Court Ordered Family Therapy (formerly The Bridges Program)

(For Families in Transition)

Introduction Court Ordered Family Therapy (COFT) is an intensive family therapy program that was originally conceived as The Bridges Program, a program designed to fill a gap in the continuum of services in helping family communication after unresolvable allegations of sexual abuse. The monograph below was written about The Bridges Program but applies to the basic philosophy and practice of Court Ordered Family Therapy except that there are not two therapists involved in COFT.

In addition to seeing families where there are unresolved allegations of sexual abuse, I also see families with parental conflict and parental/child estrangement for other reasons than allegations through COFT. In selected families, there is a need to structure reintegration between estranged parents and children in a way that is both therapeutic and protective. COFT is not meant to be supervised visitation but may coexist with such visitation or be a method for transition into or out of supervised visitation.
Goals of Program The goals of COFT are to reduce the risk of sexual abuse occurrences, optimize parent/child interaction, build trust between parents and between parents and child(ren), educate parents regarding emotional and developmental needs of the child(ren) and appropriate interpersonal boundaries, reduce parental conflict, and increase parental focus on child(ren)'s needs.
Program Plan Intake and Assessment Phase
Initial sessions are spent meeting with parents and the child(ren) individually to explain the program and review the history of the family and determine if this type of intensive family therapy is appropriate.

Preparatory Phase
The child(ren) and parents are seen individually to prepare to address anxieties before the family sessions begin.

Ongoing Phase
COFT consists of primarily family therapy organized in two hour sessions involving the estranged parent and the child(ren) alternating with individual meetings with the non-estranged parent to review questions and concerns. These sessions typically occur monthly. The two hour sessions consist of instruction to the estranged parent in areas of child development, emotional needs of the child(ren) (age specific), boundary issues, respecting the autonomy of the child(ren), and empathizing with the child(ren), followed by the parent/child therapy session. The interaction will be processed separately with the child(ren) with attention given to anxiety or unasked questions.
The issue of personal safety will be discussed with the child(ren) at the appropriate time. Opportunities for discussing the alleged offense or the sources of estrangement will be available.

In selected families, there may be a need for ongoing individual meetings with each parent and/or joint meetings with both parents in order to facilitate parental communication.

Additional interventions outside of the program may be recommended for individual emotional issues of parents.

Selection of Clients COFT is based on a careful and conservative selection process. A signed court order for both parents to participate and full disclosure of all prior evaluations is required. An accused parent must have had an offender evaluation which reflects non-predatory, non-sociopathic and non-psychotic personality dynamics and behavior. The child(ren)'s psychosocial development will be reviewed. The non-estranged parent must be non-psychotic and demonstrate a willingness to support the child(ren) in the therapy process.
Confidentiality When a family comes to COFT for family therapy, the usual privilege of confidentiality between clients and therapists exists. The information learned in therapy can be shared with other professionals only after the signed release of both parents. Confidentiality cannot be maintained if I become aware of ongoing abuse or if court orders are violated.
Financial Policy I strongly recommend that parents share the cost of COFT. It has been my experience that common ground is reached earlier in the process if both parents have a commitment to the COFT rather than a court order to participate. The objective is for both parents to understand and agree that all sessions, regardless of who is in attendance, are for the best interests of the children and for improving communication within the family.
New patients are provided with a complete copy of the office financial policy. The office will assist in billing the patient's insurance company as a courtesy. Please remember that while you may have insurance benefits, your account remains your responsibility until paid.

Appointments canceled on less than 24 hours notice will be charged as a regular appointment. Services which require extensive time outside of scheduled appointments such as telephone consultations and written reports or letters will be billed separately from the appointment fees. These charges may not be billable to your insurance company.

I cannot predict for any individual family the extent of treatment needed or outcome.
Bridges Program Monograph Paper The monograph below was written about The Bridges Program but applies to the basic philosophy and practice of Court Ordered Family Therapy except that there are not two therapists involved in COFT.

