I am a consultant to a client parent and attorney surrounding the attachment pathology displayed by his child and its treatment. A recent custody evaluation provided specified referrals for treatment and named Matthew Sullivan, Ph.D. as a primary recommended referral for my client and the child to treat the attachment pathology in the child.
I have been asked by my client to provide an opinion on the referrals offered by the child custody evaluator. I will be seeking additional information from each of the offered referrals to provide an opinion on their relative merits and my recommendation as a clinical psychologist with expertise in treating attachment pathology in children.
Matthew Sullivan, Ph.D.
Dr. Sullivan is the President of the Association of Family and Conciliation Courts (AFCC). I am certain this is applied to his credit regarding his asserted “expertise” with court-involved family conflict. At the same time, the AFCC also endorses the practice of child custody evaluations about which I have prominent professional concerns.
If Dr. Sullivan is to receive credit for his standing with the AFCC, then Dr. Sullivan’s professional judgement and practices should also bear responsibility for any failures in the practice of child custody evaluations. In issuing Model Standards of Practice for Child Custody Evaluations, the AFCC, and Dr. Sullivan as its President, bear responsibility for any failings or flaws to their child custody evaluation assessment procedures.
In addition, the professional background, education, training, and expertise of Dr. Sullivan with assessing, diagnosing, and treating attachment pathology in children (the pathology displayed by my client’s child) also bears relevance to the quality of the referral to Dr. Sullivan for the treatment of the attachment pathology in my client’s child. While Dr. Sullivan’s professional background in forensic psychology appears substantial, this would not allow him to treat other pathologies such as autism, or eating disorders, or early childhood mental health problems, without additional education and training in those domains of pathology.
My client’s child is displaying severe attachment pathology, and Dr. Sullivan has been offered to the court as an expert in treating and restoring children’s attachment bond to their parent. I will be reviewing his background education, training, and experience for evidence to support his asserted expertise in assessing, diagnosing, and treating attachment pathology in children, so that I can provide an opinion on Dr. Sullivan’s offered expertise in attachment pathology in children and its treatment.
Critiquing the professional practices of the President of the AFCC, especially when I am such a harsh critic of child custody evaluations, is fraught with professional dangers for me. I am concerned that if my analysis and opinions regarding the professional practices of Dr. Sullivan are made only through private communication to my client parent and attorney, that Dr. Sullivan will then be denied the opportunity to respond to any misperceptions I may have about his practice. I am also concerned that elements of my critique may be released that are taken out of context, that misrepresent my opinions, or are inaccurate.
For these reasons, I have decided to make my analysis and opinions public surrounding Dr. Sullivan as a referral resource for my client. In this way I take full responsibility for the accuracy of my statements and my opinions. These blogs also allow Dr. Sullivan to correct any misperceptions I may develop surrounding the practices and capabilities of Dr. Sullilvan.
Critiquing and offering an opinion as a clinical psychologist on the professional practices of the President of the AFCC should not be done in haste, and should reflect a proper assessment of the issues involved. My opinions are my opinions, they do not represent truth. I have no access to truth except through me, and “me” will always shade my perceptions. I will allow others to review and discuss, and to reach consensus opinion on where truth lies. These are my opinions based on the information I describe in support.
If my opinions are in error, I am open to, and invite, correction.
I will approach my review and analysis of the referral resource for my client and the child across several blogs. This one will focus on the association of Dr. Sullivan to the practice of child custody evaluations through his role as President for the AFCC. If his professional expertise in the practice of child custody evaluations is held to his credit, then any failings of child custody evaluations to meet professionally acceptable standards of practice would also attach to his responsibility.
My focus in this blog will not be toward Dr. Sullivan directly. Dr. Sullivan is an acknowledged expert in the practice of child custody evaluations. This blog will examine what that means, what exactly is the practice of child custody evaluation, is it a valid assessment procedure, is it ethical professional practice. I have prominent professional concerns as a psychologist that child custody evaluations are neither valid nor ethical professional practice, and instead, the practice of child custody evaluations violate multiple ethical Standards of the APA ethics code.
This blog will present the information on which I base my professional opinions regarding child custody evaluations. Standard 2.04 of the APA ethics code imposes upon me the requirement that my professional judgments be based on the “established scientific and professional knowledge of the discipline.” I am establishing that foundational knowledge here.
