Cognitive‐Behavioral Methods in High‐Conflict Divorce: Systematic Desensitization Adapted to Parent–Child Reunification Interventions

• Author: Benjamin D. Garber
• DOI: http://doi.org/10.1111/fcre.12133
• Published date: 01 January 2015
• Date: 01 January 2015

COGNITIVE-BEHAVIORAL METHODS IN HIGH-CONFLICT DIVORCE:

SYSTEMATIC DESENSITIZATION ADAPTED TO PARENT–CHILD

REUNIFICATION INTERVENTIONS

Benjamin D. Garber

Children who are triangulated into their parents’ conflicts can become polarized, aligning with one parent and rejecting the

other. In response, courts often order families to engage mental health professionals to provide reunification interventions.This

article adapts empirically established systematic desensitization and flooding procedures most commonly used to treat phobic

children as possible components of a larger family systems invention designed to help the polarized child develop a healthy

relationship with both parents. Strengths and weaknesses of these procedures are discussed and illustrated with case material.

Key Points for the Family Court Community:

• Family law and psychologyag ree that children should have the opportunity to enjoy a healthy relationship with both

parents

• Adult conflict can polarize a child’s relationships, including rejection of one parent

• Existing clinical and forensic “reunification” strategies often prove inadequate

• Reliable and valid cognitive behavioralmethods can be adopted to f acilitate this process

• A cognitive-behavioral “exposure-based” reunification protocol is discussed

Keywords: Alienation;Custody Reversal;Desensitization;Enmeshment;Estrangement;Exposure;Flooding;High-Conflict

Divorce;Parent–ChildPolarization;Psychotherapy;Reconciliation;and Reunification.

“The child develops an anxious and phobic-like response . . . a mutually escalating cycle of fear

and anxiety develop between the child and the alienating parent; the more upset the child is, the more

protective and concerned the parent is, which in turn escalates the child’s reactions and so on.

Learning theory demonstrates that the correction (extinction) of the avoidance is extremely difficult

and requires exposure and systematic desensitization to the avoided circumstance or feared object.”

(B.J. Fidler, Ph.D. as quoted in W.C. v. C.E., 2010 ONSC 3575)

INTRODUCTION

The professional literature concerned with high-conflict divorce has long been consumed with

defining the various dynamics that can cause a child to become triangulated into adult conflict, aligned

with one parent and rejecting the other. Concerned parties representing the full spectrum of family law

professions, jurisdictions, and interests have debated the definitions and relative contributions of

dynamics commonly known as alienation, estrangement, and enmeshment and the confounding role

of the child’s experience of domestic violence (Drozd & Olesen, 2004; Meier, 2010). Many now

accept that the child’s polarized position within the conflicted family is most commonly the result of

a hybrid constellation of these intense relationship pressures (Fidler & Bala, 2010; Friedlander &

Walters, 2010; Garrity & Baris, 1994; Johnston, Roseby, & Kuehnle, 2009).

Unfortunately, the same literature has devoted far less attention to the interventions intended to

repair the ruptured child–parent relationship. The little that is availablesuggests that the first and most

desirable remedy involves a process of graduated, therapist-guided, child-centered exposure to the

rejected parent, leading over time under the best of circumstances to establishment or resumption of

Correspondence: Papaben@HealthyParent.com

FAMILY COURT REVIEW, Vol. 53 No. 1, January 2015 96–112

© 2015 Association of Familyand Conciliation Cour ts

routine parent–child contact (Freeman, Abel, Cowper-Smith, & Stein, 2004). When interventions of

this nature prove unacceptable or ineffective, more intensive, retreat-like programs are sometimes

recommended (Sullivan, Ward, & Deutsch, 2010). In the extreme, some courts have reversed custody,

placing the child in the full-time (and sometimes the exclusive) care of the rejected parent (Gardner,

2001; Fidler, Bala, & Saini, 2013).

This article recognizes a distinct and valuable parallel between these court-sanctioned remedies

and the cognitive behavioral therapies presently available for the treatment of childhood phobias

(Meichenbaum & Turk, 1976; Stampfl, 1966; Wolpe, 1958). Similarities and differences between

these otherwise disparate interventions are discussed, yielding recommendations for an empirically

based, child-centered, and court-ordered cognitive behavioral reunification protocol.

ON PHOBIC AND POLARIZED CHILDREN

The phobic child lives with a persistent, intrusive, and irrational fear. By definition, the phobic

individual experiences the feared object as causing disproportionate and unwarranted anxiety to the

point of terror. These feelings are maintained by false or exaggerated beliefs and by avoidant

behaviors that implicitly reinforce these beliefs.The phobic individual’s efforts to avoid encountering

and even thinking about the feared object can constrict every area of life to the point that healthy

activities of daily living are neglected and previously enjoyable activities are abandoned (American

Psychiatric Association, 2013). In the United States, approximately 5% of children suffer from

specific phobias (Ollendick, King, & Muris, 2002). That number may be as high as 16% in 13- to

17-year-olds (American Psychological Association, 2013).

By contrast, the polarized child has been triangulated into her parents’ high-conflict relationship

(with or without separation or divorce) so as to become strongly allied with ParentA and resistant to

or entirely rejecting of Parent B.1The child’s polarized position may be due to exposureto Parent A’s

unwarranted damning words and actions concerning Parent B (alienation; Kelly & Johnston, 2001);

a breakdown of healthy boundaries in the relationship with Parent A (enmeshment; Garber, 2011);

and/or direct experience of Parent B’s abusive, neglectful, violent, or otherwise inappropriate behav-

ior (estrangement; Meier, 2010).

Both the phobic and the polarized child’s fears are irrational and maladaptive when the feared

object is known to present little or no objective threat and the child’s avoidant behaviors interfere with

otherwise healthy and expectable behavior and development.2Critical to assessing whether the

polarized child’s rejection of Parent B is maladaptive is assessment of that parent’s parenting capacity

and the child’s objective risk in that parent’s care. Within the limits of safety, the law presumes that

children benefit from the opportunity to enjoy a healthy relationship with both parents.

COGNITIVE BEHAVIORAL THERAPY (CBT)

CBT is a form of psychotherapy focused on identifying and modifying the individual’s unwanted

and maladaptive thoughts and beliefs (cognitions) and behaviors in the context of a supportive

professional relationship. CBT has been demonstrated to be an extremely effective treatment for

children (Silverman, Pina, & Viswesvaran, 2008) and for anxiety disorders (Hans & Hiller, 2013).

Fifty years of clinical investigation and empirical research with CBT has generated a number of

highly effective, time-efficient, targeted phobia treatments (Wolitzky-Taylor, Horowitz, Powers, &

Telch, 2008), most notably graduated exposure or desensitization and flooding. The value of these

methods has been demonstrated in the treatment of phobic children as young as 4 (May, Rudy,

Davis, & Matson, 2013) and continuing through adolescence (Bunnell & Beidel, 2013) and with

phobias as diverse as social phobia (Shorey & Stuart, 2012), dental phobia (Gordon, Heimberg, Tellez,

& Ismail, 2013), needle phobias (Wolff & Symons, 2013), and scoleciphobia, the debilitating fear of

earthworms (Buchanan & Houlihan, 2008).

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