Abstract
High-conflict separated parents (HCSPs) refer to parents who are divorced or separated and are engaged in ongoing conflict. While a large percentage of married couples conclude with divorce and subsequently engage in extended conflict, there is a lack of clinical research and training for therapists aspiring to address this population. As such, this article provides an overview of HCSPs, a framework to understand risk factors associated with high-conflict families, and reviews short-term and long-term negative effects on children and families. This paper also discusses therapeutic intervention strategies known in the literature and predictors of treatment success. Individual therapy, family therapy, group therapy, and parenting coordination strategies are also discussed. Additionally, clinical guidelines and practical tools are shared, as a way to provide structure during what can be a fluid and complex experience. Intervention pathways are described in detail from assessment to intervention to resolution. A case example, based on clinical experience, is also used to illustrate to early-career therapists how one may navigate a case. A review of the literature highlights the need for increased research and training for therapists encountering this complicated and understudied population.
Highlights
This paper provides an overview of high conflict separated parents and its impact on children and families.
It also examines the known literature to emphasize the gap in the field in regard to intervention strategies for this population.
Based on clinical experience, clinical guidelines and practical tools for therapists are discussed in an easy-to-understand way.
A novel case study is shared to illustrate the guidelines and tools so that therapists are able to better conceptualize the framework.
The paper underscores the need for continued research and training for this complex ever-present population.
Introduction
In the United States, about 40%–50% of initial marriages and approximately 60% of subsequent marriages conclude with divorce (Clyde et al., 2019). Divorce generally imposes stress on every member of the family. It entails an adjustment phase marked by potential psychological turmoil and coparenting disputes among former partners. Over time, these challenges often decrease in severity, particularly within the initial years post-divorce (Halford & Sweeper, 2013). Nonetheless, a notable subset of divorced parents, approximately 30%, continue to experience adversarial or antagonistic interactions, extending even a decade after the divorce has taken place (Fischer et al., 2005). “High-conflict separated parents” (HCSPs) involve parents who are divorced or separated and are engaged in ongoing, intense, and often adversarial disputes or conflicts related to various aspects of coparenting and child-rearing (Anderson et al., 2011; Quigley & Cyr, 2017). HCSP families are among the most challenging for psychotherapists to treat and manage. Unfortunately, there is a lack of clinical research and training for therapists aspiring to address this population. This article provides an overview of HCSP's family dynamics and behavior patterns, reviews short- and long-term effects on children, and discusses therapeutic intervention strategies that have been found to be helpful. Additionally, clinical guidelines and a case example are presented in order to provide therapists with practical tools for navigating these cases.
HCSP Clusters
According to Anderson et al. (2011), HCSPs fall into two clusters: pervasive negative exchanges and hostile, insecure, emotional environment. Description of these clusters helps to elucidate the internal and intra-family dynamics at play in these difficult cases.
Cluster 1: Pervasive Negative Exchange
This cluster includes features of high-conflict interactions: pervasiveness, defensiveness, aggression, escalation, and negative attributions with dualistic thinking (Anderson et al., 2011). Conflict is pervasive and dominates most topics and settings, persisting over time due to failed resolutions or compromises. Aggression and defensiveness cycles are also traits of HCSPs. Defensiveness maintains conflict by involving self-protection, avoidance, withdrawal, and control attempts. Exchanges frequently escalate, and partners tend to hold negative attributions with dualistic thinking that villainizes the other and portrays oneself as a victim. Thus begins a cycle in which each person feels attacked and is on the offensive (Anderson et al., 2011). Aggression, both verbal and physical, is often person-focused rather than issue-focused. Physical aggression may be reactive and a result of joint escalation (Anderson et al., 2011). It is important to note that when there is a high risk for severe mutual violence or battering among these couples, they should not be in treatment together and, as such, are not discussed in this article.
Cluster 2: Hostile, Insecure, Emotional Environment
This cluster has five additional features: strong negative affect, emotional reactivity, lack of safety, triangulation, and mutual distrust. Pervasive negative exchanges create a hostile emotional environment marked by negative affect, emotional reactivity, and mutual distrust. Often, high-conflict parents are unaware of the impact of these mutually negative feelings on their children (Anderson et al., 2011). Amid these negative feelings, there is often a mutual distrust in the couple, as evidenced by a skepticism the partner will change or is committed to doing so (Anderson et al., 2011).
Parents often disbelieve that the other parent can adequately care for the children (Anderson et al., 2011). Triangulation occurs when tension or conflict escalates to an intolerable level within a two-person relationship, often involving children. To alleviate anxiety between two people, one person brings a third person into the relationship to alter the dynamics without resolving the conflict. Frequently, children are placed in conflict as one parent wishes to sway the child's opinion of the other parent. High-conflict divorced couples tend to triangulate the professionals involved, including family courts, attorneys, or mediators. In a high-conflict divorce, both clusters contribute to significant financial and emotional stress for families, burden the justice system, and, most importantly, negatively impact children's psychological adjustment and well-being.
Ecological Transactional Framework
An ecological transactional model helps us to understand risk factors and indicators associated with high-conflict families, as it discerns the interactions on multiple levels. The model is broken down into four components: ontogenetic development (individual), microsystem (family), exosystem (community), and macrosystem (culture), highlighting their reciprocal interactions (Polak & Saini, 2019). Within the realm of high-conflict families, the analogous systems encompass an individual's ontogenetic progression (biological, psychological, emotional, behavioral, and cognitive), interpersonal networks (parent–child bond, family, friends, kin, and other social connections), institutions (schools, child welfare, law enforcement, and various community resources), and the physical environment (social context, legal regulations, etc.) (Polak & Saini, 2019).
