The Bright Thing in the Sky

Standard

The pathology of “parental alienation” is NOT a defined construct in clinical psychology.

AB-PA is a defined construct. 

An attachment-based model of “parental alienation” (AB-PA) – as defined in Foundations – is an explanatory application of standard and established constructs and principles from professional psychology to a set of symptoms.  That’s called diagnosis.


Q:  What is the sun?

A:  It’s that bright thing in the sky over there.

Q:  Yes, I know.  But what is it, what is the sun?

A:  I just told you.  It’s that bright thing in the sky.

“That bright thing in the sky” is NOT a professional-level definition of the sun.

Definition: The sun is a dense cloud of hydrogen gas that is so dense that the pressure exerted by the pull of its gravity is fusing the hydrogen atoms into helium (and ultimately into denser elements) and is releasing great amounts of energy in the process.

That is a professional-level definition of the sun.  “That bright thing in the sky” is not a professional-level definition of the sun.

Statement:  The child is rejecting the parent because of “parental alienation.”

Q: What is “parental alienation”?

A:  It’s when a child rejects one parent because of the influence on the child by the other parent (it’s that bright thing in the sky).

Q:  Yes, I know.  But what is it, what is “parental alienation”?

A: I just told you.  It’s when a child rejects one parent because of the influence of the other parent (it’s that bright thing in the sky).

That bright thing in the sky is NOT a professional-level definition of “parental alienation.”

AB-PA is a professional-level definition of parental alienation:

Pathological mourning (Bowlby) involving a cross-generational coalition (Haley; Minuchin) of the child with a narcissistic and/or borderline personality parent (Beck; Kernberg, Millon).

The trans-generational transmission of attachment trauma from the childhood of an allied narcissistic/(borderline) parent to the current family relationships, mediated by the personality disorder pathology of the allied parent, which is itself a product of this parent’s childhood attachment trauma.

An Attachment-Based Model of Parental Alienation: Foundations

That is a professional-level definition of the pathology.  Not “that bright thing in the sky over there.”


The Gardnerian PAS definition of “parental alienation” is that bright thing in the sky over there.

Gardner proposed a unique new form of pathology.  So unique, in fact, that this “new form of pathology” required a unique new name, “parental alienation,” and a unique new set of 8 symptom identifiers that are unrelated to any other pathology in all of mental health.

Gardner’s proposal of a unique new form of pathology drew substantial criticism from establishment psychology.  They said:

Establishment Psychology:  If there is a pathology present, then you must provide a professional-level definition for the pathology using standard and established constructs and principles of professional psychology.

Gardnerians:   It’s when a child rejects one parent because of the influence of the other parent (it’s that bright thing in the sky over there).

Establishment Psychology:  That’s not an adequate professional-level definition for a pathology.


AB-PA:  The sun is a dense cloud of hydrogen gas that is fusing into helium and releasing intense energy in the process.  And you know what?  The sun is not unique.  All of those stars we see at night are also suns, they’re just very far away.  Our sun is one of countless stars in our galaxy,  And there are other galaxies as well.

AB-PA:  The pathology of “parental alienation” is a form of “disordered mourning” (Bowlby) having to do with the distorted processing of sadness, grief, and loss, surrounding the divorce.  The “alienating parent” is the primary case of disordered mourning in the family, and this parent is passing on their own pathological mourning to the child through a cross-generational coalition with the child against the targeted parent (Haley, Minuchin).

The reason the allied parent’s mourning is pathological is because this parent has a narcissistic or borderline personality, that, at its core, fundamentally cannot process sadness, grief, and loss (Kernberg).

The reason the narcissistic and borderline personality cannot process sadness, grief, and loss is because this personality style emerges from a disorganized attachmentdisorganized attachment being a defined category of attachment. The borderline personality has disorganized attachment with anxious-ambivalent overtones, whereas the narcissist personality has disorganized attachment with anxious-avoidant overtones. At their core, the narcissist and the borderline have the same underlying disorganized attachment networks, but they manifest differently because of the overtones.

A violin and a trumpet both play middle C.  The difference in sound is not in the note itself (they are both playing middle C), the difference is in the overtones provided by the differing instruments playing the same musical note.

The “internal working models” of the narcissistic and borderline parent’s attachment system are triggered by the divorce to mediate the sadness, grief, and loss of the spousal attachment figure surrounding divorce, but since their core attachment networks are disorganized, these personality structures collapse into immensely painful disorganization surrounding the rejection and abandonment of the spousal attachment figure inherent to divorce. 

What we see as the symptoms of “alienation” are the coping strategies of the narcissistic and borderline personality trying to stave off collapse into complete – and immensely painful – disorganization surrounding the rejection and abandonment of this parent by the attachment figure of the other spouse; the collapse of the narcissistic personality structure into an inner void of utter emptiness, and the collapse of the borderline personality into an inner void of consuming darkness (you are unloved and unlovable).

That, is a professional-level definition of pathology.


The Pathology to be Defined:  A child’s rejection of a normal-range and affectionally available parent following a divorce.

The attachment system is the brain system governing all aspects of love and bonding throughout the lifespan, including grief and loss.

The child”s rejection of a normal-range and affectionally available parent is an attachment-related pathology.

Q:  How does the attachment system become turned off?

“The deactivation of attachment behavior is a key feature of certain common variants of pathological mourning” (Bowlby, 1980, p. 70)

Okay, then.  So we’re looking at a version of “pathological mourning” surrounding the divorce.

Q:  How does pathological mourning develop?

