fMRI Research Update: Spousal abuse causes physical changes in the brains of victims

In many high conflict divorce cases, the pattern of conflict that began as a verbal disagreement escalates in a predictable way until one partner is physically assaulting the other. In a previous post, I reviewed the fMRI research that documented the brain changes in the children from merely witnessing domestic violence (DV) in their families. This post is devoted to the spouse/victims of domestic violence and what we know about the effects of DV and treatments for its symptoms.

Few family lawyers would be surprised to learn that many victims of domestic abuse suffer from post-traumatic stress disorder (PTSD), the same malady that afflicts many combat veterans. The experience of talking with one domestic violence victim is usually enough to sensitize most family lawyers to the resulting anxiety and fear-driven symptoms and behaviors that can result from prolonged exposure to the cycle of abuse (most abusive relationships last an average of 7 years before the victim gets out). What we now know is that the damage is not just emotional--domestic abuse, just like combat, causes identifiable and measurable changes in the brain's structure and function that are evident in fMRI scans of victims. That means the damage is physical and the abuse changes both the physical shape of the brain AND affects the way it functions.

Just as the treatment of combat-related PTSD has proven to be challenging and frequently ineffective, the treatment of domestic violence-related PTSD is less than optimal in its effectiveness. A reasonable summary of the available research, using the latest and most effective cognitive behavior therapy (CBT) for trauma for battered women (CTT-BW) suggests that treatment is about 50% effective. It is this documented lack of treatment success in nearly half the victims that led to the fMRI studies to try to identify underlying brain pathology that was interfering with CBT effectiveness.

What the fMRI scans of these traumatized women revealed was identifiable changes in structure and function of three areas of the brain: the amydala, the insula, and the prefrontal cortex. These 3 regions are the same ones identified in the research of the combat PTSD victims and the kids from violent families, and they are dysfunctional in the same ways in all these victims. Brain centers for identifying danger are hyper-activated, and the brain center responsible for self-control and logical thinking (executive functions, as they are called) is not working like it does in normal people. This latest research noted that other brain areas (the anterior cingulate and posterior cingulate) were more active in people who were successfully treated, suggesting that the CBT was successful in activating these brain areas which led to reducing the fear-driven anticipation of something bad happening to them, leading to reductions in anxiety and other PTSD symptoms.

There are clearly family law implications for this growing body of research. Victims of domestic violence have scientifically verifiable physical brain injuries resulting from their abuse. These brain injuries affect how, and how well, the brains of these people function, and how well state of the art treatments will work to return them to normal functioning.  These findings have both child custody and property division implications which should be considered in cases involving document domestic violence.

Victims of domestic violence, both the adults and the children, are more like the victims of car accidents with head injuries than most of us would like to believe. Domestic violence doesn't just make its victims "nervous"; domestic violence causes brain damage to its victims that is very difficult to repair even with the best available treatments. And by the way, there is NO evidence that this kind of damage will "heal itself" when the victims are removed from the violence.

A number of practice tips come to mind as a consequence of these findings:

1. Longer exposure to abuse means greater brain damage for both the adults and the children. There is no "grace period". Getting away from the abuse is the first step, so the abused spouse and children must either leave or be protected by a protective order--now.

2. Effective treatment for the victim is available, may work, and takes a few (3-4) months. Get the victim into a program which offers CBT or CTT-BW as soon as possible while the litigation proceeds. An effectively treated victim is a much more rational and well functioning client (and parent).

3. Emphasize the physical brain damage effects of DV in settlement discussions about property division and visitation.

4. Insist on treatment for the perpetrator before allowing unsupervised visitation to prevent further "brain damage" to the children. (See my earlier post for details.)

Innovations in services for families: i360life

Many family law cases are complicated by the presence of a mental health issue. Sometimes it's substance abuse by one (or both) spouses; sometimes the drinking or drug use is a problem for one of the children in the family, and it is precipitated or exacerbated by the divorce and litigation. In other cases, a stay at home mom is depressed, anxious, and overwhelmed, and dad is working full time and perhaps traveling regularly for days at a time.