The advantage of the ecological transactional model is that it acknowledges that factors of high conflict are not isolated entities. Instead, it involves a substantial interconnection between risk factors, markers, and outcomes (Polak & Saini, 2019). For instance, substance abuse can predispose a parent to high conflict and precipitate its continuation. Both can impact the parent's ability to fulfill their role, the dynamics between parent and child, and the broader adjustment issues faced.
The ecological transactional model reveals three fundamental domains that are important when considering high conflict. The first domain directs attention to risk factors, or predictive elements, that signal the potential emergence of high conflict (Polak & Saini, 2019). The model assesses these risk factors and indicators across multiple levels: ontogenetic, microsystem, exosystem, and macrosystem. The ontogenetic sphere includes predisposing factors, including personality disorders, mental health concerns, insecure attachments, and substance misuse (Polak & Saini, 2019). The microsystem level encompasses negative parental behaviors, attachment insecurities, power imbalances, financial dependencies, and time-related challenges. Exosystem factors involve the extended family's involvement. The macrosystem includes influences such as legal frameworks, cultural norms, religious beliefs, and traditions.
The second domain includes the indicators that signify the presence of high conflict (Polak & Saini, 2019). Ontogenetic indicators encompass manifestations like anger, hostility, inflexible viewpoints, and substance use while responsible for childcare. At the microsystem level, indicators include chronic disputes, deficient or ineffective coparent communication, blurred parent–child boundaries, irregular parent–child interactions, and issues with child support fulfillment. Exosystem indicators encompass protracted litigation, “tribal warfare,” and extensive engagement with various services. Finally, macrosystem indicators involve conflicts related to religion and extended legal processes.
The third domain in the ecological transactional model acknowledges the consequences that ensue from the presence of high conflict within families following separation and divorce. The multifaceted impact of high conflict extends across various aspects of family life and well-being. Examples include parents’ emotional and psychological well-being, the creation of parenting problems, limits on the parent's ability to attune to their children, and effects on the parent–child relationship (Polak & Saini, 2019).
Analyzing high-conflict literature within the context of the ecological transactional model underscores the intricate nature of the high conflict between these couples. Contrary to being confined to any singular system, high conflict emerges as a complex interplay of numerous systems surrounding the family, the former partners, and the children. The ecological transactional model provides a comprehensive framework to understand risk factors and associated indicators, as it recognizes the dynamic interconnectedness among various factors, resulting in a more holistic understanding of the complexities involved.
Short-Term and Long-Term Negative Effects on Children and Families
Various studies have explored the short-term and long-term adverse effects of high-conflict divorce on children and families. Investigations revealed that high-conflict divorce is associated with parenting problems, strained parent–child relationships (including parental alienation syndrome), child maladjustment, use of negative coping strategies (e.g., substance abuse), depression, anxiety, and child abuse (Mutchler, 2017; Polak & Saini, 2019). Research on children's adjustment following divorce has consistently highlighted the significance of parental conflict. Studies have demonstrated that parental conflict is a crucial predictor of children's well-being post-divorce (Amato, 2010; Amato & Keith, 1991; Polak & Saini, 2019; Vareschi & Bursik, 2005). Moreover, the level of warmth and conflict in parent–child relationships affects children's internalizing problems, emphasizing the importance of positive parent–child interactions (Sandler et al., 2008).
Strained parent–child relationships have also been a focus of research. High-conflict divorce can lead to negative parent–child relationships, causing anxiety, distress, and loyalty conflicts for children (Polak & Saini, 2019). This situation can foster parental alliances and further undermine the parent–child relationship (Polak & Saini, 2019). Child maladjustment is a critical concern associated with high-conflict divorce. Research links chronic high conflict to children's chronic stress, insecurity, agitation, shame, self-blame, guilt, and feelings of helplessness (Polak & Saini, 2019). Additionally, high conflict can evoke fears for children's safety and a sense of rejection and neglect (Polak & Saini, 2019). Children may also face academic, social, emotional, and behavioral difficulties because of high-conflict divorce (Polak & Saini, 2019). These potentially negative adverse effects on children are important to recognize, as research has illustrated that high-conflict divorce not only impacts the parents involved but also the children.
High parental conflict is a powerful predictor of the adverse effects of divorce for both children and adults, particularly in disputes over child custody and visitation (Lebow & Rekart, 2007). Parental divorce can lead to challenges for children leading to consequences with transitions, changes in daily routines, and decreased well-being (Hirschfeld & Wittenborn, 2016). Few longitudinal studies exist for young children whose parents are divorced, but the available evidence suggests the need for interventions to address the immediate short-term consequences of divorce (Hirschfeld & Wittenborn, 2016). While short-term evidence proves that short-term consequences exist, further research is warranted to examine the long-term consequences of divorce. Nonetheless, providers and parents should attempt to mitigate consequences.
Parent–Child Relationship Dynamics
There are a range of familial dynamics between parents and children within HCSPs. It is important to differentiate when children resist contact with a parent after separation but for various normal, realistic, and/or developmentally appropriate reasons. For instance, the resistance may stem from normal developmental processes (e.g., normal separation anxieties in a very young child), rooted primarily in the high-conflict marriage and divorce (e.g., fear or inability to cope with the high-conflict transition), resistance in response to a parent's parenting style (e.g., rigidity, anger, or insensitivity to the child), resistance arising from the child's concern about an emotionally fragile custodial parent (e.g., not wanting to leave that parent alone), and resistance arising from the recoupling of a parent (e.g., involvement of a new partner or stepparent) (Kelly & Johnston, 2005).
One can conceptualize children's relationships with each parent during high-conflict separations and divorces along a continuum of positive to negative. On the one end of the continuum, children have positive relationships with both parents, in which the child values both parents and wants to spend significant amounts of time with each parent (Kelly & Johnston, 2005). Next, on the continuum, children may have an affinity for one parent but still desire contact with both (Kelly & Johnston, 2005). This desire may be due to developmental reasons such as age, gender, or shared interests, causing the child to feel closer to one parent. While these children may occasionally prefer to spend more time with one parent, they still desire to be in contact and loved by both parents.
