Tag: Child Abuse

“I don’t diagnose pathology.”

That is the most ridiculous things I’ve ever heard a licensed mental health person say. What do you think the license is for? Honest to god…

Look, seriously, you are a licensed mental health professional who is – licensed – by the state to do exactly that, diagnose and treat pathology. If you don’t diagnose pathology, who does, a plumber?

If so, can you refer me to a plumber to diagnose the pathology because we need a diagnosis. This could be a diagnosis of Child Psychological Abuse (DSM-5 V995.51), i.e., a shared persecutory delusion created in the child by the distorted parenting of the allied parent.

We need to find out if that pathology is present or absent, we need a diagnosis… and if you don’t diagnose pathology… then you’re pretty useless, aren’t you. Who does?

Because if you don’t diagnose pathology then there is absolutely no point in having you involved as a mental health person, because that’s what we need, a diagnosis for the treatment plan.

A plumber doesn’t diagnose pathology, nor does a school teacher. Who does? Hmmm, let me think… a licensed mental health professional? But just not you because you’re pretty useless.

We don’t need a plumber to fix the family conflict either. We need a diagnosis.

Who should I go to for a diagnosis if not a licensed mental health professional? Ask them. If they say this ridiculous thing to you, ask them who you SHOULD go to for a diagnosis, who would that be? I’d be curious what answer they’d give you… maybe they’d respond with just a blank stare.

Early in my training, way early, I was told by my mentor to always-always put a diagnosis.

Even if there is no diagnosis, there’s a diagnostic code for No Diagnosis, V71.09 No Diagnosis on Axis 1, that’s what you put when there is no diagnosis. Always put a diagnosis, even when there’s no diagnosis. Do you know why?

Malpractice. To start treating something before you’ve diagnosed what it is would be malpractice, and to conduct an assessment without a identifying the problem (diagnosing the pathology), even if it’s No Diagnosis (V71.09), would be malpractice.

How do you know what you’re treating if you have no diagnosis? That’s why I was told to always-always give a diagnosis, because otherwise is is automatically a misdiagnosis, which becomes the foundations for the malpractice, i.e., a negligent misdiagnosis because of an inadequate assessment.

There’s a second reason to identify no diagnosis, V71.09 No Diagnosis on Axis 1, it documents that you looked. Without that diagnosis of No Diagnosis, did you even look for a possible psychiatric disorder?

Here’s the rule-of-thumb regarding documentation in a medical record, if it’s not documented it didn’t happen.

Did you assess for a possible Bipolar Disorder, or possible ADHD? Unless you indicate you did, you didn’t. Did you assess for Generalized Anxiety Disorder and for Oppositional Defiant Disorder? Unless you say you did, you didn’t.

If it’s not in the patient’s medical record, it didn’t happen. So… document what you did and the outcome. If I conducted an assessment for possibly the relevant psychiatric disorders and there were no psychiatric disorders present… then I say so, 71.09 No Diagnosis on Axis I.

Otherwise… according to my chart… if I have nothing then I never even assessed for any possible psychiatric disorders. Document, document, document. If it’s not in the medical record, it didn’t happen.

If the patient says they are depressed, document that you asked about suicide. If they report any suicidal ideation, document that you conducted a proper risk assessment for suicide and its outcome.

When I say there is No Diagnosis, I’m saying I looked. But if I never even looked… that could be negligent malpractice.

That’s why I was told by my mentor as I entered clinical training, always-always give a diagnosis – protect yourself.

“I don’t diagnose pathology” is the most ridiculous thing I’ve ever heard from a mental health professional. Who does then? Please tell me because I need a referral to that architect or school teacher, because we need a diagnosis.

“I don’t diagnose pathology.” That is insane.

If I’m a lawyer on TV and this is my episode, I’d get them to say that first thing – “I don’t diagnose pathology” – and they’ll say it all proud like jt’s a good thing – they don’t “pathologize” people. I’d let them swell-up into their delusional beliefs.

