Since I’ve had the Conflict Coding Scale stuff out, I thought I’d try it on a recent consultation case I had. It was for a 10-year-old child with lots of factors involved, ADHD, early childhood adoption, problematic over-indulgent parenting, and a moderate cross-generational coalition with dad against mom.
There were three other mental health professionals involved, all of whom produced reports for the Court. They were disagreeing with each other about how much the “parental alienation” from the father was contributing to the child’s behavior problems generally and with mom.
One of the three mental health people sought my consultation and I reviewed her redacted report, along with the other two redacted reports from the other mental health professionals, so I had a fair amount of data from three separate mental health sources.
It was a complicated case with multiple factors. So once I had formulated my opinion based on the data, I decided to try the Conflict Coding Scale to describe my opinion. Here’s what it looked like:
Primary Origin Code:
PCC-03: 01 Child/Parent Vulnerability: Attachment Insecurity
(mother: attachment bond failure post-adoption)
(father: overindulgent parenting fostering insecurity)
Secondary Factors Codes:
PCC-00: 02 Empathic Failure: Narcissistic Failure of Parental Empathy
PCC-02: 04 PCC-02: 03 Child Vulnerabilities: Regulation Stability
Child anger regulation challenges
Child motivational-behavioral impulsivity
PCC-04: 01: 01 Parent Vulnerability: Withdrawn/Disengaged
Emotionally distant, disengaged, neglectful (father)
PCC-05: 02 Family Systems: Child Triangulation – Parent-Child Coalition Against Parent
(father-child alliance against mother)
So “alienation” (a cross-generational coalition) is present and is a factor, but it’s not a prominent factor within the context of all the other stuff, at least not in my opinion based on the data that I reviewed. The cross-generational coalition is number 5 on my list of causative factors.
Dad’s parenting is problematic (leading to Secondary Factors 1, 3, and 5). However, the primary issue is the child’s failure to achieve a secure attachment bonding post-adoption, and this leads to the child’s inherent regulation challenges (Secondary Factor 2) and contributes to the formation of the cross-generational coalition with the distant/disengaged father as a means of improving attachment bond security with the emotionally distant and disengaged father.
Now imagine if the other three mental health professionals ALSO completed the coding scale regarding their opinions. They may not identify the attachment bond failure post-adoption and they may possibly have different orderings for the factors – differing opinions about the Primary Origin cause of the conflict and the hierarchy of Secondary Factors.
What the Conflict Coding System brings is clarity.
If I’m consulting with the other three mental health professionals and we had all completed the coding scale, immediately we have clarity in our professional-to-professional dialogue. The causative diagnostic formulation for each of the involved mental health professionals would be clear, even if they disagree on the Primary Origin or the hierarchy of Secondary Factors. At least these differences of assessment-judgement are clear. Each mental health professional’s causative diagnostic thinking is clear and documented.
One mental health professional may emphasize the cross-generational coalition as being more significant in creating the child’s symptom pathology, another may emphasize the child’s inherent vulnerabilities of ADHD and impulse control problems. And this would be immediately clear from the Conflict Coding form. Then we can discuss the data on which our various interpretations of causal factors are based, and we could reach a rough consensus of opinion on the Primary Origin causal factor and a broad set of Secondary Factors influencing the parent-child conflict.
The Coding System is just a tool. It’s to be used. For example, in our consensus diagnosis we may decide to list two Primary Origin codes because persuasive arguments can be made that doing so best captures the nature of the family’s pathology. It’s a tool to be used to bring clarity. But it’s just a tool. It’s flexible. At the same time, it gains its value from bringing the clarity of structure to dialogue. So we don’t want to stray too far from the structure in our flexibility.
Clarity. The Conflict Coding System brings clarity.
Now imagine for a second if everyone in the British mental health system used the Conflict Coding System to document their conclusions regarding the causes of the parent-child conflict surrounding divorce. If your interpretation differed from some other mental health professional’s interpretation, it would immediately be clear as to why. It would immediately be clear what factors you’re identifying and what factors the other mental health professional is identifying, and each of your respective weighting for those factors would be clear and documented. Documentation.
You and the other mental health professional can then discuss the data each of you is using to reach your pathology identification opinions, and your relative weightings of the various factors. Professional-to-professional consultation.
It’s a good coding system for parent-child conflict, and it brings considerable clarity to the professional-to-professional dialogue surrounding parent-child conflict. I think this coding system will ultimately become a standard of practice for all child custody related evaluations. At the end of the Child Custody Evaluation report, the evaluator will provide his or her Conflict Code for the child’s symptoms.
Then, if another mental health professional, such as a therapist for the family, disagrees with the conclusions reached in the custody-related evaluation, this therapist can provide an alternate Conflict Code work-up based on the data from therapy (a second opinion), and it immediately becomes clear what factors are leading to the professional disagreement. One of the mental health professionals is placing more weight on some factors and less weight on others, or they are identifying entirely different causal origins for the conflict pathology in the family.
