The Dangerous Bias in Fabulous Reports

The Dangerous Bias in Fabulous Reports   © 2024 Jenni McBride McNamara, LMFT, PC Intro from Bill Eddy This month we have a great article about how to write objectively about other people’s behavior, especially for those who write reports. The article is written by Jenni McBride McNamara, who is a Marriage and Family Therapist, Parenting Consultant/Coordinator, and author. She also is a member of one of the High Conflict Family Law Consultation Groups that I facilitate for High Conflict Institute. She offered this article to our group after a discussion of report writing. We found it so helpful that we wanted to include it in our Newsletter for all of our readers, many of whom are evaluators or otherwise write reports in their work. Enjoy the insights that she shares with us! We Know This About Bias Bias can be conscious or unconscious, explicit or implicit, harmful and othering, plus just plain bad form. We also think we know this: Writing professional notes, emails, and reports conveys a lot more information when we dress up those documents a bit, throw in some concept creep, and hint at what we really mean. Those dress-up clothes, in the form of adjectives and adverbs, are the bias that lurks in our professional words, hiding among the expressions of our expertise and our highly polished abilities to analyze complex family systems. Bias exists in our reports to other professionals and to the courts. Bias exists in our emails and our notes. Bias even exists in the words I just wrote. (“Highly polished”? Says who? Just me?) Our written words can show just as many microaggressions and biases as any raised eyebrow or pasted smile. Even journalists agree. Julie Mastrine, a writer at Allsides (a media bias watch organization) writes, “Adjectives do indicate bias — even if the descriptor is not one you’d deem unfair, it indicates a viewpoint.” These viewpoints, when they can be interpreted as unfair, are what we need to try to avoid. Written Words, Evidence, Bias? In the following two examples, the same information is being shared in a family therapist’s report to a Parenting Coordinator (PC). Let’s say these notes will later inform how the PC will make decisions about parenting time. So, we’ll look at the first example, well, first, and see what we think the PC might take from it. This therapist met with Dad in my office. Dad was resistant and clearly angry with this therapist about my prior report to the PC. This therapist attempted to lighten the tension by asking questions about Dad’s recent visit with daughter, a sweet 13-year-old, but Dad’s narcissistic attitude got in the way of us having that discussion. This therapist continues to believe Dad to be highly manipulative and possibly even a danger, emotionally, to his daughter, given his unrelenting complaints about this therapist’s process and his clear unwillingness to follow recommendations. What do you notice? What kinds of words are being used? What evidence is given to support those words? Writing things like, “resistant and clearly angry” conveys the therapist’s opinion about the client, and that opinion goes something like, “This guy thinks he knows it all (resistant) and is taking it out on me (clearly angry)”. Additional phrases such as, “highly manipulative” and “possibly even a danger…” to that “sweet” daughter also convey that this therapist has little positive regard for the parent. At the end, there’s another “clear unwillingness”. Clear how? Clear to whom? We’re not sure. So, what do you suppose the PC is going to think about this dad? The opinion the PC forms from the therapist’s bias could have an impact on that father’s parenting time. Now let’s look at a version that attempts to take some bias out of the note. This therapist met with Dad in my office. Dad reported that he wasn’t sure he wanted to attend the session because “The last time I was here, it didn’t seem like you listened to me. Then you wrote that first report to the PC and I may lose some parenting time.” This therapist validated that Dad feels that way. This therapist then asked Dad, “How was your recent visit with your daughter?” Dad reported that it was “fine”, but he wanted to talk about the report and share information he hadn’t shared before. Dad reported that he disagreed with this therapist’s report because it contained “factual errors” that he wanted to have corrected. This therapist again validated Dad’s frustration and brought up the visit with his daughter in a different way to refocus the session. Dad repeated his request to discuss the errors two additional times. In the second version, the therapist writes that the client “reports” versus the therapist offering shorthand interpretations of what the Dad said or did. The therapist also used the Dad’s direct quotes to capture information, rather than using the idea of “narcissistic attitude” (with its negative, concept-creeper connotation) to convey what Dad was upset about. How likely is it, then, that the PC might form a different opinion about this father and more fairly address a parenting time question? How did YOU feel about dad from this example? Though it’s not flowery and expressive, the second version of the therapist’s notes allow the next professional up the authority chain to make decisions for a client or family based on facts and behaviors and not countertransference or assumptions. When I was teaching middle school English and creative writing back in the day, we spent a lot of time on grammar. We talked about adjectives, adverbs, and showing versus telling when we’re trying to be creative. My seventh graders got As when they could describe and enhance their stories with words that evoked the five senses or appropriately applied a figure of speech. But now, here we are, blissfully out of seventh grade (See? My bias is that I’m glad about that!). To avoid bias as much as possible, our professional reports need to be more