Disturbances of personality, which include a bias to respond to loss with disordered mourning, are seen as the outcome of one or more deviations in development that can originate or grow worse during any of the years of infancy, childhood and adolescence.” (Bowlby, 1980, p. 217)

Okay, so we’re looking at a “disturbance of personality.”  And we just continue to work it out from there.

Notice that in less than a minute of diagnostic inquiry, the pathology of “parental alienation” is defined as a form of disordered mourning involving personality pathology.

That’s sooooo much better than, “that bright thing in the sky over there.”

All mental health professionals – ALL of us – must stop referring to this form of attachment-related family pathology as “that bright thing in the sky over there” (“parental alienation”).  We can use the term in our general discussions I suppose – if I’m explaining to a child what the sun is, I might say, “It’s that bright thing in the sky over there.” 

But in our professional-level discussion with other mental health professionals regarding this form of attachment-related pathology, we must STOP referring to any non-defined form of pathology.  “Parental alienation” is a non-defined form of pathology.  AB-PA is a defined form of pathology.  If the Gardnerians wish to come up with some other proposed professional-level definition, fine by me.  Let’s hear it.  But no more “it’s that bright thing in the sky over there” definitions of pathology.  That’s NOT a professional-level definition of pathology.

All mental health professionals, in their professional-to-professional discourse, must stop using the non-defined construct of “parental alienation” (that bright thing in the sky over there) to describe a pathology.  Yes, I know that the sun is the bright thing in the sky over there.  And I suppose that is a sort of rudimentary definition of what the sun is.  But we need to go further.

The sun is a dense cloud of hydrogen gas that is fusing into helium and releasing great amounts of energy in the process.

Come on people.  We can do better than “that bright thing in the sky over there” – we can do better than, “a child’s rejection of one parent because of the influence of the other parent”  Yes.  I know.  But what is it?  What is the pathology?  Why is this occurring? – “Because of brainwashing” – ahhhgghhrrr – that’s like saying, “Sun hot.”  “Sun hot” is not an answer – “brainwashing” is not an answer.  Brainwashing is an equally non-defined construct.  Try substituting the construct of psychological control as defined by Barber (2002).

Standard and established constructs and principles of professional psychology.  Not brainwashing, not demon possession, not an imbalance in yellow bile.  Standard and established constructs and principles.

Pathological mourning.  Personality disorder pathology.  Splitting.  Cross-generational coalition.  Trauma reenactment narrative.  We’re professionals.  We’re experts.  We need to stop referring to this pathology as “that bright thing in the sky over there.”  That’s not a professional-level definition of a pathology.

It’s acceptable as a lay definition for the pathology.  Targeted parents, attorneys, the Court, they can all call it “that bright thing in the sky” because they are not mental health professionals.  Psychology is not their area of professional expertise.  But it is OUR area of expertise, and calling a pathology “that bright thing in the sky over there” is simply not acceptable at a professional level.

When I ask the corner grocery store clerk, “What’s the sun?” the clerk might reasonably say, “It’s that bright thing in the sky over there.”  But if I ask an astrophysicist, “What’s the sun?” I better at least get “A dense cloud of hydrogen gas fusing into helium.”  Come on people.  Professionals. 

An attachment-based model of “parental alienation” (AB-PA) as defined in Foundations provides a professional-level description of the attachment-related pathology commonly called “parental alienation” in the general-culture.  Foundations sets the bar for a definition of the pathology.  No more “that bright thing in the sky over there” definitions.

Gardner took everyone down the wrong road when he proposed a unique new form of pathology that required a unique new name (“parental alienation”) and a unique new set of 8 symptom identifiers that are unrelated to any other pathology in all of mental health.  He skipped the step of diagnosis.  Diagnosis is the application of standard and established constructs and principles to a set of symptoms. 

AB-PA puts us back on the solid ground of professionally anchored constructs and principles.  Disordered mourning, personality disorder pathology, cross-generational coalitions, trans-generational transmission of attachment trauma, splitting pathology, trauma reenactment schema.

Foundations sets the bar.  I’m expecting all mental health professionals to be professional.  No non-defined constructs in professional-to-professional discourse.  If you’re going to use a construct, define it at a professional level.  No primitive “that bright thing in the sky” definitions.  Professional-level definitions using standard and established constructs and principles of professional psychology.

The remarkable thing is that once we define what the sun is, a whole new realm emerges of white dwarfs and red giants, neutron stars, supernovas and black holes, galaxies and quasars.  But as long as we remain with “that bright thing in the sky” definitions, this whole world of phenomena remains beyond our reach.  I guarantee you, once we switch to an attachment-based definition of the pathology, a whole new world of wondrous knowledge will open up to us.

Mental health professionals, read this article:

Fonagy, P., Luyten, P., and Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47-69.

We should be talking about the “mentalization” of the child’s psychological state by the pathological parent.  And there is so much more once we move beyond “that bright thing in the sky” definitions of the pathology.

The attachment system is the brain system that governs all aspects of love and bonding throughout the lifespan, including grief and loss.  A child’s rejection of a normal-range and affectionally available parent is foundationally an attachment-related pathology. 

That’s the road to the realm of answers.

Craig Childress, Psy.D.
Psychologist, PSY 18857

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

Professional Competence

Standard

The current mental health response to the attachment-related pathology commonly called “parental alienation” surrounding divorce is abysmal. The field of professional psychology is rampant with profound professional ignorance and with profound professional incompetence.  Professional psychology should be ashamed of itself.

Assessment leads to diagnosis. Diagnosis guides treatment.

The first step to establishing professional competence is to obtain appropriate assessments of symptoms from ALL mental health professionals who are dealing with any form of attachment-related pathology surrounding divorce.