2.04 Bases for Scientific and Professional Judgments
Psychologists’ work is based upon established scientific and professional knowledge of the discipline. (See also Standards 2.01e, Boundaries of Competence, and 10.01b, Informed Consent to Therapy.)
The APA ethics code is not optional. It is mandatory. My analysis and my judgments formed surrounding child custody evaluations will be based on the “established scientific and professional knowledge of…
- Psychometics and validity of assessment
- The Ethical Principles for Psychologist and Code of Conduct from the American Psychological Association
- Cultural psychology
- Research on bias
These domains represent the “established scientific and professional knowledge of the discipline.”
In July of 2018, the American Psychological Association posted an invitation for public comment regarding the practice of child custody evaluation. I submitted a Comment and posted it to my website:
In this Comment offered to the APA, I describe 8 domains of concern surrounding the practice and procedures of child custody evaluations. In this current description I will add a ninth.
1.) No Inter-Rater Reliability (psychometrics)
Child custody evaluations have no inter-rater reliability. Zero. The inter-rater reliability for the conclusions and recommendations reached by child custody evaluations is zero. If an assessment procedure is not reliable (stable in its findings), then it cannot, by definition, be a valid measure of anything. Two child custody evaluators can reach entirely different conclusions and recommendations based on exactly the same data.
The conclusions and recommendations from child custody are not valid because they are not reliable, there is no inter-rater reliability.
2.) No Established Validity (psychometrics)
There is no research ever conducted to establish the validity of the conclusions and recommendations made by child custody evaluations (face validity, construct validity, content validity, predictive validity, concurrent validity, and discriminant validity).
Since there is no demonstrated validity for the conclusions and recommendations reached by child custody evaluations, then the conclusions and recommendations from child custody evaluations are not valid.
3.) No Operational Definitions for Constructs (psychometrics)
Child custody evaluations have no operational definitions for either of their key constructs, the “best interests of the child” and “parental capacity.” Without operational definitions for the constructs, the assessment is unreliable and prone to the whims and biases of the evaluator (both conscious and unconscious).
Without operational definitions for its key constructs, the conclusions and recommendations reached by child custody evaluations are not valid. They simply represent the opinion and biases of one person.
4.) Violation of Principle D Justice (ethics)
Principle D: Justice
Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists.
Equal Access/Equal Benefit: At a cost of $20,000 to $40,000 per child custody evaluation, the financial costs of the assessment procedure make it unavailable to anyone other than the most affluent of clients who can afford the excessively burdensome financial cost. This would be in violation of the requirements of Principle D Justice for “equal access to and benefit from the contributions of psychology” since lower socio-economic families are denied “access to and benefit from” the child custody input of professional psychology provided to more affluent parents and families.
Equal Quality: The absence of inter-rater reliability and standardized interpretation of clinical interview data result in highly variable quality in the conclusions and recommendations reached by custody evaluation procedures across evaluators. This variability in quality is in violation of the requirement of Principle D Justice for “equal quality in the processes, procedures, and services being conducted by psychologists”
Two prominent forensic psychologists, who literally wrote the book on child custody evaluations, Stahl and Simon, acknowledge and describe the high degree of variability in the quality of child custody evaluations:
From Stahl & Simons: “The American Board of Forensic Psychology is a subspecialty board of the ABPP. In the fall of 2011, there were approximately 250-300 ABPP board certified forensic psychologists in the United States and an unknown number of psychologists who specialize in forensic work but are not board certified. On top of that, there are many psychologists who dabble in forensic practice, occasionally performing child custody or other types of forensic evaluations, and who find themselves called to testify in court on occasion. While we recognize that there is a range of quality in their work, it is clear that forensic psychology is a growing area of specialization.” (Stahl & Simons, 2013, p. 9)
Stahl, P.M. and Simon, R.A. (2013). Forensic Psychology Consultation in Child Custody Litigation: A Handbook for Work Product Review, Case Preparation, and Expert Testimony, Chicago, IL: Section of Family Law of the American Bar Association
“…many psychologists who dabble in forensic practice…” That psychologists “dabble” in severe and highly complex family pathology is deeply distressing surrounding compliance with Standard 2.01a Boundaries of Competence. This admission by Stahl and Simon, leading figures in forensic psychology, is not reassuring that child custody evaluators who merely “dabble” in working with a pathology possess the necessary professional competence needed for assessing complex family conflict.
