We're Still Taking X‐Rays but the Patient is Dying: What Keeps us from Intervening More Quickly in Resist‐Refuse Cases?

• Date: 01 April 2020
• Author: Robert A. Schnider,Lyn R. Greenberg
• Published date: 01 April 2020
• DOI: http://doi.org/10.1111/fcre.12484

WE’RE STILL TAKING X-RAYS BUT THE PATIENT IS DYING:

WHAT KEEPS US FROM INTERVENING MORE QUICKLY IN

RESIST-REFUSE CASES?

Lyn R. Greenberg and Robert A. Schnider

Professionals frequently lament the fact that the dynamics of resist-refuse cases are often entrenched before the family

receives effective intervention. Dysfunctional behavior patterns can become entrenched, with severe impairment of children’s

ability to function. Assessment is a critical component in the process of assisting families, but can come to so dominate the

process that the situation is unrecoverable once the assessment is completed and meaningful interventions begin. The authors

will describe commonly encountered obstacles to early intervention in resist-refuse cases, ranging from systemic stressors to

the persistence of inaccurate beliefs and information and practices that undermine accountability. Practical strategies, includ-

ing a broader conceptual model, integrating assessment into intervention, encouraging lawyers and courts to take earlier

action, and suggestions for future professional development will be addressed.

Practitioner’sKey Points:

Intervention in Resist-Refuse Cases often comes too late to save the child and family from severe emotional

dysfunction

Judicial officers, attorneys and mental health professionals have unique contributions to either impeding progress or

promoting solutions

Practitioners may need to intervene to stop “emotional bleeding”and support the child’s or family’s functioning, and

weigh the risks and benefits of prolonged and repeated assessments compared to evidence-informed intervention

Scientifically informed interventions exist for many of the problems encountered in these families

Risk assessment and intervention are not mutually exclusive

Suggestions are made for judicial education, structuring services and system reform

Keywords: Child Custody; Court-Involved Therapy; Early Intervention; Resist-Refuse Dynamics.

Resist-refuse dynamics present complex challenges to professionals (Fidler, Deutsch, & Polak,

2019; Greenberg, Doi Fick, & Schnider, 2016; Greenberg, Schnider, & Jackson, 2019; Walters &

Friedlander, 2016). It is common for professionals who provide services in these cases to lament

that the family did not receive

1

specialized services more quickly, that so much time and money

was wasted on investigations that did not yield clear results, or on re-litigation of every decision,

recommendation or allegation. The problems faced by children at the center of conflict, particularly

if they have entrenched dysfunctional behavior, can seriously impair their functioning. While risk

assessment is essential, the poor outcomes in many of these cases suggest that it may be worthwhile

to revisit common approaches to addressing these issues. In this article, we explore some of the

obstacles to early intervention in resist-refuse cases and propose potential solutions, amplifying

some of our discussion with comparisons to what occurs in medical care.

Medical professionals often encounter patients who are already acutely ill. They may not have

regular physicians, or access to the patient’s medical history may be incomplete or inconsistent.

(Divorcing families may also carry their conflict into this arena.) The common perception of the

“medical model”is that physicians do a complete diagnostic workup and arrive at a definite diagno-

sis before prescribing any treatment. While an intellectually appealing idea, the reality is much more

Correspondence: lyn@lyngreenbergphd.com

FAMILY COURT REVIEW, Vol. 58 No. 2, April 2020 488–506

© 2020 Association of Family and Conciliation Courts

complex. Lab tests, complete history and radiologic studies may ultimately be important in arriving

at a diagnosis, but not all problems can be identified immediately, and it may be critical to stop the

patient’s bleeding or support respiratory function even if a complete diagnosis cannot be established

immediately. The physician must balance achieving diagnostic certainty against managing immedi-

ate risks. The patient’s response to initial attempts at treatment, as well as the added information

from diagnostic procedures, may ultimately clarify the best course of treatment. Moreover, physi-

cians frequently must weigh the value of potential information to be gained from the diagnostic pro-

cedure against the potential risks of the diagnostic procedure. Among those risks is the waste of

time, resources and the strength of the patient from undergoing excessive diagnostic procedures that

either do not yield precise results or do not change the options for managing the patient’s condition.

Similarly, practitioners who work with RRD families frequently encounter situations in which

families have undergone extensive and repeated evaluations, depleting the family’s resources and

leading to months of additional litigation as dissatisfied parents challenge the results and any rec-

ommendations for therapy or other services are not implemented.

I. THE APPEAL OF ONE MORE X-RAY –ADJUSTING THE FRAMEWORK

Certainty is appealing. The allegations expressed in RRD cases are often extreme and mutually

exclusive, while the reality is generally much more complex. Judicial officers are often asked to

order services that support one parent’s perspective over the other, such as allegations of unjustified

restrictive gatekeeping (Saini, Drozd, & Olesen, 2017) vs. allegations of poor parenting or intimate

partner violence. Judges understandably want the best possible assurance that the services they are

ordering are appropriate for the actual problem (s), and they may mistakenly believe that delaying

services avoids any risk of harm. They hope that one more investigation, trial, or evaluation will

provide definitive answers, without the process costing the family more in time, stress or financial

resources than the value of the information obtained.

To be sure, risk assessment is an essential part of both evaluation and treatment, and all pro-

viders should be constantly alert for risk factors or behavioral patterns that could endanger a child

or parent. Parenting plan evaluations, or evaluations to assess potential danger to a child, may serve

a vital function. Often, a well-conducted evaluation or child protective services investigation will

reveal those risks. In other cases, the dynamics placing a child at risk are much more subtle and

complex. Findings in those cases are rarely as clean or definitive as a broken bone observed on an

x-ray. Over time, the alert clinician may become aware of risks to a child’s safety, which may or

may not be the same as prior allegations, and should promptly report any reasonable suspicion to

child protection authorities. In many cases, however, the literal “truth”of past allegations may be

difficult or impossible to determine. In some cases, and where resources permit, some forms of

intervention can begin while a custody evaluation is still ongoing. This is often possible when the

interventions being considered are those that support a child’s general developmental needs, such as

shielding school or recreational activities from conflict, or engaging therapeutic interventions that

address the healthy coping abilities that all children need. Such options are described in greater

detail below. Early intervention may both stem risks to the child and provide important information

for both the custody assessment and treatment/intervention planning.

Over time, clinicians may be able to detect and intervene with unhealthy family dynamics that

do not constitute child abuse but nevertheless have a profound and destructive impact on children’s

ability to cope and develop. Moreover, children and families are in a constant state of change, based

on both children’s developmental issues and, in some cases, the family’s reaction to prolonged con-

flict or litigation. Children at the center of conflict often fail to master essential developmental

skills. Avoiding problems, rather than solving them, becomes a habit. Patterns of poor parenting,

undermining of a parent–child relationship, and failure to require children to adopt healthy patterns

of conduct interact to create a complex of increasingly severe emotional risks to the child. Linear

conceptualizations of cause and effect may continue to appeal to parents who are “stuck”on

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