Psychotherapy Volume 3 I/Summer 1994/Number 2



BENJAMIN D. GARBER Nashua, New Hampshire

The literature concerned with mental health professionals’ involvement in the court system has emphasized the limits and proper conduct of evaluative functions, for example, assessment in matters such as child custody and visitation. This article addresses the complementary but distinct function of performing psychotherapy with children involved in separation and divorce. While others have addressed the complex therapeutic issues inherent in this undertaking, this author focuses on many of the practical limits necessary which must be considered prior to accepting and while working with such cases in order to maximize the potential for therapeutic success and to minimize professional liability. The emphasis here is on five inter-related areas, including: 1) educating referral sources, 2) inclusion of both parents, 3) establishing a contract for treatment, 4) anticipating triangulation, and 5) considerations affecting the duration and termination of treatment. These matters are discussed within the context of rapidly evolving state mandates and legislation regarding divorce and parenting.

Correspondence regarding this article should be addressed to Benjamin D. Garber, 280 Main Street, Suite 310, Nashua, NH 03060.

Mental health professionals have become in- creasingly concerned with defining the latitude and limits appropriate to work in conjunction with the court system. Perhaps the single area within this specialty that has received the greatest atten- tion is the mental health professionals’ participa- tion in child custody and visitation decisions (Black & Cantor, 1989; Gardner, 1982; Schutz et al., 1989). Entire newsletters,1 organizations,2

and specialty ethical guidelines (Committee, 1991) have been devoted to questions in this realm.

Far less attention has been paid to the closely related and much more commonly encountered issues of conducting psychotherapy with children of divorce. Perhaps the single best overview of the clinical approaches to working with children of divorce is restricted to a single chapter (Hodges, 1991, chap. 12). However, even this resource is limited both by the need to draw the line more clearly between evaluative and thera- peutic functions, and the need to address many of the practical or functional issues that arise con- ducting therapy with children of divorce. Saun- ders (1993) has begun to address each of these needs. Yet, further dialogue based on clinical ex- perience and empirical research is necessary.

The present article builds upon the existing clinical literature and experience in addressing five practical matters related to conducting psy- chotherapy with children of divorce and in distin- guishing this intervention from evaluative func-

1 The Custody Newsletter, published by Village Publishing, Inc., Doylestown, PA.

2 The Professional Academy of Custody Evaluators (PACE), is an organization that accredits and sets standards for mental health professionals who engage in custody evalua- tive processes.




Children of Divorce in Psychotherapy

tions related to children of divorcing families. This is not an overview of theoretical approaches to therapy (cf. Hodges, 1981), nor is the present intent to address the complex issues of the evalua- tion of visitation and/or custody (cf. Schutz et al., 1989).

1. Educating referral sources and potential clients. The single most important aspect of working with a child in a separated or divorcing family is the establishment of the limits and goals of professional involvement from the moment of intake. This commonly involves the dual aspects of education and decision-making.

Mental health professionals should not expect that referral sources including schools, lawyers, and physicians, nor parents themselves have a full understanding of the services they are seek- ing. The distressed and recently separated mother who was given a therapist’s name by her son’s pediatrician has no a priori knowledge of the distinction between mental health evaluative and therapeutic roles. Her request that her son “be seen” may represent any combination of motiva- tions, including a) a desire to help her son cope with a stress and/or behave differently; b) a desire to open the door to her own therapy by way of presenting her son’s difficulty; c) a desire to estab- lish by way of expert intervention that her son’s difficulties are due to her estranged husband’s actions, a finding which she expects to use in court; and/or d) a desire to engage a professional to determine that she should be granted a certain type or degree of support, custody, or visitation.

It is imperative to the success of any therapeutic intervention and incumbent upon the therapist (Gardner, 1982, p. 35; Specialty Guidelines, IV:D-2, 1992) that these distinctions be teased apart in the initial patient contact. The parent who is genuinely seeking support and change for his or her child may proceed with an initial history meeting, as described below, while those parents seeking services for themselves, an expert ally in alienating an estranged spouse, or a formal foren- sic evaluation each need referral to other, appro- priate resources.

