Mending Fences: A collaborative, cognitive-behavioral reunification protocol serving the be

By Benjamin D. Garber and Bill Eddy

High conflict divorce can leave children polarized within the transitioning family system, aligned with one parent and resisting or refusing contact with the other parent/b. Rather than becoming mired in the bottomless pit of back and forth blame, more and more courts are seeking remedies in the form of reunification therapy.

Charged with helping the polarized child to enjoy a healthy relationship with both parents, we know what doesn’t work: individual child therapy cannot remedy a family systems problem. Dyadic interventions with the child and either parent are seldom sufficient. Even family therapies fall short when they are not grounded in well-established, reliable, and valid science.

Mending Fences introduces a child-centered, systemically informed, empirically-validated, and experientially-proven collaborative reunification protocol. Focusing on the anxiety inhibiting the system’s healthy functioning, well-respected and long-validated cognitive behavioral exposure methods are fused with structural family therapy to reduce the child’s anxieties about separating from one parent and approaching the other, the aligned parent’s fears of separation and loss, and the rejected parent’s fears of rejection.

A common vocabulary across coordinated interventions allows children across the spectrum of ages and abilities to identify and overcome an individually tailored succession of anxiety-inducing events so as to gradually (re-)establish healthy and safe relationships with both parents.

The Mending Fences protocol is practical, proven, and effective. The user-friendly discussion is peppered with up-to-date references to the scientific literature and international case law. Application via video conferencing platforms is discussed.

Included: Case illustrations, sample court orders and service agreements

• Language: English
• Publisher: BookBaby
• Release date: Oct 7, 2021
• ISBN: 9781950057146

Book preview

CHAPTER 1

THERE IS NO SUCH THING AS REUNIFICATION THERAPY

There is no such thing as reunification therapy.

This has not, however, stopped the phrase from going viral. Professional journals, popular press articles about high conflict divorce, and judicial rulings throughout the English-speaking world all commonly refer to this thing that does not exist as if it was as well-established and familiar as appendectomy or Cognitive Behavioral Therapy (CBT).

It is not.

The term reunification has historically been relevant only to child protection and removal matters. It describes the steps that courts and child protective workers take to cautiously return a child into the care of a parent who has been found to be abusive or neglectful (Terling, 1999).

Unfortunately, the term has been adopted in the last decade—together with all of its historical baggage—by aggrieved parents, their attorneys, mental health providers, and many courts to describe an imagined or hoped-for therapeutic process intended to repair the broken parent-child relationships that develop in some high conflict, divorcing families.

Although divorce with children can be, and usually is, a relatively smooth process with little long-term negative impact for the kids (Arkowitz and Lilenfield, 2013), a small minority of parents make it into a kind of tribal warfare in which everyone must pick sides. In these circumstances, a child can become strongly allied with one parent (Parent A), and resistant to or rejecting of the other (Parent B). By definition, this child has been polarized within the family system. Reunification therapy generally intends to repair the child’s relationship with Parent B.

The goal is certainly valid and worthwhile. Although psychology and the law agree on very little, the two fields do generally agree that every child should have the opportunity to make and maintain a healthy relationship with both (all) of his or her caregivers.² Unfortunately, applying the term reunification to this process introduces confounding connotations suggesting that Parent B is abusive or neglectful; deserving of his out status; and in need of remediation, supervision, and/or criminal consequences.

Fiction can be more compelling than reality. Consider, for example, the therapeutic intervention commonly referred to as anger management. Like reunification therapy, there is no such thing. There is no research, professional literature, or best-practice guidelines associated with anger management. There is, however, a very entertaining 2003 movie by this name, which seems to have been mistaken as describing a real professional service. As a result, ever since the movie’s release, psychotherapy offices across the country have been flooded with calls seeking anger management services.

The common-sense idea behind each of these two fictitious therapies is sound. On one hand, of course we should all develop the skills necessary to voice our strong negative emotions in ways that are constructive. On the other hand, of course we want kids to have the opportunity to enjoy a healthy relationship with both parents. The former is most commonly accomplished via CBT interventions (Boxmeyer et al., 2018; Lochman et al., 2004). The latter—the service often referred to as reunification therapy—is best accomplished through a form of family therapy.

