Is Court-Ordered Therapy Effective?

Individuals involved in the legal system may find themselves being court ordered to go to therapy. Some reasons may include drug abuse, anger management, or parenting issues. A common question when it comes to court ordered therapy is: Is therapy effective if someone is being ordered or “forced” to go? Typically, if someone chooses to go to therapy (“choice therapy”) he or she is already starting with some internal motivation or reasons to get help and change. But what about someone who never would have chosen to go to therapy? The research shows that court ordered therapy is actually just as effective as choice therapy. Individuals court ordered to therapy tend to have higher attendance rates and remain in treatment longer. Of course, we can attribute some of that to the fact they are required to attend a certain number of sessions and they may have legal pressure to attend, but they still have a choice to either go through the motions, or actually learn and change. So what makes court ordered therapy the most effective so the person does learn and change? Receiving the proper type of therapy for what the individual needs. If the appropriate treatment is received for the necessary length of time, mandatory treatment can be just as successful as treatment when it is voluntarily sought. For example, there are many different types of substance abuse treatments and depending on severity of the abuse/addiction, additional mental health diagnoses, and other factors, certain treatment programs may not be the best fit, even for someone choosing to receive treatment. Finding the appropriate treatment for an individual is key for successful court ordered therapy. It turns out it is not whether therapy was by choice or not that determines effectiveness, but is whether the correct type of therapy is provided for the person’s presenting issues. To best determine what type of therapy could likely help your clients, consulting with a psychologist can be helpful. A brief description of the case should allow the clinician to provide some suggestions for proper therapeutic intervention.

Adding Mindfulness to Your Child’s School Supplies List

Children encounter a variety of new stressors at the beginning of the school year such as navigating friendships, managing academic demands, and following new requirements for rules and behavior. Providing children with coping skills to manage their emotions is just as critical as supplying them with the pencils, markers, and paper necessary for the classroom. Mindfulness is a beneficial tool you can practice with your children in preparation for the upcoming school year.

Mindfulness is defined as awareness of internal and external experiences in the present moment. Internal experiences are physical sensations, feelings, and thoughts while external experiences refer to the sights and sounds around us. Mindfulness exercises promote self-understanding as children begin to identify, express, and regulate emotions. For example, mindfulness helps children recognize and self-soothe their emotional experiences, such as butterflies in their stomach or sadness about a friend. Greater awareness of facial expressions and body language can promote developing empathy for others and solving interpersonal problems. Overall, mindfulness improves self-control over thoughts, emotions, and behaviors.

Mindfulness can benefit the entire family when implemented as part of your daily routine. One technique is mindful eating during a family meal. Family members can smell the aroma of the meal, observe the colors of the foods, and slowly eat bites of the meal while noticing taste and texture. Young children often do not have the language to explain their internal experiences so it is important early mindfulness practices focus on the outside world. Young children more easily understand textures and sound than describing sadness or tension in the body. One way we introduce mindfulness to children is by explaining it as the superpower their favorite superhero uses to pay attention to his/her surroundings, such as Superman using super-hearing to hear cries for help.

Mindfulness activities with young children should be short, approximately three minutes. You will need to provide clear, step-by-step instructions as you talk children through the activity. Be sure to check-in with children at the end of an activity by asking them what they noticed, such as sounds in the room, textures they felt, or thoughts in their head. Below you will find some our favorite mindfulness exercises to use with children.

Activating the Senses: Provide your child with a grape, strawberry, nut or other small food item. Instruct them through feeling the edges of the food, observing the details of the food, taking a deep sniff of the food, placing the food in their mouth and swirling it around while noticing any tastes. Have your child slowly chew and swallow the food.

News Reporter Journal: Tell your child she is a reporter and the assignment is to document her activities in her personal journal. You would start simple by having her report on a few points of the day (woke up, ate cereal, went to bus stop) with the goal to develop a more extended, detailed story (sat with Daphne on the bus, talked about ninjas, became sad when she didn’t want to come to my house).

Balloon Breathing: Have your child lie on the floor and place a blown-up balloon on his stomach. Explain he will move the balloon up-and-down only using his breath. Teach the child to breathe in slowly through his nose, filling his stomach with air to raise the balloon. Have him pause for a couple of seconds with the balloon raised. Then instruct him to breathe slowly out of his nose to return the balloon down. Again, have him take a brief pause. Continue alternating between raising and lowering the balloon for three minutes.

Guided Imagery: Instruct your child to close her eyes and imagine a very calm place, such as the beach or playground. Tell her to pay attention to what she sees in the scene like waves crashing on the shore, birds flying in the sky, roses around the garden, or kids on a swing set. She might notice if the temperature feels hot or if there is a breeze on her face. Does she hear birds chirping or a water flowing? You could also instruct her to imagine picking up a nearby object, a flower or seashell, and notice how it feels in her hand.