Establishing these distinctions in the initial contact, even if by phone, is a desirable, if time consuming, means of proceeding, because the cases that pass this initial screening will have a much improved likelihood of therapeutic success and will present considerably lower professional risk to the therapist. Further, clarification of these

distinctions even prior to meeting the child’s par- ents face-to-face, establishes a foundation of common goals and expectations upon which the ensuing therapeutic process can be built.

2. Inclusion of both parents. The two es- tranged parents’ mutual willingness to participate in an initial meeting cooperatively may be the single best indicator of clinical success. Partici- pating together requires that estranged and often acrimonious parents put aside their differences in pursuit of the higher goal of the child’s well- being, a task that parents will be faced with to greater and lesser degrees for the rest of their lives.

Having both parents present at the initial meet- ing minimizes confusion about the therapist’s role, minimizes either divorcing party’s feeling that the therapist is covertly allied with one or another parent, and sets the momentum that the therapy, unlike many other aspects of the family’s life, is not to be a matter of dispute. The message to both parents must be that the professional pro- poses to become the child’s helper, not either parent’s helper. This goal cannot be adequately accomplished through any other combination of meetings at any subsequent time, including via meetings with each parent independently before commencing joint meetings.

Parents’ ability and willingness to see beyond their marital conflict to meet together in this initial appointment may be seen as a sample of their general ability to work together in the child’s best interests. As children continue to need both parents’ support and consistency even after di- vorce, mutual attendance at this meeting is sug- gestive not only of therapeutic outcome but also the child’s developmental prognosis in general. For this reason, it is interesting to note that many separated and divorcing partners will balk at a request to meet together with their former partners for their children’s sake, or simply refuse. It is important to understand the reasons for such avoidance as it may bear upon the therapy and the child’s well-being, and to recommend or require alternatives, as appropriate.

a. In instances where spousal abuse has been charged and/or in which a restraining or- der is in place, refusal to meet together may be entirely appropriate or necessary. It may be appropriate to have parties consult with respec- tive counsel regarding the recommendation, but in most instances it will be necessary to




Benjamin D. Garber

conduct two separate initial interviews, allowing that information from either party re- garding the child and the family is open to both parents.

b. In other instances, a parent will seek psychological services for a child and insist that the child’s other parent not be involved, and even not be informed. This is not only a likely ethical trap for the professional who has a responsibility to meet the child’s needs, but potentially a legal problem as well. In many instances, parents who have joint legal custody are required to obtain their former partner’s consent before commencing such endeavors as elective surgery and psychotherapy.

Clinically, the therapeutic value of an inter- vention in which a child sees that the therapist has an exclusive alliance with only one parent is suspect. In many instances, whether or not there is a behavioral issue to be addressed {e.g., enuresis, fearfulness, declining school per- formance), psychotherapy with children of di- vorce is intended to offer the child a neutral relationship apart from the parental conflict in which to learn to cope with the inevitable feel- ings of guilt, anger, abandonment, and grief that accompany parental separation (e.g., Hetherington, Cox & Cox, 1979; 1985). It is doubtful that such neutrality can be achieved without the mutual support and/or participation of both parents.

The complications inherent in conducting psychotherapy with a child of divorce without both parent’s involvement are compounded in those majority of instances in which some de- gree of parental alienation (Gardner, 1987; Ward & Harvey, 1993) may be operant. To the extent that the referring parent is invested in maligning his or her estranged spouse, the professional with only that parent’s input can- not help but be effected. Invariably, regardless of the behavioral or dynamic approach to the therapy, such biases effect the therapy and the child, in turn.

One parent’s complete refusal to involve the child’s other parent in the therapy may be suf- ficient grounds, prior to meeting the child, to refuse the case. In such instances, the therapist is well advised to document all aspects of con- sideration and discussion thoroughly, and to refer the parent elsewhere, as appropriate.

c. In cases where a parent refuses to con- tribute to a therapy proposed for his or her

child, many of the same concerns about clinical bias still hold true. After making every reason- able effort to notify the absent parent about the child’s referral for therapeutic services, the limits and goals of such therapy, and the re- quest for both parents’ participation, the pro- fessional must then consider whether proceed- ing with the therapy is in the child’s best interests. A good barometer of the referring parent’s ability to minimize bias in working with the therapist alone is his or her initial willingness to try to involve the absent parent.