Once the divorce litigation is filed and the case is under way, neither lawyers nor the treating professionals have had many options for providing support to the patient and the family in these challenging cases; usually those choices were counseling or therapy once or twice a week, or inpatient treatment or rehab. Neither of those options provides much support for the children--once a week therapy for mom doesn't really help them at all in the short term, and taking mom away completely for a month or two leaves them abandoned to some relative or unfamiliar caretaker. Until now, there has been nothing in between these two traditional treatment options.

I recently visited with Dr. Kevin Gililand, the CEO and founder of innovation360 to learn more about their unique and innovative services. His rapidly growing company has individually customized and personally designed services to fill the gap between inpatient programs and one hour per week therapy. (See www.i360life.com for more information.)

Innovation360 provides a menu of traditional services but also provides "14 day coming home"  programs for transitions from inpatient programs to home, life management (in home support and structure for self-management, child care supervision, etc.), and ensuring a client's home is safe (and drug free) after returning from rehab. Their "life development"  program is unique in providing in home support by a mental health professional which includes social support, nutrition support, and activity support for as many hours as needed, from a few hours per week to 24/7 care.

As I thought about the most challenging cases I had worked on over the last few years, it became clear to me that this kind of 'in-between' service could have been an immense help to a number of families during their divorces. For many people, having someone with them every day to help them make better decisions and to avoid reverting to old and dangerous behaviors while putting their therapy lessons into practice in their daily lives would have been incredibly valuable and saved the parties a lot of money and grief.

For family law attorneys in this geographic area, this is a new resource for helping in your most challenging cases.

(I am not affiliated with Innovation360 in any way and have NOT been compensated for this article.)

Research update: What happens when you challenge a narcissist?

“Narcissus does not fall in love with his reflection because it is beautiful, but because it is his. ” WH Auden

As the dangers of narcissism (NPD) in the workplace (and the courtroom) become more obvious, the research into its manifestations becomes both more interesting and more useful. A recent study examined the behavior of normal and narcissistic job applicants in their initial interviews. Narcissists scored much higher in their initial interviews, primarily because their tendency to self-promote, their ability to engage the interviewers, and  to speak at length (about themselves, of course) conveyed confidence and expertise. At first glance, this style is quite successful, as these folks are really good at self promotion. None of this is news. What is news is what happened when the interviewers challenged the self promotional "puffing".

When challenged, the normal applicants tended to back down from their exaggerated claims of expertise. Not the narcissists. Rather than back down, the narcissists "doubled down"; they increased their efforts to look better! The narcissistic response to being challenged was "Oh yea, you want to challenge me? I am not just good, I am great!" My take on  this "unexpected" response is this: Any challenge to the expertise, knowledge, success, power, or brilliance of a NPD is perceived as a narcissistic insult, and must be defeated by a display of GREATER expertise, knowledge, success, power or brilliance. The response is to being "questioned" is both automatic and predictable.  NPDs protect their image at all costs. They have to.

In the context of family law litigation, this response to being challenged is evident every day in hearings and depositions. NPDs, who are usually but not always men, dramatically exaggerate their parenting skills, their career successes, their financial acumen, and their legal "expertise" in their self-serving testimony. When challenged by opposing counsel, they don't make admissions; they make even greater self-serving exaggerations. The reactions of their long-suffering spouses to these courtroom fabrications is equally predictable: they fear that once again everyone will be taken in by the NPDs gift of believable but factually distorted self promotion and that the case will be over before the lies can be uncovered.

The practice tip for family law attorneys is this: whether the NPD is your client or the other party, pay close attention when their self-promoting pitch is being challenged--if the response is "Oh yea, let me tell another story about how wonderful I am", an NPD is loose in your case, and truth will be hard to come by. Be very skeptical of ALL their testimony or you will get burned. Nothing is more important to an NPD than their image. Nothing.

Reference: University of Nebraska-Lincoln (2012, April 2). How do I love me? Let me count the ways, and also ace that interview. ScienceDaily. Retrieved April 9, 2012, from http://www.sciencedaily.com­/releases/2012/04/120402144738.htm

Co-Parenting: Using the CAPT system as a check up

“All happy families resemble each other. Each unhappy family is unhappy in its own way. "  Leo Tolstoy in Anna Karenina

As the legal system has moved increasingly to support the policy of "joint custody"  (joint managing conservatorship-JMC- as it's called in Texas), the reality is that physical "custody" or "primary residence" for the children still resides with mom in about 85% of divorce and custody cases. But regardless of where the children live, most (about 60%) of those kids will have regular visits with the non-custodial parent, and the two parents and their fractured family will have to cooperate in some  minimal ways to function as co-parents to their children. 