The Bridges Program was conceived when we (Charlene Sabin, MD and Cathy Gwin, PsyD), as community based and private practice clinicians, noticed a gap in the continuum of services available to some of our clients, the divorced or separated families with unresolvable allegations of sexual abuse. Although the clinicians in the Program represent different disciplines, we are all children's clinicians, and through the process of working for many years in the juvenile, domestic relations and criminal justice systems, doing custody evaluations, sexual abuse evaluations, family and individual therapy, we noticed that when allegations of sexual abuse are unresolvable through the criminal system and cannot be determined to be clearly founded or unfounded, the children and adults are usually left without services for resolving the family estrangement, anxieties, relationship issues, and legal issues related to visitation.

In our community, many providers identify themselves as treating sexual abuse victims, or treating alleged offenders, or treating the non-accused parents, but prior to the existence of this Program, there were few avenues of treatment for the family as a whole in which all these different aspects can be considered jointly. Also, most mental health providers in our community who treat sexual abuse victims usually do not include alleged offenders in the treatment, especially if the alleged offender is denying the allegations and if the actual occurrence of the allegations is unclear, thus not providing for avenues for communication about the relationship issues in the family.

In a parallel situation with the dilemma of the mental health community, there are many times when the legal system does not have a clear way of approaching these families or resolving the allegations of sexual abuse. Frequently the allegations do not meet the criteria of the District Attorney or police for prosecution, due to the age of the child, the nature of the allegations, or the circumstances in which the allegations arose, including divorce or custody disputes. The families in our Program have allegations which are usually considered in a "gray" area or indeterminate category, even for law enforcement officials. If the allegations are never tried criminally or if the allegations are proven unfounded in a criminal court, there may still be cause for concern regarding the safety of the child, and the child will likely have anxieties, whether or not there has been abuse. At times, these anxieties could lead to further allegations of abuse, again, whether or not there has been actual abuse.

The family may then turn to the domestic relations or juvenile court for resolution of the visitation issues. The emotional volatility and anxiety of the situation when the family is involved in domestic relations and juvenile proceedings is obvious to the judges in our three county catchment area, but they have historically felt legally they had few avenues for resolving the visitation issues. The domestic relations bench in our area is quite educated and sensitive to the family dynamic issues, but in general, if they are not sure whether or not a child has been abused, they would order no contact or limited and supervised contact.

Subsequently, the child may not see the accused parent for years, during which time the accused parent may continue to try to establish visitation, to exonerate
themselves from the allegations, to express their anger and disappointment in a variety of non-adaptive ways, or they may choose to absent themselves from the child's life. The non-accused parent often remains anxious and very protective of the child and may have taken drastic measures to prevent the child from seeing the other parent. The non-accused parent may have actively alienated the child from the accused parent about a number of issues unrelated to the abuse allegations.

The domestic relations judges are left with a dilemma regarding the defacto termination of the parental relationship in the face of these family tensions and anxieties, versus ordering visitation which may be harmful to the child. The judges are also faced with dilemmas regarding parental rights as opposed to best interests of the child. To make matters worse, the best interests of the child are not always clear in these situations. Even if a child is afraid of the accused parent, it may be in the child's best interest to have an opportunity to resolve these issues with the parent, rather than carrying them into adulthood. The families in our Program have often spent their life savings, and the grandparent's life savings, in the courtroom. This monetary depletion is symbolic of the emotional expense and ongoing tension involving unresolved allegations of abuse, even when the child has no ongoing contact with the alleged offender.

Thus, the Bridges Program was conceived to fill a void in the services available to this specific type of family and to provide an avenue for resolution to the court when faced with such dilemmas. We only begin therapy after a court order has been signed regarding their participation in the Program, although we are willing to meet with parents and attorneys in order to answer their questions prior to the beginning of the actual Program. In the usual type of court order, the parents are ordered to participate in the Program, and the method of sharing payment is specified. We recommend that the parents each pay equally the expenses of the Program, thus recognizing that they are each contributing to their children's needs in this manner and not recognizing the issue of responsibility or fault regarding the situation in which they find themselves. In addition to the order to participate, some court orders reflect the judge's wish for any future changes in contact or visitation to be under the direction of the Program, thus hopefully eliminating the need to return to court related to the small or relatively frequent changes in visitation which might be indicated in the course of the family therapy process. When the process is finished, a final order reflecting the appropriate level of contact or visitation is usually written.

