IN RE: Yahveh–Nasir Hazekiah G.1 (2013)

MEMORANDUM OF DECISION

On March 6 of this year, the Commissioner of Children and Families filed a petition pursuant to General Statutes § 46b–129 alleging that the above-named minor child was neglected by being denied proper care and attention and being permitted to live under conditions injurious to his well-being.²  At the same time, the Commissioner sought and obtained an order of temporary custody (OTC) under § 46b–129.³  Both parents appeared for the preliminary hearing on the OTC, were advised of their rights and appointed counsel, and entered denials to the allegations of the petition.   Thereafter, the Commissioner filed a motion to place the child with paternal relatives living in Georgia, and hearing on that motion was consolidated with trial of the neglect petition, heard before this judge on multiple dates between August 22 and December 11.   Both parents appeared with their attorneys for the commencement of trial, as did counsel for the minor child, a social worker employed by the Department of Children and Families (“DCF” or “the department”), and an assistant attorney general representing the Commissioner.   The respondent father then entered a plea of nolo contendere to one count of the neglect allegations, but his attorney has remained and participated in matters related to disposition.

At trial of this matter, the court heard testimony from the following witnesses:

New Britain police officers Michael Hunt, Joseph Halt, Allan Raynis, Ramon Reyes, and David Tvardzik;

The respondent father's adult probation officer, Dawn Wascyna;

The mother's therapist, Theresa Clark, a licensed marital and family therapist;

The mother's first husband, Kelby Escotto;

Visitation supervisor Christine Carlino;

Dr. Eric Frazier, Psy.D., a clinical psychologist who performed psychological evaluations of the parents and a parent-child interactional assessment in earlier child protection proceedings regarding their older biological child, to whom their parental rights were later terminated;  and

DCF social worker Loisa Torres.

In addition, the parties introduced certain exhibits into evidence, and the court has taken judicial notice of the Juvenile Court files for both of the parents' children, orders contained therein, and other court files involving family matters between the parents.

A

Adjudicatory Phase

Trial of a neglect petition has two phases, adjudication and disposition.   Under Practice Book § 35a–7(a), in the adjudicatory phase of the proceeding, “the judicial authority is limited to evidence of events preceding the filing of the petition or the latest amendment, except where the judicial authority must consider subsequent events as part of its determination as to the existence of a ground for termination of parental rights.”   For an adjudication of neglect, the Commissioner must prove at least one of these grounds alleged in the petition by a fair preponderance of the evidence.

As Yahveh–Nasir Hazekiah was only two days old and still in the hospital when the Commissioner sought the OTC, the accompanying petition was necessarily grounded on the doctrine of predictive neglect, which our Supreme Court has recently explained as follows:  “[t]he [petitioner in a neglect proceeding], pursuant to [§ 46b–120], need not wait until a child is actually harmed before intervening to protect that child ․ This statute clearly contemplates a situation where harm could occur but has not actually occurred.   Our statutes clearly and explicitly recognize the state's authority to act before harm occurs to protect children whose health and welfare may be adversely affected and not just children whose welfare has been affected ․ The doctrine of predictive neglect is grounded in the state's responsibility to avoid harm to the well-being of a child, not to repair it after a tragedy has occurred ․ Thus, [a] finding of neglect is not necessarily predicated on actual harm, but can exist when there is a potential risk of neglect.”  (Emphasis omitted.)   In re Joseph W., 305 Conn. 633, 644–45, (2012), quoting In re Kamari C. L., 122 Conn.App. 815, 825, cert. denied, 298 Conn. 297, 5 A.3d 487 (2010).   In such a case, the petitioner must prove “that it is more likely than not that, if the child remained in the current situation, the child would be ‘denied proper care and attention, physically, educationally, emotionally or morally’;  ․ or would be ‘permitted to live under conditions, circumstances or associations injurious to the well-being of the child or youth ․’ [I]n neglect proceedings involving the doctrine of predictive neglect, the petitioner is required to meet this standard with respect to each parent who has contested the neglect petition and who has expressed a desire, or at least a willingness, to care for the child independently of the other parent.”   (Citations omitted;  emphasis omitted;  internal quotation marks omitted.)   In re Joseph W., supra, 305 Conn. 646.

