Two Diagnostic Models: Your Choice

You need to be an informed consumer of mental health services. These are your children and it is your family.  Which diagnostic model is used with your children and with your family is your choice.

So let’s compare.

There are currently two diagnostic models for determining the cause of a child’s rejection toward a parent surrounding divorce, the 8-symptom Gardnerian PAS diagnostic model, and the three-symptom AB-PA diagnostic model. They are assessed in different ways, and they lead to different outcomes.

The 8-symptom Gardnerian PAS diagnostic model has been applied for the past 35 years. It is the current diagnostic model being used. It is responsible for the current situation. If you want to see what the Gardnerian 8-symptom diagnostic model leads to, just look around… we’ve been using the 8-symptom Gardnerian PAS diagnostic model for 35 years, and it is currently the most prevalent diagnostic model being used to assess the pathology of “parental alienation” (attachment-related family pathology surrounding divorce).

AB-PA: The AB-PA diagnostic model was first described by Childress in Foundations (2015). It is mostly unknown in professional psychology, but it is rapidly gaining awareness in professional psychology.

As evidence of this increasing awareness, Dr. Childress has already conducted a six-session treatment focused assessment by court order (conducted across three consecutive days of clinical assessment sessions with the family; and a turn-around time for the treatment focused assessment report to the court in less than two weeks). An AB-PA pilot program for the family courts is also currently available in Houston, Texas; with 15 AB-PA knowledgeable mental health professionals trained to administer the six-session treatment focused assessment protocol, trained to manage the Strategic family systems intervention of a Contingent Visitation Schedule, and knowledgeable in solution-focused family therapy (Minuchin, Bowen, Berg) for stabilizing the post-divorce separated-family structure, along with 10 AB-PA knowledgeable amicus attorneys to coordinate family treatment with court orders and court support.

The three-symptom AB-PA diagnostic model represents change.

The AB-PA diagnostic model represents the application of the highest caliber of professional knowledge (Bowlby, Minuchin, Beck) and standards of practice to the assessment, diagnosis, and treatment of attachment-related family pathology surrounding divorce.

The 8-symptom Gardnerian PAS diagnostic model is based on the proposals of one man, a psychiatrist in the 1980s, that there exists a “new form of pathology” unique in all of metal health, so unique that this “new form of pathology” needs its own unique new set of symptoms unlike any other symptoms for any other pathology in all of mental health, eight symptoms made up 35 years ago, in the 1980s, by this one psychiatrist .

The three diagnostic indicators of AB-PA are based in the standard and established constructs and principles of professional psychology; Bowlby, Minuchin, Beck; the attachment system, personality disorder pathology, family systems therapy.

The 8-symptom Gardnerian diagnostic model is assessed using a six to nine month child custody evaluation costing $20,000 to $40,000.

The three diagnostic indicators of AB-PA (an attachment-based model for the pathology) are assessed in six sessions for around $2,500.  All three symptoms of AB-PA are standard symptoms fully within the existing scope of practice for all mental health professionals to identify.

When the three diagnostic indicators of AB-PA are present in the child’ symptom display, the DSM-5 diagnosis is V995.51 Child PsychologicaL Abuse, Confirmed.

When the 8-symptom Gardnerian PAS diagnostic model is used, this does NOT lead to a DSM-5 diagnosis of Child Psychological Abuse. The 8-symptom Gardnerian PAS diagnostic model does NOT result in a DSM-5 diagnosis of Child Psychological Abuse.

The 8-symptom Gardnerian PAS diagnostic model requires that targeted parents prove “parental alienation” through a court trial. It is in the two year run-up period to the trial that the child custody evaluation is typically ordered.

Since child custody evaluations take six to nine months to complete, this typically extends the time needed to obtain the court trial that’s needed to prove “parental alienation” using the 8-symptom Gardnerian PAS diagnostic model to about two years, or longer, from the start of the pathology (six months to get the court order for the custody evaluation, nine months for the custody evaluation to be completed, and three to six months to schedule the trial).  Assuming there aren’t court scheduling delays or delay tactics used by the allied narcissistic-borderline parent, the minimum anticipated time before trial is two years, and it often takes closer to three to five years before trial due when court delays and delay tactics by the allied narcissistic-borderline parent are factored in.

With the three diagnostic indicators of AB-PA, the pathology can be assessed by a mental health professional in six sessions.  This means that the time frame for an assessment and report to the court can be as short as two weeks, and typically not longer than 8 weeks.  Because the AB-PA diagnostic model returns a confirmed DSM-5 diagnosis of V995.51 Child Psychological Abuse, the start of treatment, including a possible protective separation of the child from the pathogenic parenting of the allied narcissistic-borderline parent, can begin within months of the start of the pathology.

With the 8-symptom Gardnerian PAS model (the one currently being used throughout psychology), it typically takes at least two years and over $100,000 in legal costs before even reaching the point where a decision is made by the court… and who knows what the custody evaluator will decide and then what the court will decide.

Typically the initial custody report returns a vague “both parents are contributing” analysis and conclusion (it’s a safe middle-of-the road position), with a recommendation for no change in the current de facto sole custody to the allied parent that is created by the child’s rejection of the targeted parent, and a recommendation for “reunification therapy” between the child and targeted parent to rehabilitate their relationship (that’s being damaged by the allied parent).

After a year of utterly failed “reunification therapy” in which the severity of the child’s rejection of the targeted parent has become more severe and more fully entrenched, a second “follow-up” custody report is usually ordered, typically with the same evaluator because it’s assumed the prior knowledge of the evaluator with this family will be useful. However, this assumption is usually not warranted. If the mental health professional doesn’t have the knowledge needed to correctly identify the pathology the first time, then the second time is probably not going to be all that different.

The time frame using the 8-symptom Gardnerian PAS diagnostic model becomes:

  • Initial order for a custody evaluation: six months to a year from the start of the pathology (cost: $20,000 to $40,000 per evaluation).
  • Completed custody evaluation: Six to nine months to complete the custody evaluation, typically recommending no-change in the de facto sole custody to the allied parent, and usually recommending “reunification therapy.”
  • “Reunification Therapy”: One year of failed “reunification therapy.”
  • Update custody evaluation: Six months to complete the follow-up custody evaluation, and three months to schedule the court date.

So by the time the trial arrives, it has typically been at least three years since the start of the pathology.

No matter what the outcome at trial, three entire years of the parent-child relationship is lost with the targeted parent. That time can never be recovered no matter what decision is ultimately reached at trial.

In addition, if an ultimate decision is made at trial of “parental alienation,” this means that the child has been abandoned to the pathological parenting of a narcissistic-borderline parent for three entire years of development without the compensating healthy influence of the normal-range targeted parent.  Using the 8-symptom diagnostic model of Gardnerian PAS, the damage and pathology is allowed to continue for three to five years before it is addressed.  The damage is done, and three years of parent-child time with the normal-range, loving and beloved parent, is lost, and can never be recovered.

Because the 8-symptom Gardnerian PAS diagnostic model is assessed using a child custody evaluation and proving “parental alienation” in a court trial, legal costs can often run in excess of $100,000, and often closer to $150,000 through three years of litigation and trial before action is taken to solve the pathology (typically three to five years of litigation is needed before reaching trial).

Dr. Childress: In my view as a clinical psychologist, every cent of this money should go to the child’s college education fund, not to attorneys and child custody evaluators.  In my view as a clinical psychologist, it is both unethical and immoral practice for any psychologist to actively collude with and participate in a process that is known to abandon a child for up to three years with a pathological parent, and that will knowingly drain the family’s money needed for the college education of the child, to pay for the legal and therapy costs imposed by the diagnostic model of the pathology.  When there is a more efficient, successful, and better way, it is the ethical obligation of all psychologists to take this route.

The three diagnostic indicators of AB-PA are made by a mental health professional within six to eight weeks of the initial identification of the pathology, and it is the DSM-5 diagnosis of V995.51 Child Psychological Abuse from this assessment by a mental health professional that is provided to the court to support the targeted parent’s requests for orders from the court.

With the AB-PA diagnostic model, a confirmed DSM-5 diagnosis for the pathology can be made in six-sessions ($2,500) and the targeted parent, whether represented by an attorney or self-representing pro se, begins the litigation process with a confirmed DSM-5 diagnosis of Child Psychological Abuse for the parenting practices of the allied narcissistic-borderline parent.

Dr. Childress: In my professional view as a clinical psychologist, this is a lock-down reason for selecting the AB-PA diagnostic model. The AB-PA diagnostic model provides (in six assessment sessions) a confirmed DSM-5 diagnosis of Child Psychological Abuse for the pathology.

The 8-symptom Gardnerian PAS diagnostic model does not result in a DSM-5 diagnosis of Child Psychological Abuse (in six to nine months of assessment; $20,000 to $40,000 for just the assessment).

If you use the 8-symptom Gardnerian PAS diagnostic model, the differential diagnosis in the assessment process is a pathology that’s been made up in forensic psychology to coincide with their construct of “parental alienation,” called “justified estrangement.” If targeted use the 8-symptom Gardnerian PAS diagnostic model, they will need to defend themselves against the allegation that the pathology is “justified estrangement,” meaning that the targeted parent “deserves” to be rejected for past parental failures.  When the 8-symptom Gardnerian PAS diagnostic model is used, targeted parents must defend their prior parenting, that they do not “deserve” to be rejected because of their prior problematic parenting (“justified estrangement”)

Since there are no criteria for “justified estrangement,” the mental health professionals assessing for the 8-symptom Gardnerian PAS diagnostic model can find a blend (a “hybrid”) of both “parental alienation” and “justified estrangement” – typically leading to no treatment for the “parental alienation” because the targeted parent is deemed to be partially contributing to their “justified estrangement.”

In the AB-PA diagnostic model, the presence of the three diagnostic indicators of AB-PA is a confirmed DSM-5 diagnosis of V995.51 Child Psychological Abuse. Period, end of story.  In AB-PA, there is no such thing as “justified estrangement.”

In AB-PA, the construct of “justified estrangement” is called physical and sexual abuse of the child by the targeted parent, and the rule-out diagnosis for the targeted parent is that there is no physical or sexual abuse of the child by the targeted parent, that the parenting practices of the targeted parent are broadly normal-range.

These are not differences of opinion regarding the two diagnostic models, these are the facts surrounding the use of each diagnostic model. You are the parent.  These are your children, and this is your family.  You should be an informed consumer of mental health services.

You are the parent.  The choice as to which diagnostic model you want to ask be applied with your children and with your family is up to you.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 8857

 

The Scientific Method: AB-PA

In my 2008-2010 analysis of the pathology,  I saw how the Gardnerian PAS diagnostic model was attacked as “junk science.”  I knew the pathogen would attack an attachment-based model with the same attack, so an attachment-based model needed to be solidly grounded in the scientific method, and it is.