They’re the guest star on the episode and I want to give them their moment, before….

Then I’d ask them, “Do you mean like schizophrenia, if one parent had schizophrenia, you wouldn’t diagnose that and wouldn’t tell the judge that one parent was psychotic and had schizophrenia?” I suspect they’ll begin to see the problem and back-track a little,

“Well, something like that I’d definitely diagnose and include it in my report, but there was no schizophrenia.”

What about a delusional disorder, is that a diagnosis you’d diagnose and tell the court about, or is that something you’d ignore and withhold from the court? Ouch, the words are getting sharper.

Is there a diagnosis of V995.51 Child Psychological Abuse on page 719 of the DSM-5? Is that a diagnosis you would diagnose, or is that a diagnosis you would ignore and withhold from the court?

So you do diagnose pathology sometimes, but you don’t diagnose pathology other times, sometimes you report relevant diagnostic information to the courts and sometimes you withhold relevant diagnostic information from the courts, based on how you feel, is that what you’re saying?

Oh, I see, if it’s relevant you’ll make the diagnosis and tell the court, but if you believe it’s not relevant then you withhold the diagnostic information from the courts, is that what you’re saying? That you decide what is relevant and non-relevant information for the court’s consideration, and then you tell the court what you think is important for the court to hear, and you withhold information that you decide is not important?

Is a diagnosis of a shared persecutory delusion relevant for the court’s consideration? Is a diagnosis of Child Psychological Abuse relevant to the court’s consideration?

“I don’t diagnose pathology.” That’s the most ridiculous thing I’ve ever heard. Too bad I only play a lawyer on TV, just lemme at that nonsense. Then how do you know what you’re treating if you don’t make a diagnosis – is it cancer or diabetes?

“I don’t diagnose pathology” from a mental health professional… if you hear that, just start laughing, just laugh, and laugh, and laugh as you turn around and walk out the door.

Go find yourself a good plumber or school teacher to diagnose what’s going on, because we need a diagnosis. Is it child abuse? Is there a shared persecutory delusion?

Please, someone… is there a doctor in the house? A rodeo clown? A lawyer? Who diagnoses pathology? Because whoever that profession is, that’s who we need and it’s obviously not you… so that makes you’re pretty pointless, doesn’t it.

Frontal lobe deficits in linear-logical reasoning, they actually say this stuff with a straight face. That’s where my TV lawyer guy would let the forensic mental health person swell on their first answer -“I don’t diagnose pathology” – all proud of themselves like that’s a good thing. Give the week’s guest star their moment before the dramatic collapse on the witness stand.

Okay then… would you diagnose schizophrenia if a parent had schizophenia, do you think the court should know that a parent has schizophrenia? How about a delusional disorder? What is a persecutory delusion? What is a shared persecutory delusion? Would creating a shared persecutory delusion in the child that then destroyed the child’s attachment bond to the other parent be a diagnosis of Child Psychological Abuse?

Would that be relevant for the court to know?

TV-lawyer: Hypothetically speaking, just a hypothetical question, doctor, purely hypothetical not related to this case at all… if… IF… a psychologist missed making a child abuse diagnosis because they failed to conduct a proper risk assessment, could that become negligent malpractice?

I’d use “could” if I was the TV-lawyer guy because of course it “could”, it’s a less strict word as “would” – could it? Yes, of course it could. But what do I know about asking questions, I’m just a psychologist. I’m not a real TV-lawyer guy.

“Did you order the Code Red! Did you order the Code Red?” – looks fun.

Honest to god, stupid pathogen. It comes from an inhibition to the frontal lobe executive function systems for linear-logical reasoning, along with deficits in foresight and planning ahead, and in self-reflective insight.

Linear-logical reasoning – find the point of illogic and stay linear on the question line with yes-no questions. The pathogen will want to escape into associational-emotional thinking, don’t let it, remain on yes-no questions – linear and logical. This will tie it up in knots when it reaches the thought-diorder part of the illogic.