Notice I didn’t say “parental alienation.” We must return to standard and established psychological principles and constructs in assessing and diagnosing this form of attachment-related pathology.

All mental health professionals who are involved in assessing, diagnosing, and treating any form of attachment-related pathology surrounding divorce must be held professionally accountable for conducting an appropriate professional assessment of the attachment-related pathology within the family…

… including the trans-generational transmission of attachment trauma from the childhood of an allied narcissistic/(borderline) personality parent to the current family relationships, mediated by the personality disorder pathology of the parent, that is itself a product of this parent’s childhood attachment trauma.

The attachment system is the brain system governing all aspects of love and bonding throughout the lifespan, including grief and loss. A child’s rejection of a normal-range and affectionally available parent represents a distortion to the child’s attachment-bonding system in the brain. A child’s rejection of a normal-range and affectionally available parent is an attachment-related pathology.

The correct clinical psychology term for this attachment-related pathology is “disordered mourning” (Bowlby, 1980).

The narcissistic/(borderline) parent is the “primary case” of the pathological mourning within the family, and this parent’s own disordered mourning pathology surrounding the divorce is being transferred to the child through the aberrant and distorted parenting practices of the parent.

The source of the disordered mourning is this parent’s incapacity to process sadness and grief surrounding loss.  Instead of experiencing sadness and mournful longing, the personality pathology of this parent translates sadness, grief, and loss into “anger and resentment, loaded with revengeful wishes” (Kernberg, 1977, p. 229).

An appropriate assessment of this attachment-related pathology surrounding divorce is to assess for and document the potential presence of three diagnostic indicators of pathogenic parenting by an allied narcissistic/(borderline) parent who is in a cross-generational coalition with the child against the other parent (Haley, 1977; Minuchin, 1974).

Notice I did not say “parental alienation.” We must return to standard and established psychological principles and constructs.

Pathogenic: patho=pathology; genic=genesis, creation.  Pathogenic parenting is the creation of pathology in the child through aberrant and distorted parenting practices.

Pathogenic parenting is a standard construct used in both developmental and clinical psychology.  The term pathogenic parenting is most often used with regard to attachment-related pathologies, since the attachment system never spontaneously dysfunctions, but ONLY dysfunctions in response to pathogenic parenting.

The three diagnostic indicators of pathogenic parenting associated with the trans-generational transmission of pathological mourning are:

Attachment system suppression of the child’s normal-range attachment bonding motivations toward a normal-range and affectionallly available parent.

Narcissistic personality traits in the child’s symptom display. These are the “psychological fingerprints” in the child’s symptoms of the psychological control of the child by a narcissistic parent.

A persecutory delusional belief regarding the child’s supposed “victimization” by the normal-range parenting practices of the targeted parent. This reflects the child’s incorporation into the false trauma reenactment narrative of the narcissistic/(borderline) parent.

All of these symptoms are standard forms of clinical psychopathology that are well within the standard scope of professional practice for assessment and diagnosis expected for all mental health professionals – attachment bonding disruptions, personality disorder traits, encapsulated persecutory delusions. These are all standard forms of clinical psychopathology.

The Diagnostic Checklist for Pathogenic Parenting is an assessment tool for documenting the presence these three symptoms. I also wrote a blog (which appears as Chapter 4 in my book, Essays on Attachment Based Parental Alienation: The Internet Writings of Dr. Childress) which is entitled, “Diagnosing Parental Alienation,” in which I describe each of these diagnostic indicators and the 12 Associated Clinical Signs.

Both the Diagnostic Checklist for Pathogenic Parenting and Chapter 4 of Essays regarding “Diagnosing Parental Alienation” are on my website.

Diagnostic Checklist for Pathogenic Parenting

Diagnosing Parental Alienation

If a targeted parent wants to give something to an involved mental health professional, I would recommend the Diagnostic Checklist for Pathogenic Parenting and the companion Chapter 4 from Essays describing the three diagnostic indicators and the 12 Associated Clinical Signs.

These two companion pieces become the drum-beat for professional competence in the assessment, diagnosis, and treatment of the attachment-related pathology of AB-PA.

Assessment leads to diagnosis, and diagnosis guides treatment.

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Assessment leads to diagnosis, and diagnosis guides treatment.

In all cases of child abuse, physical child abuse, sexual child abuse, and psychological child abuse, the standard mental health response is to protectively separate the child from the abusive parent, to treat the impact of the abuse on the child in order to recover and restore the child’s normal-range and healthy development, and once the child’s healthy development has been recovered and stabilized, to then reintroduce the relationship with the formerly abusive parent with sufficient safeguards to ensure that the abuse does not resume once the child is reintroduced to the formerly abusive parent.  Typically, the abusive parent is also required to obtain collateral psychotherapy to develop and demonstrate insight into the causes of the prior abusive behavior.

This is the standard of practice in all cases of child abuse based on the professional obligation called the “duty to protect.”

Assessment leads to diagnosis.  Diagnosis guides treatment.

All three of the diagnostic indicators of pathogenic parenting by an allied narcissistic/(borderline) parent are standard and established forms of psychopathology within mental health – attachment bonding symptoms; personality disorder traits; symptoms indicating an encapsulated persecutory delusion.

These symptoms are well within the standard of practice for ALL mental health professionals. There is absolutely NO legitimate reason that a mental health professional should not assess for these symptoms.  No reason.