It is often useful in cases such as these for the professional to contact the absent parent via registered mail, with a copy of the correspon- dence to the referring parent. A copy of a letter describing the proposed therapy, its limits and goals, together with the return receipt may suf- fice as documentation of the effort to involve both parties. The same recourse via the mails is useful in cases where an absent parent is willing to participate in the therapy, but physi- cally unable because of distance or timing. This latter is obviously a circumstance more condu- cive to therapy, as the absent but cooperative party can presumably participate via mail or phone.

Upon establishing that both parents are will- ing to attend an initial history meeting, sched- uling that meeting offers the parents the first opportunity to demonstrate their willingness to work together in the child’s best interests or, conversely, to try to triangulate the profes- sional between them as they may already have so triangulated the child. The therapist who takes on this responsibility by presuming that he or she can call back and forth between par- ents (with whom he or she has not yet estab- lished a rapport) to find an acceptable time to schedule a meeting, faces the prospect of ever after becoming the parents’ go-between. While parents’ efforts to put the professional in that position can be diagnostic in that it suggests a situation the child may chronically encounter, it is not conducive to establishing appropriate roles and boundaries in the therapy.

The alternative is self-evident: One parent (likely the referring parent) must take die re- sponsibility to learn when the professional is available to meet with the parents together, and then must coordinate these options with the estranged spouse before confirming with the professional. This process not only saves the




Children of Divorce in Psychotherapy

therapist innumerable hours of phoning, but also empowers the parents to work together as they must, regardless of their marital status. 3. Establishing a contract for treatment. A

written agreement can be prepared in consultation with attorneys familiar with local and state laws and provided to both parents by mail prior to the initial joint meeting as a means of documenting the limitations and goals of the proposed therapy. One such agreement is provided in Appendix A. It is useful to review the contents of this agreement aloud at the start of the initial history meeting, including the limitations of confidentiality as they apply to the proposed therapy. It is useful both clinically and in terms of professional risk man- agement to have each parent sign a copy of the agreement for the child’s file, in addition to sign- ing informed consent forms to exchange informa- tion with relevant parties including attorneys, the Guardian Ad Litem (GAL), teachers, and others.

The clinician who proposes to work with chil- dren of divorce must remain well informed in relevant matters of local, state and national law. For example, a number of states have begun to mandate that divorcing parents participate in edu- cational seminars (e.g., Georgia’s Divorcing Par- ents Seminar,3 mandated August, 1988). It is sound to retain a local family law practitioner to review documents prepared for distribution in such cases and for consultation in particular cases. Fortunately, Division 41 of the American Psycho- logical Association, local family bar associations, and various groups concerned with law and fam- ily transition frequently offer educational semi- nars and publish relevant clinical and legal news- letters and journals.

In instances where one parent is absent, this written agreement can be sent by mail for clarifi- cation of the proposed intervention. When the parent is willing but unable to participate, the agreement can be returned via mail for inclusion in the child’s file. In such instances, it may be necessary to postpone scheduling the first inter- view with the child pending receipt of both par- ents’ signed agreements.

It is important to note that such an agreement stipulates that payment is made in full at the time

3 Families First is a state mandated educational program for divorcing parents. It is currently in place in Georgia, Indiana, Texas, and being piloted in New Hampshire and several other states. For information, write Families First, P.O. Box 7948, Station C, Atlanta, GA 30357-0948.

of service and that an initial retainer will be col- lected and held against charges incurred. This stipulation is necessary in order to assure that matters of payment are established from the start. However, such a stipulation may not be feasible (and may, in fact, be illegal) when insurance re- imbursement and managed care contracts are in- volved. It is critical to work out these details from the start of the proposed therapy, including coverage for non-reimbursed, non-face-to-face services including adjunct conferences (e.g., with the GAL, teachers, other therapists or evalua- tors), review of past documentation (e.g., school records, psychological evaluations), and/or report preparation, as needed.

The issue of payment and sources of reimburse- ment begs the question of diagnosis, as third- party reimbursement commonly requires formal diagnosis. Clearly, many children of divorce present with diagnosable conditions, the most common of which may be some form of Adjust- ment Disorder (DSMIII-R, 1987), where the pre- cipitant is clearly the marital transition. However, diagnosing (and treating) a child carries with it other ramifications in the family system that the professional must be alert to, including the child’s potential perception that the family transition has occurred as a result of this diagnosable condition. Further, as the child’s records of therapy and/ or the professional’s written summary of such therapy may find its way to the divorce hearing, it is important that both parents be informed as to the values of diagnosis and, when applicable, the individual diagnosis code’s full meaning, at the earliest possible occasion.