For purposes of a neglect adjudication, the evidence readily meets this standard with regard to the mother.   There is a long history of domestic violence inflicted by the respondent father against the respondent mother, who began their intimate relationship in approximately 2002 and were married in 2007.   Ms. G. lost custody of her two oldest children from a previous marriage to their father in large part because of the ongoing violence between Mr. G. and her.   Mr. G. has been incarcerated at least three times for domestic violence against her, including a sentence of two years in 2009.   As recently as the October before Yahveh–Nasir Hazekiah was born, Mr. G. was arrested and incarcerated for threatening to kill her and her unborn child.   When the child was born, Mr. G. had just recently been released from jail for the October 2012 incident, and he had moved back in with Ms. G. Between the time of the October 2012 incident and the child's birth, Ms. G. “repeatedly minimized the domestic violence issues” when talking with DCF staff.   Petitioner's exhibit 1, social worker affidavit dated March 6, 2013, at 4. Speaking with DCF social worker Torres three days before Yahveh–Nasir Hazekiah was born, Mr. G. also “minimized the domestic violence incidents and his incarceration.   He reported he would not be in jail if mother did not file a report with the police.”  Id., 7. When asked about the domestic violence incidents for which he had been arrested and incarcerated, he “maintained[ed] that mother made them up.”   Although Ms. G. acknowledged to Dr. Frazier in October 2012 that the domestic violence with her husband had emotionally affected Christopher, she told both DCF and hospital workers after Yahveh–Nasir Hazekiah was born that she planned to continue her relationship with her husband and to live with him and the baby as a family.  Id.

In addition, Ms. G. has “a significant history of mental health problems.”   Petitioner's exhibit 3, psychological evaluation of Dr. Eric Frazier, dated 11/6/12, at 10.   Probably the most significant mental health issue, for child protection purposes, is Dr. Frazier's diagnosis of her as having a personality disorder characterized by “very idiosyncratic, rigid thinking,” which Dr. Frazier described at trial as “her tendency to ignore certain information and lean in towards idiosyncratic information [that] undermines her ability to provide care for the child in line with his developmental needs.”   Transcript, 11/14/13, at 24.   He explained his diagnosis as follows:

“[P]ersonality disorders by their nature are character or logical weaknesses and deficits that are enduring in nature, which means that they tend not to dissipate in terms of their symptomology.   And I can say that within psychological certainty that those relative deficits would likely continue ․ What I believed warranted this diagnosis was essentially her ongoing and pervasive beliefs that she knew better than other professionals and her way was the best way, in spite of other information, and her myopic thinking in terms of some of the parenting decisions that she was making.   And that was the basis for my rendering of that diagnosis;  really, the inflexibility that she demonstrated over a significant period of time in light of the fact that she was also given objective information from multiple professionals on some of these central parenting issues in this case.

Id., 51–53.   Dr. Frazier was thus concerned that she would ignore recommendations and suggestions of pediatricians and other professionals with specialized knowledge because of her own beliefs.   For example, for more than a year she ignored a recommendation from the pediatrician of her older autistic child Christopher that she take that child to a developmental pediatrician.   Although Dr. Frazier initially provided that testimony in response to a question about Ms. G.'s ability to care for Christopher, he made clear at trial that he regarded this tendency as also negatively affecting her ability to care for Yahveh–Nasir Hazekiah.⁴