Helpful Resources

Books

  • Sitting Still Like a Frog by Eline Snel
  • Planting Seeds: Practicing Mindfulness with Children by Thich Nhat Hanh

Websites

  • Annakaharris.com – Numerous mindfulness activities to practice with children and adolescents
  • KidsRelaxation.com – Check out the “Spidey Senses” activity

Apps

  • Smiling Mind
  • Breathe, Think, Do with Sesame
  • Sleep Meditation for Kids

References

Hooker, K. E. & Fodor, I.E. (2008). Teaching mindfulness to children. Gestalt Review, 12, 75-91.

Thompson, M. & Gauntlett, G. (2008). Mindfulness with children and adolescents: Clinical Child Psychology and Psychiatry, 13, 395-407.

Encouraging Healthy Media Use for Kids

CAROLINA PARENT QUESTIONS:

  1. In 2015, the American Academy of Pediatrics lifted their “no screens under two years of age” policy in favor of more nuanced recommendations that leave out time limits and instead urge parents to seek out educational content and preserve some screen-free family time. Do you agree with this policy change? How can parents set healthy media limits for young children (aged 1-5?)
  2. What are some signs that a tween or teen may have a screen addiction or be engaging in unhealthy online behavior, and what are some steps parents can take if they notice these signs in their child?

DR. COLETTE DEGALLA:
I know the AAP has changed their policy on screen time for young children and I can see why they did: screens and digital media are pervasive in this country and have become integral to daily life. The reality is that if parents are making use of the multiple forms of digital media available to us, it is very likely their children will grow up in very close proximity to it and likely begin using it very early. While I would love to think that our culture could sustain a restriction on the use of digital media with children under the age of two, the ubiquity of this technology makes a restriction seem highly unlikely to be followed. Recommendations for a healthy engagement with digital media rather than an absolute restriction seems much more likely to be followed by parents and if that’s the case, I believe the change in policy is helpful.

What’s important to remember about the use of digital media, particularly with children under the age of two, is that there is no way it will not impact the child’s developmental process given the critical brain development we know is in progress at this age. When we stop to think about exactly what’s going on during this critical period between birth and age three, it becomes more clear why it will serve us well to be intentional about the use of electronics and digital media as we raise our children. We take for granted babies will learn to talk, to walk, to use the toilet instead of a diaper, and to get along with others. But all of these basic developmental milestones depend upon active engagement with caregivers and the physical world around us. Beyond these basic milestones, there are countless other developmental achievements happening during the first years of life, from learning colors and numbers to feeling the difference between rough and smooth textures, to understanding what’s right and wrong. These developmental tasks all depend upon the physical and psychological interaction of a child with his or her environment and caregivers. When the richness of the physical world is reduced to the two dimensions of a digital screen, some of that richness is clearly lost. For example, seeing a flower on a tablet screen might be a beautiful sight but it does not compare to exploring a real flower, which has its own texture, dimension, fragrance, and living quality. So although engaging with a virtual world might not be detrimental in itself to a developing baby, it is not a substitute for interacting with the real world.

Other things to keep in mind regarding the use of digital media and screen time for young children are all of the other developmental tasks on the agenda for those first few years of life. Critical to coping and mental health, babies and toddlers are learning how to self-soothe and to regulate their own emotional state. These early years are also the time to cultivate curiosity about the world around them and the impulse to explore in order to satisfy that curiosity. Language development is critical to not only basic communication but to overall cognitive development.

Babies and young children need opportunities to develop fine and gross motor control, perceptual capacities, and a sense of balance. All of these require active engagement with the world around them. The early years are also a crucial time for learning about empathy and developing a sense of morality. While use of digital media does not necessarily prevent all of this development in itself, the more time a baby has to engage in in ways that promote development, the better off he or she will be. What is absolutely critical in the first few years of life is a healthy attachment to mother, father, or a caregiver. There is no substitute for the loving attention and presence of a baby’s primary caregiver. Digital media should not be overused as a way to distract a baby or pacify a baby when a caregiver is busy or preoccupied.

Concerning the possibility of a tween or teen being addicted to screen time or the use of technology, the first signs to note are problems in school and difficulty keeping up with daily responsibilities. If a parent is concerned that a teen or tween might have an addiction, it is important to consistently observe the child’s behavior over a period of time. Parents should make note of significant changes in overall mood – an increase in irritability, anxiety, or depression. Lying about use of digital media or trying to hide it may also occur. Withdrawal from family engagement and a resistance to activity other than the use of digital media may also be signs of a screen addiction. An unwillingness to be separated from a computer or digital device and a sense of urgency about returning to a screen when separated from it are noteworthy as well. Changes in appetite, sleep patterns, and level of physical activity, all should be noted. When an addiction sets in, all other aspects of a person’s life become secondary to the source of the addiction. There is little tolerance for any competing demands on the person and very little tolerance of distress. The screen may be used to soothe and calm oneself and the only time the addicted person may feel good is while engaged in screen time.