Next, allied children have developed an alliance with one parent. These children consistently prefer one parent and have limited contact with the other. While these children communicate a desire for limited contact with the nonpreferred parent, they generally do not seek to terminate all contact (Kelly & Johnston, 2005). These alliances often arise in older school-age children as they use their moral assessment and judgment to assess the parental dynamics of the separation.
When assessing a case, it is essential to look for realistic estrangement or separation due to bone fide abuse or neglect. This estrangement may include children separated from a parent because of that parent's history of family violence, abuse, or neglect (Kelly & Johnston, 2005). It may also include children who have repeatedly observed violence or explosive outbursts of a parent or who have been the target of violent or abusive behaviors from this parent. Unlike alienated children, estranged children rightfully harbor anger and/or fear, and providers should address the trauma appropriately before implementing reunification interventions.
Others may experience estrangement in response to severe parental deficits, including persistent immature and self-centered behaviors; chronic emotional abuse of the child or preferred parent; physical abuse that goes undetected; personality disorders or traits that impact parenting capacities and family functioning (Kelly & Johnston, 2005). In these cases, it is important for the individual parent to receive treatment prior to engaging in family or reunification therapy, as these severe deficits could derail the treatment.
On the one end, parental alienation occurs when one parent villainizes the other or targets the other parent with unwarranted claims of abuse, neglect, or wrongdoing (Kelly & Johnston, 2005; Mitcham-Smith & Henry, 2007). A parent may do so by portraying the other as dangerous, unnecessary, or neglectful; allowing the child to make decisions about visitations; denigrating and discussing flaws of the target parent; disrupting or terminating the other parent's visits with the child; probing the child to detect “negative” behaviors or occurrences; creating barriers for phone contacts or scheduled visits; and making allegations of sexual or physical abuse (Kelly & Johnston, 2005; Mitcham-Smith & Henry, 2007). These cases of parental alienation require more intensive and targeted services than the more typical HCSP cases.
Intervention Services
Individual Therapy
Research lacks on the specific outcomes of individual therapy for children with HCSPs. However, research has stated that adults who experience parental alienation and high conflict are likely to have relationship difficulties in adulthood if they are not involved in effective treatment during childhood (Moore et al., 2013). As such, individual therapy may be a crucial step for parents to mitigate problems that may arise later in life. Mental health professionals working directly with children of divorced parents must also be familiar with their role in the case and avoid giving recommendations outside of their role. Counselors risk accidentally entrenching the child and the parents in the dysfunctional family dynamic if they do not remain aware of all the extraneous variables present in each case (Moore et al., 2013).
Additionally, therapists may risk ethical violations if they step outside their role regarding custody cases (Moore et al., 2013). While individual therapy can be beneficial for a child with HCSPs, it is pertinent that the therapist be educated and knowledgeable to prevent the therapist from doing more harm than good to the child and the family. More research is also needed to uncover whether individual therapy for children with HCSPs helps mitigate potential long-term adverse effects on the children later in life.
Family Therapy
Cognitive–behavioral family therapy has been proven effective in high-conflict divorce cases. This approach aligns with systems theory and acknowledges many internal and external factors that fuel conflicts. Specifically, in a case study done by Spillane-Grieco (2000), a time-limited version of cognitive–behavioral family therapy was an effective treatment for families involved in high-conflict divorce. Within the framework, the therapist attempted to restructure distorted beliefs, increase communication skills, improve problem-solving skills, and increase successful behaviors for family functioning (Spillane-Grieco, 2000). Integrative family therapy adopts a multilevel perspective, targeting behavior, cognition, affect regulation, systemic interactions, and more significant familial or judicial contributions. This therapy consists of psychoeducation, reattribution, narrative change, and working with intense emotional responses associated with divorce (Lebow & Rekart, 2007). Emotionally focused family therapy (EFFT) combines play therapy techniques with an attachment theory-based approach (Hirschfeld & Wittenborn, 2016). An EFFT therapist seeks to change the problematic cycle of interaction in the family by helping foster new, positive interactions. Researchers hypothesize that EFFT works well with divorced families because it encourages them to talk about their feelings to help them cope with emotions resulting from divorce (Hirschfeld & Wittenborn, 2016). As a result, EFFT helps children who experience an increased need for emotional connection and responsiveness to their attachment figures, as it supports the parent–child relationship during a challenging period.
Family counseling can be an excellent resource for high-conflict parents. In family counseling, it is apparent for the therapist to remain aware of common challenges and strategies to overcome them (Mutchler, 2017). Some common challenges include the attachment to the idea of winning, negative attributions/dualistic thinking, being stuck on “the truth,” which leads them to assume the other is lying, stonewalling, triangulation, transference, and countertransference (Mutchler, 2017). Strategies to overcome negative attributions/dualistic thinking include the therapist reframing that both parents are both good and bad in an attempt for each parent to see the positive qualities of the other (Mutchler, 2017). The literature has focused on describing therapy options in all family therapy examples, and the research mainly provides case studies. As such, further research must fully ascertain each type's efficacy.