The good thing about being a scientist is that we can have conversations with science.  She’s really quite helpful and supportive once you get to know her.

I’m a psychologist.  I’m a social scientist.  I’ve had extensive conversations with science over the years.   The key thing with science, is she always wants you to make a prediction that can be verified… or disproven. 

Here is my conversation with science regarding the AB-PA diagnostic model:


Dr. Childress: Science, I need your help.

Science:  What is it?

Dr. Childress: I have information that needs to be grounded in the scientific method, so I want to walk the information through you.

Science: That’s what I’m here for.  What’s the information?

Dr. Childress:  It’s a diagnostic model of pathology.

Science: What is the prediction that the diagnostic model makes?

Dr. Childress: It makes the prediction that a specific constellation of three highly unusual symptoms will be displayed in the child’s symptoms.

Science:  Okay. The null hypothesis (H0) is that there will not be a specific pattern of symptoms in the child’s symptom display, and the research hypothesis (H1) is that there will be a specific pattern of symptoms in the child’s symptom display.  The dependent variable are the three symptoms predicted by the diagnostic model.  How are you operationalizing the dependent variable, the three symptoms?

Dr. Childress: The criteria for the diagnosis is the presence of three specific symptoms in the child’s symptom display, 1) attachment system suppression toward a normal-range parent, 2) narcissistic personality traits in the child’s symptom display, and 3) an encapsulated persecutory delusion in the child’s symptom display.

Dr. Childress: For the first diagnostic indicator, the operational definition for “attachment system suppression” is a child evidencing a desire to sever the parent-child attachment bond.  The specific evidence are verbal statements by the child indicating a desire to sever the attachment bond to the parent, child behavior indicating a desire to sever the parent-child attachment bond (hostile-rejection or anxious-avoidance), and refusal of opportunities to spend time with the rejected parent.

Dr. Childress: Also for the first diagnostic indicator, the operational definition for “normal-range parent” is a category rating of Level 3 or Level 4 on the Parenting Practices Rating Scale.  This category rating is a clinical judgement by the mental health professional based on the clinical data from the family.

Science: Those are fine.

Dr. Childress: For the second diagnostic indicator, the narcissistic personality traits, the diagnostic model predicts five specific narcissistic personality disorder traits in the child’s symptom display, 1) grandiosity, 2) absence of empathy, 3) entitlement, 4) haughty arrogance, and 5) splitting.  The operational definitions for these symptoms is provided by the American Psychiatric Association in their diagnostic criteria.

Science:  Those are fine.

Dr. Childress: The operational definition for the third criteria of an encapsulated persecutory delusion is provided by the American Psychiatric Association in their diagnostic criteria.  On the Brief Psychiatric Rating Scale, the child’s delusion belief would be rated a 4 or a 5.

Science.  That’s fine.  Your structure is grounded.  Your operational definitions are grounded. 

Science: Describe the research hypothesis, (H1), why does the diagnostic model predict this set of symptoms, and why does this set of symptoms support this diagnostic model?

Dr. Childress:  The diagnostic model is grounded in the work of Bowlby (attachment), Minuchin (family systems), and Beck (personality disorder), as well as the entire professional literature from these domains of professional knowledge.  The diagnostic model is described in the book Foundations, which describes the pathology at three separate and integrated levels of analysis, 1) family systems level, 2) personality disorder level, 3) attachment trauma level.  Beyond describing these three independent levels of analysis for the pathology, the description of the pathology is integrated across all three levels, explaining all of the interactions of these three factors. The diagnostic model explains:

  • How the attachment pathology creates the personality disorder pathology;
  • How the personality disorder pathology then creates the family systems pathology;
  • How the attachment pathology creates the family systems pathology;
  • How the family systems pathology creates the attachment pathology;
  • How the personality pathology creates the attachment pathology;
  • How the family systems pathology triggers the personality pathology.

Dr. Childress: The three symptoms predicted from the diagnostic model are each highly unusual individually;

1.) Attachment Suppression: Suppression of a child’s attachment bonding motivations toward a parent is extremely rare (associated only with sexual and physical child abuse), and is an impossible symptom toward a normal-range parent.

2.) Personality Disorder Traits: The presence of five narcissistic personality traits in a child’s symptom display is rare. Children typically do not display personality disorder pathology. This symptom indicator is strengthened within the diagnostic model by requiring multiple narcissistic symptoms (5; the threshold for a DSM-5 diagnosis of a personality disorder) and by specifically identifying which five narcissistic symptoms will be evidenced.  There is only one plausible explanation for the presence of narcissistic personality traits in the child’s symptom display, i.e., the psychological influence and psychological control of the child by a narcissistic parent, that it is the parent’s narcissistic traits toward the other spouse-and-parent that the child is acquiring and expressing.

3.) Persecutory Delusion: This is an impossible symptom. It is impossible for a child to develop a persecutory delusion toward a normal-range parent.  Yet the diagnostic model predicts that this impossible symptom will be present in the child’s symptom display.  Children never spontaneously develop an encapsulated persecutory delusion toward a normal-range parent; it is impossible for a normal-range parent to create an encapsulated persecutory delusion in the child.

Science: The structure of the design is a three-way interaction of independent variables. The independent variables are correlated; statistical analysis considerations apply regarding correlated independent variables.  The levels of the independent variables are outside of experimental manipulation, so the design is a quasi-experimental, natural groups design.

Dr. Childress: Since this is a diagnostic model not a research design, do I need to measure the levels of the independent variables?

Science: No.  The presence of the three diagnostic indicators will confirm the diagnostic model that predicted the presence of these symptoms.

Dr. Childress: What is the scientific strength of this diagnostic protocol?

Science: Confirmation of predictions made by a three-way interaction of variables represent extremely strong confirmation of the diagnostic model making the prediction (H1). If the three a priori predicted symptoms from a three-way interaction are found, this data would confirm the causal attributions of the model.  A three-way interaction of variables means developing alternative explanatory models is extremely unlikely.

Dr. Childress: So, science… is everything good to go?

Science: Yes. The diagnostic model is structurally sound.  The scientific hypothesis (H1) is that a pattern of three symptoms will be found in the child’s symptom display.  The null hypothesis (H0) is that the three predicted symptoms in the child’s symptom display will not be present. The independent variables are three nominal data categories, family systems pathology, personality disorder pathology, and attachment pathology in the family. The dependent variables are the three symptoms in the child’s symptom display, attachment suppression, specified personality disorder traits, and an encapsulated persecutory delusion.

Science: Since you are not manipulating or measuring levels of the independent variables, this is not a research protocol.  It is a scientifically grounded diagnostic protocol.  The diagnostic model makes predictions that are confirmed or disconfirmed on an individual basis.

Science: Statistical cautions will emerge if the scientific basis of the diagnostic protocol is changed into a research protocol because the three independent variables of the diagnostic protocol are conceptually entangled and correlated with each other.  For a diagnostic protocol, the entanglement of the independent variables is not a relevant issue because the outcome dependent variable (the predicted symptom pattern) provides confirmation for the diagnostic model as a whole.  For a research protocol that examines the relative influence of each independent variable (IV) on the dependent variable (DV), disentangling the constructs for the IV and operationalizing their definition would be required.

Science: The scientific methodology for the diagnostic protocol of the three diagnostic indicators (H1) allows causal statements regarding the origin of the three symptoms when they are present in the child’s symptom display.  The presence of these three symptoms in the child’s symptom display would represent scientifically grounded proof for the causal associations described in the model that predicted these symptoms.

Science: Of note, there are simpler diagnostic models that would be grounded in the scientific method and allow causal diagnostic statements for the child’s symptoms. If attachment system suppression is impossible toward a normal-range parent except in cases of child abuse, then the presence of this single symptom alone, in the absence of child abuse, would represent confirmation for the diagnostic model that predicted this symptom.

Science: Alternatively, if an encapsulated persecutory delusion toward a normal-range parent is impossible, then the presence of this symptom alone in the child’s symptom display would represent confirmation for the diagnostic model that predicted this symptom.

Science:  It is notable that the diagnostic model makes a prediction of all three symptoms being present, and that two of the predicted symptoms are impossible.  Prediction of two impossible child symptoms and one improbable symptom that are then found in the child’s symptom display is solid confirmation for the diagnostic model that made the prediction.

Dr. Childress: What are the limitations to the diagnostic protocol?

Science: First, that the null hypothesis (H0) will be confirmed and the three child symptoms will not be evident in the child’s symptom display. Since two of the diagnostic indicators are impossible (attachment system suppression toward a normal-range parent and an encapsulated persecutory delusion toward a normal-range parent), the likelihood of the null hypothesis is 100%.   These three symptoms should never be found in a child’s symptom display.

Science: If, however, the three symptoms of the diagnostic model are found, then this represents complete confirmation for the diagnostic model that predicted these symptoms, and there exists one method for creating the previously impossible symptoms, the method described by the diagnostic model.

Science: The second limitation is that there may be alternative models that describe the presence of the three symptoms found in the child’s symptom display.  Since the predicted symptoms are the product of a three-way interaction of independent variables, the possibility of an alternative explanatory model are incredibly remote, with a likelihood next to non-existent.

Science: Within the scientific method, when a model has had its predictions confirmed by evidence, it is the responsibility of critics to propose alternative explanations.  Therefore, if the three diagnostic indicators are present in the child’s symptom display, this confirms the diagnostic model that made the prediction of these symptoms and it becomes the responsibility of critics to develop alternative explanatory models (if this is possible). That represents the advancement of knowledge through the scientific method. If alternate explanatory models are proposed, then examination of differing predictions made by the two models can differentiate which one represents an accurate description of the child’s symptoms.

Science: Third, this scientific model is diagnostic, meaning that it is applied one person at a time.  If it is true in one person, that doesn’t mean it exists anywhere else in the world, until the second case, and the third case are found, each having the same pattern of diagnostic indicators.  The prevalence of the pathology is unknown by the diagnostic protocol itself and would require further epidemiological research relative to public health concerns.  A diagnostic protocol only provides information about pathology on a case-by-case basis.

Dr. Childress:  Science, are there additional advantages to the diagnostic protocol.

