Medical Branch Clinic, Naval Hospital, Jacksonville, Fla.

J Am Board Fam Med. 2001;14(3) 

In This Article

Treatment and Interventions

Most agree that parenting should be the first focus for children of divorcing families. When parents are at odds, it is important that there be a neutral third party to mediate disputes, defuse conflicts, and encourage cooperation. Divorce mediation has been shown to decrease interpersonal conflicts between the parents. Mediation focuses on the family as a system that is reorganizing and forming a new structure. Couples who used a neutral third party to resolve conflicts about financial and custodial arrangements were more likely to be communicating on a weekly basis after divorce.[6]

Counseling both parents and children before the divorce was believed to help in the transition at the time of separation. Other therapists have counseled each parent with the children, because this combination more accurately modeled the post-divorce relationships and family structure. Individual therapy for a parent with specific concerns or problems can also be useful in some cases. Counseling children individually is considered a last resort, appropriate only when the parents cannot or will not participate. All these interventions, however, have shown little, if any, effectiveness.

Group therapy for children in the form of peer-support groups focused on divorce has been consistently effective in studies to date. The most clearly and uniformly effective intervention has been divorce mediation. Resolving conflict between the two parents is the greatest stress reducer in divorce for both the parents and the children.

Parents often refuse counseling and mediation because of financial concerns. Physicians must intervene for the sake of the entire family, but especially for the children. Parents embroiled in a bitter and difficult divorce must be helped to see that the initial costs of counseling and mediation will be recouped. Parents should be encouraged to view their relationship as a neutral business-like partner-ship with the children as their joint investment. Divorced parents can benefit from clear rules on visitation, discipline, holidays, finances, and other issues. Clear regulations avoid conflict and decrease contact.[7,14] When contact is necessary, it can be civil, polite, and time-limited, much as in a business relationship.

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