The court order is clinically necessary in the families we see, as often during the process, either or both parents will become angry at the Program and want to terminate treatment, take their children to different providers, have great difficulty maintaining consistent appointments, want to move out of state, or in some other way obstruct the process. The accused parents usually feel that the Program is moving too slowly and they are not getting the desired results quickly enough. The non-accused parents usually feel that the Program is moving too quickly and their anxiety is difficult for them to tolerate. Because the clinicians in the Program strive at all times for neutrality and support of the children, neither parent may feel supported adequately. We attempt to form treatment alliances with each parent, but not around the issues of the parental conflict or the allegations of abuse. As the parents historically have found other clinicians who do not remain neutral, their experience of the Program is stressful to them at times and the court order reminds and reinforces the original agreements regarding participation in the Program.

The primary mission of the Program is to support the child or children in the aftermath of unresolved allegations of sexual abuse and to provide avenues for resolution that are alternative to the courtroom. The outcome for individual families varies greatly and there are no a priori goals regarding the form of relationships or visitation for any individual family. The general goals of the Program are to increase the family's focus on the needs of the child(ren), to decrease the focus on the parental conflicts, to prevent further allegations of sexual abuse, to facilitate adult communication to the benefit of the children, to help the children in developing assertiveness and communication skills, and to allow the parent-child relationships to develop to the extent that is possible. In some families, the development of routine unsupervised visitation is appropriate, while in other families, no further parental contact is appropriate, and there are many intermediate interventions available as well. In extreme situations, a change of custody is appropriate. The therapy process reveals the limitations and potentials of the family members in developing relationships.

Prior to beginning therapy, the accused parents, generally fathers, are required to complete psychological assessment outside the Program by a psychologist experienced in evaluating sexual offender issues. The non-accused parents, generally mothers, may also be asked to complete psychological assessment outside the Program if they initially or later seem to have psychological issues which are interfering with the treatment of the family. We do not see families in which the assessments demonstrate any specific risk factors regarding propensity for sexual abuse or poor reality testing. We often make referrals for additional separate individual treatment for the parents or the children if that is indicated.

The therapy process proceeds through a series of semi-structured family therapy sessions, always working with two therapists at a time, to understand all the different "realities" of the family members and to support the position of the children. We work with the parents individually until they are able to empathize with the children, before we have joint family sessions. Some families have not been able to have successful joint parent/child sessions due to parental limitations, but in those cases, the Program can offer some sense of closure and understanding for the children. We feel that this outcome is successful and desirable for some families, as often children have spent many years feeling afraid of the possibility of dealing with the estranged parent. Often children who have spent years in anxiety find that the estranged parent is emotionally much less powerful than his absence has made him, and just this change in perception is helpful to them. Joint parent meetings have at times been possible as the family makes progress in the Program.

The operational way of working with these families is to continually focus on the needs of the children and away from the parental conflict. The Program therapists never make a determination of the validity of the abuse allegations, and thus we model for the family the potential to proceed with relationships in the face of uncertainty. The sessions are spent talking about and demonstrating child development issues, healthy boundaries, appropriate physical, emotional, and personal safety issues, assertiveness of the children, appropriate communication between the children and both parents, and appropriate parental communication. The abuse allegations are discussed in a way that supports the reality of the child. Preventions regarding abuse are discussed extensively. The family therapy sessions are often two hours in length, with the first half hour spent preparing the accused parent separately from the child, the next hour spent with parent and child together, and the last half hour spent debriefing the parent and child separately.