Science: If the diagnostic model confirmed by the three diagnostic indicators remains undisputed by opposing evidence (an alternative explanation for the three symptoms being present in the child’s symptom display), then the diagnostic model and it’s three operationally defined diagnostic indicators represent an exceptionally good diagnostic independent variable (IV) to include in future research protocols.  Dependent variables (DV) of the investigator’s choice could be examined relative to two groups (2 levels of the IV), those with the three symptoms of the diagnostic model, and those without the three symptoms of the diagnostic model (a 1×2 natural groups design).  Alternatively, differing comparison groups could be selected from families in the foster care system, and families seeking services for school-related child behavior problems (a 1×3 design).  The diagnostic framework itself could be broken down into categories of independent variable (IV), such as families meeting all the criteria (high), families meeting some of the criteria (medium), and families meeting none of the criteria (low).  If a second factor was considered in the research design, such as the gender of the child, that would create a factorial design.  If two levels of the diagnostic category are used (presence-absence of the three symptoms) and two levels of child gender are used, that would create a 2×2 factorial natural groups design.  If three categories of the diagnosis IV were used, such as children in high-conflict divorce, children in the foster care system, and children with school behavior problems, and four levels of a second IV for parent-child relationship type (father-son, mother-son, father-daughter, mother-daughter) the design becomes a 3×4 factorial design.  The increasing number of cells in the factorial design would require larger numbers (N) of research participants for statistical purposes.  Because subjects are not being randomized to conditions, it would not be an experimental design, but would be a quasi-experimental design using naturally occurring groups. Since the diagnostic model is being used in the construction of the independent variable (IV), the nature of the dependent variable (DV) is entirely at the discretion of the investigators.  The DV might be a child characteristic, such as depression or anxiety as measured on various rating scales, or self-esteem as measured by a rating scale, or the child’s emotional and psychological functioning as measured by scores on a standardized projective test (like the Robert’s Apperception Test for Children).  Or the DV might be a quality of the parent’s pathology, such as the degree of splitting or a history of childhood trauma as measured by the Adult Attachment Interview.  Or the DV might be an aspect of the spousal-relationship, as measured by ratings on attachment compatibility and personality scales.  Multiple dependent variables can be included in any design structure, with the increasing number of independent and dependent variables impacting statistical analysis and increasing the number (N) of research participants required and recommended for statistical analysis. The diagnostic model of the three symptoms is a tool in structuring the independent variable (IV) of a research protocol.  How it is used to structure the independent variable (IV) and what dependent variables (DV) are examined are the choice of the investigator.

Science: The diagnostic model can also structure single-case research designs.  For example, treatment protocols using the single-case design could examine response to treatment or alternative treatments. The inclusion criteria into the single-case research would be the three symptom indicators of the diagnostic model.  ABA single case protocols are easily constructed for treatment (baseline data – intervention data – removal of intervention data).  When dealing with the treatment of pathology, the simple ABA protocol that leaves the child in a no-intervention condition is not recommended for ethical reasons.  In treatment related research using the single-case design, the ABAB reversal design is used (baseline-intervention-baseline-intervention; ABAB). 

Dr. Childress: Thank you. So am I good to go?

Science: You’re good to go.


Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

AB-PA and Forensic Psychology: Four Statements

Statement 1: The standards of practice in forensic psychology are substantially below the standards of practice in clinical psychology.

I suspect this statement will draw the ire of my colleagues in forensic psychology.  That’s not important.  The statement is true and needs professional focus and resolution.

Statement 2: The practice of child custody evaluations violates every professional standard of practice for the construction of an assessment procedure.

I suspect this statement will draw the ire of my colleagues who conduct custody evaluations.  That’s not important.  The statement is true and needs professional focus and resolution.

Statement 3: There is no such thing as “reunification therapy.”  It an undefined term for a snake-oil therapy of unknown and undetermined content.

I suspect this statement will draw the ire of my colleagues who conduct court-ordered “reunification therapy.”  That’s not important. The statement is true and needs professional focus and resolution.

Statement 4: The construct of “parental alienation” is disabling the mental health response to the pathology and is beneath professional standards of practice for defining and describing pathology.

I suspect this statement will draw the ire of my colleagues who use the construct of “parental alienation” to guide their practice.  That’s not important.  The statement is true and needs professional focus and attention.

A professional-level description of “parental alienation” depends on which information sets from professional psychology are applied to the clinical data, information sets from family systems therapy or information sets from attachment trauma and personality disorder pathology.

Family Systems Clinical Description of the Pathology: 

The child is being triangulated into the spousal conflict through the formation of a cross-generational coalition with the allied parent against the targeted parent, resulting in an emotional cutoff in the child’s relationship to the targeted parent (Minuchin, Haley, Bowen).

Attachment System Clinical Description of the Pathology:

The child’s rejection of a parent surrounding divorce represents the trans-generational transmission of attachment trauma from the childhood of the narcissistic/(borderline) parent to the current family relationships, mediated by the personality pathology of the parent that is itself a product of this parent’s childhood attachment trauma (Bowlby, Beck, Millon, van der Kolk).

An attachment-based description of attachment-related family pathology surrounding divorce, (attachment-based “parental alienation”; AB-PA) represents the return of clinical psychology to court involved consultation, court-involved assessment of pathology, and court-involved treatment of pathology. 

Nothing about AB-PA is new.  AB-PA represents the application of established constructs and principles of professional psychology to a set of symptoms (Bowlby, Minuchin, Beck, Bowen, Millon, Kernberg, Ainsworth, Linehan…).

An attachment-based description of the pathology is grounded entirely within the standard and established constructs and principles of professional psychology; the attachment system, personality disorder pathology, family systems therapy, and complex trauma.

Professional psychology has the obligation to provide the highest caliber of professional knowledge and standards of practice for all clients and for the court.  Forensic psychology is currently failing in this obligation.

An attachment-based model of “parental alienation” (attachment-related family pathology surrounding divorce) represents the return of clinical psychology to court-involved consultation, court-involved assessment of pathology, and court-involved treatment of pathology.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Diagnostic Indicator 2: Personality Pathology

Diagnostic Indicator 2: The child’s symptoms evidence five specific narcissistic personality traits:

  • Grandiosity:  The child displays a grandiose perception of occupying an inappropriately elevated status in the family hierarchy that is above the targeted-rejected parent, from which the child feels empowered to sit in judgment of the targeted-rejected parent as both a parent and as a person.

  • Absence of Empathy:  The child displays a complete absence of empathy for the emotional pain being inflicted on the targeted-rejected parent by the child’s hostility and rejection of this parent.

  • Entitlement:  The child displays an over-empowered sense of entitlement in which the child expects that his or her desires will be met by the targeted-rejected parent to the child’s satisfaction, and if the rejected parent fails to meet the child’s entitled expectations to the child’s satisfaction then the child feels entitled to exact a retaliatory punishment on the rejected parent for the child’s judgment of parental failures.

  • Haughty and Arrogant Attitude:  The child displays an attitude of haughty arrogance and contemptuous disdain for the targeted-rejected parent.

  • Splitting:  The child evidences polarized extremes of attitude toward the parents and a rigid inflexibility in which the supposedly “favored” parent is idealized while the rejected parent is devalued and demonized as an all-bad and entirely inadequate parent.

The child’s emotional response and behavior toward the targeted parent is dysregulated (chronically hostile, angry, and rejecting).  The child is rude, defiant, and disrespectful toward the targeted parent.  While the child’s behavior toward the targeted parent is oppositional and defiant, the child’s emotional and behavioral dysregulation is not Oppositional Defiant Disorder (although it will meet diagnostic criteria for Oppositional Defiant Disorder), it is instead a reflection of narcissitic personality traits of haughty arrogance and contempt for the parent.  The child intentionally says hurtful things to the parent without apparent empathy or compassion for how the child’s cruelty affects the parent.  The child is harshly judgemental of the parent, and feels empowered and entitled to judge the parent.  The child’s harshly judgemental attitude toward the parent is rigidly fixed and uncompromising, it is not open to change.

The child, however, does not have a personality disorder.  The child displays this attitude only toward the targeted-rejected parent.  With teachers and the general public, the child is well-behaved and well-regulated.  The child is cooperative with teachers in the classroom, presenting no behavior problems, and is reportedly well-behaved and respectful with the allied parent. 

The selective display of narcissistic traits is only toward one target.  Personality disorder pathology affects all relationships.  This means that the child does not have a personality disorder.

Q:  How does a child acquire multiple narcissistic personality traits of haughty arrogant judgement, entitlement, an absence of empathy, and splitting, directed only toward the specific target of the other parent? 

A:  Through the psychological control (Barber) of the child by a narcissistic-borderline personality parent, who is transferring this parent’s own narcissistic attitudes of harshly critical judgement, arrogant contempt, absence of empathy, and inflexibly negative polarized perceptions toward the other parent to the child.

It’s not the child who has these beliefs toward the other parent, it’s the allied narcissistic-borderline parent who has these attitudes toward the other spouse, and the child is acquiring these narcissistic personality traits displayed selectively toward the targeted parent through the psychological control and influence of the child by the allied narcissistic-borderline parent.

A parent cannot psychologically control and distort a child without leaving “psychological fingerprint” evidence of the control in the child’s symptom display.  The five narcissistic personality traits displayed in the child’s symptoms represents the “psychological fingerprint” evidence of the child’s psychological control by an allied narcissistic-borderline parent.

The psychological control and influence of the child to hold the same attitudes as the parent is the only conceivable process that creates five selectively displayed narcissistic personality traits toward a single target, the other parent-and-spouse.  The child and allied parent have formed a cross-generational coaliton against the targeted parent, and the child is acquiring the allied parent’s contemptuous, judgemental, blaming, critical, and harsh attitudes and beliefs about the targeted parent-spouse.

Narcissistic personality disorder pathology in a child is an extremely rare symptom.  It is almost never seen in juveniles (only in cases of juvenile delinquency and conduct disorder, and only rarely even in these cases). Narcissistic personality pathology is just not something that’s seen in childhood disorders, and yet five specific narcissistic personality disorder features are clearly evident in the child’s symptom display.  This is incredibly unusual, and this is predicted by an attachment-based model for the construct of “parental alienation.”

The child’s narcissistic personality traits are not endogenous to the child, because they are displayed selectively only toward a specific target, the other parent. The a priori prediction of five specific narcissistic personality traits in the child’s symptoms, which are then evidenced in the child’s symptom display, represents extremely strong confirmatory evidence for the diagnostic model that predicts these symptoms.

The narcissistic personality traits displayed by the child toward the targeted parent represent the “psychological fingerprint” evidence of the psychological control of the child by a narcissistic-borderline parent who has formed a cross-generational coalition with the child against the other parent.

Psychological Control of the Child

The manipulative psychological control of the child by a parent is a scientifically established family relationship pattern in dysfunctional family systems. 