The other significant mental health issue affecting Ms. G.'s ability to care for her son when the neglect petition was filed was her long-standing “anxiety in which she experiences clinical symptoms causing her frequent distress.”   Petitioner's exhibit 3, at 10.   Her therapist, Theresa Clark, had reported to Dr. Frazier that their therapy “mainly focused on ‘decreasing anxiety to control panic;’ id.;   and that Ms. G. was actively participating in and making progress in treatment.   But Ms. G. told Dr. Frazier in October 2012, when he interviewed her for the psychological evaluation conducted in Christopher's case, that she still had monthly panic attacks that “can temporarily destabilize her,” and she described for him a panic attack that occurred in September 2012 during which “she ‘thought I was going to pass out, getting out of breath, and my heart was palpitating.’  “ Id. Dr. Frazier thus concluded in October 2012 that “even with treatment [her] symptoms have persisted through the present time though with relative improvement.”  Id.

This and the other evidence presented at trial were more than sufficient to meet the Commissioner's burden of proof for an adjudication of neglect on both grounds alleged in the petition.   Our legislature has found that “family violence can result in abuse and neglect of the children living in the household where such violence occurs and that the prevention of child abuse and neglect depends on coordination of domestic violence and child protective services.”  General Statutes § 17a—106b(a).   At trial, Dr. Frazier credibly described the harmful effects to a child of being exposed to domestic violence:

Q What would be the impact of domestic violence of—within the home on—on an infant?

A So one of the primary concerns is that it results in trauma because it creates a level of stress response in a child, fear, and that can have, we know now from the research, significant implications on brain development.   And infants and young children can develop PTSD symptoms at a very early age and then that goes on to disrupt their appropriate and normal pathway of development if it's not addressed.

Transcript, 11/14/13, at 28.  “It well-acknowledged that domestic violence can have a negative impact upon children living in a household where such violence occurs.”   In re Yadiel C., Superior Court for juvenile matters at Waterbury, docket number U06CP07006203A (August 8, 2013) (N. Rubinow, J.) See also In re Zachariah M., Superior Court for juvenile matters at Fairfield, docket number CP12009556A, 54 Conn. L. Rptr. 442 (August 6, 2012) (Stevens, J.) (holding that “[a] finding of neglect can be established by evidence proving that a parent has failed to prevent a child from being exposed to domestic violence”);  In re Jordan A., Superior Court of Connecticut, Judicial District of Windham, docket number W10CP1316369A (September 9, 2013), (Dyer, J.);   Malekahmadi v. Katz, Superior Court, judicial district of New Britain, Docket No. CV 11 06011239 (May 23, 2012, Cohn, J.);   and In re James W., Superior Court for juvenile matters at Waterford, docket number K09 CP 09 012079 (September 20, 2010, (Driscoll, J.).   The ongoing domestic violence and Ms. G.'s unwillingness to recognize its risks for her child, combined with her mental health issues, which though being treated still presented risk issues for the child, established by a fair preponderance that the child would have been neglected by being denied proper care and attention and permitted to live under conditions injurious to his well-being if left in Ms. G.'s care.   The father's plea of nolo contendere supports a neglect adjudication with regard to him.

B

DISPOSITIONAL PHASE

“After an adjudication of neglect, a court may (1) commit the child to the Commissioner, (2) vest guardianship in a third party or (3) permit the parent to retain custody with or without protective supervision.  General Statutes § 46b–129(j).”  In re Brianna C., 98 Conn.App. 797, 804, 912 A.2d 505 (2006).  “In determining the disposition portion of the neglect proceeding, the court must decide which of the various custody alternatives are in the best interest of the child.   To determine whether a custodial placement is in the best interest of the child, the court uses its broad discretion to choose a place that will foster the child's interest in sustained growth, development, well-being, and in the continuity and stability of [the child's] environment.”  (Internal quotation marks omitted.)  In re Ja-lyn R., 132 Conn.App. 314, 323–24, 31 A.3d 441 (2011).   As this court has noted many times, the best interest standard governing dispositions in neglect proceedings is inherently flexible and fact-specific to each child, giving the court broad discretion to consider all the different and individualized factors that might affect a specific child's welfare.   In the dispositional phase of the proceeding, the court may consider all the evidence through the close of evidence.