This book describes a form of family therapy known as Multi-Modal Systemic Therapy (MMST) and recommends it as the best choice among possible therapeutic interventions when reunification therapy has been ordered. MMST is just what it sounds like: a systemic (as opposed to an individual, dyadic, or a family) intervention conducted by a team of skilled professionals integrating multiple, simultaneous, and interwoven treatment modalities in support of the singular goal of assisting participants to modify maladaptive, undesirable, and unhealthy structures (roles and rules) and patterns of interaction (dynamics) in the best interests of their child.³

Dynamics Must Not Be Confused with Diagnoses

A diagnosis describes a constellation or pattern of thoughts, feelings, or behaviors within an individual that has been consensually deemed (albeit often culture-specific) to constitute pathology. A dynamic describes a pattern of thoughts, feelings, or behaviors that repeats or persists between individuals with no necessary connotation of pathology.

Diagnoses describe illness. Dynamics describe relationships.

This distinction is important for a number of reasons. The idea of diagnosis (and, indeed, the idea of mental illness) is derived from medicine. It carries with it the implication that a person’s distress and dysfunction can be understood and treated exclusively within that person. In this paradigm, the provider’s job is to identify a pattern of symptoms, correlate the observed pattern with similar patterns observed in other individuals, and, on that basis, to diagnose an illness and prescribe a treatment.

For better or worse, most mental health professionals are trained to practice in the medical model. Thus, depression and anxiety are approached in much the same way as Lyme Disease and thyroid cancer—survey internal symptoms, then match the results to established patterns so as to diagnose illness and provide individual treatment accordingly. What’s missing here? The answer is that the medical model neglects the individual’s interpersonal existence entirely. The medical model routinely fails to consider if and how relationship dynamics may have caused, exacerbated, and/or may be sustaining the problem (Rosenbaum et al., 2019).

Nowhere is this oversight more glaring and destructive than when a child presents for care with mood or behavior problems. To presume that the child’s distress and/or dysfunction is necessarily and exclusively caused by diagnosable pathology is to actively do harm to the child. This is commonly illustrated when a child’s adaptation to a chaotic and conflicted family environment is mistakenly diagnosed as attention deficit hyperactivity disorder and medicated accordingly (Garber, 2001; Schwarz, 2016). The same myopia is evident, albeit louder and more inflammatory, in the now-defunct call to codify the systemic dynamic often known as parental alienation as a diagnosis in the Diagnostic and Statistical Manual (Bernet, 2013; Lubit, 2019).

Compounding this problem is the health insurance industry’s insistence that payment depends first and foremost on the identification of an individual as the patient (as opposed to a couple, parent-child dyad, or family system), and on the diagnosis of that patient with a specific illness. Thus, mental health providers are financially incentivized to conceptualize and treat every presenting problem as individual pathology. Without an identified and properly diagnosed individual patient, health insurance companies will not pay professionals to treat family dysfunction, co-parenting issues, or for providing reunification therapy.

True, destructive systemic dynamics can cause diagnosable pathology in individuals. Many children caught up in their parents’ selfish conflicts suffer anxiety and depression with concomitant school failure, substance abuse, physical pain, and social implications. Getting proper mental and physical health, along with academic supports for these conditions, may be critically important—even life-saving—but individual care is seldom sufficient. At best, individual treatment can be compared to throwing a buoy to a drowning man. It might help keep him afloat, but what he really needs is to get out of the water. That’s the job of family or systemic therapy. And at worst? At worst, individual diagnosis and treatment confirms what the scapegoating family has been saying all along: the problem is not ours, its hers. In short, [i]n the absence of participation of the other family members, individual child therapy often serves to reinforce the child’s cognitive distortions and problematic behavior. Further, individual therapy identifies the child as the problem or the one who is responsible to fix the problem (Fidler and Ward, 2017, p. 31).

Even if we get beyond confounding historical connotations, the distinction between diagnoses and dynamics, the risks of stigma, and the need to treat the system rather than the individual (or either of the two bifurcated families), there remains one further reason to reject the phrase reunification therapy. That is, the phrase suggests that there is only one relationship in need of repair.