Group Therapy
Group therapy studies have also explored whether group-based interventions are effective for high-conflict divorce families. The program “No Kids in the Middle” targets children in prolonged conflict post-divorce. It is a group-based, time-limited, multifamily intervention for children and creates a space for parents to empathize and connect with their children's experiences (Høigilt & Bøe, 2021). Therapists lead parent and children's groups in structured sessions to facilitate communication between the two groups. Specifically, children present a message to the parent group and vice versa (Høigilt & Bøe, 2021). This study found that most parents’ daily lives had improved, as it allowed them to move forward with their lives positively even if conflict still existed (Høigilt & Bøe, 2021). This study, however, had a very limited sample size where only five out of the 36 parents volunteered for interviews, emphasizing the challenges of finding volunteers within this type of population (Høigilt & Bøe, 2021). Additionally, this study was conducted in the Netherlands, and it is unclear whether this treatment is commonly used, thus limiting its feasibility. The Overcoming Barriers Family Camp (OBFC) is a 5-day immersive experience that combines psychoeducation, structured interventions, and coparenting work (Sullivan et al., 2010). The camp attempts to create safe “connections” between the rejected parent and the child in a carefully constructed environment. It facilitates problem-solving skills between the two parents as they agree and create an aftercare plan (Sullivan et al., 2010). Findings from the camp were positive, although the limited availability of the camp, as well as the absence of funding, make it a less feasible option for families.
Parenting Coordination
In addition to the array of intervention services available for families navigating high-conflict divorces, parenting coordination is a procedure that can be useful for families. The task of a parenting coordinator (PC) is to facilitate communication between high-conflict divorcing couples about the needs of their children (Mitcham-Smith & Henry, 2007). Specifically, the coordinator aids parents in implementing parenting plans, resolving disputes, and providing educational guidance within court-defined parameters. The role differs from counseling as it is structured, nonconfidential, and court mandated. In a two PC model, the divorced couple works with two PCs together and each PC helps the parent to navigate the emotional terrain of the process (Behrman, 2016). Individual meetings between the PC and the client occur as required, aiming to tackle contentious areas (Behrman, 2016). Collaboratively, both PCs delve into understanding the couple's dynamics, surmount emotional barriers hindering effective communication and decision making, and aid in devising parenting-focused action plans (Behrman, 2016). Successful case studies support the efficacy of this model in fostering better parental cooperation amid emotionally charged circumstances.
Predictors of Treatment Success
High-conflict divorce cases present complex challenges requiring a strategic approach for successful intervention. Baker et al. (2020) outline predictors of success and essential components for clinicians to keep in mind. First, proper assessment and screening is required to distinguish between alienation and estrangement. Accurate assessment is vital to understanding the risks for the child involved in reconnecting with the rejected parent (Baker et al., 2020). An in-depth evaluation and risk assessment determines the most appropriate intervention strategies. Second, developing and monitoring treatment goals is central to effective intervention. Four key treatment issues have emerged as pivotal for successful interventions: (1) correcting the child's cognitive distortions; (2) holding the favored parent accountable; (3) providing unwavering support to the targeted parent; and (4) assisting the child in navigating a relationship with both parents (Baker et al., 2020). Third, understanding what constitutes successful treatment and devising measurable metrics to evaluate progress is essential. Clinicians should consider treatment success as resuming parenting time, except in cases with documented safety concerns (Baker et al., 2020). Lastly, addressing barriers to successful treatment is crucial to mitigate the obstacles. Common barriers include child-related barriers, such as lack of investment and a solid commitment to distorted views; favored parent-related barriers, such as hindering session scheduling and conveying bias to the child against the treatment process; and rejected parent-related barriers, such as defensiveness, impatience, and anger (Baker et al., 2020). Additional barriers may stem from complexities arising from varying professional understandings among legal and mental health providers.
Intervention Guidelines
Intervening with high-conflict families is sometimes like traversing through hazardous terrain without a map. When approaching these challenging cases, it is critical to develop routine processes and procedures as a way to impose structure on what can be a chaotic and fluid experience. In this section, we describe intervention pathways from assessment to intervention to resolution based on our clinical experience in the hopes of providing practical guidelines for therapists who are new to the world of high-conflict families.
Intake Process
The intake process for HCSPs typically begins with a referral from a legal professional such as a mediator, guardian ad litem, parent coordinator, family court judge or attorneys representing the parents. At times, the referral will come with a court order that specifies the services that are being requested along with a breakdown of financial responsibility (e.g., both parents have to split the bill for therapy 50/50). Like with any area of concern within psychotherapy, each new case begins with a thorough assessment. Prior to contact with parents, informed consents should be obtained from all parties and stakeholders (including release of information forms to speak with attorneys and other related professionals). Supporting documents from court, prior psychological reports, and any other relevant documentation pertinent to the case should be reviewed prior to first face-to-face contact with the family. Administration of standardized clinical measures (e.g., Child Behavior Checklist (CBCL), Children's Depression Inventory 2 (CDI 2), Multidimensional Anxiety Scale for Children Second Edition (MASC 2), Behavior Assessment System for Children 3 (BASC-3), Children's Perception of Interparental Conflict Scale (CPIC), Child Inclusive Mediation (CIM), Painful Feelings About Divorce Scale (PFAD)), to both parents is advantageous for assessment and treatment planning and is highly recommended. These measures should assess children's mental health and behavioral/academic functioning as well as the child's perception of the interparental conflict (Baker & Brassard, 2013; Baker & Verrocchio, 2015; Halford & Sweeper, 2013; Lange et al., 2023; Quigley & Cyr, 2017; Sandler et al., 2008; Verrocchio et al., 2018). Additionally, teachers and other adult collaterals may also be asked to complete measures in order to provide a more holistic view of the child's functioning. Standardized measures such as the Youth Self-Report may also be administered to the child at the time of assessment. Data gleaned from these measures are used by the therapist for a number of purposes including: (1) to identify and diagnose psychopathology in the child; (2) to identify any discrepancies in the reporting between the parents and other professionals involved in the case; (3) to better conceptualize the case and formulate the treatment plan; and (4) to obtain hard data on the child's level of distress that can then be used to guide and justify specific therapeutic interventions.