In his book regarding parental psychological control of children, Intrusive Parenting: How Psychological Control Affects Children and Adolescents, published by the American Psychological Association, Brian Barber and his colleague, Elizabeth Harmon, identify over 30 empirically validated scientific studies that have established the construct of parental psychological control of children (studies referenced by Barber and Harmon).  In Chapter 2 of Intrusive Parenting: How Psychological Control Affects Children and Adolescents, Barber and Harmon define the construct of parental psychological control of the child:

“Psychological control refers to parental behaviors that are intrusive and manipulative of children’s thoughts, feelings, and attachment to parents.  These behaviors appear to be associated with disturbances in the psychoemotional boundaries between the child and parent, and hence with the development of an independent sense of self and identity.” (Barber & Harmon, 2002, p. 15)

According to Stone, Bueler, and Barber:

“The central elements of psychological control are intrusion into the child’s psychological world and self-definition and parental attempts to manipulate the child’s thoughts and feelings through invoking guilt, shame, and anxiety.  Psychological control is distinguished from behavioral control in that the parent attempts to control, through the use of criticism, dominance, and anxiety or guilt induction, the youth’s thoughts and feelings rather than the youth’s behavior.” (Stone, Buehler, & Barber, 2002, p. 57)

Soenens and Vansteenkiste (2010) describe the various methods used to achieve parental psychological control of the child:

“Psychological control can be expressed through a variety of parental tactics, including (a) guilt-induction, which refers to the use of guilt inducing strategies to pressure children to comply with a parental request; (b) contingent love or love withdrawal, where parents make their attention, interest, care, and love contingent upon the children’s attainment of parental standards; (c) instilling anxiety, which refers to the induction of anxiety to make children comply with parental requests; and (d) invalidation of the child’s perspective, which pertains to parental constraining of the child’s spontaneous expression of thoughts and feelings.” (Soenens & Vansteenkiste, 2010, p. 75)

Research by Stone, Buehler, and Barber establishes the link between parental psychological control of children and marital conflict:

“This study was conducted using two different samples of youth.  The first sample consisted of youth living in Knox County, Tennessee.  The second sample consisted of youth living in Ogden, Utah.” (Stone, Buehler, & Barber, 2002, p. 62)

“The analyses reveal that variability in psychological control used by parents is not random but it is linked to interparental conflict, particularly covert conflict.  Higher levels of covert conflict in the marital relationship heighten the likelihood that parents would use psychological control with their children.” (Stone, Buehler, & Barber, 2002, p. 86)

Stone, Buehler, and Barber offer an explanation for their finding that intrusive parental psychological control of children is related to high inter-spousal conflict:

“The concept of triangles “describes the way any three people relate to each other and involve others in emotional issues between them” (Bowen, 1989, p. 306).  In the anxiety-filled environment of conflict, a third person is triangulated, either temporarily or permanently, to ease the anxious feelings of the conflicting partners.  By default, that third person is exposed to an anxiety-provoking and disturbing atmosphere.  For example, a child might become the scapegoat or focus of attention, thereby transferring the tension from the marital dyad to the parent-child dyad.  Unresolved tension in the marital relationship might spill over to the parent-child relationship through parents’ use of psychological control as a way of securing and maintaining a strong emotional alliance and level of support from the child.  As a consequence, the triangulated youth might feel pressured or obliged to listen to or agree with one parents’ complaints against the other.  The resulting enmeshment and cross-generational coalition would exemplify parents’ use of psychological control to coerce and maintain a parent-youth emotional alliance against the other parent (Haley, 1976; Minuchin, 1974).” (Stone, Buehler, & Barber, 2002, p. 86-87)

Cross-Generational Coalition:

The construct of a cross-generational coalition within the family is described by both Salvador Minuchin and Jay Haley, preeminent theorists in family systems therapy.  Jay Haley provides a definition the cross-generational coalition:

“The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two… In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer.  By ‘coalition’ is meant a process of joint action which is against the third person… The coalition between the two persons is denied.  That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition… In essence, the perverse triangle is one in which the separation of generations is breached in a covert way.  When this occurs as a repetitive pattern, the system will be pathological.” (Haley, 1977, p. 37)

Salvador Minuchin, provides a clinical description of the impact of a cross-generational coalition on family relationships following divorce:

“An inappropriately rigid cross-generational subsystem of mother and son versus father appears, and the boundary around this coalition of mother and son excludes the father.  A cross-generational dysfunctional transactional pattern has developed… The parents were divorced six months earlier and the father is now living alone… Two of the children who were very attached to their father, now refuse any contact with him. The younger children visit their father but express great unhappiness with the situation.” (Minuchin, 1974, p. 61-62; 101)

On page 42 of their book, Family Healing, Salvador Minuchin and his co-author Michael Nichols provide a structural family diagram for the inverted family hierarchy created by minuchin cross-gen slidean over-involved (enmeshed) relationship of a father and the child that excludes the mother.  The three lines between the father and child in this diagram indicate an enmeshed relationship of psychological over-involvement, and the child has replaced the mother atop the hierarchy with the father, holding an elevated position with him in which they are entitled to judge the mother. 

The structural family systems diagram provided by Minuchin and Nichols graphically illustrates that the cross-generational coalition of the child with the father creates both an inverted family hierarchy in which the child is elevated into a position of judgement above the mother, from which the child feels entitled to judge the adequacy of the mother as a parent, and also creates an emotional cutoff in which the mother is rejected by the alliance of the father and child (emotional cutoff: Murray Bowen; Titelman). 

Conclusion

Diagnostic Indicator 2: Personality Disorder Pathology is the result of the child acquiring the narcissistic attitudes of contempt, absence of empathy, harsh and critical judgement, and inflexible polarized attitudes of demonization toward the targeted parent from the pathogenic parenting of the allied narcissistic-borderline parent through processes of psychological control and the formation of a cross-generational coalition against the targeted-rejected parent-and-spouse.

The presence in the child’s symptom display of five a priori predicted narcissistic personality disorder traits represents definitive diagnostic evidence for the child’s cross-generational coalition with an allied narcissistic-borderline parent against the targeted parent-spouse. 

However, in the diagnostic identification of an attachment-based model of “parental alienation” (AB-PA), the presence of five narcissistic personality traits in the child’s symptom display is only one of three diagnostic indicators that must all be present; attachment system suppression toward a normal range parent (Diagnostic Indicator 1), five specific narcissistic personality traits in the child’s symptom display (Diagnostic indicator 2), and an encapsulated persucutory delusion displayed by the child regarding the child’s supposed “victimization” by the normal-range parenting of the targeted parent (Diagnostic Indicator 3).

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

References

Barber, B. K. (Ed.) (2002). Intrusive parenting: How psychological control affects children and adolescents. Washington, DC: American Psychological Association.

Barber, B. K. and Harmon, E. L. (2002). Violating the self: Parenting psychological control of children and adolescents. In B. K. Barber (Ed.), Intrusive parenting (pp. 15-52). Washington, DC: American Psychological Association.

Stone, G., Buehler, C., & Barber, B. K.. (2002) Interparental conflict, parental psychological control, and youth problem behaviors. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents. Washington, DC: American Psychological Association.

Soenens, B., & Vansteenkiste, M. (2010). A theoretical upgrade of the concept of parental psychological control: Proposing new insights on the basis of self-determination theory. Developmental Review, 30, 74–99.

Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.), The interactional view (pp. 31-48). New York: Norton.

Minuchin. S. & Nichols, M.P. (1993). Family healing: Strategies for hope and understanding. New York: Touchstone.

Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson.

Titelman, P. (2003). Emotional cutoff in Bowen family systems theory: An Overview.  In Emotional cutoff: Bowen family systems theory perspectives, P. Titelman (ed). New York: Haworth Press.

 

 

Diagnostic Indicator 1: Attachment Suppression

Diagnostic Indicator 1 – Attachment System Suppression: 
The child’s symptoms evidence a suppression of attachment bonding motivations toward a normal-range and affectionally available parent.

The psychological control and manipulation of the child by a narcissistic/(borderline) parent leaves telltale indicators in the child’s symptom display.  Three highly unusual symptoms are always present when a child is manipulated by one parent into rejecting a relationship with the other parent following divorce. 

The first diagnostic symptom displayed by the child is a suppression of normal attachment bonding motivations toward a normal-range parent.

Attachment Bonding Rejection

The first diagnostic indicator frames the category of the pathology, it is an attachment-related pathology. 

The attachment system is the brain system governing all aspects of love and bonding throughout the lifespan, including grief and loss. A child rejecting a parent is an attachment related pathology; it is a problem in the love and bonding system of the brain. 

Attachment bonding rejection by the child is an extremely unusual and rare symptom, and is only caused by a limited number of factors (autism, colic and sensory-motor processing dysfunction in infancy, exposure to severe child abuse and neglect). It typically occurs in infancy and is associated with reactive attachment disorder, autism, abusive parental neglect, and severe sensory-motor dysfunctions disrupting the infant’s bonding to the parent. 

Except in cases of severe child abuse (incest or prolonged violent parenting), attachment bonding rejection never occurs in children older than two.  Above the age of two, attachment bond rejection toward a normal-range and affectionally available parent never happens – except in incest, and sometimes from prolonged exposure to violent parenting – but incest and violent parenting are not normal-range parenting and would therefore not meet criteria for Diagnostic Indicator 1 regarding attachment suppression toward a normal-range parent.

Attachment bond rejection by a child older than two toward a normal-range and affectionally available parent never happens. 

Therefore, attachment bond rejection toward a normal-range and affectionally available parent is not an symptom that is authentic to the child.  This child symptom, Diagnostic Indicator 1, is being created by an outside influence acting upon the child attitudes and beliefs, because attachment-bond rejection in an older child toward a normal range and affectionally available parent is not an authentic symptom.  It never happens.

Q: What about general parent-child conflict?

Dr. Childress: Authentic parent-child conflict does not evidence the child’s desire to terminate the attachment bond to the parent.  High protest child behavior (anger, defiance, tantrums, demanding) is a symptom feature of insecure anxious-ambivalent attachment (described below) in which the child’s protest behavior is designed to elicit INCREASED parental involvement from an inconsistently available parent. 

In the symptom definition for Diagnostic Indicator 1, the parent is “affectionally available.”  A normal-range and affectionally available parent does not produce high levels of child protest behavior. Parent-child conflict may emerge in the relationship, but this normal parent-child conflict is limited in intensity and frequency, and it does not include the child’s desire to sever the attachment bond to the parent. 

In fact, high intensity and high frequency protest behavior is a symptom indicator of the child’s desire to form an attachment bond to the parent, the child is trying to form an attachment bond to an unavailable parent (creating an insecure anxious-ambivalent attachment marked by high-protest child behavior).