Experience teaches that therapies that work exclusively to repair the rupture between the child and Parent B (that is, the family rather than the superordinate system) are doomed to failure. No matter the cause of the rupture, the problem doesn’t exist in the dyad or even in the reconstituted family—it exists in the entire system. Mom might throw up her hands and complain that she did nothing, the problem is completely between the child and his father. Not true. If Mom is part of the child’s emotional world, then she must be part of both the problem and its solution. Systems are, after all, complex, tightly knit fabrics of relationships. When any single element changes, the whole fabric is affected. Thus, any effort to repair the child’s broken relationship with Parent B must simultaneously endeavor to adjust the quality of the child’s relationship with Parent A, and improve the quality of the adult-adult (co-parent) relationship. To do otherwise is a bit like trying to remove a child from the low end of a seesaw without affecting the child at the high end.

Why, then, have I included the word reunification in the title of this book at all?

In part to get your attention. I’m shamelessly motivated to get these ideas into the minds of people who genuinely intend to work with families in the best interests of their children, and into the hands of the judicial officials who order these services. In truth, I would far rather have titled this book, Multi-Modal Systemic Interventions with Polarized Children of High Conflict Divorce, but then, you wouldn’t have picked it up and we wouldn’t be having this conversation.

Now that you’re here, I believe I would be a hypocrite and risk compounding the problem if I were to refer to the goal of the systemic therapy process described here as reunification. I’ve considered adopting alternative labels that occasionally pop up in the literature (reconciliation, reconnection, or rebalancing), or even manufacturing my own word (reacclimation therapy or depolarization therapy). But none of these labels ring true, particularly in a field that’s already awash in jargon and acronyms. Instead, I’ve chosen to use reunification (in italics) in the hope and belief that writing the word in italics will remind you of these several, very important caveats that limit its meaning.

Multi-Modal Systemic Therapy (MMST) doesn’t exactly role off the tongue, but the phrase is unambiguous. MMST is a court-ordered, psychosocial intervention that braids together the concurrent efforts of several mental health and family law professionals in support of the singular goal of helping a family system to (re-)establish healthy roles and relationships in the best interests of their child(ren). While MMST can provide a very effective avenue to correct a variety of destructive systemic dynamics (e.g., triangulation, enmeshment), this book describes the MMST model as applied to families in which one or more children have become aligned with Parent A, and resist or refuse contact with Parent B, no matter the children’s ages; the legal status of the adult relationship; the religion, race, or gender of the children or the adults; or the reasons for the child’s polarized position.

Role Definition and Alignment Pressures

The MMST treatment team is both an instrument of systemic change and a model of healthy systemic functioning for participants to emulate. The protocol requires that the avenues of communication, cooperation, and problem-solving within the treatment team, and between the treatment team and the family system, are all transparent to the adults. The inevitable either/or alliance pressures that define the polarized family system (Garber, 2011) are outed and defused in favor of building new, healthier alliances. Most importantly, each professional’s role within the team and in interaction with family members is clearly defined.

This fractal aspect of the intervention—the ways in which the treatment team creates a superordinate family-like system that contains the dysfunctional court-ordered system, which itself contains the two post-divorce families—is among the many reasons that MMST calls for a collaboration among several professionals. Both as a matter of pragmatism and as a matter of ethics, a single professional cannot fulfill all the roles necessary to mend the polarized relationships. Thus, the treatment team includes clinicians who provide direct service to the child, to each parent, along with the roles of Systems Therapist (ST) and Team Leader (TL), the latter of whom coordinates the overall process and communicates progress to the court.

My purpose in writing this book is to describe the MMST protocol in detail from the court’s initial order through termination of services, whether or not that coincides with the resolution of the child’s polarized position. I presume that whatever type and extent of family-systems evaluation and adjudication necessary for the court to order a reunification intervention is now complete. This book is not about—and the treatment team’s job does not include—evaluating whether the child should have the opportunity for healthier relationships with both parents. Rather, this book is about—and the treatment team’s primary focus must be on—how to help the child enjoy those relationships.

In short, the court determines the destination. The treatment team’s job is to fix the car so the family members can get there.