It is important to remember, as with any addiction, that if a child seems to be addicted to screen time, harsh judgment and anger directed at the child will not help. If a parent is concerned his or her child may have an addiction, step one in addressing it is paying attention to what’s going on with the child. The parent’s own use of technology should also be considered – is the parent modeling behavior that would facilitate unhealthy use of digital media for the child? If so, parent behavior should be modified. Limits and once again, intentional use of digital media are important. It should not be used as “filler” for free time, whether at home, in the car, or during other “idle” times. If a child seems to be struggling with an addiction, it is time for helpful interventions that address the actual problem. Power struggles and angry punishments will be detrimental to addressing the problem and can have a negative impact on the child’s self-esteem. Some first-line interventions are to talk to the child about the concern including sharing observations without judgment, offer alternative activities in which both parent and child can participate, and to spend time outside playing or exercising. When parental interventions do not seem to be enough to change the behavior, parents can seek the help of a qualified mental health professional.

https://www.carolinaparent.com/Encouraging-Healthy-Media-Use-for-Kids/

Coaching Clients to Effectively Use a Parenting Coordinator

In a previous post we talked about what a Parenting Coordinator (PC) is and the benefits to using one. This article is aimed at helping you prepare your clients to work effectively with their PC. A PC can be most helpful with calming a hostile and chaotic family dynamic if both parents are willing to work with the PC and make changes within themselves.

To increase the chances that the PC work and relationship goes well, you can help prepare your client by sharing the following suggestions:

  1. Be positive in your interactions with the PC; do not project your anger at your ex onto the PC.
    Some people who did not want a PC interact with the PC with a lot of hostility, sometimes even before any PC decision has been made for them to disagree with! Being calm and positive with the PC can help pave the path for a good relationship with your PC. That doesn’t mean every decision will go your way, but by being positive with your PC he or she will be able to best hear and consider your perspective when making tough calls.
  2. Remember, the PC’s decisions are not personal. The PC is a neutral party who does not have an emotional history with the family and is making decisions based on best practices for divorcing families. Those decisions won’t always be in line with what you want and they won’t always be “even.” A good PC is going to make decisions that are best for the child and based on what is considered best practice. Along those lines, avoid thinking of PC decisions as you or your ex “winning” or “losing.” That framework keeps you locked into Conflict Mode with the other parent, which results in high hostility and stress for everyone involved – including your child.
  3. Do what your PC says. Follow the official PC decisions to the letter as those are legal in nature (i.e., same as if a judge ordered them). When the PC implements structure to help increase effectiveness and efficiency of the work (e.g., email the other parent only through the PC, limit number of communications), work within that structure. If the PC makes suggestions (e.g., how to phrase something to the other parent), take them. They are trying to help you decrease hostility and develop skills so that you and the other parent can function effectively on your own in a way that is healthy for your child.
  4. Keep your child in focus with every decision. When you find yourself entering into a conflict with the other parent ask yourself, “Am I arguing for something that is clearly in our child’s best interest, or could this be a matter of opinion?” Sometimes after years of conflict people can develop a pattern of arguing just for the sake of arguing; your brain immediately assumes the worst and/or develops a position opposite of what your co-parent suggested. Remember, the point of PC work is to decrease hostility and make decisions for the good of the child, so if your PC suggests you may be arguing for no good reason, listen and work to be less argumentative.

Those may seem like some obvious basics but nonetheless can be quite challenging for couples that are locked in such hostile conflict that they require a PC. The following are more aspirational goals:

  1. Two things contribute most to a child having a good outcome from a divorce – low hostility between parents and a strong, healthy relationship with each parent. Support their relationship with the other parent. The child needs you both. Never speak poorly about the other parent in front of your child – children see themselves as half each parent, so when you disparage their other parent you cause emotional pain to your child.
  2. Keep the focus on the present and the future. Your goal is not to convince the PC with examples from the past that you are the good parent and the other parent is bad, your goal is to do what is best for your child from here forward.
  3. Enter the relationship with the goal of learning from the PC so you can stop working with them and be effective, amicable co-parents for the benefit of your children. Depending on your PC’s background and style, you might have the chance to learn about child development, your child’s experience in two homes, and skills to improve communication and resolve conflict. You are paying for this service – get everything you can from it. Your PC has no interest in wasting your time or money so take their suggestions on how to engage most effectively in this process and as a co-parent.
  4. Avoid being an accountant, keeping track of how many decisions are made in each parent’s favor. This only contributes to the mindset of being in an adversarial relationship with the other parent when a major goal of working with a PC is to have an effective working relationship with the other parent for the sake of your child.
  5. Think of the PC and the other parent as your teammates in making decisions that affect your child. Be respectful of your teammates and assume they are doing what they think is best for your child. Come to each meeting (or email) prepared with what you want to discuss and keep your interactions brief, to the point, and polite or even friendly.
  6. Be familiar with the PC order so you know what your PC is allowed to be involved with. For example, the PC is never allowed to make decisions about money or make major custody changes. Talk with your attorney when there are issues outside your PC’s purview.

