Download Families and family therapy

Linda Gottlieb, LMFT, LCSW, r
www.Lindagottlieb.com
[email protected]
8 Folger Lane
Dix Hills, NY 11746
(631) 673-6665 Office
(631) 967-1616 Fax
Honorable Judge Judges Name
Name of Court House County Court House
ADDRESS
CITY, STATE, ZIP
To The Honorable Judge Judges Name:
Attached you will find a nine (9) page notarized copy of my Amicus Brief in
Support of intervening with family therapy before rushing to use psychotropic
medications and/or stimulants when children are symptomatic. In case at time of the
hearing I need to be directly contacted for any clarification or confirmation, my office
phone number is (631) 673-6665 and I would be more than happy to telephonically or by
Skype, under Oath, to articulate points Your Honor would require of me.
I make an explicit point that I have not evaluated the parents nor their child(ren)
for the purpose of this Brief, nor do I favor one party over another. Nevertheless, I do
believe given my history of over four (4) solid decades of professional work experience
and examinations, my statements will carry weight in Your Honorable Court in
consideration of assessing the family dynamics as the cause and maintenance of the
child’s symptoms rather than a bio-chemical factor being a cause of such symptoms.
Finally, I declare that I was neither compensated nor otherwise received any
financial compensation or other benefits for writing this Brief.
Respectfully signed on letterhead, notarized and submitted for the case of Plaintiff's
Name vs Defendant's Name
____________________________
Linda J. Gottlieb, LMFT, LCSW-R
Licensed Marriage Family/Relationships Therapist, Speaker and Published Author
Member of American Association for Marriage and Family Therapy (AAMFT)
COVER PAGE
IN THE COURT OF COMMON PLEAS OF Name of County COUNTY, STATE
CIVIL ACTION LAW – FAMILY LAW
_________________________________________________________
:
NAME Last Name
:
Plaintiff,
:
vs.
:
:
NAME Last Name
:
Defendant.
:
:
Docket No. Docket No.
IN DIVORCE
Docket No. Docket No.
IN CUSTODY
AMICUS BRIEF IN SUPPORT OF FAMILY THERAPY RATHER THAN MEDICATION
AS THE INTERVENTION OF FIRST CHOICE
Honorable Judge Judges Name
Name of Court House County Court House
Address
City, State, Zip
Report of Linda Gottlieb, LMFT, LCSW-R
Total Number of Pages: 9
Honorable Judges Name:
My name is Linda J. Gottlieb, LMFT, LCSW-R, and I am writing this
Amicus Brief letter in support for intervention with Family Therapy as the
initial treatment of choice rather than the prescription for medication when
a child is symptomatic. I am making this recommendation based on my 13
years of training and supervision at the Minuchin Center for the Family.
Salvador Minuchin, my mentor, is the world renowned and highly
respected child psychiatrist who was one of the founders of the family
therapy movement in the 1950’s. My recommendation herein is exactly
reflective of his position for the treatment of children. Dr. Minuchin stated
the following:
The Problem is not the identified patient but certain family
interactional patterns. People are continuously molded by their
contexts and the characteristics elicited by context.
And such is the wisdom of my mentor, Salvador Minuchin, perhaps the
most world-renowned and highly respected child psychiatrists. Dr.
Minuchin’s wisdom is based on 70 years of education, training, and
treatment of dysfunctional families and of children demonstrating the
symptoms of the severest mental health disorders, such as psychoses and
eating disorders. Dr. Minuchin’s fundamental professional opinion is that
such disorders are not the result of a biochemical disturbance but rather
are caused and are maintained by dysfunctional family dynamics. Given
this assessment standard, before a biochemical cause can be determined
to be the source of the child's symptoms, the family's interactional patterns
must be ruled out as the cause.
In addition to espousing the philosophy of my mentor, and I am also
making my recommendation based upon a total of forty-three (43) years of
professional experience working with families and children, my initial
twenty-four (24) years as a social worker and then as an administrator in
New York's foster care system and subsequently for nineteen (19) years
as a family therapist currently in private practice, specifically focused on
parents and children of high-conflict divorce. In my professional career, I
have worked with several thousands of children who had been placed in
foster care and, in my practice as a family therapist, with more than 500
children who have experienced their parents’ high-conflict separation or
divorce.
A contemporary of Dr. Minuchin was psychiatrist, Murray Bowen, who
developed the concept of the “Pathological Triangle”----the term he applied
to the dysfunctional family dynamic of a parent co-opting a child in a
coalition to deprecate and reject the other parent. Dr. Bowen determined
that the family pattern of triangulation is the cause and maintenance of the
child’s symptoms. In fact, he was so convinced about the family’s role in
the child’s symptoms that, when he hospitalized a child, he simultaneously
hospitalized the entire nuclear family. Dr. Bowen’s peers who were cofounders of the family therapy movement adopted the concept of the
“Pathological Triangle”. Dr. Minuchin was one of those peers who faithfully
assessed the child’s symptoms according to the philosophical
underpinnings of the triangulation process.