The Attachment System

The attachment system is a primary motivational system of the brain.  It developed across millions of years of evolution through the selective predation of children. Children who formed strong attachment bonds to parents received parental protection from predators, and the genes that motivated them to form strong attachment bonds to parents increased in the collective gene pool.  Conversely, children who failed to form a strong attachment bond to parents fell prey to predators at higher rates and their genes for weaker attachment bonding were systematically eliminated from the collective gene pool.

Over millions of years of evolution involving the selective targeting of children by predators, a very powerful and resilient primary motivational system developed that strongly motivates children to form an attachment bond to parents.  As a primary motivational system of the brain, the attachment system functions in characteristic ways, and it dysfunctions in characteristic ways.

Children do not reject parents. Children who rejected parents (even bad parents) were eaten by predators. Genes that allowed or encouraged children to reject parents were systematically and entirely eliminated from the collective gene pool over millions of years of evolution.

In response to problematic parenting, the attachment system MORE strongly motivates the child to form an attachment bond to the problematic parent.  Problematic parenting more fully exposes the child to predation.  Children who rejected problematic parents were more likely to die from predation, starvation, and exposure.  Genes allowing the rejection of problematic parents were systematically and completely eliminated from the gene pool.

On the other hand, children who became MORE strongly motivated to bond to the problematic parent were more likely to receive parental protection from predators.  These children survived at higher rates, and their genes for more strongly motivating them to bond to the problematic parent increased in the collective gene pool.

Children do not reject parents.  The attachment system – a primary motivational system of the brain – never motivates the child to reject a parent.  Problematic parenting creates an insecure attachment that MORE strongly motivates the child to bond to the problematic parent. 

The attachment system is a primary motivational system of the brain.  It is a goal-corrected motivational system.  Within the evolutionary context that shaped the development of this primary motivational system (through the survival advantage conferred to the child by the parent-child attachment bond), the attachment system ALWAYS seeks to form an attachment bond to the parent.

In response to problematic parenting, the attachment system changes HOW it tries to bond to the parent, but it ALWAYS maintains the goal of forming an attachment bond to the parent.  The attachment system is a goal-corrected motivational system, it always maintains the goal of forming an attachment bond, and it adjusts and changes strategies for bonding based on the parenting it is exposed to. 

Problematic parenting creates an insecure attachment that more strongly motivates the child to bond to the problematic parent.  Three categories of insecure attachment have been identified by the research literature:

Insecure Anxious Ambivalent:  This type of insecure attachment is caused by an inconsistently available parent.  The insecure-ambivalent attachment is also called a “preoccupied attachment” because the child is overly focused on the parent-child relationship. 

This type of insecure attachment produces high protest behavior from the child (crying, tantrums, anger, demanding) in order to elicit the involvement of the inconsistently available parent.  The child’s anger and protest behavior is motivated by the child’s desire to form an attachment bond to the parent, which is being frustrated by the parent’s non-availablity.

Insecure Anxious Avoidant:  Anxious-avoidant children display low-demand, self-involved behavior.  Anxioux-avoidant attachment develops in response to a parent who becomes overwhelmed and withdraws if the child places demands on the parent.  In order to maximize attachment bonding to a parent who is withdrawn and overwhelmed, the child develops a strategy of being low-demand and low-protest.

The child’s self-sufficiency in anxious-avoidant attachment is often confused with the child being secure.  The difference is that a secure child will seek the parent for regulation of the child’s distressing emotions, the anxious-avoidant child does not. The anxious-avoidant child does not display distressing emotions and does not seek parental comfort for distressing emotions, because the parent becomes overwhelmed and withdraws from the child whenever the child places demands on the parent.

These are the two most common types of anxious-insecure attachment.  One type is a high-protest high-demand response to problematic parenting (anxious-ambivalent attachment), in which the child’s display of emotional dysregulation is with the goal of establishing involvement with the parent.  The other is a low-protest low-demand response to problematic parenting (anxious-avoidant attachment), in which the child withholds the display of emotional distress to avoid overtaxing the emotional and psychological resources of an overwhelmed parent.

The third category of insecure attachment is disorganized attachment.  Disorganized attachment is pathological.  The other two attachment strategies are adaptations to problematic parenting.  Anxious-ambivalent and anxious-avoidant attachments represent strategies for maximizing the child’s attachment bond to a problematic parent.  Disorganized attachment represents a failure to develop any organized strategy for forming an attachment bond to the parent.

Disorganized attachment is created by a set of severely aberrant parenting practices that create intense fearfulness and psychological disorientation in the child.  Disorganized attachment develops from the child’s efforts to bond to a parent who is simultaneously both a source of danger to the child and is also the child’s source of comfort and safety. When the child is in danger, the attachment system motivates the child to flee the danger and seek the protective comfort of the parent.  Disorganized attachment occurs when this parental source of comfort is at the same time the source of danger.

The threatening and dangerous parent triggers the child’s attachment system to flee from the parent as the source of danger (the “predator”-danger within the attachment system) and to seek bonding with the parent for protection, and yet it is this very bonding to the parent that is the source of danger.  This represents a double-bind for the child of two imperative yet incompatible motivations that prevent the child from developing any organized strategy for attachment bonding to the parent.  The child’s behavior collapses into disorganization that lacks a coherent approach to resolution.

An Inauthentic Display of Pathology

A child rejecting a parent surrounding divorce is an attachment-related pathology – a problem in the love and bonding system of the brain.  The symptom is high-protest child behavior (anger, defiance, tantrums, protest).  High-protest child behavior is the product of an anxious-ambivalent attachment in which the child is seeking to maximize the involvement of a unavailable parent.

And yet, that’s not the attachment symptom presentation being displayed by the child. The child’s high-protest behavior is NOT seeking to maximize involvement with an unavailable parent. The parent IS available and the parent is actively inviting the child to bond. Instead, the child’s motivation is to sever the parent-child attachment bond.

The attachment system NEVER motivates the child to sever the parent-child attachment bond – except in cases of incest (the parent becomes a predatory risk to the child) and prolonged child exposure to parental violence.  The first differential diagnosis therefore becomes incest and excessively violent parenting (such as beating the child with electrical cords).  If incest and excessively violent parenting are not present, then the child’s attachment symptom of rejecting a normal-range and affectionally available parent is an inauthentic display of pathology.

Once incest and chronic violence are ruled out as a causal factor for an older child’s rejection of a parent, the child’s attachment symptom becomes inauthentic.  The child’s symptom is not consistent with the actual functioning of the attachment system; a primary motivational system of the brain.

 Problematic parenting creates an insecure attachment. 

High-protest behavior (anger, tantrums, demanding) is a symptom of insecure anxious-ambivalent attachment.  Anxious-ambivalent attachment seeks to maximize the child’s involvement with a parent who is unavailable.

 The child’s attachment symptoms are not authentic:

The parent is available and is inviting the child to bond.  The child’s high-protest behaviors are not seeking to maximize the involvement of an unavailable parent, but are instead seeking to terminate the parent-child attachment bond.  This is now how the brain works.  It is not how the attachment system works. 

Diagnostic Indicator 1 reveals the inauthentic symptom display by the child. The child’s attachment bonding rejection is not authentic to the child, but is instead being manufactured in the child by an outside influence that is acting to nullify the child’s authenticity; i.e., the authentic functioning of the child’s attachment system.

The explanation for this child symptom is that it is being created by the psychological control and psychological influence exerted on the child by the allied and supposedly “favored” parent who has formed a cross-generational coalition with the child against the other parent.  The child is displaying an inauthentic attachment symptom directed toward the targeted parent.  The child’s attachment bond rejection toward the targeted parent is being manufactured by the pathogenic parenting practices of the allied parent.

Attachment-Based “Parental Alienation”

Suppression of the child’s attachment bonding motivations toward a normal-range and affectionally available parent is, by itself, a definitive diagnostic symptom of the psychological control and manipulation of the child by the allied parent (who has formed a cross-generational coalition with the child against the other parent).

However, in the diagnostic model for attachment-based “parental alienation” (AB-PA), the suppression of the child’s attachment system toward a normal-range and affectionally available parent is only the first of three symptom indicators of the pathology that are predicted to be present in the child’s symptom display.

AB-PA predicts that the child will evidence all three highly unusual symptoms, 1) attachment system suppression toward a normal-range and affectionally available parent, 2) five specific narcissistic personality disorder traits in the child’s symptom display, and 3) an encapsulated persecutory delusion regarding the child’s supposed victimization.  AB-PA predicts the presence of all three of these symptoms, and AB-PA explains in detail the origin of each symptom in the pathology.

If all three of these highly unusual symptoms predicted to be present in the child’s symptom display are indeed evident in the symptom display of the child, this represents extremely strong confirmatory evidence for the diagnostic model that predicted these highly unusual and disparate symptoms.  No other pathology in all of mental health will produce this specific set of three symptom indicators other than the pathology of attachment-based “parental alienation” (AB-PA; Foundations).

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Comment on Child Custody Evaluations

The American Psychological Association has asked for comment on the assessment practice of child custody evaluations.  This is my comment:



I am a clinical child and family psychologist.  My professional background includes work with a full range of childhood pathologies, with a specialty in ADHD, early childhood mental health, attachment trauma, oppositional-defiant pathology and family conflict. 

In the early 2000s, I was on medical staff at Children’s Hospital of Orange County working on a collaborative intervention project with the University of California, Irvine Child Development Center (Dr. Swanson) on the identification and treatment of ADHD in preschool-age children.  I then became the Clinical Director for an early childhood assessment and treatment center dealing primarily with children in the foster care system.

In 2008, I left the Clinical Director position to enter private practice as I began to wind down my career.  It was when I entered private practice that I first became acquainted with court-involved family conflict and attachment-related family pathology surrounding divorce.  As I began to unravel the pathology, and the mental health response to attachment-related family pathology surrounding court-involved high-conflict divorce, I have increasingly been called on to provide expert consultantion and expert testimony for family law attorneys regarding the assessment, diagnosis, and treatment of family pathology.

In this capacity as an expert consultant and witness regarding clinical child and family psychology, I have often been asked to review as a clinical psychologist the information contained in a child custody evaluation that has been conducted for the family.  As a clinical psychologist with extensive experience with a range of child and family pathology, who has worked throughout my career with top level institutions and projects, I am deeply concerned regarding the apparent profound professional ignorance and deficient standards of professional practice that I have encountered with regard to the practice of child custody evaluations.

Clinical psychologists are trained to specialty practice in assessment. As a clinical psychologist, the practice of child custody evaluations is particularly disturbing to me because child custody evaluations violate every standard of professional practice for the construction of psychological assessment procedures.  In my professional opinion as a clinical psychologist, the practice of child custody evaluation is substantially below the professional standards of practice expected in clinical psychology.