Once consent forms, releases of information, and standardized clinical measures are gathered, it is time to interview the various members of the family. Parents are ideally interviewed separately. While that requires additional session time and may be costlier, it is necessary given the typical rancor and acrimony parents in these circumstances have for one another. It is impractical for the therapist to effectively conduct a semi-structured clinical interview with both parents bickering and objecting to one another's reporting. Additionally, it is helpful to ascertain discrepancies between the two parents’ reports as this may reflect genuine differences in family dynamics across the two households. During the interview with the parent, therapists should follow a semi-structured style, typically asking the parent about their primary concerns and priorities and working their way from there. Certain critical areas of investigation during the interview would include behavioral and emotional concerns about the child, history of the family conflict, assessment of family dynamics and communication patterns, identification of core conflicts within the family, and potential barriers for intervention success.
At the time of the interview with the parents, therapists will often be asked questions about the intervention process (e.g., what will the intervention involve, how long will it take, how much will it cost). Therapists are advised to be forthcoming and comfortable acknowledging that there is typically a great deal of uncertainty in these cases. For instance, it is appropriate to inform parents that therapeutic interventions may involve a combination of individual, family, conjoint parent–child, and coparenting therapy depending on the needs of the family. However, it is difficult at the outset of treatment, what the exact combination of therapy modalities will be. Additionally, parents can be told that predicting outcomes and timelines is very difficult in this line of work, and that certain factors contribute to positive outcomes such as cooperating with the therapist's guidelines, maintaining civil and prompt communication, and supporting the therapeutic process. Furthermore, therapists should set expectations at the initial point of face-to-face contact that therapeutic interventions with HCSPs are typically lengthy and laborious and that they should not expect quick and easy fixes.
Establishing boundaries during the intake process is fundamental. Therapists should notify parents of the importance of transparency and civility in communication. HCSPs typically have a history of hostile, defensive, acrimonious, and sometimes abusive and manipulative communications with one another. It is easy for the therapist trying to intervene to get sucked into the conflict and melodrama. Therapists are advised to keep thorough documentation of emails to and from parents, to keep email communication highly professional, to resist the urge to engage in tit for tat communications, and to consistently encourage the parents to keep their communications clean. Guidelines that can be useful include: (1) don’t send emails or have phone conversations that you would not want to be made public in a family court setting (as anything written can and will be used in court); (2) set the example for the parents by regulating your own emotions, manage frustration and stress (as these cases are often highly stressful and aggravating), and strive to be a role model for assertive, respectful communication; and (3) be sure to copy both parents on emails (unless otherwise indicated) and alert each parent when phone calls and conversations are being had with the other parent so as to avoid the appearance of communicating behind their back. These guidelines will help to establish trust between the parents and the intervening therapist, and will assist the therapist in maintaining their integrity throughout the case.
During the interview with the child, the therapist should also approach the interaction in a semi-structured way and assess for behavioral and emotional difficulties that the child may be experiencing, and should learn more about how the child is experiencing the family's conflict (e.g., identify allegiances within the family, potential conflicts that are impacting the child's ability to form and maintain healthy relationships with either parent, learn about their concerns regarding their parents’ divorce/separation and their worries about the future, and assess the child's readiness and receptivity to engaging in therapeutic interventions). Crucially, the therapist should make attempts to connect with the child at the time of the first interview, to meet them with validation and an attitude of support, and to take extra steps if needed to build trust (e.g., take time at end of the interview to play a game if a younger child, or engage in ice breaker/rapport building activity). Lastly, therapists should be direct with children about the purposes of the intervention, namely that the therapist is attempting to intervene in the family conflict, to reduce hostilities, improve communication patterns, and heal relationships. Children should be given an opportunity to vocalize their feelings and concerns about the intervention and to have their position validated by the therapist. Ultimately, the therapist should work to enlist the child's support in the process.
Treatment Planning
Once the intake process has been completed then the treatment planning begins. Important questions to consider in treatment planning include: (1) how should the therapist spend session time; (2) what are the main family conflicts; (3) what is the quality and nature of the coparenting relationship; (4) is there psychopathology present in any of the family members; and (5) what is the quality of the parent–child relationships (e.g., is there parent alienation or estrangement present in the case). Determining the answers to these questions through the intake process will then inform how the intervention will take shape.
The HCSP interventionist will likely recommend some form of individual and conjoint family therapy in order to address the various conflicts and issues at hand. However, in cases in which the relationship breakdown among the family members is seemingly beyond repair, or if the parents are engaging in active litigation, the presumptive therapist may need to recommend that the family engage in other services until they are ready to enlist in family therapy. Additionally, in many cases, the lone family interventionist is not sufficient to address the complex web of problems present in the high-conflict family. As such, additional recommendations should be made during the treatment planning process. These may include: individual therapy for one or more members of the family, psychiatric referral for one or more members of the family, recruitment of another family therapy interventionist to assist in addressing family subsystems, substance abuse treatment referral for parents when necessary, specialized trauma therapy (e.g., trauma-focused cognitive behavioral therapy to address childhood trauma), additional recommendation for coparenting therapy, referral for custody evaluation if indicated, and referral for parent coordinator services in instances when the HCSPs are unable to resolve even basic parenting disagreements without third-party intervention.
HCSP Intervention Therapy
Therapy in HCSP cases most typically takes the form of a combination of individual and conjoint family therapy (e.g., parent–child or coparenting family therapy). Therapists should prioritize session time for the member(s) of the family that need the most work and may need to take a “phase-like” approach to the intervention. While we use the term “phase” which implies a sequential process, it is not uncommon for HCSP therapists to engage multiple members of the family in individualized session time in parallel as they work toward integrating them into therapy together.