The only reason a mental health professional would NOT assess for these symptoms is an obstinate and intransigent insistence on remaining incompetent in the assessment of attachment-related pathology.  No matter the consequences on the child and family, this mental health professional insists on remaining incompetent in the assessment of attachment-related pathology surrounding divorce.

“No. You can’t make me be competent in my assessment of pathology. I absolutely refuse to assess for standard symptoms of pathology.  No.  I refuse. I will not be professionally competent in my assessment of pathology.”

However, mental health professionals are not allowed to be incompetent.


For psychologists, Standard 2.01a of the American Psychological Association states:

2.01 Boundaries of Competence
(a) Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.

For marriage and family therapists, Standards 3.1 and 3.10 of the Code of Ethics for the American Association of Marriage and Family Therapy states:

3.1 Maintenance of Competency
Marriage and family therapists pursue knowledge of new developments and maintain their competence in marriage and family therapy through education, training, and/or supervised experience.

3.10 Scope of Competence.
Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies.

For Master’s level mental health counselors, Standard C.2.a. of the Code of Ethics for the American Counseling Association states:

C.2.a. Boundaries of Competence
Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.

For social workers, the Ethics Code of the National Association of Social Workers states:

Value: Competence
Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional expertise. Social workers continually strive to increase their professional knowledge and skills and to apply them in practice.

1.04 Competence
(a) Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience.

In Canada, the Values Statement for Principle II, Responsible Caring, of the Canadian Code of Ethics for Psychologists states:

In order to carry out these steps, psychologists recognize the need for competence and self-knowledge. They consider incompetent action to be unethical per se, as it is unlikely to be of benefit and likely to be harmful. They engage only in those activities in which they have competence or for which they are receiving supervision, and they perform their activities as competently as possible. They acquire, contribute to, and use the existing knowledge most relevant to the best interests of those concerned.

II.6 Competence and self-knowledge
Offer or carry out (without supervision) only those activities for which they have established their competence to carry them out to the benefit of others.

In Australia, Standard B.1.2.a of the Australian Psychological Society Code of Ethics states:

B.1 Competence
B.1.2. Psychologists only provide psychological services within the boundaries of their professional competence. This includes, but is not restricted to: (a) working within the limits of their education, training, supervised experience and appropriate professional experience

In Great Britain, Standard 2 of the Code of Ethics and Conduct of the British Psychological Society states:

2 Ethical Principle: COMPETENCE
Statement of Values
Psychologists value the continuing development and maintenance of high standards of competence in their professional work, and the importance of preserving their ability to function optimally within the recognised limits of their knowledge, skill, training, education, and experience

In South Africa, Standard 1 of the Professional Board for Psychology, Health Professions Council of South Africa, Ethical Code of Professional Conduct (Effective from 1 April 2002) states:

1. Professional Competence
Psychologists shall develop, maintain and encourage high standards of professional competence to ensure that the public is protected from professional practice that falls short of international and national best practice standards. Psychologists shall accept that they are accountable for professional actions in all domains of their professional lives.

1.1  Competency Limits

1.1.1  Psychologists shall limit practice to areas within the boundaries of their competence based on formal education, training, supervised experience, and/or appropriate professional experience.
1.1.2   Psychologists shall ensure their work is based on established scientific and professional knowledge of the discipline of psychology.

1.2.  Maintaining Competency

Psychologists shall maintain current competency in their areas of practice through continuing professional development, consultation, and/or other procedures in conformance with current standards of scientific or professional knowledge.

In the Netherlands, Standard 3.4b; Article 100 states:

3.4b Professional competence

Article 100 Maintenance and development of professional expertise

Psychologists must maintain and develop their professional expertise in accordance with recent developments in psychology. They must keep informed of the relevant professional literature and participate in relevant additional and refresher courses


Mental health professionals are not allowed to be incompetent.  

Professional incompetence is a violation of ethical standards of practice for all mental health professionals everywhere.

This means that if a mental health professional is assessing and diagnosing an attachment-related pathology in a family, then that mental health professional MUST BE COMPETENT in the assessment and diagnosis of the attachment-related pathology as it manifests in the family relationships (notice I did not say “parental alienation” pathology).

The symptoms to be assessed are all STANDARD forms of pathology in mental health:

Attachment bonding symptoms in the child’s symptom display (diagnostic indicator 1)

Personality disorder symptoms in the child’s symptom display (diagnostic indicator 2)

An encapsulated persecutory delusion in the child’s symptom display (diagnostic indicator 3)

These are all STANDARD and established forms of pathology within professional psychology that are entirely within the scope of professional practice for assessment and diagnosis by ALL mental health professionals everywhere.  All we’re asking for is standard professional competence in the assessment and documentation of the child’s symptoms.

The only – the ONLY – reason a mental health professional would not assess for these symptoms of a trans-generational transmission of attachment-trauma relative to an attachment-related pathology in the family is a completely obstinate refusal on the part of the mental health professional to be competent in their job.

That is astounding to me.  Yet I know it is occurring even now.  That mental health professionals would insist – absolutely insist – on being incompetent in their assessment of pathology is a professional disgrace. 

ALL professionally competent mental health professionals WILL ASSESS for and document the presence of the three diagnostic indicators of pathogenic parenting associated with the trans-generational transmission of “pathological mourning” (Bowlby, 1980) within the family; an attachment-related disorder which is being mediated by the personality pathology of the allied parent (Giammarco & Vernon; 2014; Kernberg, 1975; Millon, 2011) who is in a cross-generational coalition with the child against the other parent (a “perverse triangle”; Haley, 1977).

It stands now with the professional organizations.  Will they back up their standards for professional competence with enforcement?  Or are their standards requiring professional competence just words without meaning or substance?  Platitudes to appease but not to be taken seriously.