Foresight and planning ahead – The pathogen doesn’t., they are very now-reactive. They won’t know the package is arriving until it’s at their doorstep, no foresight.

Because they are entirely now-reactive with no forsight, they will say what seems best in the moment. This will lead them into making contradictory statements in different contexts. Once they start contradicting themselves, put their own statements side-by-side and ask them to reconclie the contradiction.

Self-reflective insight – they have none. They are arrogant and overly inflated with the self-importance of their opinions. They think they’re important… just because. Everytime you expose them, you create a narcsisistic injury.

Be careful, they may try to retaliate using their power. That should never-never happen. But it does. Be careful.

They can’t because it’s illogical. The licensed mental health person who says, “I don’t diagnose pathology” is illogical – of course you do, that’s your training, that’s what the license is for. Honest to god…

They have to testify and testimony is all about linear lines of questions. They could be in trouble if their thinking isn’t as linear-and-logical as the line of questions.

They don’t diagnose pathology… well, that makes you pretty irrelevant then, doesn’t it, because that’s what we need. If we need our Tarot cards read, we’ll be sure to think of you.

Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857

I want to make a recommendation to Dorcy Pruter.

Hi Dorcy, I want to talk to you personally so I thought I’d post it to my Public Facebook page, you’ll understand why.

I recommend you take the 4-day seminar from PESI by Bessel van der Kolk with an added bonus hour of Ed Tronick. Take if for Ed, you’ll love Bessel… but you’ll love Ed more.

You don’t actually need to know this stuff because you already do. I know you do because it’s the same thing you say and do. I just think you should have the scientific support available for what you say and do.

You’re not a psychologist, duh, so there’s no requirement… there will be for them though, the psychologists. I’m going to be looking for this seminar in my vitae reviews of forensic psychologists. You already know the material, but you should be aware of the scientific support you have in what you say, and for what you do.

To everyone else… What Dorcy Pruter tells you is accurate and correct. It’s backed up by the state-of-the-art scientific knowledge. I know. I’ve known van der Kolk and Tronick for decades.

I’m a trauma psychologist out of foster care. I had a sexy poster of Bessel hanging on my bedroom wall as a kid. I know this information and always have since I’ve been here in the court-involved family conflict.

Dorcy has too, she just hadn’t read the books, and she’s not a psychotherapist – thank god. But you see how I hold my professional colleagues to task for their knowledge and competence. Dorcy meets and exceeds my standards.

Ms. Pruter and the Conscious Co-Parenting Institute have my full support. She’s not a psychologist, she’s is a businesswoman and family coach, successful at both. I am a clinical psychologist, we do different things. I am well familiar with the professional work of Dorcy Pruter, it is excellent. What she says is accurate and correct.

I have twice co-presented with her at professional organizations, at the AFCC national convention in 2017, and at the APA national convention in 2019. There’s a reason.

I have personally reviewed the Higher Purpose Parenting course curriculum and it has my full endorsement and support. No parenting skills you learn will work if you don’t use them. If you use the parenting skills taught in Higher Purpose Parenting, the skills will be successful. I consider the Higher Purpose Parenting curriculum to be the only trauma-informed parenting curriculum available.

I am familiar with the research methodology used in compiling data for the Custody Resolution Method. The qualitative research methodology used in the Custody Resolution Method, called “coding”, is a standard, reliable, and valid research methodology.

I have personally reviewed the protocol for the 4-day High Road workshop, and I have personally observed all four days of the workshop. I understand how it achieves its consistent and remarkable success. The High Road workshop is effective and gentle, the kids love the workshop and love Dorcy.

I have also received a client into my private practice from the High Road workshop for follow-up care. The High Road workshop obtained a full and complete recovery of the 15 year-old adolescent from three years of documented child psychological abuse – documented by three separate psychologists.