Is this then the new standard for professional competence, that psychologist can enter a field to dabble in treating autism, dabble in treating eating disorders, dabble in treating panic disorders, dabble in treating trauma, is that the standard for professional competence established by Standard 2.01a Boundaries of Competence?
Even more disturbing than this open admission regarding the “range of quality in their work,” is the seeming cavalier disregard for the potential negative impact of this “range of quality” on the clients. Stahl and Simon appear to instead accept this wide “range in quality” from psychologists who merely “dabble in forensic practice” as a good thing because it indicates that the industry of conducting (invalid) child custody evaluations is growing:
From Stahl & Simon: …while we recognize that there is a range of quality in their work, it is clear that forensic psychology is a growing area of specialization.”
It would appear that forensic child custody evaluators are more concerned for their financial success and the growth of their industry than they are in the quality of care they provide to their patients.
5.) Unanswerable Referral Question (bias)
Assessment is always to answer the referral question. The referral question for assessment accepted by child custody evaluators is, “What should the child’s custody schedule be?” This is an over-broad and unaswerable referral question by any information existent in professional psychology. Know one knows, it is impossible to answer.
Because there is no answer possible, whatever answer is given is merely a guess made by one person based on nothing of substance in particular. Just their guess, of that one person.
The key criteria for determining the custody visitation schedule are the “best interests of the child.” However, this key construct to the assessment is undefined and fundamentally undefinable by any information existent in professional psychology.
Again, Stahl and Simon describe the fundamentally undefinable nature for the construct of the child’s “best interests”:
From Stahl & Simon: “A critical subject facing those working in the field of family law, whether they’re legal professionals or psychological professionals, is the concept of the best interests of the children. Even recognized experts in this concept differ with regard to what it means, how it should be determined, and what factors should be considered in determining what is in the best interest of a child. Thus, this ubiquitous term escapes consensus and remains fundamentally vague.” (Stahl & Simon, 2013, p. 10-11)
From Stahl & Simon: “It is defined differently from state to state; and even in Arizona, where there are nine statutory factors associated with the best interest of the child, the meaning behind many of the factors is obscure. Additionally, when psychologists refer to the best interests of children, they are referring to a hierarchical set of factors that may have different meanings to different children with different families and that may be understood differently by psychologists with different backgrounds and different training.” (Stahl & Simon, 2013, p. 11)
This inability to define the basic fundamental criteria for the evaluation invalidates any conclusions and recommendations reached by the child custody evaluator.
6.) Cultural and Personal Bias (bias)
That the construct so central to the assessment is fundamentally undefined, opens the assessment process to distortion by a variety of evaluator biases, including both cultural biases against differing value systems in parenting, or the different ethnicities of the parties, or the different genders of the parties, as well as counter-transference bias from past family of origin or personal marital-spousal issues (e.g., the mother reminds the evaluator of his ex-wife, or the evaluator never had a bonded relationship with their parent and this influences their perceptions and judgements).
The only justification for restricting a parent’s time and involvement with their child is a child protection concern. If there is child abuse, diagnose child abuse (DSM-5: V995.54 Child Physical Abuse, V995.53 Child Sexual Abuse, V995.52 Child Neglect, V995.51 Child Psychological Abuse) and protect the child.
If there is no child abuse… then parents have the right to parents according to their cultural values, their personal values, and their religious values. It is exceedingly problematic when psychologists assume a role of deciding if a parent “deserves” to be a mother or father based on non-defined criteria (the best interests of the child) when there is no diagnosis of child abuse.
7) No Oversight or Review
The individual practices, conclusions, and recommendations of individual child custody evaluations receive no separate review or oversight. Unlike a clinical diagnosis and decision-making based on DSM-5 and ICD-10 diagnoses that are subject to a second opinion review, the decisions emerging from child custody evaluations are un-reviewable, they are sealed by the court, and the prohibitive cost ($20,000 to $40,000 each) and length of time needed (six to nine months each), prevent any second opinion.
Child custody reports are never reviewed for accuracy or for applied professional standards of practice.
As a clinical psychology consultant to parents and attorneys regarding treatment of attachment-related pathology, I have had the opportunity to review the child custody reports for my clients to assist in treatment plan development. The child custody reports I have reviewed have consistently been substantially beneath acceptable standards of practice in clinical psychology assessment, often reach deeply troubling conclusions and recommendations that are entirely unsupported by their reported data, and that often contain prominent indicators of clear bias in interpretation.
I will offer two of the most egregious examples of the problematic professional standards of practice I have encountered.