Will professional organizations allow – and by allowing, will they collude with – such rampant disregard by so many mental health professionals for basic standards of professional competence in the assessment of attachment-related pathology surrounding divorce?

That’s the question now before ALL professional organizations.  Do they mean what they say in establishing standards requiring professional competence?

Attachment-related symptoms are a standard form of pathology within mental health. 

Personality disorder traits are a standard form of pathology within mental health.

Delusional pathology is a standard form of pathology within mental health.

All we are asking is that all mental health professionals who are assessing, diagnosing, and treating any form of attachment-related pathology surrounding divorce ASSESS for and document these symptoms in the child’s symptom display. 

That all.  Just assess for the symptoms.  That’s all we’re asking.

Craig Childress, Psy.D.
Psychologist, PSY 18857

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. NY: Basic Books.

“The deactivation of attachment behavior is a key feature of certain common variants of pathological mourning.” (p. 70)

“Disturbances of personality, which include a bias to respond to loss with disordered mourning, are seen as the outcome of one or more deviations in development that can originate or grow worse during any of the years of infancy, childhood and adolescence.” (p. 217)

Kernberg, O.F. (1975). Borderline conditions and pathological narcissism.. New York: Aronson.

“They [narcissists] are especially deficient in genuine feelings of sadness and mournful longing; their incapacity for experiencing depressive reactions is a basic feature of their personalities.  When abandoned or disappointed by other people they may show what on the surface looks like depression, but which on further examination emerges as anger and resentment, loaded with revengeful wishes, rather than real sadness for the loss of a person whom they appreciated.” (p. 229; emphasis added)

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

“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.” (p. 37; emphasis added)

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.

“The rigid triangle can also take the form of a stable coalition.  One of the parents joins the child in a rigidly bounded cross-generational coalition against the other parent.” (p. 102; emphasis added)

Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley. 

“Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders.  Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs.  Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking.  Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions.  Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence.  They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up.  Delusional systems may also develop as a result of having felt betrayed and humiliated.  Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast.” (p. 407-408; emphasis added).

Giammarco, E.A. and Vernon, P.A. (2014). Vengeance and the Dark Triad: The role of empathy and perspective taking in trait forgivingness. Personality and Individual Differences, 67, 23–29

“First cited by Paulhus and Williams (2002), the Dark Triad refers to a set of three distinct but related antisocial personality traits: Machiavellianism, narcissism, and psychopathy.  Each of the Dark Triad traits is associated with feelings of superiority and privilege.  This, coupled with a lack of remorse and empathy, often leads individuals high in these socially malevolent traits to exploit others for their own personal gain.” (p.  23)

The Diagnosis of Unicorns

Standard

To all mental health professionals:


Diagnosis is the application of standard and established constructs and principles from professional psychology to a set of symptoms.

In proposing a new form of pathology – a “new syndrome” – which was supposedly unique in all of mental health, so unique in fact, that it required an equally new and unique set of symptom identifiers created just for this form of pathology, Richard Gardner skipped the crucial step of diagnosis.

While he correctly identified the existence of a pathology, he too quickly abandoned the application of established psychological constructs and principles to the symptoms of the pathology by proposing that the symptoms he was recognizing represented an entirely new form of pathology – a “new syndrome” – which was unique in all of mental health – so unique that this new form of pathology required its own unique new name for this unique new form of pathology – “parental alienation.”

But in proposing a unique new form of pathology, Gardner was wrong.  He was a poor diagnostician.  He too quickly abandoned the professional rigor necessary to understand the origins of the pathology using standard and established psychological principles and constructs.  Instead, Gardner’s approach of proposing a unique “new form of pathology” was – to put it bluntly – conceptually lazy and diagnostically unsound.

Professional diagnosis involves the application of standard and established constructs and principles to a set of symptoms.  Richard Gardner violated this professional tenet, this standard of professional practice regarding professional diagnosis. That’s a problem. 

In skipping the step of diagnosis by proposing a “new syndrome” – a unique new form of pathology unlike any other pathology in all of mental health – Gardner put everyone on the wrong path.  Bad things happen when professional standards of practice are not followed.  Professional diagnosis involves the application of standard and established constructs and principles from professional psychology to a set of symptoms.  Gardner skipped this step of diagnosis, and the result has been 30 years of controversy and a still unsolved pathology.

Current mental health professionals who, like Gardner, are still proposing the existence of an entirely “new form of pathology” called “parental alienation” are as conceptually indolent in their professional diagnostic obligations as Gardner was in not applying the professional rigor necessary for a professional diagnosis of the pathology.  My statement to these mental health professionals who are continuing to propose a unique new form of pathology called “parental alienation” is:

Do the work required of professional diagnosis.  Apply standard and established constructs and principles from professional psychology to the symptom set.  No “new syndrome” or new forms of pathology short-cuts.  Make the diagnosis using standard and established constructs from professional psychology.  Do the work.  Your clients need you to do the work, targeted parents and their children need you to do the work.

AB-PA, as described in Foundations, represents what a professional diagnosis of psychopathology looks like; a detailed and exhaustive application of standard and established constructs and principles to a set of symptoms.  A visual representation for the pathology of AB-PA is available on my website: Diagram of AB-PA Pathology.

The diagnostic construct of “parental alienation” doesn’t exist in clinical psychology.  It is a unicorn.  A mythical pathology.  There is no such thing as “parental alienation” in clinical psychology.