SLIC Solutions: Setting Limits and Imposing Consequences in 2 ½ Steps

SLIC Solutions: Setting Limits and Imposing Consequences in 2 ½ Steps   © 2024 by Bill Eddy, LCSW, JD We live in a rapidly changing world, with rules and standards frequently in flux. However, most people are sufficiently self-regulated to maintain civility and cooperation in the midst of vagueness and uncertainty. Not surprisingly, setting limits on those with misbehavior has become one of the most important skills to have in today’s world, especially in high conflict situations. This is especially true since the pandemic and the increase in high conflict behavior worldwide. But in today’s world, Setting Limits is often ineffective if it isn’t combined with Imposing Consequences (thus the acronym: SLIC). People often say: “But I told him to stop!” Or: “I’m sure she’ll come to her senses.” As I describe in my new book—Our New World of Adult Bullies: How to Spot Them – How to Stop Them—some people really do lack the ability to stop themselves, so others have to do it. While most of us dread imposing consequences, it doesn’t have to be complicated. Since 2008, High Conflict Institute has been developing and teaching simple techniques for managing high conflict behavior. These skills can be learned by almost anyone with practice. SLIC Solutions is the last of four simple techniques that we teach for any conflict situation in our overall CARS Method® of conflict resolution: CONNECTING includes a simple EAR Statement® for calming upset people and connecting with them. ANALYZING options includes Making Proposals in 3 Steps™ for making decisions large and small. RESPONDING with a BIFF Response® can be used with emails and other written communication when someone is hostile, demanding, or misinformed. Now, for SETTING limits. we suggest SLIC Solutions™ which can be applied in 2½ steps. This article will explain how you can gain confidence in setting limits and imposing consequences in any situation. Step 1: Setting Limits Setting limits simply means defining the behavior you want or don’t want another person to do. It’s good to emphasize the positive—what you want someone to do—although sometimes saying what you don’t want may be just as important. For example: “Please be quiet in the hallway or move your discussion somewhere else. We’re trying to have a meeting in here.” This is always better than yelling “Shut Up out there.” It helps to set limits in a matter-of-fact or just slightly-raised tone of voice, even if you’re upset. When you vent intense emotions on another person, it tends to trigger their defensiveness and they may react to your tone rather than thinking about how to fulfill the limit you requested. Try not to make it personal, so that the person doesn’t feel that their life, reputation, or credibility are being challenged. Instead, make it clearly about the specific behavior you want. “Please refrain from discussing with Fred the confidential information I gave you yesterday.” This is much better than: “Shut the “f” up about what I said yesterday, you a—hole!” People often confuse being aggressive and profane with being firm. Showing that you are in control of yourself, and that you can be calm and reasonable are usually much more effective and you will be respected more for it. Including a Credible Threat of Imposing Consequences Setting limits without the credible threat of imposing consequences is often pointless when serious behavior or high conflict people are involved. They don’t like being told what to do. At first, when you are setting limits, you might put it as a request or an order, if you are a parent, a judge, or administrator. But if it is important to you and it is ignored, then the second time you say what the limit is it helps to notify the person of what the consequence will be. “If you keep talking about my mother in those terms, then I’m going to have to end this conversation.” “If you keep interrupting me in front of my supervisor, then I’ll have to meet with him without you.” “If you keep scheduling events for our child during my parenting time, then I’ll have to talk with my attorney about next steps.” “If you keep talking after your three minutes are up at this community meeting, then I’m going to have to turn off your microphone and have you escorted out of the meeting.” Amazingly, a credible threat of serious consequences may at least give a high conflict person pause to think about their behavior. They really don’t routinely think about consequences as they are so emotionally preoccupied in the moment. It can be especially impactful if your tone of voice and history of setting limits show that you are very likely to impose the consequence if necessary. Step 2: Imposing Consequences If the person continues engaging in the behavior you set limits on, then it’s time to impose the consequences. Sometimes you may decide to go more quickly to the consequence or give the person a third chance. But be careful not to continue to make empty threats. That’s the surest way to teach the person that you do not mean what you say for now and in the future. Setting limits without imposing consequences can make things worse. When you are imposing the consequence, make sure it is something you have control over. Telling someone that they should feel guilty or ashamed of themselves for their behavior, or telling them that they are being inappropriate, is not effective limit-setting. Yet people say this all the time as a substitute for real limit setting. It just doesn’t work because you don’t have control over how another person thinks or feels. With high conflict people, they may believe that their behavior is normal and necessary even when no one else does (because it has been part of their personality possibly from birth or at least early childhood. Think your consequence through ahead of time, especially before you announce it. Don’t be surprised when the other person argues with you and resists

Microbiome and “Gut Feeling” in High Conflict Behavior

Woman on blurred background using digital x-ray of human intestine holographic scan projection 3D rendering

