Information for Referring
or Collaborating Legal Professionals
On this page you will find detailed information about CFT, please scroll down to see all of the information regarding:
The CFT process overall
Details about each phase during the process
Definition of clinical roles
Information on the process of professional collaboration
Complex Family Therapy (CFT) is the term Watermark uses to refer to the clinical process that we use when a court referred family requires professional mental health intervention. CFT has three different components that provide a structured approach to addressing family system distress. Families may need one, two, or all three of the CFT processes to address the presenting problem.
CFT can provide clinical support in the following ways:
For Parenting Support: Coparenting therapy or Parenting Coordination to address high conflict parenting dynamics.
For Parent-Child relationship concerns: (often referred to as reunification) this will always focus on repairing a relationship between parent and child.
For Individuals: Either adults or children, sometimes a specific person in the family system may need direct support for stress associated with trauma or family system distress.
Our approach always includes a scaffolded process that includes pre-assessment and multi-step treatment phases, which are explained in detail below. We frequently utilize a treatment team approach which employs a multi-professional model for cases that require concurrent clinical processes (e.g. Parenting coordination and Parent-Child relationship repair). Together, we can assist both parents and children to realign a relationship in a safe, productive and healthy way.
Regarding Parenting support:
Coparenting and Parenting Coordination (two distinctly different processes) are both focused on reducing conflict and toxic stress between parents who must communicate and make decisions about shared children. Coparenting is best suited for parents who share children and have a goal of working towards an amicable cooperative, coparenting relationship.
In contrast, Parenting Coordination is a process designed to manage high-conflict parenting relationships through structured solution-focused communication. Parenting Coordination is best suited for parents that need a parallel parenting structure, when there have been past elements of IPV/DV or other relational factors that prevent rebuilding a collaborative relationship. Both Coparenting and Parenting coordination do not involve children directly. We recommend monthly meetings, usually conducted virtually, that focus on relevant parenting decisions and do not address historical conflicts.
Regarding children involved in a CFT process:
When children must be involved in the process, it is imperative that the adults involved are prepared to effectively participate and support the repair process. If the adults involved are unable or unwilling to put forth effective efforts, we will not proceed with children in the process. Further, the parental conflict levels must be reduced through a coparenting process in order to be able to support children actively involved in a CFT process.
If the parental conflict levels are unmanaged or chronically chaotic, it may be inappropriate to continue services that directly include children. In general, we will not involve children in the clinical process until there is a baseline of functional cooperation between the parents. This boundary prevents children from unintentionally being triangulated or put into a decision-making or responsibility roles, which we believe is both developmentally inappropriate and potentially harmful to any child. We do expect CFT to be challenging for children. Therapy will focus on building distress tolerance as an expected part of the process. Further, clinicians will use their clinical judgment to stop a clinical process if we determine that a child is having unreasonably distressing responses to the therapeutic process.
Our structured, supported processes and collaboration with legal professionals and mental health care providers lead to better outcomes for families, while minimizing the negative and distressing impacts on children and parents in contentious family situations.
The CFT Process in Detail:
Complex Family Therapy at Watermark has four phases that typically span on average 6-18 months- depending on the complexity of the situation and the compliance and cooperation from the parties involved. Most families spend around 12 months actively engaged in the process.
Parenting support is often conducted virtually to reduce in-person stress. Family work with children is usually conducted in person to facilitate relationship building.
Phase One
Exploration/Information Gathering. During this phase, we will assess if functional repair is possible and if there are any major barriers to repair (such as a parent who refuses to participate, or contraindications such as abuse, domestic violence, or unmanaged mental health concerns). This phase will always include individual intake sessions with all adult parties, and usually a joint co-parenting session to begin to establish mutually agreed upon treatment goals.
When there is an adolescent involved, he or she may also meet for an initial appointment to asses their readiness to participate.
If desired, a written initial clinical summary and proposed treatment plan with recommendations can be provided to ensure clear communication with the legal process.
Sometimes, legal professionals (attorneys and GAL’s) have opted to utilize this phase as a free-standing assessment plan to gather information and inform upcoming hearings or court orders. Please reach out to our office if you would like to refer for this service.
Phase Two
Preparing parties to work towards repair goals. This phase will include the clinician facilitating the needed therapeutic sessions to prepare the individuals for successful repair and begin to recalibrate the relationship.
If coparenting is the focus of treatment, parties will receive any individual necessary clinical support to be able to participate meaningfully with the coparenting process.