The pathology that Richard Gardner identified does exist, but it’s just not a “new form of pathology,” a “new syndrome,” that’s unique in all of mental health.  It is a manifestation of standard and fully established forms of existing pathology.

An Attachment-Related Pathology

The pathology that’s traditionally called “parental alienation” in the general-culture represents an attachment-related pathology.

The attachment system is the neurologically embedded brain system that governs all aspects of love and bonding throughout the lifespan, including grief and loss.  The pathology called “parental alienation” in the general-culture represents a disruption to the love-and-bonding system of the brain; the attachment system.  It is an attachment-related pathology.

The form of attachment-related pathology is called “disordered mourning” (Bowlby), involving the pathological processing of sadness, grief, and loss.  The allied parent, who is the primary case of pathological mourning, is transferring this parent’s own disordered mourning surrounding the divorce to the child through aberrant and distorted parenting practices.  Under the distorting influence of the allied parent, the child’s sadness, grief, and feelings of loss surrounding the divorce are being translated into “anger and resentment, loaded with revengeful wishes” (Kernberg) that are identical to how the allied parent (the primary case of disordered mourning) is processing this parent’s own experience of sadness, grief, and loss surrounding the divorce.

The distorting parental influence of the allied parent is being imposed on the child through the formation of a cross-generational coalition (Haley, Minuchin) of the allied parent with the child. This cross-generational coalition is created through the psychological control (Barber) and manipulation of the child that acts to triangulate the child (Bowen) into the spousal conflict by creating a loyalty conflict for the child surrounding the divorce and break-up of the intact family structure.

The mild-moderate-severe dimension of the parent-child conflict noted by Gardner’s proposed range of “parental alienation” pathology represents the mild-moderate-severe range typical of the cross-generational coalition pathology, in which the allied parent is diverting spousal anger (Minuchin) directed toward the targeted parent through the child by creating and supporting the child’s conflict with the other parent.

The distinctive symptom feature evidenced in the pathology of the child’s active rejection of a relationship with a normal-range and affectionally available parent emerges from the addition of parental narcissistic/(borderline) personality pathology to the cross-generational coalition.  The addition of the splitting pathology (an extreme polarization of perception and the inability to tolerate ambiguity) of the narcissistic/borderline parent to the cross-generational coalition with the child transmutes an already pathological “perverse triangle” (Haley) into a particularly virulent and malignant form in which the child seeks to entirely terminate the relationship with the targeted-rejected parent.

The pathology of splitting (an extreme polarization of perception and inability to tolerate ambiguity) is characteristic of both the narcissistic and borderline personality pathology.  The addition of parental splitting pathology to the cross-generational coalition with the child creates the distinctive feature of this attachment-related pathology involving the child’s complete, polarized, extreme, and non-ambiguous rejection of a parent. Gardner identified these symptoms, he just didn’t diagnose these symptoms (apply standard and established constructs from professional psychology – in this case the pathology of splitting associated with both narcissistic and borderline personality pathology – to the symptoms he identified).

With the addition of the splitting pathology of the narcissistic/(borderline) parent (polarization and the inability to tolerate ambiguity), the ex-wife must also then become an ex-mother; the ex-husband must also become an ex-father.  This complete absence of ambiguity in the relative role-relationships within the family represents a neurologically imposed imperative required by the splitting pathology of the allied narcissistic/(borderline) parent, which is being transferred to the motivational agenda of the child through the child’s cross-generational coalition with the narcissistic/(borderline) parent.

This is called diagnosis; the application of standard and established constructs and principles from professional psychology to a set of symptoms.

Gardner skipped the step of diagnosis.  Instead, he opted for a conceptually lazy approach of proposing an entirely “new form” of pathology, which he proposed was so unique in all of mental health that it required its own category of diagnosis and it’s own unique name, “parental alienation,” and, according to Gardner, its own unique new set of diagnostic identifiers that Gardner simply made up to be specific for this “new form” of pathology.

Gardner was wrong.  It is not a new form of pathology.  Gardner was simply a poor diagnostician.  As are all mental health professionals who are proposing a Gardnerian-based model for the pathology.  Professional diagnosis involves the application of standard and established psychological principles and constructs to a set of symptoms. Do the work.

Proposing a “new form of pathology” that is unique in all of mental health is beneath the acceptable professional standards of practice for a professionally responsible diagnosis of pathology.  I hope that’s clear. 

Professionally responsible diagnosis of pathology involves the application of standard and established constructs and principles from professional psychology to a set of symptoms.  I hope that too is clear.

For thirty years now, establishment psychology has been providing the Gardnerians with this constructive professional feedback.  But for thirty years the Gardnerians have steadfastly refused to listen to and accept this constructive professional feedback from establishment psychology.  For thirty years the Gardnerians have been trying to force establishment psychology to accept a “new form” of pathology rather than apply the professional rigor necessary to appropriately diagnose the pathology using standard and established psychological constructs and principles of professional psychology applied to the set of symptoms.  Diagnosis.  Professional diagnosis of pathology.

The pathology we are diagnosing is NOT a unique new form of pathology.  It is an attachment-related pathology called pathological mourning (Bowlby).  It involves the child’s triangulation into the spousal conflict (Bowen) through the formation of a cross-generational coalition of the child with an allied parent against the other parent (Haley; Minuchin).  The application of standard and established psychological constructs and principles to a set of symptoms: Diagnosis.

The variant factor in this particular form of attachment-related pathology is simply the addition of parental personality disorder pathology from the allied parent in a cross-generational coalition with the child.  When the allied parent has prominent narcissistic and/or borderline personality pathology, the addition of the parent’s splitting pathology to the cross-generational coalition transmutes the already pathological “perverse triangle” (Haley) of the cross-generational coalition into a particularly virulent and malignant form in which the child seeks to terminate the child’s relationship with the targeted-rejected parent.