Issues of Prominent Concern:

1.)  No Inter-Rater Reliability

If an assessment procedure is not reliable, it cannot, by definition, be valid.  If an IQ test gives a score for a client of 120 this week (above average) and when this same test is administered the following week it produces a score of 70 (below average) for this same client, this IQ test is not reliable (test-retest reliability).  If the IQ test is not reliable, the results and conclusions of the test cannot possibly be valid (true) because the test results are not stable (one week the test results say the client is a genius, and the next week the test results say the client is cognitively challenged).  It is axiomatic in professional assessment that an assessment procedure MUST be reliable in order to be valid.  Reliability does not ensure that the test results are valid, but reliability is required for validity.

There are four types of reliability in professional assessment, 1) test-retest reliability, 2) inter-rater reliability, 3) alternate forms reliability, and 4) split-half internal consistency reliability.  For the assessment procedure of child custody evaluations that rely on the opinions of the evaluator for interpreting the meaning of the data, the appropriate form of reliability would be inter-rater reliability (that two evaluators would reach the same conclusions based on the same data).  

There is no inter-rater reliability established for child custody evaluations.  Zero.  None.

Without established inter-rater reliability, two different child custody evaluators can reach entirely different conclusions and recommendations based on exactly the same data.  This means that the conclusions and recommendations reached by child custody evaluations represent the lone opinion of a single individual evaluator, and are not necessarily based on any underlying constructs or principles of professional psychology.

If an assessment procedure is not reliable – in the case of child custody evaluations; inter-rater reliability – then the assessment procedure cannot, by definition, be valid.  This is axiomatic in assessment.  This means that the conclusions and recommendations reached by child custody evaluations cannot, by definition, be valid because they are not stable across evaluators. 

The absence of scientifically established inter-rater reliability and hence validity to the conclusions and recommendations reached by child custody evaluations, by itself, represents sufficient reason for discontinuing the assessment practice of child custody evaluations, since the conclusions and recommendations reached by child custody evaluations (and therefore, the assessment procedure itself) are not valid. 

2.)  No Established Validity

The assessment procedure’s reliability is just the ground foundation of establishing the validity of an assessment procedure.  Once reliability is established, the next psychometric procedure is to establish the validity of the assessment.  There are a variety of methods used to establish the validity of an assessment procedure, including face validity, construct validity, content validity, predictive validity, concurrent validity, and discriminant validity. 

No study has ever even tried to establish the validity of the conclusions and recommendations of child custody evaluations.  The conclusions and recommendations of child custody evaluations have no established validity.  The conclusions and recommendations of child custody evaluations are merely the opinions of one person, and these opinions may or may not be accurate.

The absence of established validity (face validity, construct validity, content validity, predictive validity, concurrent validity, discriminant validity) for the conclusions and recommendations of child custody evaluations represents sufficient reason for discontinuing the practice of child custody evaluations because it is not a valid assessment procedure.

3.)  No Operational Definitions

Foundational to the construction of an assessment procedure is to begin by operationally defining the key constructs of the assessment.  With regard to child custody decision-making surrounding the custody evaluation, the key construct is the child’s “best interests.”  However, there is no operational definition for the construct of the child’s “best interests” for the purposes of the child custody assessment.

In their review of forensic practice in child custody evaluation, two leading figures in forensic psychology, Stahl and Simon, describe the problematic definition of “best interests of the child” (note who published this work, The Family Law Section of the American Bar Association):

From Stahl & Simon:  “A critical subject facing those working in the field of family law, whether they’re legal professionals or psychological professionals, is the concept of the best interests of the children. Even recognized experts in this concept differ with regard to what it means, how it should be determined, and what factors should be considered in determining what is in the best interest of a child. Thus, this ubiquitous term escapes consensus and remains fundamentally vague.” (Stahl & Simon, 2013, p. 10-11)

From Stahl & Simon:  “It is defined differently from state to state; and even in Arizona, where there are nine statutory factors associated with the best interest of the child, the meaning behind many of the factors is obscure.  Additionally, when psychologists refer to the best interests of children, they are referring to a hierarchical set of factors that may have different meanings to different children with different families and that may be understood differently by psychologists with different backgrounds and different training.” (Stahl & Simon, 2013, p. 11)

Stahl, P.M. and Simon, R.A. (2013). Forensic Psychology Consultation in Child Custody Litigation: A Handbook for Work Product Review, Case Preparation, and Expert Testimony, Chicago, IL: Section of Family Law of the American Bar Association.

There is no operational definition in the assessment procedure for the key construct of the child’s “best interests.”  Substantial information is collected as part of the child custody evaluation, but what constructs and principles from professional psychology are then applied to the information to reach a conclusion about the “best interests” of the child remains arbitrary and undefined.

Each individual custody evaluator is allowed to apply, not apply, or misapply, any, some, or none of the established constructs and principles of professional psychology.  Child custody evaluators are even allowed to make up idiosyncratic new forms of pathology that are absent a professional-level definition in clinical psychology.

The absence of an operational definition for the construct of the child’s “best interests” would be analogous to conducing an assessment of intelligence without first providing a definition for the construct of intelligence.  In the history of developing an assessment protocol for intelligence, there was a vigorous professional discussion regarding the meaning of the construct “intelligence.” This vigorous professional debate is a good thing because it helps elaborate the nature of the construct being assessed, with differing professional definitions of the construct producing differing assessment protocols that are based on the definition.

For a construct as important as the “best interests” of the child surrounding the child’s post-divorce custody and visitation schedule, a decision that can have profound and life-long consequences for the child, a similarly robust and vigorous professional debate is needed regarding the definition of the construct, the “best interests” of the child.  However, as noted by Stahl and Simon, the construct of the child’s “best interests” has never been defined.  Instead, each individual custody evaluator is allowed to make up their own idiosyncratic definition for the meaning of this term in each individual case, and this definition is not necessarily based on any established constructs or principles of professional psychology.

In the development of an assessment procedure, the first step is to define the construct being assessed; in the case of custody evaluations, it is the “best interests” of the child construct.  The second step is to identify the procedures used to assess the construct definition; the operational definition for the construct.

However, the first step of a vigorous professional debate regarding how the construct of the child’s “best interests” is to be defined has not occurred, and the practice of child custody evaluation skips the second step of developing an operational definition of the construct for assessment purposes.  Instead, child custody evaluations skip directly to collecting the data to assess a non-defined construct.  In skipping the first steps in the professional standards of practice for developing an assessment protocol of defining the construct to be assessed and then creating an operational definition of the construct for assessment purposes, the practice in forensic psychology of conducting child custody evaluations has preempted professional debate regarding the meaning of the construct, “best interests” of the child.

Furthermore, as a clinical psychologist familiar with the scientific literature on parenting and child development, I would submit that the definition of the child’s “best interests” is an undefinable construct in professional psychology because it involves too many variables and unknown parameters.  

There is no information from professional psychology that can provide supported criteria to differentiate the possible outcomes for the child from a 60-40%, 70-30%, 80-20%, or 90-10% custody visitation schedule in any given situation.  No criteria are available from professional psychology for these differential opinions regarding the “best interests” construct.  Furthermore, rendering an opinion on the “best interests” of the child requires prognosticating an outcome for the future development of the child based on these fine-grained current custody visitation schedules.  Predicting the future is beyond the capacity of professional psychology.

The only scientifically and theoretically supported recommendation from professional psychology for post-divorce child custody is for shared 50-50% custody visitation in all cases except diagnosed child abuse (see cultural considerations below).

In family systems therapy (Bowen, Minuchin, Haley), the family is transitioning from an intact family structure that was united by the marriage, to a new separated family structure that is united by the child through the child’s shared bonds of affection with both parents.   It is always in the child’s best interests for the family to make a successful transition to a healthy and cooperative separated family structure. This is the only definition of the child’s best interests supported by the professional literature.

Beyond that broad outcome definition for the child’s best interests (that the family makes a successful transition to a healthy separated family structure following divorce), children benefit from a complex relationship with both parents.  There are four types of primary relationship, each central to the child’s emotional and psychological development:

Mother-son,
Mother-daughter,
Father-son,
Father-daughter. 

Each of these relationship types is unique, and each is of profound emotional and psychological value for the child.  None of these relationships is expendable to the child’s healthy development.  The loss of any of these primary parent-child bonds during childhood will be damaging and traumatic to the child’s development (the death of a parent, the loss of a parent, is a traumatic childhood experience), and there is no supported foundation in the scientific or professional literature that would allow for a professional opinion on the relative costs and benefits to the child’s emotional and psychological development from a 60-40%, 70-30%, 80-20%, or 90-10% visitation time-share in any given situation.

Example: Two Scenarios

Before any assessment procedure can be developed to determine the “best interests” of the child, both the broader definition of the child’s “best interests” must be specified, and an operational definition of this construct for assessment purposes must be provided.  Child custody evaluations should be discontinued as an assessment procedure until an operational definition for the key assessment construct of the child’s “best interests” is identified.

4.) Violation of Principle D of the APA Ethics Code

The forensic psychology practice of child custody evaluation is in violation of Principle D: Justice of the APA’s ethics code.

Principle D: Justice
Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists.

Child custody evaluations are prohibitively expensive for a large number of families, typically costing between $20,000 to $40,000 to complete, and yet child custody evaluations are required by established standards of practice in forensic psychology before a mental health professional can render an opinion on child custody visitation schedules for the family.  The excessive financial cost of child custody evaluations effectively denies lower-income families “access to and benefit from the contributions of psychology” regarding the court’s child custody decision-making with their families.

Child custody evaluations also deny “equal quality in the processes, procedures, and services being conducted by psychologists” by having no established inter-rater reliability for the assessment procedure.  Without any established inter-rater reliability for the assessment procedure, different custody evaluations can reach entirely different conclusions and recommendations based on the exactly same data.  The arbitrary, idiosyncratic, and potentially differing conclusions and recommendations reached by child custody evaluators – who are free to arbitrarily apply, misapply, or not apply, any, some, or none of the established constructs and principles of professional psychology – denies “equal quality in the processes, procedures, and services being conducted by psychologists.”

Child custody evaluations are in violation of two separate components of Principle D: Justice of the APA’s ethics code.  Each violation individually would warrant the discontinuation of the assessment procedure. 

5.) Over-broad & Unanswerable Referral Question

Axiomatic in professional assessment is that the referral question organizes the assessment procedures.  The psychometrics underlying assessment are based on probability and statistics.  An over-broad and unfocused referral question (such as “What’s wrong with Johnny?”) leads to the collection of large amounts of information in a wide range of domains that statistically raise the probability of spurious findings based on statistical probability alone (associations in the data that are just chance associations).  A more focused referral question, on the other hand (such as, “Does Johnny have autism?”), limits the scope of data collection to the information necessary to answer the referral question, thereby limiting the probability of obtaining spurious associations based on chance.