As their attorney you might at times receive complaints from your client about PC decisions, or their perception that the PC is aligning with the other parent. After looking into this, if you feel the PC has been neutral it is helpful to the PC process to remind the client that the PC is a neutral party keeping their child in focus, and that compromise and negotiation isn’t part of being divorced, it’s part of being a parent – married or not. Also, attorneys and PCs can model good communication by having a good working relationship too. Reach out to the PC at the beginning of a case just to open the lines of communication, and help the PC if you can any time they reach out to you. Together attorneys and PCs can often help clients get the most out of their PC experience.

Technology Fatigue: What It Is and How To Deal With It, Part One

Technology fatigue: what is it? This is what I call the mental fatigue that comes to those of us who were not born with an iPhone in our hands but are now at the cutting edge of the integration of technology into practically every facet of our daily lives. We are now participating in a very significant moment in history and in the evolution of our species: the transition from the Industrial Revolution to the Information Age or what I like to call the Age of Technology. Right now, we are experiencing the full effect of riding the technology wave. We’re in what surfers call the “gas chamber” of the technology wave – basically like being in a tunnel surrounded by water as you surf. Here we are, balancing on a surfboard, whipping over the surface of the ocean as it hurls us toward shore. The adrenaline and excitement are intoxicating as our lives are transformed at a pace that generations before us never could have imagined.

Our economy, our language, our culture are all being affected by the runaway speed of technological advancement. We are no longer left to ourselves for a stretch of time while out on a walk or at home in the evening with a good book. We receive texts and emails while walking the dog, driving to work, during dinner, and in the movies. With technology permeating nearly every aspect of our lives, there’s so much to learn and re-learn: we have not one remote in the living room but four remotes to keep track of and then these four remotes might later get consolidated into one new, more advanced universal remote, which gives us yet another remote to learn how to use. Remember the old days when there was an on/off button on the t.v. and a dial to change the channel? Remember what it was like to daydream or wonder about something you knew nothing about? Lost are the random moments of day dreaming in response to a problem or pondering possibilities when it comes to something that can be “Googled” on a smartphone or nearby device. Wondering has been replaced by “Googling.” Sitting down to write a letter to a friend in a distant state or country has been replaced by a digital exchange on Facebook, by a moment-in-the-life conveyed via Instagram, or a micro-documentary via SnapChat. And while any of these is taking place, some other friend might shoot a text your way to interrupt the Facebooking, Instagramming, or SnapChatting. It’s a new way of being in the world. Rarely are we without our phones or some kind of device nearby and we are nearly constantly learning how to use something new.

Learning to make use of personal technology is similar to learning a new language. In learning a new language there are the mechanics of speaking, the grammar and syntax to learn, and a whole new vocabulary. We know that the very young are most adept at learning new languages when the brain’s plasticity is most elastic and absorbent. The same goes for technology: we learn new mechanics of its use, how to integrate it into our lives, and how to manage the constant flow of information coming at us from all directions. It’s easiest for the young to pick up new technology and because they don’t have to rely on their parents and the community to learn it, like babies do when learning language, they can soar past their elders in how quickly they learn it. They learn technology from technology itself. With new hardware, new software, new apps, and a plethora of passwords to remember or to store in a digital keychain, our psyches, both young and old, are being taxed in a totally new way.

So what happens to us, the bridge generation or generations that can remember when every telephone had a wire and the screen in a home stayed put? What happens as we rush to adapt to the integration of technology into so many aspects of our lives? Like any growth spurt, adaptation to something so new and so pervasive takes a lot of energy. Mental fatigue, memory issues, a decrease in motivation, and an increase in stress characterize technology fatigue. There is no diagnosis in the DSM-5 for this condition but Wikipedia calls it “technostress” and describes the physical and emotional symptoms resulting from the stress. See if any of these symptoms of the resulting anxiety match your experience: “headaches, backaches, eye strain, neck pain, stiff shoulder, joint pains, mental fatigue, depression, nightmares, panic, resistance, and a feeling of helplessness. suffering insomnia, loss of temper, irritability, frustration, [a possible] increase of errors in judgment and poor job performance if not dealt with.” This, of course, is not a mental health diagnosis and Wikipedia is not a reliable source of information for mental health issues, but the fact that Wikipedia has an entry for “technostress” is indication that many people have pondered the effects of the rapid changes that characterize the Information Age.