In HCSP cases, parents typically need a lot of individualized attention in session prior to being ready to engage with their child or the other parent therapeutically. It is not uncommon for HCSPs to exhibit a pattern of rigidity and controlling behavior that is serving to distance the child from them, the therapist should commit the bulk of the initial phase of therapeutic intervention to working on perspective taking, challenging cognitive distortions, empathy building, and validation strategies. The therapist in these cases should be sure to explore the problematic parent's communication style, preconceived notions about parenting, to self-identify their own negative and toxic narratives and primary grievances with the other parent while encouraging them to be more flexible and open minded in their approach toward the other members of the family. As the problematic parent gains insight into their harmful communication patterns and improves their interpersonal skills, they can then be gradually integrated into a session with their child and/or the other parent. It is also common that HCSPs need additional parent management skills (e.g., use of positive labeled praise with young children, familiarity with reward systems, selective attention/planned ignoring, use of time outs, and understanding developmentally appropriate expectations) in order to bolster their parenting skills. Investment in building these skills will go a long way toward improving parenting and will thus reduce conflict and lay the foundation for a better parent–child relationship.
Alternatively, at times, the HCSP therapist may determine that the child requires more initial individualized attention in order to be able to engage in family therapy. Children in these cases may be dealing with their own psychopathology (e.g., anxiety, depression, and disruptive behaviors) that may be contributing to or exacerbating the family conflict. Additionally, children in high-conflict families are likely struggling with the relational dynamics within the family, may be displaying resistance/rejection of one of the parents, and may be resistant to family therapy altogether. These difficulties are likely to present barriers to effective family interventions and as such, warrant focused clinical attention by HCSP therapists. It is likely that children presenting with these difficulties need help in developing coping skills to navigate the family conflict or opportunities to process their feelings about their parents’ ongoing conflict, and more time should be spent with the child individually prior to conjoint parent–child therapy.
In other HCSP cases, it is the coparenting conflict and ongoing hostilities that are creating the most distress for the children. In these cases, the therapist should devote a greater amount of attention to establishing civil, clear, direct, and professional communication patterns between the parents. While doing so requires substantial effort, it is essential in order to stabilize the family, build trust in the therapeutic process, and to create an environment in which therapeutic healing can occur. When engaging in coparenting sessions, the HCSP therapist should begin by spending session time with each parent separately in order to build trust and understanding. As therapy progresses and the parents begin to show a greater willingness to engage in constructive, civil conversation, then the HCSP therapist should start to integrate them into sessions together. During conjoint coparenting sessions, the HCSP therapist serves as a guide, a mediator, and a referee. It is important to establish clear rules and boundaries in communication during these sessions (e.g., allowing each parent to speak in turn, not interrupting, striving to understand and validate the feelings of the other person's perspective prior to responding). As therapy progresses, ideally HCSPs gain a better understanding of one another's grievances and subjective perspective on the family, become familiar with the negative narratives that they hold and the ways in which these narratives are destructive to their parenting, and learn to better compartmentalize their negative emotions toward one another in the service of better coparenting.
Children and parents are ready for the family therapy phase of intervention when the critical members of the family are exhibiting sufficient levels of insight into their contributions to the conflict, willingness to at least engage and give the therapy process a chance to be successful, relative stabilization of individual psychopathology (at least stabilized to a point in which it will not derail the family therapy), and have gained sufficient interpersonal and coping skills to interact productively with the other members of the family in a therapeutic setting. During conjoint family therapy sessions, the HCSP therapist is tasked with giving voice to each family member's concerns and conflict, facilitating validation among the family members and providing structure to the communication. The therapist should be directive, have a clear agenda coming into the session, should set ground rules for communication (e.g., be respectful, one person speaks at a time), and should elaborate at the outset that the goal of these sessions are to learn how to better get along, resolve issues that can be resolved, agree to disagree on issues that cannot be resolved, and develop new expectations for interactions and productive communication patterns.
Potential Pitfalls
HCSP intervention therapy is often tricky and challenging, and therapists should proceed with exceptional sensitivity for dynamics at play. Therapists should prioritize building rapport and trust with each individual member of the family separately. Family members should ideally feel that the therapist is independent and objective and is trying to do the right thing. Actions that risk alienating individual family members should be avoided. Children should not be made to believe that the therapist is there to push one of their parent's agenda. As such therapists should exhibit empathy and provide validation for each family member's perspective. In cases of parent reunification therapy, children will need to be encouraged (e.g., pushed) to gradually engage with the rejected parent. However, if the therapist pushes too hard or advocates for family therapy engagement prior to proper readiness, then the effort will backfire and be counterproductive.
In communicating with parents via email, phone, and even text message, therapists should be transparent, civil, respectful, and empathetic to the pain and turmoil that family members are experiencing. Therapists must avoid being manipulated by parents. At times, HCSPs will lobby therapists to take action that would benefit their position (e.g., asking them to write a letter for court in support of one parent's view over another's). Other times the therapist can be triangulated by one or both parents and have statements made in therapy used against them. To protect against these actions, HCSP therapists must be mindful of potentially destructive interaction patterns present in the family and should always maintain fidelity to objectivity and be guided by the principal of the “best interest of the child,” when providing feedback, interventions, and recommendations. A useful technique is to ask oneself prior to any communication or statement, “Would I be comfortable making this statement in family court?” This requires a disciplined habit of self-control, emotional regulation, and understanding one's counter-referential issues. HCSPs can easily subsume the therapist into toxic relational dynamics if the therapist is not prepared.
Most importantly, HCSP cases should work within a team environment or in the very least, engage in therapeutic supervision with a more experienced clinician. Weekly supervision can be used as a platform for discussing cases, planning treatment, analyzing strategies, exploring counter-transference issues, and allow for the therapist to vent their frustration in a healthy, supportive way. Without such professional supports in place, the HCSP therapist may quickly burnout. Relatedly, therapists should also be mindful of the number of families they have on their caseload. Overloading with cases will lead to burnout, feeling overwhelmed, and will increase the likelihood of making mistakes, which will not serve anyone, least of all the family in treatment.
