thought disorders and the treatment of severe attachment pathology surrounding child custody conflict, consistent with Standard 2.01(c)(d) of the APA ethics code:
2.01 Boundaries of Competence
(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.
(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study.
Throughout healthcare, second-opinion consultation is often used to improve the quality of services delivered.
From Improving Diagnosis: “Clinicians may refer to or consult with other clinicians (formally or informally) to seek additional expertise about a patient’s health problem. The consult may help to confirm or reject the working diagnosis or may provide information on potential treatment options. If a patient’s health problem is outside a clinician’s area of expertise, he or she can refer the patient to a clinician who holds more suitable expertise. Clinicians can also recommend that the patient seek a second opinion from another clinician to verify their impressions of an uncertain diagnosis or if they believe that this would be helpful to the patient.” (Improving Diagnosis in Healthcare, 2015)
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857
GreatCosmicMothersUnite 