Example 1: MMPI 4-6-9 Elevation
I reviewed one child custody report in which the father received an MMPI elevation on three scales; 4 Psychopathic Deviant, 6 Paranoia, 9 Mania (Narcissism when elevated 4). The MMPI is not a personality measure, it is a pathology measure. When it identifies a pathology – it’s not personality, it’s pathology.
The father was identified by the MMPI as a potentially having psychopathic-narcissistic spectrum character traits with prominent paranoia. The mother’s MMPI was entirely normal. The children’s chief complaint against the mother was that she fed them leftovers, so their dad had to come over when they called him and bring them take-out food because they hated their mother’s cooking. They never wanted to see their mother again, because she was a bad cook and fed them leftovers. I kid you not, documented fully in the child custody report, that was their chief complaint. Father had a 4-6-9 elevation on the MMPI, mother’s MMPI was entirely normal.
The custody evaluator never elaborated on the 4-6-9 MMPI elevation beyond a one-paragraph standard nondescript horoscope-type general description, and awarded full custody to the father and placed the children on restricted visitation with the mother and… “reunification therapy.” No review. No oversight. No reason given.
Example 2: Lazy Forensic Psychologist
Lest you think that is an isolated example, I reviewed one child custody evaluation that was nothing more than a transcript of the “interviews” with the family members, entirely quotations throughout, with only connecting sentences provided by the custody evaluator to the transcript.
No discussion, no analysis, nothing. The custody evaluator simply block quoted the verbatim transcript as the entire body of the report, and then made a three-paragraph pronouncement that lacked any proffered reasoning or justification, simply three paragraphs of personal conclusions and recommendations (the substance of which was deeply concerning because they were apparently wrong, based on the information provided in the transcripts).
So distressing was the professional practices exhibited by this child custody evaluation that I redacted it and posted it to my website for educational purposes – this represents standard of practice – actually “high quality” standard of practice, for child custody evaluations.
I redacted all direct quotes as blue and all original sentences in red.
I can have a high-school kid audio record people’s complaints, get it transcribed, and give me a random opinion based on nothing in particular. I’m sure they’d be a lot cheaper than the $20,000 to $40,000 for a child custody evaluation, and likely be more accurate. Still no inter-rater reliability though.
Notice the signature line for this child custody evaluator,
“Diplomate of the American Board of Assessment”
I wonder if the American Board of Assessment knows this is the quality of work produced by one of their Diplomates? Is this what they train them to do, record, transcribe, and give a three-paragraph pronouncement based on nothing?
This is a “high-quality” forensic child custody evaluation, by one of their “Diplomates in Assessment.” This is one of their good ones.
A (volunteer) Professor at a Prestigious School of Medicine and Institute
I wonder if the prestigious School of Medicine and Institute knows that this is the quality of professional work that they are being associated with through a “Volunteer” Professor (what exactly is that?).
This is one of their “good ones” – from a “Diplomate in Assessment.”
These are two examples, unfortunately, they are not a-typical. No review, no oversight, $20,000 to $40,000 for each evaluation, combined with people who merely “dabble” in child custody evaluations, breeds ignorance, sloth, and incompetence throughout the “industry” of child custody evaluations.
8) The “Custody Prize”
When we make the child’s “voice” and expressed opinions the basis for our decisions surrounding child custody and visitation, we essentially turn the child into a “custody prize” to be won by who can prove that they are the “better parent.” The judge in this matter of who is the “better parent” is the custody evaluator, who will go through a ritualized (and expensive) set of procedures to make a determination of which parent is the winner of the “custody prize” – the child.
Each parent must not only plead their case to the custody evaluator to choose that parent as the “better parent,” but the value placed on the child’s voice means that appeasing the child and getting the child to align with that parent’s side in the marital conflict will ensure that the custody prize goes to the parent who is better able to seduce and coerce the child into verbally taking that parent’s “side” in the marital-custody conflict.
The child’s voice is now a prize to be one. On your mark, get set, go… go convince the child to be on your “side” – whoever wins the child’s voice will be the winner of the custody prize. Okay, times up. Now go visit the custody evaluator and “Plead Your Case.”
Oooo, I’m sorry, it’s a draw, no decision. You’ve been sent to the “Reunification Therapy” doldrums. You’ll need a Second Child Custody… Reevaluation… by the SAME custody evaluator as last time, because after two years of the “Reunification Therapy” doldrums, the child’s pathology has gotten WORSE.