The family symptom data supporting the various pathology identifications and relative weightings can then be professionally described and discussed.
When dealing with complicated complex pathology, clarity is a good thing.
November 19th from 5:00 to 6:00, an addendum seminar in the Conflict Coding System. You can then take this coding system back to England. You and your clinical psychologist will be the ONLY mental health professionals in England trained to do the Conflict Coding System (excepting other potential November seminar attendees).
Then unleash me into the British mental health system to advocate that ALL mental health professionals use the Conflict Coding System as a standard of practice in documenting their evaluations of parent-child conflict surrounding divorce.
Where-oh-where will the British mental health system obtain training in the Conflict Coding System? A: From an Advanced Certified AB-PA mental health professional who is trained in the Conflict Coding System. You and your clinical psychologist can train the other mental health professionals in England in the use of the Conflict Coding System.
Now look what we’ve accomplished by working together. The entire British mental health system is coming to YOU and your clinical psychologist for training. I think that would be a good thing, don’t you? The entire British mental health system involved in high-conflict divorce is coming to you to be trained. Sounds good to me.
They are coming to be trained in the Conflict Coding System. So you have to teach them that system so they can use it in their assessments, and if later they have a question about how to use it, they can consult with you and your psychologist on the interpretation of various symptom features – “How would you code this, Karen?”
I think the British mental health system asking you for direction and advice in their assessments, that would be a good thing. Don’t ya think, Karen?
We are going to give all targeted parents and their children a standard of practice for the assessment of the pathology in their families, families in Iowa, and in New Jersey, and in Europe, and South Africa. Everywhere. We are going to give all of these families a standard of practice for the assessment of the pathology in their families.
I’m leveraging the data sets of Bowlby and Beck and Millon and Kernberg and Minuchin and Haley and Bowen to move establishment psychology into creating a semi-structured and flexibly standardized assessment protocol – a standard of practice assessment protocol.
Don’t you see the advantages of our working together Karen?
But if the British mental health system doesn’t know about AB-PA, then they won’t need to develop a structured and standardized assessment protocol as a standard of practice. If they don’t need to develop a structured and standardized assessment protocol, then they won’t need to come to Karen to be trained in a structured and standardized assessment protocol.
If, however, the British mental health system is aware of AB-PA and wants the features of AB-PA (the Contingent Visitation Schedule; the Conflict Coding System), then they have to come to Karen for training. The entire British mental health system coming to Karen for training is a good thing.
But the entire British mental health system is turning to Karen for training because of AB-PA. You must train them in AB-PA. You can add to AB-PA. You can add all the beautiful ponies that you want to AB-PA, as long as you provide the baseline training in the AB-PA assessment protocol.
In return for training them in the AB-PA assessment protocol, the entire British mental health system will be turning to you for training and expert consultation. Sounds good to me.
But none of this will happen if the British mental health system doesn’t even know that AB-PA exists. No one will come to Karen for training in the Conflict Coding System, and no one will turn to Karen for professional consultation on how complex cases should be coded.
Stop fighting me and work with me. The entire British mental health system involved in high-conflict divorce seeking training and consultation from Karen Woodall is a good thing. Oh, but in order for that to happen, you must teach them the AB-PA model, not the Gardnerian PAS model, and you are insisting that only the Gardnerian PAS data set be used in reaching a solution.
Dang. That’s too bad.
Come on Karen, if you turn down the opportunity to become Advanced Certified in AB-PA then I’ll train someone else to be the AB-PA Advanced Certified mental health professional for England (and this may be happening already). And instead of coming to you for training and consultation, the entire British mental health system involved with high-conflict divorce will turn to the other AB-PA Advanced Certified mental health professional for training and consultation.
I’ve been contacted by mental health professionals from Great Britain and the Continent inquiring about the AB-PA Advanced Certification training in November. AB-PA will be coming to Europe. No doubt about it. You can be on the cutting edge of this change, leading in the training and professional expertise. Or you can watch as others assume roles of training and leadership.
The Conflict Coding System is choice, Karen. It’s a structured and standardized way of describing clinical judgements regarding the origins of the parent-child conflict. It brings substantial clarity to the professional-to-professional discussions of family pathology and the attributed causes for the parent-child conflict. I suspect that the Conflict Coding System will become a standard of practice for all child custody related evaluations involving parent-child conflict.
Beyond the categorical causal-diagnostic work-up, the Conflict Coding System ultimately creates the treatment plan. The Primary causal factor becomes the organizing core for the treatment plan, followed by each of the Secondary Factors in order of hierarchy – from most important to least causal – with the treatment plan addressing and resolving each causal factor as the treatment unfolds.
Come on Karen. November 19th 5:00-6:00, Conflict Coding Seminar with Dr. C. Let’s have the entire British mental health system coming to you for training and consultation.
Oh, but dang. The British mental health system doesn’t even know about AB-PA. Too bad.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857
Tags: Dr. Childress, Dr. Craig Childress