Ms. G. has a long history of using marijuana to cope with her feelings of depression and stress, but there was not enough admissible evidence, as of the adjudicatory date, to consider this history as a basis for the adjudication of neglect.   Prior to the adjudicatory date, Ms. G. had denied the use of marijuana since approximately 2010.   In the months before the OTC, Mr. G. reported to DCF that Ms. G. was again using marijuana.   Ms. G. denied both to Dr. Frazier and her own therapist that she had resumed using marijuana, but, at the time of the 2012 psychological evaluation, Dr. Frazier rationally and credibly concluded that, in light of her lengthy history of marijuana use, Ms. G.'s denial “should be verified in terms of her self-reported abstinence because it was—it was a significant risk factor.”   Transcript, 11/14/13, at 29.   A drug screen done by her doctor at DCF's request in February 2013, had been negative.

After the filing of the petition, however, the evidence showed that ongoing substance abuse continues to remain a problem.   She had a positive hair test showing use of marijuana and OxyContin in April of this year.   In October of this year, during the trial of these matters, Ms. G. admitted to DCF social worker Torres she was still using marijuana (although she claimed that her usage was decreasing).   Social worker Torres asked her to participate in another hair test, and Ms. G. agreed to do so, but she then missed three separate appointments;  and her failure to attend those appointments discredits her claim to Torres that her substance abuse was declining.

Her continuing marijuana use, whether sporadic or continuous, is a valid basis both for rejecting Theresa Clark's opinion in early March that “mother would be okay with the baby”;  petitioner's exhibit 1, at 5;  and for worrying about the baby's safety if left in Ms. G.'s care.   As Dr. Frazier explained at trial, marijuana use “can create an effect on mood ․ resulting in irritability, again, heightened stress, obviously create dependency which we know, which is the desire to use a greater amount.   And it can impair judgment ․ [A]n infant is at a developmental stage where they need around the clock care with a parent who is completely lucid to provide the best care and introducing a substance that has the significant risk for one, disregulating mood and creating irritability, and secondly, impairing judgment could result in a situation where an infant would be uncared for, harmed, or worse.”   Transcript, 11/14/12, at 30–31.

The evidence also shows that her “rigid, idiosyncratic” thinking continues to manifest itself in ways that pose a risk to her child.   During visitations, for example one time she placed a home remedy containing honey on the baby's tongue and another time she rubbed VapoRub on the baby's chest.   Both times she ignored the advice of DCF staff about safe practices with infants because she believed that she knew better than the social workers about what was best for her son.   In each instance, she potentially jeopardized her son's health and well-being.   Her failure to heed that advice typifies the rigidity of thinking and unwillingness or inability to follow the directions and advice of others that Dr. Frazier concluded was his basis for diagnosing her with a personality disorder.   According to Dr. Frazier, moreover, “in general, personality disorders are the most treatment-resistant disorders and the prognosis tends to be unfavorable for them.   And this is because people that have these kinds of features and symptoms don't agree with that opinion and that creates a conflict in the therapeutic relationship, the trust and the alliance that's central to an appropriate and useful therapeutic relationship ․ I'm not saying that it's untreatable, I'm saying that it's very challenging and very difficult and the research supports the understanding that the prognosis is poor.”   Transcript, 11/14/13, at 54.   Dr. Frazier did testify that individual therapy, in which Ms. G. is engaged with Theresa Clark is the “indicated” method of treatment of people with personality disorders.   See id., at 53.   He also testified, however, that successful treatment in therapy requires a patient to disclose fully and openly with the therapist,⁵ and the evidence shows that until now Ms. G. has not done so.  (For example, she withheld her marijuana use from Clark and did not tell her about certain domestic violence incidents.)