Case Example
The following HCSP case example illustrates a number of therapy elements that have been discussed in this paper and is presented for instructional purposes. The details of the case have been altered to protect the anonymity of the family. The case example involves an 11-year-old, Caucasian-American male, John Turner and his parents, Mr. Turner and Ms. Turner, who had separated when he was approximately 5 years of age. John had a younger sister, Melanie, who was an infant at the time of her parent's separation. Mr. Turner and Ms. Turner had a history of persistent, hostility, and conflict, along with a lengthy litigation history in which they had disputed over various issues including child custody, child support, and payment for their children's private school and extracurricular programs. At the time of their entry into therapy, the parents had 50/50 custody. However, John was refusing to spend overnights at his father's home following an intense argument in which he believed that his father was going to “kill him,” based on how enraged he had appeared. John had subsequently texted his mother and asked her to call 911. When she did, and law enforcement arrived, the situation had been defused, but the damage was done. John was convinced that his father was infuriated with him and would always be mad at him. Mr. Turner blamed John's mother for causing the incident by creating “an overly sensitive momma's boy” and for calling law enforcement. Acting out of fear of Mr. Turner's potential reprisals and purported fear for her son's safety, Ms. Turner filed a temporary restraining order against Mr. Turner and his parenting time with John was subsequently limited. To make matters worse, Mr. and Ms. Turner were no longer on speaking terms and rarely communicated even over text or email other than to iron out the occasional perfunctory logistical question. Ultimately, the family was referred by the family court judge into HCSP therapy.
At the beginning of therapy, Mr. Turner referred to himself as “old school,” in his parenting, meaning that while he would not hit his children, he would frequently yell and imposed his will more out of fear than out of love. Additionally, he often became highly dysregulated when he felt that he was being disrespected, slighted, or taken advantage of by his children and his ex-wife. Furthermore, Mr. Turner was acting upon a negative narrative (that contained a kernel of truth) that Ms. Turner was feeding into John's anxieties, accommodating him, “babying him,” and generally turning their son against him. Unfortunately, Mr. Turner's aggressive parenting style, negative narrative about his ex-wife, and persistent insecurities about his relationship with his children caused both John and Melanie to be afraid of upsetting him and to feel anxious and stressed prior to visits with him. However, despite a gruff and intimidating physical exterior, Mr. Turner did evidence sincere love and affection for his children and had a willingness to learn how to be a better parent. He also expressed regret over the way in which he had exploded on John during the fateful episode in which the police were called and shared that he was unsure whether or not his relationship with his son would ever recover.
Ms. Turner was very different from her ex-husband, as is often the case among HCSPs. She presented as more diminutive, passive, and agreeable when compared to her ex-husband. Ms. Turner was very accommodating to the children, tended to “go easy” on them, often expressed sympathy that they had to spend time with their father who in her mind was a difficult man to be around and hence, believed that she was responsible for compensating for this by being more indulgent with John and Melanie. Additionally, Ms. Turner showed her children a great willingness and interest to hear their complaints about their father, was quick to provide them with sympathy for their grievances, and rarely gave her ex-husband the benefit of the doubt. This pattern led her to accommodating John's anxious/avoidant behavior and as time went on, he gradually began presenting with symptoms of generalized anxiety (e.g., frequent worries, avoidance of stressful situations, preferences to be alone with his video games and YouTube, and living a more insular lifestyle). Additionally, John began exhibiting significant resistance to visiting with his father on weekends. Melanie, for her part, was a resilient and well-adjusted child, who tried to stay above the family fray and strove to be on good terms with both parents while not explicitly expressing a favorite, and remained compliant with the parenting plan (e.g., attending overnight visits at her father's home) despite John's refusal to do so.
During the initial phase of therapy, primary attention was paid to working with Mr. Turner on improving his parenting skills, helping him to understand and validate his son's perspective, identifying his own preconceived notions about parenting and how a father–son relationship should be, and providing him space to process and discuss his grievances with his ex-wife. During these sessions, Mr. Turner exhibited a willingness to hear the therapist's feedback and to incorporate it. This was fundamental to his improvement and not to be taken lightly as many parents (fathers in particular), struggle with the basic concept that they may be wrong and that there may be a better way of doing things. Through dialoging and validating his views, the therapist was able to make headway in helping Mr. Turner gain insight into the ways in which his hard-edged parenting style was doing him a disservice. He began to recognize that his communication, rife with expressed emotion, was a poor fit for John, who like it or not, had a more sensitive sensibility. Additionally, Mr. Turner learned validation skills and ways of showing curiosity in conversation (e.g., asking “help me understand that” to his son when he was perplexed by John's reaction to something). Over the course of 10 sessions, Mr. Turner, while not perfect, had shown noticeable improvement in his communication style.
In a parallel fashion, the therapist worked with John to understand that his parent's differing parenting styles both represented ways of showing love for him, but how both styles had their drawbacks and contributed to conflict and complications. John was given space to vent out and process his negative feelings about his father and to explore ways in which he would like to see his father change (e.g., improving his tone of voice and anger management being the primary issues). This feedback was then incorporated by the therapist into the session time with Mr. Turner separately so that he could learn from it. Additionally, John was provided with anxiety management strategies (e.g., deep breathing, visualization, cognitive coping skills, and mindfulness exercises), provided with psychoeducation about anxiety and stress, and assigned exposure homework (e.g., having increasingly more conversations with his father) in order to help him overcome his anxiety and resistance to his father.