If you feel you might be suffering from technology fatigue, what should you do about it? First, recognize it, if this is true for you. Without an acknowledgement that you are experiencing this it will be difficult to address. Second, you will need to set your intention to address the issue. With your intention set, it will be much easier to follow the next set of recommendations:

  1. Take regular breaks from technology throughout the day. Give yourself periodic breaks to breathe deeply and reconnect with your body. Turn away from your computer or phone and shift your awareness into your body where you can identify places of tension. Imagine breathing into those places of tension and releasing the tension. Do this several times throughout the day.
  2. Give yourself some limits on use of devices, such as not using your phone in bed, not checking email before 9:00am, or not spending more than 30 minutes on Facebook. Use a friend or spouse to help keep you accountable.
  3. Take technology-free vacations either for a day on the weekend or, if you’re really brave, maybe your whole vacation!
  4. Cultivate hobbies that do not require use of technology. Learning to make something with your hands is an excellent way to reconnect with the physical world around you.
  5. Find ways to interact with others for fun in person, not via social media. Playing good, old fashioned card games or board games is a great way to enjoy the company of friends or family.
  6. Learn mindfulness meditation so you can train your mind.
  7. Exercise, especially outdoors.

It’s also important to assess whether your stress is a result of overuse of technology or of other aspects of your life. Stress from technology fatigue can and should be addressed in and of itself but this might not eliminate all sources of stress from your life. If you need help addressing other sources of stress in your life, seek help from friends, partners, or a therapist. Digital technology is an extremely useful and, at times, enjoyable aspect of life in the 21st century. Our challenge is to use it wisely.

Providing Clients Guidance on How to Best Approach Psychological Testing

Clients coming in for psychological evaluations can frequently have little idea what to expect, and it can be an anxiety-inducing experience for them, considering the potential legal implications of an evaluation. Additionally, it can feel somewhat intrusive to have your personality and functioning evaluated by a stranger. Therefore, they naturally look to attorneys for guidance on how to best prepare for and present themselves during the evaluative process. This article describes some general guidelines for preparing clients for this process.

While there are variations, the forensic evaluation process generally consists of a few components: the clinical interview, psychological testing, review of past related records, and the interviewing of collateral contacts. The interview is the opportunity for the client to share their story and history face-to-face with the evaluator. It is generally somewhat standardized and walks the evaluator through the timeline of one’s life and the events that necessitated the evaluation. Since a defining characteristic of a forensic evaluation is the gathering of information from multiple sources and perspectives, we ask clients undergoing an assessment to bring in the contact information of a few collateral contacts we can interview who can speak to their functioning. Ideally these people are as neutral as possible; for example, if a client is undergoing a psychological evaluation pursuant to a custody dispute, interviewing one side’s best friend whom has a grudge against the other party would not provide much usable information. Coming prepared with a few names of people the evaluator can call will streamline the process and foster a shorter turn-around time on the assessment. The best choices are neutral professionals such as therapists, teachers, childcare providers, etc. In addition it is helpful to advise your clients to provide consent for the evaluator to obtain any relevant records (mental health, academic, legal history, etc.)

Likely the most helpful and significant guidance attorneys can share with their clients is to be open, straight-forward and forthcoming in their evaluation. Many of the tests used include validity scales that assess the approach one is taking to their evaluation, and these scales are fine-tuned in being able to identify malingering, “fake good” profiles, defensiveness, or other forms of less-than-honest responding styles. It is actually common for examinees to provide a defensive profile or a fake-good profile when the testing is for court. In a fake-good profile, the person is motivated the deny problems and appear to be better off psychologically than is the case. In a defensive profile, the person is motivated to present unrealistically favorable impressions by emphasizing positive characteristics and minimizing negative ones, but the examinee does not do this as blatantly as in a fake-good profile. It should be noted a fake-good profile can reflect deceit in the test-taking situation but cannot be seen as a more general tendency to lie or deceive others in daily life. Also one cannot infer in a fake-good or defensive profile the examinee is covering up psychological problems.

Nonetheless sending to the court a report that indicates the responder was so defensive in their test-taking approach so as to render the results meaningless or questionable is not ideal as the judge’s mind can naturally assume the worst when that occurs, and he or she can project whatever that worst case scenario is on what the person may be hiding. Counseling your clients to be up front and forthcoming in responding and in interviews helps increase the likelihood they will provide valid testing useful for the case, and valid testing helps bolster the argument that their interview report is likely truthful as well.

These simple pieces of guidance – what to expect, bring collateral contacts, provide records, and be open and honest – can turn what can be a sometimes anxiety-evoking experience into one in which a client feels heard, understood and like there was an opportunity to tell their story.

Competency to Stand Trial: Effort v. Malingering

Imagine you are interviewing a 17-year-old young man about his knowledge of court proceedings. The young man is unable to explain the role of the judge and cannot describe the charges against him. He appears to have average intelligence, which makes his responses even more perplexing to you. He suddenly turns his head to look at the wall and informs you that he hears someone else speaking, but you assure him this is not the case. His medical records reveal several psychiatric diagnoses throughout his life. Your opinion: Competent or not competent to stand trial? Is he malingering? Is he even trying?

The critical task for psychologists in these situations is determining whether the individual is malingering or not putting forth adequate effort. The former is a deliberate and intentional misrepresentation of oneself that is driven by secondary gain while the latter is sometimes intentional, but lacks purposefulness.