Another founder of the family therapy movement, psychiatrist, Nathan
Ackerman, mentor to my mentor, Dr. Minuchin, also concluded that the
family dynamic of triangulation is the cause and maintenance of the child’s
symptoms. His famous treatment of a psychotic girl who insisted that she
lived on a female-inhabited planet called “Queendom” is frequently cited as
a superb example of how the family dynamic of triangulation is the basis of
a child’s symptoms. In this case, the girl’s mother, grandmother, and the
girl were in a coalition that marginalized and humiliated the father. The
girl’s delusion symbolized the insanity of the family’s organization and
relationships.
Further support for the placement of the symptom within the
dysfunctional family interactional patterns rather than within a bio-chemical
disturbance within the individual child can be found in the prolific works of
numerous other first generational family therapists, including but not limited
to Jay Haley, Don Jackson, Virginia Satir, Carl Whitaker, and John
Weakland; and with second generational family therapists including but not
limited to Lynn Hoffman, Richard Schwartz, Linda Gottlieb, Michael
Nichols, Maurizio Andolfi, Luigi Boscolo, Gianfranco Cecchin, Paolo
Menghi, and Anna Maria Nicolo-Coriglianno.
It has also been my experience working with approximately 2000
children during a 43-year practice that the family dynamic of a
dysfunctional and conflictual parental subsystem has always been the
cause and maintenance of the child's symptoms. And yet we rush to
judgment so readily to prescribe strong psychotropic medications with
serious side effects without making a full assessment of the true possible
cause of the symptoms.
Why is it so irrational and destructive to children to take this rush to
judgment? There are no empirical tests for a mental health diagnosis
based upon a biochemical imbalance. The diagnosis is arrived at merely
based upon the diagnostician’s impressions. This defies logic! Think about
this: even given all the empirical tests for a medical disorder----EKGs,
MRIs, blood work, urinalysis, etc.----and these diagnoses still have a 25%
error rate. A mental health disorder with an alleged bio-chemical cause is,
consequently, so much less accurate in the absence of empirical texts. I
dare say the error rate is much, much higher. If it were based on solid
science, then why is the medication continually adjusted up or down,
changed completely, and/or supplemented with additional medications?
Yet we accept that when a medication is taken for a medical disorder, for
example antibiotics for an ear infection, there is a virtual certainty that it will
be effective.
And at last, the philosophy underlying the principles for diagnosis by Dr.
Minuchin and his fellow family therapists is supported by the recent
research of Dr. Irving Kirsch, psychologist at Harvard University, who
discovered that a placebo was equally as effective as were
antidepressants in treating mild to moderately depressed patients. It was
only the small percentage of highly depressed patients who responded
better to antidepressants.
Additional reason to question a bio-chemical basis for mental health
disorders was presented in a 5/6/12 article in Scientific American, which
exposed the inconsistency and inaccuracy that occurs in mental health
diagnosis. The author, Ferris Jabr, reported that depression and anxiety,
for example, reached only the threshold of the “could be accepted”
standard for a diagnosis to be accepted into the DSM----this being the bare
minimum for acceptance. Mr. Jabr stated, “The APA [American Psychiatric
Association] uses a statistic called kappa to measure the reliability of
different diagnoses. The higher the value of kappa, the more reliable the
diagnosis, with 1.0 representing perfect reliability. The APA considers a
diagnosis with a kappa of 0.8 or higher miraculously reliable; 0.6 to 0.8 is
excellent; 0.4 to 0.6 is good; 0.2 to 0.4 “could be accepted” and anything
below 0.2 is unacceptably unreliable. Low reliability is a big problem for
clinicians, patients and researchers alike: it means that only a minority of
clinicians agree when diagnosing a disorder.” Our typically accepted
diagnoses have surprisingly low Kappa scores as follows: anxiety=.o2;
depression=.03
Would anyone consider having an operation if the doctor stated that the
diagnosis upon which the operation was based reached only a reliability
level of “could be accepted?” This is the basis upon which our children are
being prescribed psychotropic medications with strong side-effects.
And speaking of side effects, just what are the side effects of the
stimulants we give to children for the diagnosis of ADD and ADHD? A 2/06
editorial in the New York Times (the editorial is attached here) documented
the high correlation between stimulants and the risk for cardiovascular
disease.
In my 2012 book, The Parental Alienation Syndrome: A Family Therapy
and Collaborative Systems Approach to Amelioration, I documented 12
children who were placed on psychotropic medications for alleged ADHD
and/or for bipolar disorder but whose symptoms were completely mitigated
when the effects of the parental hostility----in this case the parental
alienation----were reversed and eliminated. Amazing!
There is---all too frequently---a rush to judgment when
diagnosing children. Who can dispute the immense influence of parents on
children and the depth that parental conflict adversely affects children?
The unforgiveable failure of the psychiatric community is that input from
both parents is generally not sought, thus resulting in the situation that
dysfunctional family dynamics cannot be ruled out as being the cause of
the child’s symptoms. When, for example, parents are pulling in opposite
directions or when one parent requests the child's allegiance in that
parent’s battle with the other parent, the child will undoubtedly exhibit
irritability, anxiety, depression, impulsivity, inattention, and a myriad of
other symptoms. The child is like a rope and a tug war between her/his
parents, and just like the rope, the child will unravel.