The evidence suggests some progress on Ms. G.'s part in addressing domestic violence, however.   The mother and father no longer live together, the father has instituted a divorce action, Ms. G. has twice filed for restraining orders against her husband, and she has made numerous complaints to the police about him.   Her therapist Theresa Clark testified that she believes Ms. G. now recognizes and understands the cycle of domestic violence and has learned how to avoid it.   DCF has made a referral for Ms. G. to participate in additional domestic violence services at Prudence Crandall, and those services began in October.   On the other hand, Ms. G. has continued to exhibit an interest in Mr. G. that raises questions about whether she has actually severed her emotional ties with him.   For example, she has been observed lingering at DCF after her visits end and before his begin.   During the summer of 2013, she continued to text and follow her husband, even visiting him at the shelter where he was staying.   Although she has filed for two restraining orders, she did not appear at either restraining order hearing.   The Commissioner also introduced evidence about several times when Ms. G. filed police reports complaining about domestic violence but the police decided there was not probable cause for an arrest.   It was difficult to tell from the evidence about these reports whether they represented actual instances of violence or threats, or were instead an effort to Ms. G. to continue to entwine her life with that of her husband.   Whether Ms. G. has in fact extricated herself from a relationship that subjected her and her children to domestic violence will probably only be determined by the passage of time.

The evidence thus shows by a fair preponderance that the best interest of this young child requires his commitment to the Commissioner of Children and Families.   The mother's personality disorder and substance abuse issues remain unabated.   An active threat of domestic violence may, possibly, have subsided, but Mr. and Ms. G. have a long history of separating and reuniting Moreover, Ms. G also has a history of not being honest about her relationship with Mr. G., and her persistent interest in him warrants caution in finding the home atmosphere safe.   Under these circumstances, a prudent concern for the child warrants waiting longer to see if the separation between the parents continues for longer than a few months.

In arriving at the conclusion that the child's best interest is served by committing him to the Commissioner, the court has considered all of the evidence, and has placed special weight on the credibility of the testimony and report of Dr. Frazier, and his conclusion that, at the present, placing the child with Ms. G. would pose a “substantial risk of harm to the child.”   Partial transcript of 11/18/13, at 33.   Although he has not examined Ms. G. for more than a year, and his written report was specifically directed at her ability to care for her older child, his conclusions remain relevant to her ability to do the same for the child under consideration in this proceeding.   His conclusions also provide a context for understanding and evaluating the testimony of the other witnesses.

The department and respondent father have asked the court to approve placing the child out of state with Mr. G.'s brother and sister-in-law in Georgia.   There is a history of domestic violence in that family, but the Georgia child welfare authorities reported that “they have availed themselves [of] services such as anger management classes and in-home counseling when offered” and approved them as a custodial placement under the interstate child placement compact (ICPC).   All three of their children appear to be doing well.   See Petitioner's exhibit 8, Georgia ICPC study, at 8. The respondent mother, on the other hand, asks the court to deny the interstate placement so that she may work toward reunification.   All parties agree that placing the child with the paternal relatives would effectively dash any hopes of Ms. G. for reunification.   The child's own interest in stability and permanency would seem to dictate against disrupting him from the placement where he has lived virtually his entire young life, but placement with relatives would, on the other hand, serve his interests in maintaining connections with his biological family should reunification with one of his parents not prove feasible.

The evidence on the feasibility of reunification with Ms. G. is distinctly mixed and, on balance, probably weighs against such a prospect.   On the one hand, the court found credible the testimony of social work case aide Carlino, who has attended most of Ms. G.'s visits with Yahveh–Nasir Hazekiah, and testified that, except for the honey and VapoRub incidents, in her interactions “mom was very good with the baby.”   Transcript, 9/27/13, at 41.   On the other hand, the prognosis for successful treatment of her personality disorder, so that she no longer substitutes her own “idiosyncratic” views for the considered opinions of her children's doctors and other professionals, is poor, particularly in view of her unwillingness thus far to be honest and forthcoming with her therapist.   But therapy has been somewhat successful in helping her anxiety and depression, and until now has not sought to address Ms. G.'s personality disorder.   In view of the mother's partial, although incomplete success on the domestic violence and mental health issues and the child's interest in stability, the court does not find it to serve the child's best interest to remove the child from the only home he has ever known, with the only caregivers he has ever had, and thereby cut off the mother's prospects of working for reunification.   The motion to approve out-of-state placement is thus denied at this time, without prejudice to reconsideration later.