Psychologists alert you to inadequate effort in the behavioral observations section of the competency to stand trial evaluation. They will depict an individual going through the motions of the evaluation without concern for their performance. Descriptions of behaviors will include phrases such as poor motivation, minimal effort, low tolerance for frustration, or refusing to respond to questions. Consequently, the psychologist will likely conclude that the evaluation was an unreliable assessment of the individual’s current level of court knowledge and ability to consult with counsel.

An individual who is malingering during the evaluation may deny having basic court knowledge, intentionally respond to questions incorrectly, or feign a mental health disorder that would preclude them from functioning in the court process as well as attaining competency in the future. Psychologists have several tools for assessing each of these scenarios.

Psychologists can review school and medical records for inconsistencies in functioning, administer specific tests to assess malingering, and conduct cognitive testing when an individual is believed to be intentionally misrepresenting their level of court knowledge. For example, The Test of Memory Malingering (TOMM) distinguishes malingering from memory impairments while the Inventory of Legal Knowledge (ILK) assesses whether an individual is feigning their knowledge of the legal system. Furthermore, cognitive tests such as the Wechsler Adult Intelligence Scale-Forth Edition (WAIS-4) provide information regarding the individual’s level of cognitive functioning in regards to general knowledge, abstract problem-solving, working memory, and speed of processing information.

Clinical interviews used in conjunction with psychological testing are tremendously valuable when there are concerns of feigned behaviors. For instance, individuals malingering mental health symptoms often demonstrate blatant behaviors characteristic of a disorder while often missing subtle behaviors, which are observed by psychologists during the clinical interview. Furthermore, structured interviews such as The Structured Interview for Reported Symptoms, 2nd Edition (SIRS-2) assess the genuineness of an individual’s responses as well as inconsistencies in self-reported mental health symptoms. Personality measures, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) also provide information on the individual’s response pattern. The MMPI-2’s validity scores have the most empirical support for use in assessing malingering behavior.

Although psychologists provide opinions regarding competency-to-stand-trial based on the impact of developmental/cognitive or mental health diagnosis, clinical judgment and psychological assessment is also necessary when malingering is under question. When you read through the report, pay close attention to whether the psychologist painted a vivid picture of how the individual presented during the evaluation. Also, check the lists of administered tests as administration of the TOMM, ILK, or SIRS-2 suggests that the psychologist may have been concerned if the individual was responding truthfully. If personality testing was administered and found to be unreliable, make sure the psychologist elaborated on the reasons for this response pattern, such as random responding or presenting oneself unfavorably. Finally, remember the threshold for malingering is exceptionally high in competency to stand trial evaluations with only 10% of adults found to be malingering during evaluations.

Cooperative Parenting Part III: Embracing a New Life

Cooperative Parenting Part III: Embracing a New Life

Sometimes during the separation period or soon after the divorce it’s hard not to hold on to the past – either wistfully, angrily, or something in between. In this third article on Cooperative Parenting we’ll look at why it’s important to let go of the past and how doing so will help you embrace your new life, especially your new parenting role.

It’s the most difficult role change for some. You might go days without seeing your child, then when they are with you, you spend a lot of time together – either because their stage requires you to or because you want to make the most of your time with them. When your child is with you, you act as both parents, making decisions on the spot that you once might have deferred to the other parent… and the same goes for your co-parent. There are bound to be situations where one person thinks a certain decision should be a joint one and the other thinks it’s a decision for the parent in charge at that moment. It’s one of the many times in co-parenting where minimal hostility and good communication is crucial. In general, there will probably be fewer shared decisions now than when you were married but be clear within yourself which decisions are up to each individual parent and which are joint decisions. Communicate with your co-parent about this (there will be opportunity to practice the skills of negotiation and compromise here) – it’ll greatly decrease conflict and hostility if both parents use the same guidelines.

You won’t just be making more decisions on your own when your child is with you – you will be doing things with or for your child that used to be in the other parent’s domain. If you’ve never been the cook in the family, you will be now. If you didn’t help with homework before, you will now. You will have to learn new skills and develop new routines which will help stabilize this new life for you and your child. Keep in mind that while the two households won’t operate identically, the more similar the rules and routines are, the easier it will be for your child to live in two places. Again, this will require respectful communication and negotiation between the parents.

Letting Go


This change in roles, as well as respectful communication and negotiation, is easier to do if you’ve let go of the past. For many people this involves grieving, a healthy process of accepting loss. Regardless of which partner initiated the divorce, you might be grieving the loss of intimacy with your ex, the loss of financial security or lifestyle, the loss of the dream of your ideal family life. Remember that your child is grieving as well – loss of routine, security, perhaps friends and school if he moved, and maybe things that can get lost in the shuffle of change and conflict – like favorite afterschool activities that don’t coordinate easily with the custody schedule. There are several stages of grief you might see in you and your child (and the other parent): shock, denial, guilt, anger, bargaining, depression, hope for the future, and finally acceptance. These stages aren’t necessarily sequential but it’s important to notice if you or your child seem to be stuck in one.