This caveat about the limitations of MMST intervention has an even broader meaning: MMST cannot recommend the child’s ultimate schedule of care. Only an impartial family-systems evaluation can yield that recommendation (APA, 2010, item 9.01[a]; cf., Tippins and Wittman, 2005) and only a court can make that decision. As tempting as it may be, and as well as the treatment team may come to know the system over time, MMST cannot and must not speak to the future allocation of parenting rights and responsibilities.

Not incidentally, the role definition and dynamic transparency that characterizes the MMST protocol and serves as a model for the court-ordered family also serves as a shield for the clinician who agrees to wade into the midst of the adult war. Faced with the two parents’ utterly convincing, yet mutually exclusive stories about each other, it’s easy for a clinician to be drawn into the fray the same way the child has been. To take sides. To become triangulated, if not polarized. To begin to imagine that you know the system better than the forensic evaluator does, and that you know better than the court what the child really needs.

Mother pleads that no one understands. The court is forcing her to return her beloved children to an abusive, narcissistic, sociopathic beast. Look, Dr. Brilliant, here are text messages and photographs that prove it!

Father pleads that no one gets it. The court is biased against men! The court is allowing Mother to undermine the children’s love for him. Certainly, Dr. Brilliant, you can see what no one else has been smart enough to see so far: Mother has Borderline and Histrionic Personality Disorders! She is obviously alienating and adultifying and enmeshed with the children! Come on, Dr. Brilliant, I thought you were the best guy in town! You must see it!

The clinician whose role is ambiguous, who lacks the ever-present sounding board and perspective inherent in working as part of a treatment team, and whose neglect of self-care has compromised his ego-strength, will be sucked into these riptide relationship pressures at an incalculable cost to his professional status, financial well-being, and sanity.

How to Polarize a Child

It is not the clinician’s job to map out the dynamics that have caused and continue to cause any child’s polarized position within her highly conflicted, court-involved family system. That job has already been done by an evaluator and adjudicated by the court. Nevertheless, the clinician who hopes to be effective in this high-risk endeavor must be conversant with the dynamics at play. The pages that follow constitute a very brief primer in the dynamics of the polarized family.

System describes a collection of interpersonal relationships that impact one another. At the macro level of definition, system describes all the employees in a particular company, all the citizens of a specific country, all the members of a specific club, and all the people who live together under one roof. The system is defined by the fact that its members’ thoughts, actions, and feelings affect one another. If you imagine looking down at planet Earth from outer space with an infinitely powerful telescope, systems can be seen at every level of magnification, from the broadest focus that takes in the entire planet, to the narrowest focus on the smallest types of relationship systems—most notably, sibling groups, couples, and families.

Family is one type of system. Contrary to many common definitions, I contend that family is not defined by the legal, financial, biological, genetic, generational, or geographic status of its constituent members, nor does it depend in any way on the gender, sexual orientation, race, religion, or age of its members (allowing that at least one family member must be an adult). Family is defined, instead, by the mutual (but seldom symmetrical) emotional interdependency of its members.

By this definition, Parent A and Parent B probably (but not necessarily), once upon a time, made one family together. Baby Billy’s birth expanded the family to three. All three members of this family group depended on one another emotionally. The particulars of these dynamics—that is, its patterns of thoughts, feelings, and behaviors—are unique, emergent, and reactive. Thus, in a very real sense, the family lives, grows, and changes.

One such change occurs when the intimate relationship between Parent A and Parent B breaks down. If they didn’t share a child, the story would end there. The family of two would dissipate; however, given that Baby Billy exists, regardless of the legal status of the adult relationship, regardless of whether either or both adults relocate, regardless of whether either or both adults take on new partners or enlist others to help with childcare, and regardless of the assumed or court-ordered allocation of parenting rights, one family becomes two: Parent A and Child (and anyone else Parent A elects) constitute one family. Parent B and Child (and anyone else Parent B elects) constitute another family. The fact that the thoughts, feelings, and behaviors within each family continue to impact the members of the other family demands that we recognize that the two newly coalescing families are part of a single, superordinate, dynamic system.

I wholeheartedly believe that as Billy grows up migrating between Parent A’s care and Parent B’s care, he needs to learn that he has two separate and distinct families. This message creates an important conceptual boundary (for the adults as much as for the child) that empowers each parent in his or her respective home, and helps Billy navigate the differences between the two.

