Conclusion

This chapter provides a brief historical context about how political controversies have limited professional writing about parent–child contact problems and describes the ways in which this volume provides a more nuanced and nonpartisan perspective on family-based interventions for these complex problems. The chapter first highlights the conceptual formulation of parent–child contact problems that underlies the treatment approach described throughout the book. It next suggests essential components of the Overcoming Barriers intervention model. This discussion is followed by comments on limitations of the empirical evidence available to inform policy and practice. Conundrums in clinical practice that involve risks of harming rather than helping families are then considered. Finally, the chapter explores how to practice ethically while awaiting more definitive direction from accumulated research on these matters.

Coparenting, Parenting, and Child-Focused Family Interventions

This chapter describes the clinical work with individual families during the Overcoming Barriers camp program. Though the practical goal is to restore parent-child contact and relationships in a gradual progressive between rejected parents and their children, the focus of these interventions is on the individual and relationship issues within the family that entrench the resistance or refusal dynamics. The chapter addresses the goals, objectives, and specific techniques that make up the clinical work with the coparents, the favored parent and child, the rejected parent and child, and the whole family. Also described is the progression of this work from intake through the final session. The process culminates with the documentation of any agreements that have been reached and with the parents’ committing to a specific aftercare plan.

Management of the Camp Experience

This chapter focuses on the therapeutic milieu environment at Overcoming Barriers camp and its integration with the program’s traditional mental health interventions. First, a brief history of milieu therapy and a review of the research literature on therapeutic camp programs are presented. Key elements of the milieu at Overcoming Barriers programs are then described, including roles of key personnel and program components. The roles of nature, a novel physical surrounding, and carefully planned recreational activities are emphasized as critical aspects of how reintegration and other change in the family system may occur. Finally, this chapter explicates the relationship between milieu-based activities and other clinical programming at Overcoming Barriers camp.

The Perfect Storm

This chapter discusses a constellation of features associated with families where children are resisting or refusing contact with a parent—personality disorder, high conflict, and court involvement—that the authors refer to as the “perfect storm.” High rates of personality disorder and associated characteristics have been described among child custody–litigating families in the psychological assessment and clinical literatures. Such personality features cause notoriously strong reactions in therapists and professional teams, especially under the added strain of separation or divorce and ongoing litigation. Left unexamined, the effects of these dynamics can undermine treatment and result in ethical missteps in clinical practice. This chapter describes each component of the perfect storm and proposes strategies for clinical management based on current writing about court-involved therapy. Case material is used to highlight key points.

Clinical Decision-Making in Parent–Child Contact Problem Cases

This chapter summarizes the continuum along which parent–child contact problems may be conceptualized and differentiated and addresses how legal and clinical interventions may be tailored to the nature and severity of the problem in a particular family. Parent–child contact problems include affinity, alignment, justified rejection, and alienation as well as hybrid cases, each of which can range from mild to severe. Which of these problems is observed in a given family and parent–child relationship depends on numerous factors, including the child’s developmental stage, whether a parent has engaged in parental alienating behaviors, whether and when there was violence between the parents, and whether a parent was abusive or neglectful of the child. The chapter provides an overview of psychoeducational and clinical interventions for mild, moderate, and severe cases. It also explicates protocols for managing initial queries, preliminary screening, clinical intake, and contracting for such interventions.

Translating the Overcoming Barriers Approach to Outpatient Settings

This chapter discusses ways the essential components of the Overcoming Barriers approach (including the whole-family approach, experiential and recreational activities, and coordinated case management) can be translated to outpatient work with families experiencing parent–child contact problems. The nature and severity of the parent–contact problem inform the differentiated clinical and legal intervention response. Mild and moderate cases of affinity, alignment, alienation, or realistic estrangement and mixed or hybrid cases may be suitable for a whole-family, systems-based psychoeducational intervention. These interventions may begin in outpatient settings or start with a multiday family intensive intervention, with outpatient multifaceted family therapy as aftercare. Protocols for preliminary screening, clinical intake, contracting (including legal structural components), and treatment goals and planning are summarized. An overview is provided of tools and resources to assist the clinician in implementing a treatment plan tailored to meet the needs of a particular family. Case examples illustrate key points.

“West Group”

This chapter describes the characteristics of the parents in the Overcoming Barriers camp program whose children are resisting contact with them as well as the group work that is done with these parents. The West Group process from beginning to closure is described, as well as specific goals, objectives, and techniques that contribute to the other components of the camp intervention. The shared experiences of these parents have generated common beliefs, feelings, and attitudes—often focused on a sense of victimization—that pose significant obstacles to reconnecting with their children and developing a more functional coparenting relationship with the children’s favored parent. The group work draws on these commonalities to build group cohesion and mutual support. At the same time, it challenges group members to take responsibility for their contributions to the child’s rejection and to shift to more active and adaptive coping with their difficult family situations.

“East Group”

This chapter focuses on the group psychoeducation done with the favored parents in families with parent–child contact problems attending Overcoming Barriers programs. A systems-based understanding of parent–child contact problems highlights the importance of intervention with each member of the family. The author describes the personality traits, beliefs, feelings, and attitudes of favored parents as well as challenges that such characteristics pose to clinical intervention. Strategies to promote a shift in favored parents’ beliefs about the health of their children are discussed, including calling attention to cognitive distortions, teaching about concepts such as memory and suggestibility, and building skills for coping with emotional triggers. The role of group process and relationships among group members are discussed as possible mechanisms of change. Case material is used to illustrate key points.

More Than Words

This chapter proposes the integration of experiential therapy techniques with family treatment for use with families experiencing parent–child contact problems, including parental alienation. This population typically enters family therapy with high levels of defensiveness, treatment resistance, and mistrust of mental health interventions. This situation requires a high degree of clinical flexibility and tools that include, but are not limited to, traditional talk-based techniques. The authors provide a theoretical and clinical rationale for integrating experiential techniques with family therapy. A range of experiential strategies are detailed (e.g. play, recreational therapy, and animal-assisted treatment) as techniques to enhance families’ engagement, relax treatment resistance, impart psychoeducation, and provide opportunities for reconnection. Case material illustrates key points.

The Current Status of Outpatient Approaches to Parent–Child Contact Problems

This chapter describes the status of outpatient clinical interventions for unjustified parent–child contact problems using an ecological systems approach. It starts with a review of the multiple factors found to be associated with the development of parent–child contact problems, which include parenting styles and skills, parental alienating behaviors, cognitive distortions, history of the parent–child relationship, parental psychopathology, interparental conflict, and court involvement. Next, the chapter considers the specific goals of reunification treatment for the alienated child, the rejected parent, and the favored parent. Finally, the chapter critically reviews the state of outcome evidence for a range of outpatient and intensive reintegration interventions. Key clinical and theoretical components of each intervention are highlighted, noting both components that the interventions share and those that distinguish them.