If the focus is repairing a parent-child relationship, our family clinicians will work with clients as needed, to include siblings (as a group, if applicable) to prepare to engage in a successful repair process.
This phase is the most important phase and often takes the longest amount of time, it is important to encourage clients to be patient with this part of the process as it is the foundation for a new relationship.
Phase Three
Repair Sessions with family therapy. If the treatment plan includes a family component, this phase will directly address the rupture or repairs needed as a whole group. Frequently, both therapists are in the room with the children and parents.
New rapport and healthy relationships are built within the family system.
This phase is often the fastest phase (if foundational work is done properly) but can be very hard for children involved as it is the mechanism by which new trust experiences, deeply held narratives are revised and relationships are rebuilt.
If the focus remains coparenting, sessions will continue on a regular basis to reduce conflict and hostility, and build functional coparenting behaviors.
Phase Four
Maintaining repaired relationships. This final phase ensures that the therapeutic gains are maintained and that any issues that arise during and after the process are dealt with quickly. Often this maintenance phase focuses on longer term coparenting, keeping conflict low, supporting a parenting plan, and monitoring the development of the family system. Successful maintenance prevents further ruptures to the newly developing trust in a family system. Parenting Coordination cases will continue to regularly meet and maintain a low conflict working relationship between coparents.
Often, the frequency of meetings will decrease over time. Families will eventually be able to disengage from regular sessions and reach out for support as needed. Ultimately, we consider it a metric of success when families no longer need clinical support and can move forward without therapeutic intervention or services.
Outcomes
Our hope is that through CFT, families are able to find new and healthy ways of relating to each other. The maximum achievable outcome varies by family and no two family outcomes look the same. Sometimes, only basic contact for logistics between parents is the healthiest outcome possible. Other times, shared parenting and secure relationships with parents and children can be achieved. The outcome goals and expectations will be discussed frequently throughout the process.
Other typical outcomes include resolution of ongoing conflict, reduced family system chaos, new communication skills, establishing and maintaining boundaries in the family system, and minimized litigation.
Legal professionals often report that information from mental health professionals about family dynamics, clinical diagnoses, and relevant information are crucial pieces of information that assist in resolving family conflict.
When there are unresolvable family dynamics, the clinicians may be able to provide recommendations for next steps to all decision makers involved in the family.
Definition of Clinical Roles
Complex Family Therapist
The main goal of the Family Therapist is to provide clinical care for a complex family situation that requires coordinated, intentional efforts to improve the family dynamic. This therapist works to remove barriers that may be preventing healthy coparenting or a parent and child from having a healthy, stable relationship. The overall family goal is to improve relationships through coparenting or parent-child relationships by navigating communication, resolving problems, and facilitating a functional family environment.We see a wide range of challenges in CFT that disrupt relationships such as major communication deficits, multiple and lengthy court interventions, poor parenting skills, history of DV/IPV, a lack of understanding of child development, mental health or substance use problems, parental interference by a custodial parent, anger management problems, personality disorders, blending of step families and child mental health issues- to name just a few.
The Complex Family Therapist’s job is to identify barriers and attempt to mitigate, manage or improve them through appropriate therapeutic or practical interventions. A family therapist does not make specific parenting decisions for parents, formally assess for parenting time or capacity, or function as an arbitrator. This process always includes communication with the relevant legal decision makers (GAL, attorneys and the Court) to inform about progress and participation.
Parenting Coach therapist
This is a mental health professional designated to provide support for parenting skills. This therapist helps a parent to refocus their relationship to developmentally appropriate, practical, or solution-focused approaches towards the well being and parenting process of the children. This therapist may offer effective tools and strategies to guide parents into new healthier ways responding to children, minimizing inconsistencies or conflict and creating new secure emotional connections.
Clinical Family Coordinator
This role can be a specific designation as this clinician acts as the facilitator/leader in a complex family system where multiple therapists or processes are involved. A Clinical Family Coordinator can assume the lead role in the Complex Family Therapy process, ensuring collaboration and progression with other therapists while communicating with adjacent professionals. The role of this clinician is to guide and monitor the family system, especially when there are multiple factors and processes that contribute to the dysfunctional family system. A Parenting Coordinator often conducts the coparenting therapy while ensuring adjacent clinical processes are happening as planned. The Family Coordinator maintains working collaborative relationships with all parties involved and works towards goals that are mutually agreed upon by clients. This clinician utilizes clinical skills, mediation skills, leadership skills, and a relational approach to move the entire family system in the desired direction.