It is not the role of psychologists to sit in judgement of parents to determine who is the “better parent” to be awarded the “custody prize” of the child. And psychologists should know better than to give uncritical substance to the child’s expressed “voice,” and should apply a broader analysis to the data.
9) Intentionally Withholding Relevant Information from the Court and Litigants (ethics)
Child custody evaluators are directly instructed by the AFCC to withhold relevant information from the courts and the litigants. Standard 4.6c of the Model Standards of Practice for Child Custody Evaluations published by the AFCC directs child custody evaluators to withhold information about “diagnostic labels” from the court and from the litigants.
4.6 Presentation of Findings and Opinions
c) Evaluators recognize that the use of diagnostic labels can divert attention from the focus of the evaluation (namely, the functional abilities of the litigants whose disputes are before the court) and that such labels are often more prejudicial than probative. For these reasons, evaluators shall give careful consideration to the inclusion of diagnostic labels in their reports. In evaluating a litigant, where significant deficiencies are noted, evaluators shall specify the manner in which the noted deficiencies bear upon the issues before the court.
By “diagnostic labels” I assume they mean “diagnostic labels” such as V995.51 Child Psychological Abuse and ICD-10 F24 Shared Psychotic Disorder (a shared delusional disorder with the parent as the “primary case” – the “inducer”; American Psychiatric Association, 2000).
Withholding a “diagnostic label” of child psycholgical absue and a shared persecutory delusion between the child and the allied parent from the court’s consideration is a deeply troubling instruction for the AFCC to give to their child custody evaluators.
Do they make a similar policy regarding withholding the “diagnostic labels” of schizophrenia or bipolar disorder from the court’s consideration as well? Or is this policy to withhold information about “diagnostic labels” a matter of personal choice left up to the individual discretion of each custody evaluator, to weigh and balance the “probative” value of the “diagnostic label” for one litigant’s case versus the potentially “prejudicial” impact that the “diagnostic label” will have on the chances of the pathological parent to obtain custody of the child.
This is a decision specifically instructed on the child custody evaluator by the AFCC, to determine the probative value for one litigant versus the prejudicial impact of the “diagnostic label” for the pathological parent, and if the child custody evaluator decides that the “diagnostic label” is too substantially “prejudicial” to the chances for the pathological parent to gain custody of the child, then to withhold this information from the court.
What is perhaps even worse, is that child custody evaluators also withhold this relevant diagnostic information about the parent’s “diagnostic labels” from the litigants. This means that the court does not obtain this information about the “diagnostic label” of one parent, and the litigant for whom it may have “probative” value is denied access to this information as well, so they cannot provide this potentially “probative” information to the court.
The child custody evaluator is essentially being told by the AFCC through Standard 4.6c of the Model Standards of Practice for Child Custody Evaluations to make a prior decision on the probative and prejudicial impact of a “diagnostic label” and then to disclose or entirely withhold this information from both the court and from the litigants involved, so no one ever knows, and no one can challenge this prior-decision made solely and secretly by the child custody evaluator.
This is a deeply troubling over-reach from the psychologists ethically, and while I am not a legal professional, it seems an inappropriate abrogation of the court’s role and authority in evaluating the evidence, and the rights of the litigants to present to the court unbiased evidence.
The child custody evaluator is instructed by the AFCC to put their finger on the scales of justice without the court’s knowledge, and tip the scales in favor of the pathological parent by withholding the “diagnostic label” for the pathological parent from the court’s consideration and the litigant’s knowledge.
For these nine reasons, I am deeply troubled by the practice of child custody evaluations as practiced by forensic psychologists and as advocated for and instructed by the AFCC.
My website contains an area where I describe a variety of my concerns surrounding child custody evaluation:
drcachildress.org: Attorneys – Child Custody Evaluations
Dr. Sullivan is the President of the AFCC who produce the Model Standards of Practice for Child Custody Evaluations. The AFCC actively supports the practice of child custody evaluations, and it is assumed that Dr. Sullivan is also an established practitioner of child custody evaluations.
Any prior bias I may have in my assessment of Dr. Sullivan as a resource for resolving parent-child attachment pathology is acknowledged by these nine points, and I invite Dr. Sullivan to provide response to my concerns that will reassure as being unfounded. I am concerned, however, because each of the nine concerns is substantial, each appears warranted, and any of the nine by itself would warrant the discontinuation of the practice.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857