4. Anticipating triangulation. Just as the parents may have tired to triangulate the profes- sional in such preliminary matters as scheduling the initial appointment, similar situations are likely to continue to arise throughout the therapy. In contested custody proceedings, in particular, each parent’s respective efforts to triangulate and/ or enlist the therapist as an ally may become in- creasingly frequent and demanding as the custody finding becomes more imminent. It is not uncom- mon for therapists working with a child of divorce to receive multiple calls each week from one or both parents charging that their estranged partner has somehow, “broken the rules.” Such calls range from complaints about compliance with vis- itation agreements to outright charges of abuse.

It is critically important to the therapy that the professional not be in a position as trier of fact




Benjamin D. Garber

or finder of truth. Not only is this an impossible job necessarily left to the judicial system and more nearly the responsibility of an impartial evaluative body, when available, but it threatens to corrupt the purpose of the therapeutic alliance with the child. Parents involved in such disputes must learn to direct their complaints to some other party, optimally the court appointed GAL, whose court mandated responsibility is to determine what is in the best interests of the child.

In splitting functions in this manner (i.e., the GAL and the court make decisions and the mental health professional does therapy), the therapist preserves his or her capacity to hear and support any emotion from the child. The therapist who is the position to draw conclusions about one parent or the other parent’s behavior, inevitably compro- mises the therapeutic rapport by tacitly endorsing a view of one parent as good and the other parent as bad.

In general, a child’s therapist has recourse to four mutually compatible responses when con- fronted by one parent’s charge about another. First, and most important, is documentation. Every contact, in person and by phone, must be adequately documented as part of the child’s file. Parents must be aware from the start that this is standard procedure. Except in cases of alleged abuse, it may be sufficient to inform the parent that their complaint has been noted.

Second, a therapist can remind the parent that evaluating such charges is not his or her responsi- bility, and redirect their call to the GAL. It is important in all cases that the therapist and the GAL are in constant and open communication in the child’s best interests, representing a model of the sound caretaking system one hopes parents could emulate regardless of marital status.

Third, it is often appropriate to respond em- pathically to the parent’s complaint, taking care to acknowledge their perception or their allegation rather than any representation as fact, and suggest that such information helps to understand what the child must feel like in the family system. As much as the therapist and the GAL may represent an alternative parenting model to the parents, the therapist can also vocalize what being caught in the middle must feel like to the child.

Fourth, a parent meeting can be called to ad- dress the matter at hand, with the goal of resolving the miscommunication or failure of coordination represented by the particular problem. A child’s therapist must take care to consider who should

be invited to such a meeting, including consider- ation of each of the parent’s respective therapists, their respective new partners, and/or the GAL.

Involving the child in such a meeting is rarely useful, as it may recreate the caricatured scene in which the parents stand at either end of the room cajoling the child in the middle to come to them. In addition, the child’s experience of a joint meeting with both parents, much as it may reassure the child that the parents are working together, may reinforce the message that misbe- havior breeds reunion. In general, a child’s perva- sive reunion fantasies (Gardner, 1976) must be considered as a constant force throughout the therapy.

The exception to the clear division of therapeu- tic and decision-making responsibilities between therapist and GAL can arise when charges or evi- dence of abuse arise. Therapists must understand their responsibility as mandated reporters of abuse under state law and, encountering charges of abuse in a family system, must report immedi- ately to the appropriate agency.

In such instances, it is important to understand the potential that reporting may alienate the child patient who maintains a strong bond with each parent, including the alleged perpetrator. Obvi- ously, the question of safety must be addressed even at the cost of the therapy. However, in some instances, the physical risk to the child may be properly addressed and the risk to the therapeutic alliance mitigated when circumstances and state law allow the therapist and the GAL to work together to report in the GAL’s name. Therapists are well advised to consult in advance of such circumstances with counsel regarding the feasibil- ity of such an arrangement.