Moving forward will be easier if you are willing to acknowledge wonderful memories you had as a family. Depending in what way you are still holding on (angrily, longingly, sadly) this might feel very hard to do but those moments did happen and acknowledging them can help you heal. Forgiveness is another important component for letting go and moving forward. It doesn’t mean you condone whatever it is your ex-spouse did that hurt you, it means that you let go of the negative emotions toward them and think of them as positively as possible (this is where remembering those positive memories can come in handy). The more you hold on to anger, pain, vengefulness, being the victim, or a desire to win, the more conflict and hostility will enter the co-parenting relationship and negatively affect your child.

Think of it this way: the cost to you of holding on to the past is that the anger and sadness eat away at you, drain you of energy and happiness over time, damage your self-esteem and self-concept, and can interfere with future relationships. The cost to your child is that they will probably be caught in loyalty binds even if you try to avoid them, their relationship with one or both parents will be negatively affected, and their self-esteem and self-concept might be damaged since children view themselves as half one parent and half the other.

To let go of the past and embrace your new life you need to disengage from the other parent. People stay engaged primarily by either trying to hurt the other parent through revenge or angry conflict, or trying to take care of the other parent (outside of support agreed upon as part of divorcing, such as alimony) with the hope of reuniting or out of fear of the unknown. Both prevent you from truly moving forward wholeheartedly with your new life.

So, how to move forward? It’s simple but not necessarily easy. It starts with turning your mind – just deciding to let go of the anger, bitterness, sadness, hope, fear, and unfulfilled dreams. Start nurturing a curiosity and optimism about what your future might hold. Some people find that to do this they need to disengage physically from their ex-spouse – not see them, communicate only about the child and only through email and text, remove signs of them from the house (except for the child’s bedroom). It’s not recommended as a long-term solution since this kind of distance between parents can be damaging to your child, but it’s less damaging than hostility and constant conflict. It can be a critical first step to disengaging emotionally so that you can interact with your co-parent more effectively and healthily in the future. Many parents find that after this turning of the mind, performing a disengagement ritual eases the transition to the next stage. We have rituals for other life transitions (marriage, graduation, death) and they can be helpful with psychologically closing the last door and opening the next one. If you find that you are stuck in a stage of grief; engaged unhealthily with anger, fear, or unreasonable hope; or that the temporary disengagement from your co-parent goes on for more than a few months then you might consider seeing a divorce therapist to give you and your child the best chance of moving wholeheartedly into your new life.

Ditch the Diet This Holiday Season

Yes, you read it right, ditch the diet this holiday season- the season of parties and buffet tables filled with cookies and cake, pies, chips and dips, breads and cheeses, and hot creamy drinks spiked with alcohol. Why is this health professional encouraging you to ditch the diet during this time? Because the diet mentality causes restrictive, negative thinking that sets you up for stress, struggles, and usually guarantees defeat. Doesn’t sound very festive does it? Not to mention most people agree this time of year brings about a whole lot of stress and anxiety. Family conflicts, financial strain, finding the right gift, travel plans going awry, and unpredictable weather can wreak havoc on our minds and bodies, so why ADD to all of that by putting restrictions on what we can eat?*

Here are some ways to stay stress-free, healthy, and happy while still enjoying all the delicious food the holidays has to offer:

  • Make A Game Plan. You’re most likely not going to a holiday party every night of the week, so when you’re not out, center your meals around the nutritionally dense foods (whole grains, vegetables, lean proteins, healthy fats). Have healthy foods ready and available. To avoid arriving at a party in starvation mode, eat a small meal before you go so when you get to the buffet table you can make smart choices. Having nutritious meals available for the days after the party can also help you get back into the groove of healthy eating for the rest of the week (or until the next party).
  • Contribute. If you are going to someone’s home for a get-together, offer to bring a healthy appetizer or dish of your own that you would feel good eating while there.
  • Indulge in Tradition. Grandma’s homemade scratch apple pie is special. The apple pie bought at the grocery store is most certainly not. Ask yourself if what you want to eat was made with love by people you know, or if someone just picked it up at the store for the sake of bringing something. Enjoy the foods of your culture, not the mass produced stores.
  • Savor the food. Eat slowly and taste every bite, after all, you only eat this special holiday food once a year! It also takes our brain 20 minutes to register when our belly is full, so by eating slowly we are more likely to feel ourselves getting full and to stop. When we eat too fast, we can end up eating way more than what our stomachs can handle, leading to the uncomfortable (or painfully) full feeling (you know what I’m talking about!).
  • It’s ok to say “no.” It’s ok to say “no” when you are offered another helping of the fried meatballs made with your family’s secret recipe. Like most things, when you have too much of something it becomes less special. Plan a few phrases to say to those food pushers. Sometimes you might just have to repeat yourself with a simple, “No thank you, I’m really full!” Remember, no one can make you eat anything you don’t want to and it’s not your responsibility to make them feel better by eating.
  • Be Kind To Yourself. So you ended up having that eighth cookie. While your stomach may be hurting, you don’t need to add extra pain by berating yourself or feeling guilty. Acknowledge that you ate and enjoyed it, then move on to enjoying other non-food related activities.