C

CONCLUSION

The child is found to have been neglected and adjudicated thusly.   The Commissioner proved by a fair preponderance of the evidence that if the child remained in the custody of the mother, the child would be “denied proper care and attention, physically, educationally, emotionally or morally” and would be “permitted to live under conditions, circumstances or associations injurious to the well-being of the child.”   The father's plea of nolo contendere to the conditions injurious allegation of the petition is sufficient to find that it is more likely than not that the child would have been neglected if placed in the custody of the father.   The petitioner further proved by a fair preponderance of the evidence that it is the child's best interest to be committed to the Commissioner.   The petitioner's motion for out-of-state placement is denied.

The general statutes require a court, when committing a neglected child to the Commissioner of Children and Families, to order “specific steps that the parent must take to facilitate the return of the child or youth to the custody of such parent.”  General Statutes § 46b–129(j)(3).   To comply with that requirement, the clerk shall schedule a case status conference followed by an in-court review for purpose of the court adopting specific steps the parents should take in order to seek reunification with the child.

BY THE COURT

STEPHEN F. FRAZZINI

JUDGE OF THE SUPERIOR COURT

FOOTNOTES

FN2. General Statutes § 46b–129 provides, in relevant part, as follows. “(a) [T]he Commissioner of Children and Families, having information that a child or youth is neglected, uncared-for or abused may file with the Superior Court that has venue over such matter a verified petition plainly stating such facts as bring the child or youth within the jurisdiction of the court as neglected, uncared-for or abused within the meaning of section 46b–120 ․” General Statutes § 46b–120 provides, in relevant part, as follows “(6) A child or youth may be found “neglected” who, for reasons other than being impoverished, ․ (B) is being denied proper care and attention, physically, educationally, emotionally or morally, or (C) is being permitted to live under conditions, circumstances or associations injurious to the well-being of the child or youth ․”.  FN2. General Statutes § 46b–129 provides, in relevant part, as follows. “(a) [T]he Commissioner of Children and Families, having information that a child or youth is neglected, uncared-for or abused may file with the Superior Court that has venue over such matter a verified petition plainly stating such facts as bring the child or youth within the jurisdiction of the court as neglected, uncared-for or abused within the meaning of section 46b–120 ․” General Statutes § 46b–120 provides, in relevant part, as follows “(6) A child or youth may be found “neglected” who, for reasons other than being impoverished, ․ (B) is being denied proper care and attention, physically, educationally, emotionally or morally, or (C) is being permitted to live under conditions, circumstances or associations injurious to the well-being of the child or youth ․”

