Expert Witness: What mental health forensics has to teach us about child therapy

By Michael G. Brock I am sometimes referred to as a child mental health specialist, although I do not hold myself out as such. I think the confusion results from the fact that I have done a lot of work in the court as a custody evaluator, abuse investigator, and parenting coordinator. I have made a study of the forensic literature and applicable laws in this area and have acquired a certain degree of expertise. However, when I am in a treatment role, I refuse to treat children without not only the consent, but the involvement of the parents or caretakers of the child. I have long subscribed to the family systems approach to therapy with children for what to me seem obvious reasons: children do not control their environment the way an adult can, and are considerably more reactive than adults in a family situation because of this. Moreover, the younger the child with the problem, the greater the probability that there is some dysfunction in the family creating the child's problem. Even if there is no family dysfunction, there may be some form of endogenous (hereditary) depression or other mental condition that needs to be understood to effectively treat the child. These conditions affecting treatment have long been understood and employed by child and family therapists, but there are less obvious factors that have been brought to light by forensic practice and related developmental literature which need to be examined in the light of what they have to teach us about the treatment of children. Forensic research and practice have taught us that we cannot always count on the presenting parent to provide us with accurate information about the child or his condition because the parent sometimes has a need to view the child's problem in a way that is beneficial to them. We also have discovered that children are very susceptible to being led during interviews by either parental coaching or interviewer bias, and that repeated or leading questioning will suggest to the child that their responses were not what the interviewer expected to hear; they are the "wrong" answers. The best evidence in forensic cases comes from establishing a rapport with a child (as we would with any other client), and seeking a free narrative from the child concerning the events about which we are concerned. If this is true in forensic work, it begs the question, is this not also a good idea in other forms of mental health involvement, specifically treatment? Yet therapeutic charts I review often indicate that treatment is based more on what the presenting parent says than what the child says, and that when the two conflict, the therapist will usually accept the parent's explanation of events and symptoms over those provided by the child. The charts also frequently reflect that there is a substantial amount of pressure put on the child to accept the parent's view of the problem, and to conform to the behavior sought by that parent or presenting party. There is usually very little indication that the therapist is looking for potential problems in parenting techniques, or making an effort to modify those that are not productive. Nor is it uncommon to read charts where there is no clear distinction made between what the child says and what the presenting parent says, a distinction that is clearly as important to providing treatment to a child as it is to discovering forensic truth. There is a notion in treatment mental health that it is more useful to know the client's view of reality than it is to have an objective opinion of what actually happened in a given environment because it is the client's perception and responses to his own reality that we are treating, not the objective situation. Another way of saying this is that we are treating the client's "inner environment," not the "outer environment" or the client's situation. This is clearly different when we are doing forensic work, because it is the goal and responsibility of the court to rectify the outer environment, and it is the responsibility of the forensic MHP to assist the court in the discharge of that duty. I would argue that in treating children and their families, it is equally important to obtain both the subjective views of the child and the parents, as well as getting as much objective information as possible, because we are treating both the individuals' inner environments as well as their outer environments and their interaction as a group. If we presume that the parent(s) is presenting objective reality, we may miss the possibility that the child, though less verbal and articulate, may actually have clearer view of the problem than the parent, and that it may be more necessary for the parent to change than the child. Of course, parents do not like to hear that they are wrong and their children are right, and that they are the ones who need to change, but in my experience it is highly unusual for a child from a perfectly functional family to have serious behavioral or psychological disturbances. If confronted with the need to change, the parent may (and often will) seek another therapist who will validate that the problem is the child and not them. They are inclined to take this course of action when confronted with a dysfunctional behavior of their own in individual therapy, but more so when the problem involves their children. Parents just don't want to believe they are the problem and not their child. The current trend of overmedicating kids who present any kind of difficulty rather than looking at possible ways to remedy the problem with changes in the environment (i.e., providing hyperactive kids more physical activity) is a good indication of this phenomenon. Whether or not a parent seeks out a therapist who will diagnose what the parent wants them to, however, should not be our concern. It is unfair, unjust, and counter-productive to diagnose and treat a child for a problem that actually belongs to the parent, or belongs equally to the parent and to the child. Such treatment amounts to blame-placing and ganging up on the child, which can only aggravate the condition. Regardless of the parent's response, treatment therapists need to take a lesson from developmental research and forensic practice; learn to identify what information is coming from the child and what is coming from the presenter; and not to assume that the child cannot be relied upon for valuable information. Therapists must attempt to view the entire family constellation in an objective and unbiased manner, and treat the problems they perceive in that system if therapy is to have the desired positive affect on the health and well-being of the child and the family unit. ---------- Michael G. Brock, MA, LLP, LMSW, is a forensic mental health professional in private practice at Counseling and Evaluation Services in Wyandotte, Michigan. He has worked in the mental health field since 1974, and has been in full-time private practice since 1985. The majority of his practice in recent years relates to driver license restoration and substance abuse evaluation. He may be contacted at Michael G. Brock, Counseling and Evaluation Services, 2514 Biddle, Wyandotte, 48192; (313) 802-0863, fax/phone (734) 692-1082; e-mail: michaelgbrock@ comcast.net. Published: Wed, Nov 16, 2011