Triangulation describes what happens when a child is drawn into the differences between his or her two (or more) parents or families. It describes the social and emotional pressures within the superordinate system that cause an individual to feel like the rope in a tug-of-war battle. The child feels (and often has objectively become) caught in the middle of an adult conflict.

Triangulation forces the child into a loyalty bind—pick sides. Loving Parent A means losing Parent B.⁴ Given that we all are motivated to win our parents’ affection, attention, and acceptance at least as much as we are motivated by the need for food, clothing, and shelter, the triangulated child is left with only four options: (1) emotional regression, as evident in depression, anxiety, behavioral acting out, and even psychosis; (2) emotional escape to other relationships that can provide essential nurturance, such as when teenagers manage family conflict by investing in peer groups; (3) chameleon-like responses that seek to satisfy each parent that the child is on that parent’s side; and/or (4) aligning with Parent A while resisting or rejecting Parent B.

Polarization describes the last option. The polarized child has taken sides in the adult conflict. That outcome may be adaptive, such as when a child resists contact with an objectively insensitive, unresponsive, and/or abusive parent. It may also be coerced, such as when Parent A undermines the quality of the child’s relationship with Parent B without good reason. It may be a house of cards, built on a misunderstanding, magnified by confirmational bias, and cemented by antagonistic and zealous advocates. But more often than not, the child’s polarized position is the result of some combination of all of these scenarios (Garber, 2020).

MMST is to psychotherapy what ANOVA is to statistics: a tool with which one clarifies what belongs within and what belongs between. MMST simultaneously seeks to reinforce the healthy boundaries that distinguish the two post-separation family groups from each other and give the child the opportunity to enjoy a healthy relationship within each group. The several braided strands of intervention that make up the MMST process are all child-centered, but the patient is not the child, not the parents, and not even either family group. The patient is the system.

The Family Law Community Is Itself Polarized

At this point, the discussion becomes ironic because you, dear reader, are at risk of becoming triangulated into in an adult conflict, and so may end up becoming polarized:

Some family law professionals (e.g., Baker, 2005) assert that children become polarized within their conflicted family systems for one of two reasons: first, if the rejected Parent B is known to have been abusive, then the rejection is justified (i.e., estrangement). Second, if the rejected parent is not known to have been abusive, then Parent A must be alienating. Period. Milchman et al., (2020) refer to this as the single-factor position.

Other family law professionals speak of the single-factor position as completely implausible (Mercer, 2019). They take a more nuanced approach, acknowledging that many factors commonly coincide to cause the child’s polarized position. In one form, the hybrid model proposes that a child’s polarized position is likely to be the result of some combination of alienation, estrangement, and enmeshment pressures (Drozd and Olesen, 2004; Friedlander and Walters, 2010).

01.01 On alienation and enmeshment.

Here and throughout this volume, the term alienation and the phrase alienating behaviors are used to describe Parent A’s unwarranted negative words, actions, and expressed emotions about Parent B to and around the child. Estrangement and estranging behaviors are used to describe a child’s (vicarious or direct) experience of Parent B’s relatively insensitive, unresponsive, abusive, and/or neglectful behaviors. Enmeshment describes a developmentally unhealthy corruption of the social, emotional, and/or physical boundaries that distinguish the child from the parent.

Three forms of enmeshment are commonly discussed (Garber, 2011):

1. Adultification describes Parent A’s words, actions, and expressed emotions, serving to prematurely promote a child to become that parent’s ally, partner, or friend.

2. Parentification describes Parent A’s words, ctions, and expressed emotions, serving to prematurely promote a child to become that parent’s caregiver.

3. Infantilization describes that parent’s words, actions, and expressed emotions, serving to inhibit the child’s otherwise developmentally appropriate movement toward autonomy.

I advocate for an even broader position than the hybrid model. I believe that family-law professionals have an obligation to draw the telescope back even further in order to consider the total ecology of the system within which the child’s polarized position has emerged (Garber, 2020). This position acknowledges at least thirteen distinct variables that must be considered, from such seemingly benign factors as the child’s access to preferred friends, to those more nefarious and manipulative pressures, including alienation and estrangement.