FN3. General Statutes § 46b–129 provides, in relevant part, as follows “(b) If it appears from the specific allegations of the petition and other verified affirmations of fact accompanying the petition and application, or subsequent thereto, that there is reasonable cause to believe that (1) the child or youth is suffering from serious physical illness or serious physical injury or is in immediate physical danger from the child's or youth's surroundings, and (2) that as a result of said conditions, the child's or youth's safety is endangered and immediate removal from such surroundings is necessary to ensure the child's or youth's safety, the court shall either (A) issue an order to the parents or other person having responsibility for the care of the child or youth to appear at such time as the court may designate to determine whether the court should vest the child's or youth's temporary care and custody in a person related to the child or youth by blood or marriage or in some other person or suitable agency pending disposition of the petition, or (B) issue an order ex parte vesting the child's or youth's temporary care and custody in a person related to the child or youth by blood or marriage or in some other person or suitable agency.”.  FN3. General Statutes § 46b–129 provides, in relevant part, as follows “(b) If it appears from the specific allegations of the petition and other verified affirmations of fact accompanying the petition and application, or subsequent thereto, that there is reasonable cause to believe that (1) the child or youth is suffering from serious physical illness or serious physical injury or is in immediate physical danger from the child's or youth's surroundings, and (2) that as a result of said conditions, the child's or youth's safety is endangered and immediate removal from such surroundings is necessary to ensure the child's or youth's safety, the court shall either (A) issue an order to the parents or other person having responsibility for the care of the child or youth to appear at such time as the court may designate to determine whether the court should vest the child's or youth's temporary care and custody in a person related to the child or youth by blood or marriage or in some other person or suitable agency pending disposition of the petition, or (B) issue an order ex parte vesting the child's or youth's temporary care and custody in a person related to the child or youth by blood or marriage or in some other person or suitable agency.”

FN4. In response to a question from the assistant attorney general as to whether “your recommendations solely focus on Christopher's particular needs or any child that would have—would be subject to her custody and care and control,” Dr Frazier answered as follows:  “Well, again, the answer is both because with respect to Christopher's needs, some of my recommendations and opinions are specific to the—the uniqueness of his clinical disorder and needs of that.   Overarching that is essentially any child's needs for proper safety, care and concern.   And where this dovetails again is the inability to accept professional feedback, such as coming from a pediatrician, which any child will—would go to for routine care and the deviancy from best practice that introduces a substantial risk ․” Transcript, 11/14/13, at 26..  FN4. In response to a question from the assistant attorney general as to whether “your recommendations solely focus on Christopher's particular needs or any child that would have—would be subject to her custody and care and control,” Dr Frazier answered as follows:  “Well, again, the answer is both because with respect to Christopher's needs, some of my recommendations and opinions are specific to the—the uniqueness of his clinical disorder and needs of that.   Overarching that is essentially any child's needs for proper safety, care and concern.   And where this dovetails again is the inability to accept professional feedback, such as coming from a pediatrician, which any child will—would go to for routine care and the deviancy from best practice that introduces a substantial risk ․” Transcript, 11/14/13, at 26.

FN5. In response to the question of “would there be a concern if the therapist is not receiving all of the information from Mrs. G. about her current physical, as well as mental health, well being?”   Dr Frazier answered as follows.  “Well, there certainly could be.   So, the fundamental premise of the potential gains from psychotherapy significantly rest upon what's called a therapeutic alliance.   And, not to get too technical, but, essentially it just basically means that the client trusts the therapist, and the therapist is aware and mindful of that trust that the client is imparting upon the therapist.   And, having that level of confidence and trust allows issues, concerns, problem areas, tragedies, to be discussed with a degree of openness with the expectation that the therapist will provide feedback.   Absent that, it's putting at least one hand behind the back of the therapist, as a metaphor, to be able to serve in their role functionally.”   Partial transcript of 11/18/13, at 10–11..  FN5. In response to the question of “would there be a concern if the therapist is not receiving all of the information from Mrs. G. about her current physical, as well as mental health, well being?”   Dr Frazier answered as follows.  “Well, there certainly could be.   So, the fundamental premise of the potential gains from psychotherapy significantly rest upon what's called a therapeutic alliance.   And, not to get too technical, but, essentially it just basically means that the client trusts the therapist, and the therapist is aware and mindful of that trust that the client is imparting upon the therapist.   And, having that level of confidence and trust allows issues, concerns, problem areas, tragedies, to be discussed with a degree of openness with the expectation that the therapist will provide feedback.   Absent that, it's putting at least one hand behind the back of the therapist, as a metaphor, to be able to serve in their role functionally.”   Partial transcript of 11/18/13, at 10–11.

Frazzini, Stephen F., J.