The research is very clear. Kids who have a working co-parenting arrangement suffer less and function better after the divorce than those children who don't have regular involvement from both of their parents. Regardless of the many challenges in co-parenting with a person whom you have recently divorced, the kids benefit if the co-parenting relationship is free from hostility; if the hostility between the parents continues, the children will suffer, many of them permanently harmed by the toxic environment in which they live. 

In between the extremes of no visitation, and the ideal of genuinely cooperative co-parenting without conflict, lies the vast majority of co-parenting relationships where mostly well meaning people do their best to make the post-divorce life of their children as good as they can. The question for many of them is: How are we doing and how can we tell?

Here's a simple four factor system for parents to use to evaluate their co-parenting   track record, and then use as a guide to making any improvements that may be needed. The four factors are: Communication, Affection, Power, and Task Completion.

Communication

Good communication between co-parents is open, not guarded, and information is neither withheld nor shared with hostile intent. Information about school, grades, activities, friends, health, pets, awards, school discipline, or emotional crises are freely shared in a timely and thoughtful and considerate way. The communication is appropriately "dosed" not to much and not too little.

When this level of open and free flow of information isn't yet possible, then the BIFF system is used: communication is Brief, Informative, Firm, and Friendly.

Affection

In healthy intact families, affection is freely expressed and warmly received. Children hug their parents and parents hug their children, and touch is used as a way to communicate genuine care and concern. In fractured families, children sometimes withhold public displays of affection for one or both parents because they are afraid that any expression of affection for one parent will be interpreted as disloyalty to the other parent. And parents can likewise use their overly exuberant displays of affection at times of exchanges of custody as a weapon aimed at their former spouse (and now co-parent). 

For co-parents the goal is to express affection to your children, and to encourage your children and your co-parent to express their affection without concern that it will be threatening. 

Power

In healthy intact families, power is usually shared by the parents, with decisions made by joint consultation. For some decisions, dad will have more influence and final authority; for others, mom's expertise will make her the more influential parent. In any case, the final authority will rest with the parents: NEVER with the children. In healthy families, children are NEVER in charge.

For most co-parents, the power arrangements have been settled by the terms of the divorce decree. The decree should spell out who has the "right" to make decisions about health care, counseling for the kids if needed, educational issues, and other matters. The decree is intended to be the "go to" if co-parents cannot cooperate. Regardless of who owns the right according to the decree, the more that co-parents cooperate in decision making, the better the children will do in the long run. 

In co-parenting families, effective use of power requires healthy communication (see above). The opportunity for children to manipulate parents, and to gain control to the point where it is bad for the children, is greatly increased when communication between co-parents is poor.

Task Completion

Healthy intact families get things done. Income is produced, bills get paid on time, household chores and maintenance are done regularly and without drama, homework is done early and checked by mom and dad, after school activities are enrolled, paid for, and kids get to practices and games (or rehearsals and performances) regularly and on time without drama. Life is busy, active, and productive.

The challenge for co-parents is much greater because of the physical (and emotional) distance between the parents. Task completion requires much more attention, focus, and discipline for both parents and children in fractured families. However, the bottom line for the children is the same: if the kids are doing their daily chores, getting to school, doing their work, getting to their activities, and getting to bed on a regular schedule, then this part of family life is being successfully accomplished after divorce.

If any of these four areas of family life are not working as well as you would like, then the first thing to do is to start with the first factor: communication. Have a chat with your co-parent at a Starbucks, and express your concern, and have a suggested solution. If the two of you have a history of conflict, then start with email rather than face to face discussions. Remember to use the BIFF system: keep the email Brief, Informative, Firm and Friendly. Stick to one issue at a time, don't do a long laundry list. Solve one issue, and then move on with a track record of success.

Your children will benefit from your efforts by having the advantage of two parents who work together for their welfare, just like kids from healthy intact families. Do it for your kids.