When the High Road workshop is available for the resolution of child psychological abuse, the High Road workshop is my first recommendation.

Ms. Pruter is a family and parenting coach of skill, accomplishment, and knowledge. When she entered the field of court-involved family conflict, she studied and learned about the pathology, her profession, and her craft in creating effective solutions. Her body of professional work is both remarkable and highly successful in solving the pathology surrounding court-involved child custody conflict.

Ms. Pruter is the most experienced professional working with court-involved child custody conflict. We all need support. Bessel van der Kolk and Ed Tronick provide Dorcy with all the support she needs. You need to take Bessel’s four-day course, Dorcy – for the support it provides.

I know trauma and child abuse. I know van der Kolk and Tronick and more. I know Kohut and self psychology, Dorcy doesn’t even know she’s a Kohutian, but she is. I know the work of Dorcy Pruter and the Conscious Co-Parenting Institute, Ms. Pruter’s work is excellent, everything she says is true and correct, and scientifically supported.

Dorcy is offering a Facebook group, the Chosen Parent Collective. My recommendation for parents is to join the Collective and acquire as much knowledge and wisdom from Dorcy as you can. Everything she says is accurate and correct.

I’d recommend that mental health professionals also listen to Ms. Pruter’s consultation. She’s not a mental health professional – thank goodness – everything she says is true and accurate. She is the most experienced professional working in the family court system in recovering children from complex trauma and child psychological abuse.

If Ms. Pruter is involved on any matter where I’m a consultant, I would consider Ms. Pruter part of my treatment team, the trauma recovery specialist on the team. We’d want a family systems therapist for the maintenance care and family therapy. I’d want Dorcy’s input and consultation throughout.

Bowlby – Minuchin – Beck – were the first three points on the line. I used them for the structure of Foundations. But van der Kolk and complex trauma, and Tronick and child development, are at the core of the pathology and its solution.

I will be opening them next, their information and their knowledge, and applying it. Parents don’t need to take this course… I’d recommend it for all humans. Knowledge is a good thing, especially knowledge about children.

So I’d recommend parents take this 4-day seminar from Bessel van der Kolk… and the bonus from Ed Tronick. Or obtain the same information in a more accessible form through Dorcy Pruter. We use different words for the same constructs, I like her words better.

Porges and the vagal nervous system, van der Kolk on complex trauma and child abuse, Tronick on connection and the dyadic state of consciousness in childhood and in all of us – this is not new information. It’s 20 years old.

I first became aware of Porges, van der Kolk, and Tronick, around 2004. I know this information, I’ve known it for the past 20 years. The problem is not that we don’t know what the pathology is and what to do about it… the problem is you don’t listen.

I’ll be awakening “forensic” psychology to their obligations under Standard 2.04 and 9.01, the Bases for Scientific and Professional Judgments and Bases for Assessment. This will extend into Standard 2.01 Boundaries of Competence that would be evidenced on their vitae.

In my review of a psychologist’s vitae, I will note the presence or absence of this 4-day training from Bessel van der Kolk through PESI as evidence of professional competence under Standard 2.03,

2.03 Maintaining Competence
Psychologists undertake ongoing efforts to develop and maintain their competence.

As we move into solutions, it is time to address another required ethical Standard of the American Psychological Association, Standard 2.03 Maintaining Competence.

Standard 2.04 – Standard 9.01 – Standard 2.01 – Standard 2.03 – mandatory for all psychologists. There are reasons for ethical standards of practice. There are avenues to redress grievances.

I’m an old guy like Bessel. We know the field. We know the barriers in professional ignorance, apathy, and sloth. It’s part of the pathology in our collective culture of child abuse.

You, the mental health people… are insane.

It needs to end. We will end it because it must end – we never abandon a single child to child abuse, not in my world, not where I come from. The world is changing – because we are changing it – because it needs to change.

This is child abuse. This is spousal abuse using the child as the weapon. It needs to stop. Now.

Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857