Child custody evaluations seek to answer the referral question, “What should the child’s custody visitation schedule be?”  This is an overbroad referral question that results in the unfocused collection of family history information.  Spurious associations will occur in the information simply as a result of the over-extended collection of data and the psychometric context created by an over-broad referral question. 

In clinical psychology, when an over-broad referral question is initially offered by the client, clinical psychologists (who are knowledgeable in assessment) work with the client to develop a more appropriate limited-scope referral question.  In court-involved family conflict surrounding attachment-related family pathology following divorce, I would propose that a more professionally responsible referral question for assessment is:

Limited Scope Referral Question: “Which parent is the source of pathogenic parenting creating the child’s attachment-related family pathology surrounding divorce, and what are the treatment implications?”

This more limited scope referral question avoids having to operationally define the “best interests” of the child and provides the structure necessary for a structured and limited-scope assessment of pathology (that substantially reduces the financial costs of the assessment, making the benefits from professional psychology accessible to all families, including lower-income families).

A Limited Scope Assessment Protocol

6.) Cultural and Personal Bias

The practice of child custody evaluations is highly vulnerable to cultural and personal bias.  Personal bias would enter the assessment through the evaluator’s own unresolved family of origin issues (counter-transference).  Cultural bias would similarly enter the assessment process through the evaluator’s own cultural context for interpreting the data.

While some may argue that personal bias can be eliminated by self-awareness (not a position I would take), cultural bias is absolutely present in the evaluator’s assessment.  Everything we do as psychologists is embedded within a historical and cultural context.  This is established foundational knowledge of cultural psychology.  The child custody evaluator will be influenced by this evaluator’s historical and cultural context. That is a fact established by the field of cultural psychology.

The issue is not whether the historical and cultural context is influencing the custody evaluator, the issue is limiting the bias inherent to the assessment process against cultural value systems that differ from the White Protestant Northern-European values of the surrounding culture in the United States, and from the culturally embedded personal beliefs and values of the individual custody evaluator.

The more latitude the evaluator is allowed regarding the interpretation of the evaluation data, the greater the potential for unconscious personal and cultural bias to enter the conclusions and recommendations reached by the evaluator.  Both personal and cultural bias in assessment can be substantially limited the more structured the assessment protocol becomes. 

What specific steps do child custody evaluations take to limit the personal and cultural bias of the evaluator?  None.  Guidelines can encourage evaluators to refrain from bias due to personal or cultural beliefs, but these Guidelines have no practical impact on the actual conduct of any individual custody evaluation.  Custody evaluations are conducted by one person and the reports are typically sealed by the court.  Custody evaluations never receive review by any other psychologist regarding the accuracy of the interpretations contained in the evaluation, nor for the potential of cultural bias in the conclusions and recommendations offered.  Because custody evaluations are sealed by the court and are not reviewed for accuracy and bias, an evaluator who introduces  personal bias and the evaluator’s own personal cultural bias into the interpretation of the data, the conclusions reached, and the recommendations made, is never revealed.

There exist NO structural safeguards with the child custody evaluation protocol to limit the impact of personal and cultural bias on the interpretation of family data, on the conclusions reached, and on the recommendations made in child custody evaluations, and to the degree that there are no guidelines specific to how designated principles and constructs of professional psychology are to be applied to interpret the child custody data (identification of relevance and weighting), child custody evaluators are allowed to apply, not apply, or misapply, any, some, or none of the constructs and principles of professional psychology.  This is exactly the type of arbitrary assessment procedure that becomes extremely vulnerable to the introduction of personal and cultural bias into the interpretation of data.

7.) No Professional Oversight or Review

Child custody evaluations are typically sealed by the court to protect the privacy of the child, which is a laudable goal.  However, this creates a professional problem in that the interpretations, conclusions, and recommendations of child custody evaluations are never subject to professional review for accuracy. 

When child custody reports are reviewed, they are typically reviewed by another forensic child custody evaluator as to whether the proper procedures were followed, NOT as to whether the interpretations, conclusions, and recommendations made are accurate.

The financial cost and extensive data collection procedures associated with child custody evaluations essentially prevent parents from seeking second opinions regarding the custody decisions being addressed by the court.  A more limited scope treatment focused clinical assessment protocol can be conducted in a relatively brief time frame (six to eight weeks) at a substantially reduced cost ($2,500) compared to financial cost of a child custody evaluation ($20,000 – $40,000).  This reduced financial cost and time frame for a limited scope treatment focused assessment allows parents to seek a second opinion regarding the symptoms evident and the interpretation of these symptoms.

8.) The Custody Prize

Child custody evaluations support the family pathology of the child’s triangulation into the spousal conflict through the formation of a cross-generational coalition with one parent against the other parent (Minuchin, Haley, Bowen) by making the child a prize to be won by the supposedly “better parent” – which is a symbolic substitution for the “better spouse” within the spousal conflict surrounding the divorce.  Professional psychology has been seduced by the premise that the child represents a prize to be awarded to the “better parent,” as determined by the custody evaluator.

It is an inappropriate role for professional psychology to become the arbiter of who is the “better parent” who should be awarded the “custody prize” of the child following divorce.  Based on the four types of parent-child relationship (father-son, father-daughter, mother-son, mother-daughter) and the foundational principle that children benefit from a complex relationship with both parents, the only recommendation from professional psychology for child custody that is supported by the scientific and professional literature is a 50-50% custody time-share in all cases except child abuse.

If there are family conflicts, this is a treatment issue, not a custody issue.  If the child is evidencing parent-child attachment-related pathology surrounding the divorce, the differential diagnosis becomes identifying which parent is the source of pathogenic parenting creating the child’s attachment-related pathology following divorce

Furthermore, when the custody evaluation procedure seeks and values the child’s expressed preferences for parent, this supports the family pathology of triangulating the child into the spousal conflict by making the child’s beliefs and expressed wishes a prize to be won by the parent, with each parent seeking to convince the child to choose them as the child’s “preferred” parent.  This creates a destructive family environment where each parent seeks to convince, manipulate, and coerce the child into choosing them as the “preferred parent” (creating a loyalty conflict that can rip the child apart psychologically). 

If either parent has empathy for the child and does not put the child in the middle of having to choose a parent, this parent will lose custody to the parent who does put the child in the middle, and who does seek to convince, manipulate, and psychologically coerce the child to select them as the “preferred parent.”  Children should be neutral in the spousal conflict surrounding divorce, and children should never be placed in a position of choosing between parents following divorce. 

To the extent that child custody evaluations seek, value, and report on the child’s “preferences” for parents, the child custody evaluation supports the pathology in the family of a cross-generational coalition by turning the child into a custody prize to be won by whichever parent convinces, manipulates, and psychologically coerces the child to choose them as the child’s supposedly “preferred parent” following the divorce.

Professional psychology should not be in the role of determining the “better parent” who should be awarded the “custody prize” of the child.

Conclusion

Each of these eight issues of prominent concern would individually warrant the discontinuation of the practice of child custody evaluation.  Taken together, they represent a robust and compelling argument for the discontinuation of child custody evaluations.

My recommendation as a clinical psychologist is for professional psychology to get out of the business of identifying the “better parent” who is to be awarded the “custody prize” of the child following divorce.  This can be achieved by the professional recommendation for shared 50-50% custody in all cases except child abuse.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

A Limited Scope Assessment Protocol

I am a clinical psychologist.  As a clinical psychologist, I am trained and professionally knowledgeable in the construction, administration, scoring, and interpretation of assessment instruments and procedures.  I have constructed assessment protocols in the past. 

In this companion blog to Comment of Child Custody Evaluations, I am going to describe the six-session treatment focused assessment protocol.  But before beginning, I want to set the context for the level of the discussion.   This is not my first time developing a structured assessment protocol for a category of pathology.  I have done so with juvenile firesetting behavior for FEMA and the Department of Justice, and I have done so with early childhood pathology for a multi-university collaboration in the assessment and treatment of childhood trauma pathologies.

Before beginning my description of the six-session treatment focused assessment protocol for attachment-related family pathology surrounding divorce, I am going to describe the two prior assessment protocols I developed for other pathology types, and provide the direct protocols for these assessments.  My goal is to set the standard of professional expectation for discussion of pathology assessment protocols, and the psychometric properties of protocol development. 

Juvenile Firesetting

I served as the Clinical Director for a FEMA/Department of Justice project to develop a mental health assessment protocol for juvenile firesetting behavior.  I worked with Dr. Kenneth Fineman on this project, he is a Board Certified forensic psychologist and an internationally recognized expert on juvenile firesetting behavior.  He provided the professional expertise in juvenile firesetting behavior, I provided the professional expertise on the design and construction of pathology assessment protocols. 

Of note regarding this prior project on assessing juvenile firesetting behavior and my current involvement in the assessment of court-involved family conflict, is that juvenile firesetting behavior is also a domain of court-involved pathology.  The assessment protocol we developed for juvenile firesetting behavior addressed both the court-involved juvenile justice component and the mental health component of the behavior. 

Child custody family pathology is not my first encounter as a clinical psychologist with world of court-involved forensic psychology .  I understand the requirements of the court and legal system, and I have integrated this knowledge into the structure of the treatment-focused assessment protocol.

The juvenile firesetting assessment protocol we developed for FEMA and the Department of Justice involved several layers.  The initial protocol was a screening assessment performed in the field by the contact fire fighter who responded to the juvenile firesetting incident.  This screening instrument triaged the firesetting behavior into one of three categories (Simple curiosity firesetting; Complex firesetting behavior requiring additional mental health assessment; Emergent firesetting behavior of high concern and immediate risk).  The categorization of firesetting behavior into Simple, Complex, or Emergent types was based three factors, 1) the type of fire set, 2) what the juvenile intended to set on fire, and 3) the outcome of the firesetting behavior.

Based on the initial triage screening, three levels of intervention followed.  For simple child curiosity firesetting behavior, the child received a full-day fire safety education class from the fire agency.  For Complex firesetting behavior, an additional comprehensive mental health assessment of the firesetting behavior was conducted.  For Emergent firesetting behavior, a juvenile justice response and immediate risk management steps were initiated.

In addition to the initial screening of the firesetting behavior, we also wanted a triage screening instrument for possible emotional, psychological, and family problems, independent from the direct assessment of the firesetting behavior.  This mental health screening instrument needed to identify a full range of potential psychological issues, it had to have solid psychometric properties, and it needed to be sufficiently simple to be administered by a non-professional (the fire fighter in the field).  After a review of the structural and psychometric properties of possible instruments, we selected the Pediatric Symptom Checklist as the mental health triage screening instrument.