This issue is ever more complicated by the in- creasing prevalence of charges of abuse used as a manipulative tool in child custody battles (Faller, Corwin & Olafson, 1993; MacFarlane, 1988). As much as a mental health professional may believe that any given charge is no more than a manipula- tive tool, it is not within a therapist’s role (or competence, in many cases) to evaluate such charges, where failure to report poses a breach of both ethical and legal standards, as well as a risk of actual harm.

5. Considerations affecting the duration and termination of treatment. In the managed care environment of contemporary mental health care there is little room for on-going, supportive psy- chotherapy. The clear emphasis is on brief, solu-




Children of Divorce in Psychotherapy

tion-focused interventions. In cases where man- aged care is involved and a child of divorce is referred with a distinct and concrete symptom, four to six meetings may be sufficient for symp- tom resolution.

However, in a majority of cases, instead of or in addition to concrete treatment foci, children of divorce must be understood to be experiencing a major life transition requiring on-going interven- tion. In short, the foundation upon which such a child has tenuously begun to build their personali- ties has failed and, much as they may have adopted successful short-term strategies for cop- ing (e.g., denial, over-compensation, parenting the parent), they are in need of long-term support until either or both parents can reestablish a secure base to which they can return. Clearly, the long- term sequelae of divorce are potentially and com- monly devastating (Hetherington, Cox & Cox, 1979; 1985; Schwartzberg, 1992).

This is not to say that children of divorce must remain in therapy forever. Quite the contrary. So long as a child has some kind of secure and sup- portive base, therapy may be short term or unnec- essary. In younger children, such a base may be a neighbor or neutral caregiver outside the family transition. Older children may have had enough secure experiences prior to the marital transition to have internalized a large degree of security (ego strength), and may be able to find their support through teachers, or involvement in a preferred activity, or even from peer groups.

Children who have never had any form of secu- rity in their lives are more likely to need long- term and supportive therapy, regardless of the status of the parents’ marriage. For these chil- dren, victims their whole lives of marital discord and family upheaval, the opportunity to develop a supportive and responsive relationship is a unique experience of huge therapeutic potential. Many times it is only when the marriage finally dis- solves (or in other cases when abuse is reported) that these children get their first opportunity for therapy.

The course of therapy is certainly and foremost a function of documented clinical need, often re- ferred to as medical necessity by third-party pay- ers. It is the therapist’s responsibility to recom- mend the interventions that are clinically indicated to both parents and the GAL, without prior consideration of financial resources.

Once the clinical recommendation is known, the parents can negotiate alternative means of

meeting these recommendations, including nego- tiating a reduced fee with the therapist when pos- sible, seeking alternative personal means of pay- ment, or seeking similar services elsewhere.

In addition to the clinical variables relevant to anticipating the duration of any psychotherapy (e.g., severity of difficulties, presence of sup- ports, premorbid functioning, expressive skills), the therapist working with children of divorce may need to consider the following: a) What ad- junct evaluative or therapeutic processes are on- going (e.g., custody evaluation, parent’s therapy, marital mediation); b) What role can the parents play in this therapy and how responsive are they to recommendations about parenting strategies? c) How often can meetings with the parents and the GAL be arranged to review the child’s prog- ress and plan ahead? d) What other changes might the pending divorce impose on the child, in- cluding questions about relocation, remarriage, and other losses and transitions? and, e) What is the projected course of the divorce process as that may affect how long either or both parents’ homes are in flux? Finally, consideration of the child patient’s clinical needs should include what role group therapies available in the community and/ or through the child’s school may have in facilitat- ing his or her adjustment.

One model of primarily supportive therapy use- ful for children of divorce calls for weekly therapy meetings for four to six weeks, followed by a review meeting with the parents. At the time of the review meeting, if a strong therapeutic rapport has been established and no new problems have been identified, the frequency of therapy can be reduced to alternate week meetings with another review scheduled in three months. At that point it may be appropriate to consider moving individual meetings to monthly and to consider starting par- ticipation in a children of divorce group therapy. Simultaneously, recommendations and/or avail- able options for support to the parents may be identified as they become available, including ed- ucational interventions, psychoeducational and support groups (Parenting Apart Groups),4 or in- dividual therapy.

In all, the argument here is for comprehensive consideration of the practical aspects of conduct- ing psychotherapy with children of divorce as a

4 Parenting Apart refers to a six-week, programmed psy- choeducational group for separated, divorcing and divorced parents developed by the author.