Microbiome and “Gut Feeling” in High Conflict Behavior   © 2024 by Ekaterina Ricci, MDR The relationship between mental disorders and gut microbiome has become a popular topic in the past five years. Depression and anxiety, which often accompany mental health disorders, have become the major causes of disabilities worldwide (Wainberg, 2017). Depression is also associated with high-conflict behavior, which is usually self-defeating and, therefore, depressing. This article was written to provide insights into the gut microbiome and its effect on depression. High Conflict Individuals Increase Conflicts Most individuals, when encountering traumatic events such as family loss, unexpected financial responsibilities, conflicts, and other social factors, can bounce back over time and develop coping mechanisms; that is, most people find their way to enjoy life’s journey. When it comes to high-conflict individuals, however, instead of following the same pattern, they seem to get even better at driving conflicts. It gets increasingly difficult for legal professionals to deal with high-conflict personalities while handling their legal cases (Eddy, 2016). As professionals in the legal field report, highly conflict-litigious individuals get stuck in the court system pushing for some black-and-white set of opposing ideas, frequently displaying irritability, sadness, stress, anxiety, and difficulties staying focused on a particular topic. The Role of Human Microbiome in Depression Recent studies reveal that the human microbiome plays a significant role in depressive disorders (Kumar, 2023). An imbalance in the microbial gut “community” (all the microorganisms in our digestive tract) disrupts the activity of happy hormones, such as serotonin, resulting in bad mood, sleep deprivation, racing, repetitive thoughts, depression, paranoia, and, as a result, worsening relationships. Our Central Nervous System (CNS) communicates with the gut microbiome to manage stress levels (Sharon, 2017). Scientific studies report that patients who lack microbiome diversity are unable to manage their stress response, which in turn makes them stuck in stress and depression. It becomes a chronic accumulation of unmanaged problems. Happiness and Mental Health are Gut Influencers Cognitive Behavioral Therapy is proven to be an effective way of treating depression. In some acute cases, cognitive-behavioral therapy is combined with medications to achieve the best results. High conflict-driven personalities, in particular cluster B in DSM-5-TR (narcissistic, borderline, antisocial, and histrionic), frequently are prescribed drugs that help to cope with depression, anger, and impulsivity. Those drugs increase the amount of serotonin in the brain (for example, Prozac, Celexa, Lexapro, etc). In healthy individuals, over 95% of serotonin is produced in the gut (Appleton, 2018). Most patients who have depression are also diagnosed with microbiome gut imbalance, which affects the production and utilization of happy hormones. Moreover, studies have shown that the degree of depression varied as microbiome content and diversity of bacteria varied in healthy and depressed patients (Clapp, 2017). Human clinical studies consistently showed that elevated levels of a microbiome strain linked to depression and anxiety is Eggerthella. On the other hand, low levels of Subdoligranulum, Coprococcus, and Ruminococcaceae are linked to depression (Kumar, 2023). The microbial community diversity and communication between the gut and brain are crucial for mental activity; they influence our emotions and decisions. The Combination of Genetics and External Factors Affect Gut Microbiome A combination of genetics and our life choices can induce an imbalance in friendly microbe types. For instance, antibiotic use, poor nutrition, infections, cancer, cardiovascular problems, diabetes, and other medical conditions, ASD, ADHD, schizophrenia, and personality disorders described in DSM-5-TR can influence the microbiome, which in turn influences our mood. Those who have depressive disorders may find it beneficial to feed “good” bacteria with specific nutrients, such as the list below. This “feeding” may influence the marginalization of “bad” bacteria, leading them out of our microbiome. This will, in turn, improve the absorption of micronutrients, regulate serotonin production, and limit inflammation. Antidepressant Nutrient Plant Foods List (LaChance, 2018): Broccoli Brussels sprouts Butternut squash Cauliflower Dandelion greens Kale Strawberry Spinach Watercress New Ways to Antidepressant Microbiome diversity is a combination of genetics and environmental factors. While we do not have control over genetics, using probiotics to influence the immune system and boost cognitive functions is becoming increasingly popular (Cleveland Clinic, 2023). The gut microbiome is becoming a new tool for managing depression. Probiotics are considered safe-to-use supplements (National Center for Complementary and Integrative Health), and their effectiveness depends on their colonization (Han, 2021), which can be challenging to achieve. Probiotics require creating an environment that promotes their growth and division, which can only be possible by investing in high-quality organic food, nutrition, water, and prebiotics. However, the quality of organic food may be declining due to soil health, a decline in nutrient density, and poor water quality. If our food lacks nutrients, then it is challenging to provide the necessary “food” for probiotics; thus, they don’t stay. Prebiotics, the food source for probiotics, can be a good alternative to investing in high-quality food (Children’s Hospital of Philadelphia). Before using probiotics, we should evaluate whether we can reasonably maintain the “food” for probiotics so it does not go to “waste” after we finish the bottle. It’s essential to prioritize the health of our microbiome by providing them with the environment and nutrients they need to thrive. Conclusion Research can help us change the composition of our microbiomes with expectations for health benefits. Increased anger, irritability, lack of focus on a particular topic, and sadness are signs of depression. High-conflict individuals are often prescribed drugs that target the increase of serotonin in the brain. However, research shows that 90% of serotonin is produced in the gut and can effectively manage stress and happiness in healthy individuals. This is why maintaining a diverse abundance of good bacteria can be life-changing for individuals with depression. Factors such as genetics, diseases, drugs, geographic location, lifestyle, and diet can all affect our microbiome. However, we do have some knowledge about the link between microbiomes and mental health. Focusing on specific nutrition can improve our gut feelings and promote more positive emotions. We can use particular nutrition to optimize our gut feelings from negative