At the second level of assessment is the mental health assessment protocol for the juvenile firesetting behavior.  At this level, we developed a structured clinical interview assessment instrument for the parent and a separate structured clinical interview for the child that systematically reviewed a set of features associated with juvenile firesetting behavior. For the child, this included a behavior-chain interview regarding the firesetting incident designed to identify triggers to the behavior.

Firesetting Assessment: Structured Child Interview Protocol

The interpretation of the data from this comprehensive mental health assessment protocol for juvenile firesetting behavior was summarized on a form:

Firesetting Reinforcement Summary

This description of the assessment protocol we developed for juvenile firesetting behavior is provided as an indication that the current six-session treatment focused assessment protocol for attachment-related family pathology surrounding divorce is not my first project in developing an assessment protocol for a court-involved pathology. 

If the assessment of court-involved attachment related pathology surrounding divorce required an assessment protocol at a higher level of specificity, I could develop it.  I know how to do that.  I’m a clinical psychologist.  Developing assessment instruments and assessment protocols is within the specialty scope of practice for clinical psychologists.

But the assessment of attachment-related family pathology surrounding divorce does not require such an extensive assessment protocol.  What it does require is the diagnostic foundation for the pathology in order to identify a parsimonious set of symptom features that are characteristic of only this form of pathology (AB-PA).  Each assessment protocol for pathology presents its own unique set of challenges and solutions.

During the period of my work on the FEMA/DOJ juvenile firesetting project, I was also on medical staff as a pediatric psychologist at Children’s Hospital of Orange County.  Along with my role as an on-call psychologist with the various medical units of the hospital, my primary role was as the lead clinical psychologist from CHOC working with our collaborative partners at the University of California, Irvine Child Development Center (Dr. Jim Swanson).  Dr. Swanson is one of the leading figures in ADHD.  I left Children’s Hospital of Los Angeles and took the job at CHOC specifically to work with Dr. Swanson and the UCI Child Development Center.  The project was a collaborative CHOC-UCI venture to identify (and resolve) ADHD in preschool-age children.  While at CHOC, I also served as a clinical supervisor in their APA accredited internship program and with post-doctoral fellows recruited to the hospital for training in medically involved pediatric psychology.

The next phase in the unfolding of my professional experience in child and family pathology began when I left CHOC to serve as the Clinical Director for an early childhood assessment and treatment center operated under the auspices of Calif. State University, San Bernardino.  The clinic was an integrated project with the County of San Bernardino department of mental health, county child protective services, CSUSB’s psychology program, Loma Linda University’s occupational therapy program, and the University of Redlands speech and language program.  The primary population we served were children ages birth to five in the foster care system; prenatal exposure to drugs and alcohol, exposure to violence and child abuse, profound parental neglect, sexual abuse victimization, autism-spectrum and developmental issues, foster care placement and attachment pathology.

The clinic had professional staff from each of the universities at the clinic.  I was CSUSB’s clinical psychology representative.  Initially, the psychology team was split into an infant division (zero to two) and a preschool-age division (two to five years old).  I was initially the Clinical Director for the preschool-age children division, and a clinical psychologist from Loma Linda was the director for the infant division.  My professional background was with ADHD, which is an older child issue, and I came to early childhood through ADHD.  Infant psychology from zero to two is a unique sphere of professional practice because of the child’s foundational psychological emergence and limited capacity for communication during infancy.  Assessment is different in infancy, and treatment is different in infancy.  About a year into the project, the infant program director from Loma Linda University left, and I assumed the Clinical Director responsibilities for both infant assessment and treatment and for preschool-age assessment and treatment.

Along with professional staff from each of the university partners, each university also placed student interns at the clinic.  The clinic assessment protocol for children ages zero to five in the foster care system integrated assessments protcols from clinical psychology (CSUSB), occupational therapy (Loma Linda University), and speech and language (University of Redlands), administered through clinical interns from the respective university training programs.  In my role as the Clinical Director, I supervised both a professional staff and a set of MFT interns and post-doctoral fellows regarding the assessment of early childhood pathology and its treatment.

Our funding was primarily through the county Department of Behavioral Health in collaboration with the Department of Children and Family Services (child protective services).  County mental health services have a standard documentation protocol.  However, as a triparate interdisciplinary collaboration of three university training programs, our clinic sought to provide the highest standard of professional practice in the assessment and treatment of early childhood pathology.  As the Clinical Director for the program, I developed the early childhood intake assessment protocol to reflect the highest standards of professional practice for the clinical intake assessment of early childhood mental health pathology.

Early Childhood Assessment Protocol

Following the intake assessment, we then developed the specific assessment protocol for each child, integrating child-specific psychological testing and assessment with occupational therapy and speech and language assessments.  In many cases, the child’s emotional and behavioral dysregulation created from childhood trauma would not permit the child to participate in traditional assessment procedures.  To address this, we also developed the capacity for unstructured play-based assessment.

Play Based Assessment

A sexually abused two-year-old of a meth-addicted mother, who was prenatally exposed to drugs and alcohol, and who is in their third foster care placement, doesn’t always cooperate with standardized assessment procedures.  But when we know what we’re looking for, we can develop in-vivo circumstances that allow the young child to display current and emerging cognitive and social capabilities. 

In the assessment protocol for attachment-related family pathology surrounding divorce, the two parent-child sessions similarly represent in-vivo opportunities for the child to display their current cognitive beliefs and their emotional regulation capacities.

Treatment Focused Assessment

I left the clinic and entered private practice in 2008, anticipating that I would begin winding down my career into writing books about the neuro-development of ADHD and its association to the attachment system and intersubjectivity.  It was through my private practice that I was contacted by a guardian ad litem who asked me to submit my vitae.  I did, and this GAL selected me as the treating therapist.  This client became my introduction to court-involved attachment-related family pathology surrounding divorce.

My work with this pathology has grown, and I have been sought out by family law attorneys for expert consultation and testimony.  In this capacity, I’ve had the opportunity to review many child custody evaluations.  As a clinical psychologist, I am appalled at the absence of professional rigor and professional standards of practice consistently displayed in the child custody evaluations I have reviewed.  Ethical violations by professional colleagues triggers Standards 1.04 and 1.05 of the APA ethics code directing my response.  In order to address my professional concerns under the requirements of Standards 1.04 and 1.05 of the APA ethics code, I have undertaken a variety of initiatives – from posting YouTube videos, to writing a blog, to composing a Petition to the APA now signed by over 20,000 parents.

I also set about the process of developing a structured assessment protocol for court-involved attachment-related pathology surrounding divorce.  In addition to providing a professional critique of the inadequacies of child custody evaluations, the treatment focused assessment protocol that I developed for attachment-related family pathology surrounding divorce provides a clear definition of an alternative assessment approach and protocol that is embedded in the standards of practice for clinical psychology.  By developing this assessment protocol, I am anchoring the discussion of the clinical psychology assessment of pathology in a concrete example of what I would propose as a clinical psychologist experienced in protocol development for pathology.

The six-session treatment focused assessment protocol begins by limiting the scope of the referral question to one that can be answered by clinical psychology:

Referral Question: “Which parent is the source of pathogenic parenting creating the child’s attachment-related pathology, and what are the treatment implications?”

Attachment-related pathology is always caused by pathogenic parenting (patho=pathology; genic=genesis, creation).  Pathogenic parenting is the creation of significant psychopathology in the child through aberrant and distorted parenting practices.  Pathogenic parenting is an established construct in both developmental and clinical psychology, and is typically used with regard to attachment-related pathology since the attachment system never spontaneously dysfunctions, but only becomes dysfunctional in response to pathogenic parenting.

The differential diagnosis is to identify which parent is the source of pathogenic parenting creating the child’s attachment related pathology surrounding divorce.  The assessment protocol is structured around two data documentation instruments, one documents the potential pathogenic parenting of the targeted parent through abusive parenting practices (Parenting Practices Rating Scale), and one documents the potential pathogenic parenting of the allied narcissistic-borderline parent who has formed a cross-generational coalition with the child against the targeted parent (Diagnostic Checklist for Pathogenic Parenting).

The information needed to complete these two data documentation instruments can typically be obtained in six semi-structured clinical interview sessions in three phases, with each session collecting a subset of relevant information.

The first phase of clinical interview sessions is to collect history and symptom information from each parent individually.  In the second phase of clinical interviews, the child’s symptoms and the parenting of the targeted parent is directly evidenced in-vivo.  In the third phase, the parents are presented with information about the outcome of the assessment, and the cognitive schemas of each parent for organizing this information is assessed.

A structured report is then prepared for the parents (and the court) that provides the data from the two data documentation instruments and discusses the treatment implications based on predefined patterns of child and family symptoms (operational definitions of the pathology).

As a clinical psychologist, it is my professional opinion that a six-session treatment focused assessment protocol by a knowledgeable psychologist (the attachment system, personality disorder pathology, family systems therapy, complex trauma) can answer the referral question of “Which parent is the source of pathogenic parenting causing the child’s attachment-related pathology?”

Professional standards of practice in assessment encourage that the assessment protocol be as limited as required to answer the referral question. This surrounds the issue of protecting the privacy of the family members.  Child custody evaluations are a substantial (and unnecessary) intrusion and exposure of the family’s personal privacy surrounding the marriage and divorce. The referral question is not about the marriage and divorce, the referral question is about establishing a post-divorce child custody and visitation schedule (or about identifying the source of pathogenic parenting creating the child’s attachment-related pathology following the divorce).

The alternative referral question of identifying the source of pathogenic parenting creating the child’s attachment-related pathology provides a limited scope and focused assessment protocol and report to the court that substantially limits intrusion into the privacy of family members.

If additional standardized test data is sought, I would recommend 1) the Robert’s Apperception Test for Children– Second Edition (RATC-2) to assess the child’s emotional and psychological functioning directly from the child through standardized testing using projective techniques, and 2) the Personality Inventory for Children–Second Edition (PIC-2) to obtain parent-rated perceptions regarding the child’s personality and emotional characteristics.  However, while the information from these two standardized assessment instruments would be interesting (particularly from the projective techniques of the RATC-2), the information seems of little assessment utility because it is unclear how the information would be weighted and used in answering the referral question.

What the discussion of possible additional test instruments highlights is that the six-session treatment focused assessment protocol serves as a core for a limited-scope treatment focused assessment of pathology.  If information from additional procedures or instruments is deemed valuable, then these assessment procedures and instrumens can be added to the core protocol.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857