Outside of the main focus on Mr. Turner and John, Ms. Turner was enlisted as a supporter of the therapy process. A few key individual therapy sessions were devoted to Ms. Turner in order to build trust and rapport, gain an understanding of her fears and concerns for John and her ex-husband, and to work with her on understanding the relational dynamics that she was contributing to (e.g., her accommodating behavior toward John, her barely disguised contempt for Mr. Turner, her indirect encouragement of her children complaining about their father after visits with him). As mentioned earlier, Ms. Turner was a more agreeable parent, and was able to incorporate therapeutic feedback and to serve as her ex-husband's “wingman” of a sort in the effort to help him and John achieve reconciliation.
After around three months of weekly therapy, the various family members were deemed ready by the therapist to engage in conjoint family therapy sessions. Session agendas were developed and communicated by the therapist. During the conjoint sessions, the therapist would meet first with John for 15 min, then with Mr. Turner for 15 min, and lastly with both together for the final 15 min. The conjoint session time would increase gradually as they progressed. In order to achieve healthy reconciliation in a high-conflict family, there needs to be recognition of guilt, a genuine apology for hurt that was caused, and a demonstrated ability to change going forward. Mr. Turner was able to take responsibility for the ways in which his former parenting style had contributed to the strain in his relationship with his son, apologize to John for the intense yelling that he had engaged in over the years, and was able to demonstrate in the sessions that he was able to be calmer, understanding, and validating of John's views than he had been before. John in turn, was able to acknowledge how he genuinely wanted a good relationship with his father, that he was fearful of his father and insecure in his relationship, was worried that his father did not accept him because he was sensitive and so unlike his father, and was worried that they would never be able to have a close relationship. Mr. Turner in response was able to hear these concerns and to provide validation, reassurance that he loves and accepts his son for who he is, and a willingness to improve their relationship going forward. Ms. Turner was brought into their therapy process after 10 sessions, once greater stability was achieved and was able to reflect to Mr. Turner and John, in a helpful way, that she was happy that they were improving their relationship and that she genuinely wants peace and harmony in the family rather than conflict and constant litigation. Melanie was also integrated toward the end of the process and expressed how she was just relieved that the other members of the family were no longer fighting.
Eventually, John was able to return to the normal 50/50 custodial plan and he and his father's relationship was substantially improved. While they continued to have setbacks and regresses from time to time, their overall trajectory moved in a positive direction. Gradually, they transitioned to a “therapy as needed” plan in which they were called in for “check-ins” or booster sessions. While this case example describes a happy ending, seamlessly and uncomplicatedly summarized across a few pages, the unfortunate truth is that these cases are filled with setbacks, highs and lows, and that happy endings are very difficult to achieve for many HCSP families. In the case of John Turner and his family there were a number of protective factors in place that contributed to a positive resolution. These included that Mr. Turner was so willing to take therapeutic advice, that both parents were highly motivated to improve the conflict as they were suffering from the financial toll of the ongoing litigation, that Ms. Turner's interests were aligned with Mr. Turner in helping John overcome his generalized anxiety-related issues, and that both John and Mr. Turner seemed to genuinely want a healthy, positive relationship with each other. Not all cases are as fortunate as this.
Gaps in the Literature and Research Needs
The examination of extensive research on HCSPs reveals the complexity of factors impacting families, particularly children, following separation. Key findings consistently highlight the detrimental effects of high-conflict divorces on children's well-being and family dynamics. Parental conflict emerges as a critical predictor of children's adjustment post-divorce, influencing parent–child relationships, internalizing problems, and overall psychological health. Strained relationships and the potential for parental alienation syndrome further complicate the landscape, emphasizing the need for effective intervention strategies.
The literature review employed a comprehensive search strategy utilizing specific terms relevant to the field. The search involved keywords such as “high conflict divorce,” “empirical research,” “quantitative study,” “family therapy,” “intervention,” “custody dispute,” and “literature review.” The aim was to compile existing empirical, quantitative, and review-based studies on high-conflict divorce, family therapy interventions, and custody disputes.
Intervention strategies, from individual and family therapies to group-based approaches like “No Kids in the Middle” and the OBFC, exhibit promising outcomes in fostering improved family dynamics. However, the literature reveals several limitations within high-conflict divorce research. Studies often lack adequate control groups and use small sample sizes, which limits the ability to draw robust comparative analyses and generalizability. Additionally, the population of high-conflict individuals makes research challenging due to biased responses or behaviors, and avoidance of engaging in research measures. The complexity arising from variables involved, such as legal/court involvement, in high-conflict divorces presents difficulties in establishing standardized research methodologies. Lastly, high-conflict divorce cases exhibit multifactorial phenomena, causing significant variations within the studied population.
The challenges faced by clinicians in engaging in high-conflict divorce cases are presented as well. Working on these cases is inherently stressful due to their complexity and emotional intensity. There is also a notable absence of structured guidance and adequate training at the graduate level, leaving clinicians ill-equipped to handle the intricacies of these cases effectively. Multiple attempts to research empirical information on the subjects, such as “training high conflict divorce therapists” and “divorce and psychologists in training” have rendered no results, thus emphasizing a large gap in the field that must be filled. Clients involved in these systems can also exhibit distorted, manipulative, or triangulating behaviors, creating significant challenges for clinicians to manage. Clinicians often have trouble with establishing and maintaining a therapeutic alliance in high-conflict divorce cases (Parady et al., 2018). The gaps in the literature underscore the need for further research addressing methodological limitations, training deficiencies for clinicians, and the complexities inherent in high-conflict divorce cases, particularly concerning therapeutic alliance development and maintenance.
Footnotes
Data Availability
This paper does not rely on an existing data set, nor was data collected for the purposes of an empirical study. The paper is theoretical, containing a literature review, and provides clinical guidelines and a case study in which identifying names and details have been altered.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Compliance with Ethical Standards
This paper consists of a literature review and did not involve human subject research. Furthermore, the paper contains a case study in which the names and other details have been altered in order to protect the privacy of the individuals involved.