Clinical Team Member
These clinical team members are therapists who work concurrently and specifically with individuals inside the family system. This often looks like a therapist who supports an adult, a child individually, or a sibling group while a family therapy process continues. This role provides crucial support for children because it provides a safe, lower pressure space for them to process their experience and increase coping skills during a typically stressful time. Additionally, when joint family therapy occurs in the later stages of a Complex Family Therapy process, a team clinician is able to be in the room (in a co-therapy format) alongside their client, to provide support in the moment.
Client
The client may be an individual person, the parenting dyad or the family. Adults will always consent to services independently as clients. While improving family system may be the focus of the treatment plan clients always participate individually as clients. All adults who participate agree to shared treatment plan goals especially when the family system may be the focus of intervention.
About Professional Collaboration
Collaboration of therapists and legal professionals can be a challenging task due to professional knowledge gaps and differences in professional communication. There may be competing ethical dilemmas and complex situations that are difficult, but worthwhile, to navigate. In order to increase effective collaboration, we strive to communicate proactively and transparently during our clinical processes so that we can maximize the benefits of the professional skills that are available to the CFT family. As mental health professionals, we will only operate in our professional areas of competence and we encourage our collaborating colleagues to operate with similar professional boundaries. We do not give legal advice and will always redirect clients to their attorneys.
When a new CFT case begins, it is important that we communicate and agree about the broad clinical goals for the family system.
We welcome phone conferences from time to time to check in with the clinical process. We find it helpful and efficient to talk to all of the therapists and attorneys involved (as a group) and we will do our best to coordinate that.
We can provide a written clinical summary of the process whenever you request. We aim for these summaries to be neutral, fact focused documents that all parties involved will have access to. Clinical summaries will generally include dates of sessions, the treatment plan, a summary of the process to date, clinical observations and recommendations for next steps.
We will communicate with our clients as needed, which sometimes means communication outside of sessions. Clients can expect to have access to the therapists when they need support. Please encourage your clients to communicate with us as needed.
Helpful Hints for Legal Professionals and their Clients:
Court orders that contain accurate language about the therapeutic process are crucial for collaborative success. We are always happy to clearly define what we are able and willing to do (clinically) to assist you in documenting the desired therapeutic plan accurately and clearly. Specifically, we have seen success with naming, “family therapy” or a specific Clinical Family Coordinator in the court order to ensure the therapeutic process is intentionally facilitated and that clients understand the roles and expected clinical processes.
The term “reunification therapy” is a designated term applied to situations where there is relational estrangement, usually with a trauma component, between parent and child or a child is refusing/resisting a relationship with a parent. In cases where there is ongoing contact between parent and child, but there is distress and relationship problems, the most accurate way to refer to this is “family therapy” or “Parent-Child family therapy.” Further, the term “reconciliation therapy” is often confused with “reunification therapy” and generally implies relationship repair but is not a term typically used by clinicians. Utilizing correct terminology, especially in court-ordered processes is very important and has multilayered impacts both clinically and legally. When in doubt, you can use the word “therapy” as it is the most generalized and applicable.
Diagnoses are not always applicable or present in all cases. A “presenting problem”, or the reason for treatment, is often more helpful than a medical diagnosis. Usually, a family system with complex problems is best understood through relational dynamics which can be identified through the clinical process.
Confidentiality. We inform all of the clients that with the collaborative nature of a Complex Family Therapy process that they should assume that they will forfeit some of their confidentiality due to the interdisciplinary nature of the work and the need for professional collaboration. Watermark consent documents outlines this concept very directly. Privacy, basic and best ethical practices of confidentiality will always still apply.
We highly discourage attorney subpoenas of our session notes, especially during an active treatment process, due to the interference with the clinical process and the damage that can be done to the existing working relationships. We will always provide alternative written clinical summaries or verbal communication whenever needed.
We can provide testimony in court related to our clinical work, but we always prefer not to appear in court. We will submit timely summary documents or have phone calls to provide decision makers with pertinent information. Court appearances incur additional costs to the clients and are a poor use of our time as clinicians.
Sometimes, we may need to ask you to work with us to communicate to your client more effective ways of participating in the clinical process; if your client is not participating appropriately, we will communicate about this concern.
It is the client’s responsibility to maintain their therapy schedules, stay up to date on payments, and inform us of upcoming court dates or needed documentation.
The client will sign a clinical consent form and a policies document with our office, failure to abide by the terms may result in their termination from our services. We can provide you copies of the consent and policy documents upon request.
We encourage legal advocates to stay in contact with us so that we can collaboratively care for our shared clients.