Many of the families in the Program also participate in supervised visitation. The visitation is entirely separate from the family therapy and is seen as a chance to "play" as contrasted with the "work" of the therapy. As the Program progresses regarding communication and trust issues, there are some families who progress to unsupervised visitation. At times of visitation transitions, the Program provides ongoing therapy and debriefing of the visitation, as well as a known location for the transitions. The Program staff monitors the visitation and makes recommendations regarding increasing or decreasing visitation. Our general policy is to make changes very slowly, allowing substantial time for the children to get used to changes. If a family is making the transition to unsupervised visitation, the process may take six to nine months, from the time of short unsupervised visits to longer overnight visits. The transitions to visitation or to different types of visitation are better managed through the therapy process than through the court or adversarial process, as the court system has more difficulties making frequent small changes in visitation, with contingencies and follow-up, than does a therapy process. One judge from far out of state, who does not know us professionally, did manage all these transitions through frequent telephone hearings, and he consistently ruled each time to make the visitation transition that the Program recommended.

The use of two therapists has many advantages, allowing us to debrief sessions simultaneously with parent and child. The greatest advantage of the use of two therapists is the maintenance of neutrality and a balanced view of all parties in these families and the availability of professional support in dealing with these difficult and conflict-laden situations. If the parents or children are in other therapy, we meet with those therapists regularly to attempt to form a cohesive treatment team. If there are obstacles in forming a cohesive team, then this will be an obstacle in the family's process in resolving the allegations and relationship issues. At times, other therapists have not been able to support the work of the Program and may increase the polarization in the family. At times we have asked the children's attorney to assist us in dealing with other therapists.

The obstacles to the Program can be thought of as intrafamilial and extrafamilial obstacles. The obstacles within the family usually involve each parent trying to prove that they are correct in their views of the children's needs. The accused parents may have difficulty wanting to exonerate themselves and thereby prove that they have been wronged. They may want to talk more about the past rather than learn about their children in the present. The non-accused parents usually want to prove that the accused parent is not only a sexual offender, but also an unworthy parent in general. The non-accused parent may be highly anxious or may be a child abuse victim also. The grandparents often echo these views. It is our perception that the extended family in these situations is more overly involved than in other family problems we see, suggesting intergenerational separation and boundary issues.

Our main approach to the family systems obstacles has been to demonstrate, at all times through our behaviors and statements, the ability to tolerate the conflict, to maintain a neutral stance in these highly polarized situations, and to educate the family and extended family, including grandparents, about the needs of the children. Often the family members need information, not only about what is best for the children, but also what is in the best interests of the adults in the process. In our framework, facilitating the best interests of the children is in the best interests of the adults, who want to maintain and develop relationships with the children. Having the court order and the support of the domestic relations bar is extremely helpful in reminding parents what is in their best interests. It is helpful to remind both parents that the Program has no a priori goals or time table for changes in the family and that these changes are driven by what we see in the children. It is helpful to remind the parents that a child will have anxiety in the therapy situation, whether or not sexual abuse has occurred. The ultimate sign of our success in overcoming the adult obstacles is seen when the parents can be in the same room, communicating, and their child can be in a different room, knowing that his or her parents are talking. While some children in divorced families take this for granted, the children in our Program find this to be a very powerful experience.

The extrafamilial obstacles include the extended legal system and at times, other therapists. These other systems often parallel the polarized process of the family. For example, in one of our families, the judge in our urban county had ordered participation in the Program. The Program progressed slowly with frequent interruptions, but after a year of therapy, there was a recommendation from the Program to begin supervised visitation, after several healthy family therapy sessions. The non-accused parent, who had moved to a nearby, but more rural county, went to the child protective services in that county to object to this progress. In that county, the services worker stated, "We don't do this kind of therapy," and she told the parent to not bring the child to the Program any longer, which of course was what the parent wanted. The family's conflict was paralleled and replicated at the judicial level with a discussion of jurisdiction. Even with the change of jurisdiction, the rural judge did order supervised visitation.

Our approach to dealing with the systems issues obstacles, including the polarization of attorneys, judges, child protective agencies, and other therapists, has been similar to dealing with the family obstacles, i.e., to continually focus on the needs of the children. In order to facilitate the systems working together in the interests of the children, it is necessary to have face-to-face contact with treatment planning meetings to include all involved adults at times. In general, we have been very fortunate in working with attorneys who understand that the therapy process will more easily and effectively resolve these issues than will the adversarial process, so they are able to encourage their clients to participate fully in the Program. The community of therapists and attorneys is relatively small here, and the networking and trust that has been built over the years working within this system is invaluable in supporting the work of the Program.