Consider, for example, the young teenage girl who refuses to sleep over at her father’s house. She is perfectly happy spending days with Dad, but she just doesn’t want to sleep over there. Incensed, Dad claims alienation while Mom suspects abuse. Lawyers, experts, and evaluators get involved at huge expense. Court dates are set. Hearings are held. The acrimony between the two homes escalates, exacerbating the child’s anxiety such that she eventually refuses to spend any time at all with her father. In this very real and memorable case, the adults’ profound acrimony and selfish need to win their petty and very expensive war blinded all involved to the simple reality of the matter: the child had had her first period. She was embarrassed and scared. She needed to be home with her mother, where she knew what to do and where she had what she needed. Mom and Dad never communicated, so there was no hope that Mom might help Dad prepare his home to make their daughter comfortable. Instead, the child’s very natural feelings were twisted to become more fuel for the adult fire.

Or consider my favorite illustration of a systemic molehill turned into a litigious volcano: five-year-old Suzy’s parents separated one year ago. Suzy spent alternate weekends with her Father, beginning at school dismissal on Friday through school delivery on Monday. On one particular Monday after a weekend with Dad, Suzy got off the school bus at Mom’s home, hugged her Mommy hello, and told her funny stories about kindergarten.

Mommy asked what Suzy had done over the weekend with Daddy. The woman later testified with complete certainty that the child replied, He taught me all about sex.

RED ALERT! Mother tried to stay calm even while she dialed her lawyer, who told her to call the police. Child protective services became involved. The judge granted an ex parte motion to suspend Suzy’s contact with Father while the matter was investigated. Months passed. Suzy was interviewed by a number of well-meaning professionals without clarification. She said she missed her Daddy. She was scared. Did she do something wrong?

Mother became hypervigilant, taking pictures of the child’s body, standing guard while the child slept. Co-parental communication broke down. Suzy resonated with Mother’s anxiety about her father and began to fear him. By the time the truth came out, the damage had been done—Suzy didn’t want to see Daddy.

The truth was that Daddy had indeed taught the child all about sects. About beetles and caterpillars and spiders and bees. Insects, as articulated by a five-year-old, as heard by a very anxious and angry woman, as distorted by confirmational bias and magnified by zealous advocates, and as adjudicated by a very cautious, very overworked court.

Neither of these cases began with obvious elements of alienation, estrangement, or enmeshment (the hybrid factors), although both children quickly became polarized within their respective parents’ conflicts. The facts that both children are female and both aligned with their mothers are incidental. These are the sorts of experiences that highlight why we must remain open-minded in considering the entire system in which the child functions before concluding that malicious motives are afoot (Polack and Saini, 2018).

01.02 How to polarize a child.

A thorough review of the literature yields at least thirteen non-mutually exclusive dynamics that can contribute to a child becoming polarized between his or her parents (Garber, 2020). Evaluators are advised that all thirteen of the following questions need to be answered in order to fully understand why a child has become polarized amidst his or her parents’ conflict:

1. How do characteristics of the child contribute to the dynamic? Individual differences, such as temperament, can cause a child to align with a temperamentally similar parent.

2. Do objective historical data suggest that the child has ever had a healthy relationship with both parents? Rejecting a parent who was once beloved is a very different dynamic than resisting contact with a parent who is effectively a stranger to that child.

3. Is the child saying what s/he believes the listener wants to hear? Many children adapt to the disparate and conflicting messages of their high conflict environment by becoming emotional chameleons, saying and doing what they believe the proximal caregiver wants to hear and see (Garber, 2014).

4. Is the child expressing a developmentally appropriate affinity? Children are predisposed to align with one or another parent as a function of developmental interests and activities. This is most often evident among preschool children, who sometimes crave the same-gender parent’s attention.

5. Is the child’s resistance/rejection acute and reactive? Is there a pattern to the resistance/rejection? Over what period of time? It is important not to mistake transient reactive behaviors (e.g., due to anger over a particular punishment or fawning over a promised reward) for a more insidious dynamic.

6. Is the child’s resistance/rejection event- or time-dependent? A child may resist contact with Parent B simply because that contact conflicts with other, more appealing activities.

7. Does the child resist/reject all separations from Parent A? Separation anxiety from Parent A must not be mistaken for resistance/rejection of Parent