There’s going to be a lot of stress we cannot control during the holidays, but we can help ourselves deal more effectively with the stress by eating well and allowing ourselves to enjoy the fun holiday foods.

*This is not giving you permission to ignore any health advice your doctors have given you, particularly if you have certain health conditions.

CRAZY OR CRISIS?

CRAZY OR CRISIS?
Evaluating mental health functioning and parenting abilities
in the midst of court crisis and litigation trauma.

Picture this: Within the past week you were notified that you are being audited by the IRS on Friday, a hurricane just struck and caused irreparable damage to your home making it unlivable, and your closest friend suddenly passed away. Today you are told to go into a strange office and complete a bunch of tests and interviews to see if you are fit to retain custody of your children. You’ll do great, right?!

Probably not, but it is in high crisis times like these that evaluations are often ordered by the courts. Typically, individual psychological evaluations for use in a custody case or custody evaluations of the whole family are ordered when there has been extensive litigation, allegations of abuse, or one party is stating the other suffers from a mental illness.

Many marital separations are characterized by blame, shame, and criticism, often with considerable anger and resentment. There is grief over the loss of dreams, hopes, and the contract of permanent attachment. Those who have experienced childhood wounding are re-wounded. Adding ongoing litigation can create further stress and trauma.

High conflict divorce can be horrendous for all parties and mimics trauma in many ways. It is a battlefield of accusations, feelings of betrayal, deep feelings of abandonment, a sense of personal assault, a profound sense of loss and an intense distrust of your former partner. Those involved often feel out of control; external influences (courts, attorneys, GAL, therapist) are significantly influencing their lives, and emotional turmoil is high. The court system is adversarial by nature. One party “wins” while the other “loses” and there is an unwritten agenda to defeat the other parent. It is your job to make your “opponent” look bad and parents are forced to disparage each other in an effort to simply maintain their roles as parents. Fear and hostility run high when parents are threatened by the potential loss of their children. Additionally, during high conflict divorce both parents can engage in alienating behaviors at one time or another. This series of stressful events is the very definition of a crisis.

How might this look on a psychological evaluation? The experience of a crisis carries into the evaluation room and can cause the individual to appear angry, paranoid, aggressive, and anxious. The current trauma of custody disputes can very well create personality traits that distort the results of psychological testing. The natural emotions stemming from divorce and custody disputes include a combination of stress, frustration, grief, powerlessness, and numerous other emotions. These are natural reactions and have nothing to do with the basic personality of the individual or their ability to parent. Testing may show that one or both parents experience traits closely related to their concerns (e.g. anxiety/paranoia – the other party is “out to get you” or discredit you). Don’t think you are off the hook if you do not show any of these responses. This may be indicative of more antisocial and abusive attitudes and enjoyment of being able to deceive others, remain engaged with your former spouse, and create anxiety in your former spouse. It is vital the evaluator parse out traumatic reactions to the current crisis from long-standing personality issues.

Defensiveness is also common in custody evaluations. Who would not want to “look good” when they are being evaluated in order to maintain their relationship with their child? This can be misinterpreted as one parent trying to “hide” something or as lacking insight regarding their own “psychological issues.” This may be an inaccurate conclusion. In times of trauma, denial may be necessary to maintain daily functioning and again not an overriding characteristic of the individual. Disorganization and emotional flooding may also be present and interpreted as stable characteristics rather than as occurring secondary to the crisis of custody litigation.

If one parent does experience a significant mental health issue, the other parent’s evaluation may be impacted as well. It is rare to find one parent with severe mental health illness or personality problems and the other without some deficits as well. The “healthy” parent has likely developed some unhealthy coping strategies to get by, thinking has likely become distorted, and they may have lost sight of what is “normal.”

It is important to tease these issues out and determine what is long standing, what is transient and specific to the trauma/crisis associated with divorce and custody litigation, and what characteristics will likely remain moving forward. If a parent does have a long standing mental health issues, the evaluator must determine how it impacts their parenting and the best interest of the child. Their mental health may or may not be relevant to custody. A former or current mental health diagnosis does not prevent a person from being a good parent. The impact on parenting must be assessed.

When looking at testing results, be sure your evaluator has dug deeper. Look to see your evaluator has done a true forensic evaluation in which multiple sources of data are used and history is explored in depth for a full picture of past and current functioning. Be sure the evaluator has distinguished between long standing mental health issues that could impact parenting, versus current trauma reactions to the crisis that will likely pass. Clinically significant scores may not indicate “crazy,” but rather an ongoing crisis that would make us all look a little crazy. An experienced forensic evaluator should be able to parse out the difference.