The complimentary functions of attorneys and therapists are illustrated frequently in our work. In the initial phases of a family's entrance into the Program, the attorneys are often feeling as frustrated and exhausted by the process as are the family members, and they usually see the Program as an avenue for resolution which they cannot necessarily offer their client through the court process. Most attorneys view the Program as protective of children and are able to reassure their clients regarding that issue. We often advocate for the involvement of attorneys for children, and most children's attorneys see the Program as being helpful to their clients.

In dealing with other therapists whose involvement may have predated the Program, we find it helpful to meet with them and involve them also in the treatment planning. We recognize the difficulty that some therapists may have in tolerating the anxiety associated with not knowing with certainty about the occurrence of the allegations, their subsequent response to the anxiety, which is to try and see things more clearly in absolute terms, and the resulting polarization.

Our Program has two primary clinicians, working in various combinations of two at a time, an administrative assistant, and a regular consultation with other mental health experts in such areas as offender issues, personality disorder issues, and systems issues. The Program charges for services at an hourly rate that is considerably discounted from the sum of our individual rates, and the families pay for the services privately or a times through the use of insurance. We offer some sliding scale fees to accommodate appropriate families. We can see approximately six to eight ongoing families at any one time, as we all have other professional activities in addition to the Program. We generally see families monthly or bi-weekly, as the family work is quite intense for the children, and they need some time to experience that their real world goes on whether or not they are seeing the estranged parent and some time to integrate their experiences. We have seen approximately 40 families over the past seven years, with approximately one-third to one-half of those families progressing to unsupervised traditional visitation schedules. Two families have experienced a change of custody. Some families have discontinued the Program without a planned termination, and about one-third of the families have ended the Program with supervised visitation or with no contact as the final state of the relationship.

The Bridges Program has no official affiliation with any other program in the community, but we enjoy substantial inter-program referral and support. Before the Program began, we met with the primary domestic relations judges, and we asked them for input regarding the needs of the court in these families. We have continued to send them updates about the development of the Program, and they continue to refer families to the Program. In our community, there is a sexual abuse evaluation program, and we communicate regularly with their staff. They are able to refer children when they feel that the allegations are indeterminate. We refer children to the supervised visitation program in our community, and they refer children to the Bridges Program when they are perceiving that the children are ready for a transition.

The community support has been critical to the development of the Program, and a times, has been critical to the success or failure of the therapy of the individual family. The judges see the need for the Program, and they are willing not only to order the participation in the Program, but also to continue to reinforce the participation when either parent may be feeling unhappy with the process. The support from child protective organizations, in this state known as the State Office for Services to Children and Families, is variable depending on the trust of the worker and the extent of their understanding of the therapy process. At times, the protective services organization seems to have difficulty shifting their view from the adversarial process and their more black and white views of the issues, to the possibility for healthy relationships. At other times, the protective services organization has been instrumental in keeping children in the Program.

Due to the positive experiences of judges and attorneys and other therapists in the community in dealing with these difficult situations, the community members acquainted with the Program began suggesting that we do family therapy with families without sexual abuse allegations but with other types of high conflict situations. We have been referred families with conflict arising from past custodial interference, past alcoholism, past anger control problems, past domestic violence, and in general high conflict families whose children have anxiety regarding visitation. The similarities in many of the psychodynamic issues between the families with sexual abuse allegations and the families with other sources of conflict is striking, and the treatment interventions we have developed for the initial population of families seems very applicable to the subsequent families as well.

We would like to develop more follow-up information about the families we have treated and to provide more training to other professionals, as we feel this type of professional activity has been very interesting intellectually to us and useful to both the legal community and the community at large. For others to develop a similar type program, we would advise meeting with the legal community in advance of actually beginning. The experience of maintaining neutrality and dealing with such high conflict families is difficult, and we would advise obtaining regular outside consultation and supervision. We have given workshops at the national and regional levels, and we are developing training materials.