In situations of high conflict divorce, it is incumbent upon the medical
provider who is prescribing stimulants to assess the family dynamics as
the possible cause of the child’s symptoms and rule out the “Pathological
Triangle” or another dysfunctional family dynamic BEFORE prescribing
psychotropic/stimulant medications.
REFERENCES:
Ackerman, N. W. (1958). The psychodynamics of family life. New
York, NY: Basic Books.
Ackerman, N. W. (1961). The emergence of family psychotherapy on
the present scene. In M. I. Stein, (Ed.), Contemporary
Psychotherapies. Glencoe, IL: Free Press.
Ackerman, N. W., & Franklin, P. (1965). Family dynamics and the
reversibility of delusional formation: A case study in family
therapy. In I. Boszormenyi-Nagy & J. Famo (Eds.), Intensive
family therapy (Ch. 6.), New York, NY: Harper and Row.
Ackerman, N. W. (1966). Treating the troubled family. New York,
NY: Basic Books.
American Psychiatric Association. (2002). Diagnostic and statistical
manual of mental disorders. (4th ed., text rev.). Washington, DC:
Author.
Andolfi, M., Angelo, C., Menghi, P., & Nicolo-Corigliano, A. (1983).
Behind the family mask. New York, NY: Brunner/Mazel.
Andolfi, M., Angelo, C., & Nichilo, M. (1989). The myth of atlas. New
York, NY: Brunner/Mazel.
Boscolo, L., Cecchin, G., Hoffman, L., & Penn, P. (1987). Milan
Systemic family therapy. New York, NY: Basic Books.
Bowen, M. (1971). The use of family theory in clinical practice. In J.
Haley (Ed.), Changing families: A family therapy reader (pp. 159192). New York, NY: Grune & Stratton.
Bowen, M. (1978). Family therapy in clinical practice. New York, NY:
Jason Aronson.
Haley, J. (1963). Strategies of psychotherapy. (1st ed.) New York,
NY: Grune & Stratton.
Haley, J., & Hoffman, L. (Eds.). (1968).Techniques of family therapy.
New York, NY: Basic Books.
Haley, J. (1971). Changing families. New York, New York: Grune &
Stratton.
Haley, J. (1973). Uncommon therapy. New York, NY: Norton.
Haley, J. (1977). Toward a theory of pathological systems. In P.
Watzlawick & J. Weakland (Eds.),The interactional view (pp. 3744). New York, NY: Basic Books.
Haley, J. (1990). Strategies of Psychotherapy, Rockville, MD: The
Triangle Press.
Hoffman, Lynn. (1981).Foundations of family therapy. New York,
NY: Basic Books.
Jackson, D., & Weakland, J. (1971) Conjoint family therapy: Some
considerations on theory, technique, and results. In J. Haley
(Ed.), Changing families. (pp. 13-35). New York, NY: Grune &
Stratton.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA:
Harvard University Press.
Minuchin, S., with Baker, L., & Rosman, B. (1978). Psychosomatic
families: Anorexia nervosa in context. Cambridge, MA: Harvard
University Press.
Minuchin, S., with Fishman, C. (1981). Family therapy techniques.
Cambridge, MA: Harvard University Press.
Minuchin, S., with Nichols, M. (1993). Family healing. New York, NY:
The Free Press.
Minuchin, S., with Lee, W., & Simon, G. (1996). Mastering family
therapy. New York,NY: John Wiley & Sons.
Minuchin, S., Nichols, M., & Lee, W. (2007). Assessing families and
couples: From symptom to system. New York, NY: Pearson.
Napier, A., & Whitaker, C. (1978). The family crucible: The intense
experience of family therapy. New York, NY: Harper Perennial.
Nichols, N. (1992). The power of family therapy. Lake Worth, FL:
Gardner Press.
Nichols, M., & Schwartz, R. (2004). Family therapy: Concepts and
methods. New York, NY: Pearson.
Whitaker, C. (1983). In M. Andolfi, C. Angelo, P. Menghi, & A.
Nicolo-Corigliano. Behind the family mask. New York, NY:
Brunner/Mazel.
Whitaker, C., & Bumberry, W. (1988). Dancing with the family: A
symbolic-experiential approach. New York, NY: Brunner/Mazel.
NY: Pearson.
I am enclosing with this Amicus Brief my Professional
Resume/Curriculum Vitae (CV). Please feel free to contact me with any
questions.
____________________________
Linda J. Gottlieb, LMFT, LCSW-R
Licensed Marriage Family/Relationships Therapist, Speaker and Published Author
Member of American Association for Marriage and Family Therapy (AAMFT)
website: www.LindaGottlieb.com e-mail: [email protected]
Office/Practice Location: 8 Folger Lane, Dix Hills, NY 11746
(631)673-6665 Phone (631)967-1616 Fax
Amicus Brief, Number of Pages: 9