Benjamin D. Garber

process distinct from forensic custody evaluation and in need of enormous clarity from the time of the first phone contact. The mental health profes- sional who carefully considers these matters in advance of accepting a child of divorce for ther- apy has a greater likelihood of clinical success and a decreased vulnerability to charges of ethical misconduct and/or illegal acts.

APPENDIX A Sample Agreement for Parents Regarding Limitations and Goal of Psychotherapy with a Child of Divorce

Children of Divorce in Psychotherapy BENJAMIN D. GARBER, PH.D.

Psychotherapy can be a very important re- source for children of separation and divorce. Es- tablishing a therapeutic alliance outside of the home can:

• Facilitate open and appropriate expression of the strong feelings which routinely accom- pany family transitions, including guilt, grief, sadness and anger

• Provide an emotionally neutral setting in which children can explore these feelings

• Help children understand and accept the new family composition and the plans for contact with each member of the family

• Offer feedback and recommendations to a child’s caregivers based on knowledge of the child’s specific emotional needs and develop- mental capacities

HOWEVER, the usefulness of such therapy is extremely limited when the therapy itself be- comes simply another matter of dispute between parents. With this in mind, and in order to best help your child, I strongly recommend that each of the child’s caregivers (e.g., parents, step-par- ents, day-care workers, Guardian Ad Litem) mu- tually accept the following as requisites to partici- pation in therapy.

1. As your child’s psychotherapist, it is my primary responsibility to respond to your child’s emotional needs. This includes, but is not limited to, contact with your child and each of his or her caregivers, and gathering information relevant to understanding your child’s welfare and circum- stances as perceived by important others (e.g., pediatrician, teachers). In some cases, this may include a recommendation that you consult with a

physician should matters of your child’s physical health be relevant to this therapy.

2. I ask that all caregivers remain in frequent communication regarding this child’s welfare and emotional well-being. Open communication about his or her emotional state and behavior is critical. In this regard, I invite each of you to initiate frequent and open exchange with me as your child’s therapist.

3. I ask that all parties recognize and, as neces- sary, reaffirm to the child, that I am the child’s helper and not allied with any disputing party.

4. I strongly recommend that all caregivers in- volved choose to participate in PARENTING APART psycho-educational groups. These are six-week groups in which separating and divorced parents learn basic strategies for conducting a divorce in the best interests of the child.

5. Please be advised regarding the limits of confidentiality as it applies to psychotherapy with a child in these circumstances:

• I keep records of all contacts relevant to your child’s well-being. These records are subject to court subpoena and may, under some cir- cumstances, be solicited by parties to your divorce, including your attorneys.

• Any matter brought to my attention by either parent regarding the child may be revealed to the other parent. Matters which are brought to my attention that are irrelevant to the child’s welfare may be kept in confi- dence. However, these matters are best brought to the attention of others, such as attorneys, personal therapists or counselors.

• I am legally obligated to bring any concern regarding health and safety to the atten- tion of relevant authorities. When possi- ble, should this necessity arise, I will ad- vise all parties regarding my concerns.

6. This psychotherapy will not yield recom- mendations about custody. In general, I recom- mend that parties who are disputing custody strongly consider participation in alternative forms of negotiation and conflict resolution, in- cluding mediation and custody evaluation, rather than try to settle a custody dispute in court.

7. Payment for my services is due, in full, at the time of service in a manner agreed to by all parties involved. Any outstanding balance ac- crued (for example, in conference with attorneys,




Children of Divorce in Psychotherapy

the GAL, or teachers), must be paid promptly and in full. An initial retainer of $XXX will be required prior to commencing this therapy to be held against charges incurred and subject to reim- bursement at the conclusion of this therapy, as appropriate.

Your understanding of these seven points and agreement in advance of starting this therapy may resolve difficulties that would otherwise arise and will help make this therapy successful. Your sig- nature, below, signifies that you have read and accept these points.

Caregiver Name

Caregiver Name




Mental Health Professional

Caregiver Name Date

Caregiver Name Date



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SCHUTZ, B. M., DIXON, E. B., LINDENBERGER, J. C. & RUTHER, N. J. (1989). Solomon’s sword. San Francisco: Jossey-Bass.

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