Notice that nowhere in this diagnostic statement did I need to resort to creating some “new form” of psychopathology. Diagnosis involves the application of standard and established psychological constructs and principles from professional psychology to a set of symptoms.

Gardner skipped the step of diagnosis by too quickly proposing that the set of symptoms he was noticing in his patients represented an entirely “new and unique” form of pathology – a “new syndrome” – that required a unique new category of pathology and a unique new name for the pathology – “parental alienation.”

Gardner was wrong.  The pathology he identified as a unique new form of pathology – which he called “parental alienation” – is NOT a new form of pathology. It is a manifestation of standard and fully established, existing and fully accepted, forms of pathology in mental health. It is an attachment-related pathology (a severe disruption to the love-and-bonding system of the brain) called “pathological mourning” (Bowlby), that involves the child’s triangulation into the spousal conflict (Bowen) through the formation of a cross-generational coalition of the child with the allied parent against the other parent (Haley, Minuchin), that includes the addition of parental personality pathology (Beck, Kernberg, Millon, Linehan) to the cross-generational coalition.  Gardner was simply a poor diagnostician.

What does this mean, that Gardner was a poor diagnostician?  It means that Gardner’s proposal of a “new form” of pathology called “parental alienation” is incorrect.  There is no new form of pathology called “parental alienation.” The pathology identified by Gardner represents a symptom manifestation of standard and established forms of pathology; pathological mourning, cross-generational coalition, parental personality disorder pathology.

There is no “new form” of pathology.  The pathology of “parental alienation” doesn’t exist.  Gardner was wrong.  He was a poor diagnostician, that’s all.

I want that to sink in for a bit…

In professional clinical psychology, there is no such thing as “parental alienation.”  It doesn’t exist.  It is a diagnostic unicorn.  A mythical pathology.

I know that Gardner said that this was a new form of pathology.  But he was wrong.  It’s not a new form of pathology, it is a manifestation of well-established and existing forms of pathology.

What’s required from us as mental health professionals is an accurate diagnosis of the pathology – and we achieve this accurate diagnosis of pathology by applying the standard and established psychological constructs and principles of professional psychology to the set of symptoms.

A child’s rejection of a normal-range and affectionally available parent represents a dysfunction to the love-and-bonding systems of the brain; the attachment system.  This is fundamentally an attachment-related pathology.  Then we begin to work out the diagnosis from there; cross-generational coalition, narcissistic symptoms displayed by the child, a fixed and false belief regarding the child’s supposed “victimization” by the normal-range parenting practices of the targeted parent (an encapsulated persecutory delusion) … diagnosis.

The term “parental alienation” is a popular-culture term that has developed from Gardner’s incorrect and inaccurate diagnosis of the pathology as being a unique “new form of pathology” – a “new syndrome” – that required a new term to describe it.  This term – “parental alienation” – is being used in the general-culture to describe an attachment-related pathology in which a child rejects a normal-range and affectionally available parent as a result of the distorting parental influence applied to the child by an allied parent in a cross-generational coalition with the child against the other parent.

But just because Richard Gardner said that a new form of pathology exists, doesn’t mean that a new form of pathology actually exists.  A pathology exists most definitely.  No question about that.  It’s just not a “new form” of pathology that requires a “new name.”  It is a manifestation of well-established and existing forms of pathology that already have existing names with strong research and theoretical support surrounding these existing pathologies with existing names, such as:

  • Pathogenic parenting
  • Cross-generational coalition
  • Disordered mourning
  • Narcissistic and borderline pathology (and the Dark Triad personality)

Most recently, I’ve added AB-PA to the set of possible diagnostic descriptors for the pathology.  The construct of AB-PA represents a comprehensive description of the attachment-related pathology across multiple levels of analysis using standard and established constructs and principles from professional psychology.  While AB-PA incorporates the term “parental alienation” it does so in order to avoid disorienting people who have become accustomed to the term “parental alienation” as a descriptive label for this type of attachment-related pathology.  However, the definition of AB-PA is based entirely on standard and established psychological constructs and principles of professional psychology (Childress: Foundations).

There is No Santa

So I hate to be the one to break it to the Gardnerians, but… here goes… there is no such thing as “parental alienation.”  It is a diagnostic unicorn, a mythical form of pathology.  It doesn’t exist.

I can hear the howls of outrage…

I’m sorry, but someone needs to tell them that “parental alienation” is a mythical pathology.  What they are calling “parental alienation” based on Gardner’s diagnostic failure is actually an attachment-related pathology involving a cross-generational coalition of the child with a narcissistic/(borderline) parent.  I know that children can become upset when they first learn that there is no Santa Claus and no Easter Bunny.  Sorry.  But it’s time to grow up into professional psychology, using standard and established constructs of professional psychology to diagnose pathology.  No unicorns, no pixies, no demon possession, no mythical forms of pathology.

A child’s rejection of a normal-range and affectionally available parent is a disorder of the love-and-bonding system of the brain, the attachment system; it’s an attachment-related pathology.  Start from there.  Stand on that solid ground of professional psychology.  It’s an attachment-related pathology.

If you want to work it out on your own, that’s fine.  But just no mythical “new forms” of pathology.  Your diagnosis has to be entirely based on standard and established psychological principles and constructs.  That’s an absolute and steadfast requirement of professional diagnosis.  So stop using the term “parental alienation” in your professional discourse.  Pathogenic parenting is fine, cross-generational coalition is fine, disordered mourning is fine, and if you want to just bundle everything up into a nice tidy little conceptual package, AB-PA is fine.  But just NO “parental alienation” – no mythical forms of pathology.

If you want, you can take my hand and I’ll help you find your way.  Look to family systems theory; triangulation, cross-generational coalitions, and emotional cutoffs.  Look to attachment theory; disorganized attachment, the trans-generational transmission of attachment trauma, schemas and internal working models, role-reversal relationships and regulatory objects, trauma reenactments, the grief response and pathological mourning.  Look to personality pathology; narcissistic and borderline personalities, splitting pathology, the invalidating environment.  Look to research on the Dark Triad personality; the absence of empathy and their propensity for revenge and the creation of conflict.  Look to research on psychological control, such as the work of Barber.  Look to psychological boundary violations, such as the work of Kerig.

Don’t worry.  The pathology is all there.  It’s all described.  We won’t leave you without a pathology… it just won’t be called “parental alienation.”

I’d suggest we use the standard and established construct of pathogenic parenting (patho=pathology; genic=genesis, creation) to label this standard and established form of attachment-related pathology.  Pathogenic parenting is the creation of significant psychopathology in the child as a result of aberrant and distorted parenting practices. The construct of pathogenic parenting is frequently used in association with attachment-related pathology since the attachment system never spontaneously dysfunctions but only dysfunctions in response to pathogenic parenting, and in fact the construct of “pathogenic caregiving” was referenced in the DSM-IV TR regarding an attachment-related pathology.  It is a standard and accepted construct in professional psychology.

Plus, I suspect that there’s not a targeted parent out there who doesn’t fully recognize the creation of pathology in their beloved child by the aberrant and distorted parenting practices of their ex-spouse, the child’s other parent.  All targeted parents clearly recognize that the distorted parenting practices of the allied parent, who is in a cross-generational coalition with their child, are absolutely creating significant love-and-bonding pathology in their beloved child.  The standard and professionally established construct of pathogenic parenting completely captures this pathology-creating feature of this form of attachment-related pathology; i.e., pathogenic parenting: the allied parent’s creation of significant attachment-related pathology in the child through aberrant and distorted parenting practices.

Or, if you prefer, the established professional construct of a cross-generational coalition fits equally as well.  In fact, the correspondence of the cross-generational coalition construct is so close to the construct of “parental alienation” that there’s hardly a hair’s breadth of difference between the two.  And once we add the personality disorder pathology of a narcissistic/(borderline) parent to the cross-generational coalition construct, the correspondence of pathology to the construct of “parental alienation” is nearly identical.  So maybe you’ll feel more comfortable with the construct of a cross-generational coalition.  The nice thing about shifting into family systems constructs is that you’ll also get two additional constructs, triangulation (i.e., a professional term for the “loyalty conflict”) and emotional cutoffs (which leads into the multi-generational transmission of trauma through Bowen’s work).

However, the really rich domain of constructs comes from attachment theory.  The constructs of attachment theory open a whole range of doors to understanding, including disorganized attachment, role-reversal relationships, regulatory objects, trans-generational transmission of attachment trauma, and internalized schema patterns.  Attachment theory provides such deeply rich conceptual material for understanding the core roots of this attachment-related pathology

Or you can choose to adopt the comprehensive description I’ve uncovered in AB-PA.  It’s spot-on accurate.  AB-PA provides a thorough and in-depth analysis of the pathology from within three separate and distinct levels of analysis (the family systems level, the personality disorder level, and the attachment system level) as well as an integrated analysis across all three levels, in which the attachment system level is responsible for creating the personality disorder level, which then creates the pathology found at the family systems level.  No model of pathology could provide such an integrated description of the pathology both within and across three separate and distinct levels of analysis unless the model was accurate and correct.  AB-PA is absolutely an accurate model for the pathology.

AB-PA gives us three definitive diagnostic indicators that lead directly to a confirmed DSM-5 diagnosis of V995.51 Child Psychological Abuse through the construct of pathogenic parenting.  In addition, because AB-PA is based entirely on standard and established professional constructs and principles, it allows targeted parents to hold ALL mental health professionals accountable for the accurate assessment and diagnosis of the pathology.  And AB-PA leads directly to treatment models.  Assessment leads to diagnosis, and diagnosis guides treatment.

But it’s up to you which path you take.  You can take any path to professional diagnosis that you want.  You can find your own way, or you can take some of the paths I’ve suggested.  But what you cannot do anymore is diagnose unicorns.  The diagnosis of unicorns doesn’t exist anymore.  Unicorns is a made-up mythical pathology – “parental alienation” is a mythical form of pathology.  It doesn’t exist.  Sorry, but true is true.  Pathogenic parenting exists.  Cross-generational coalitions exist.  The trans-generational transmission of attachment trauma exists.  But “parental alienation” does not exist as a professional construct.  There is no “new form of pathology” unique in all of mental health.  We are going to cease compounding Gardner’s initial diagnostic failure by continuing down the road of mythical constructs.

Professional diagnosis is the appliction of standard and established constructs and principles from professonal psychology to a set of symptoms.  No “new forms” of pathology proposals.  That’s NOT diagnosis.  That’s just nonsense.  No unicorns.

So from here on out, I’m going to expect professional competence from ALL mental health professionals.  So realize this, whenever I hear a mental health professional use the term “parental alienation” as if that construct actually had meaning, I’m going to be mentally substituting the word “unicorns” in its place.  I can’t stop you from diagnosing “unicorns” if you’re dead-set on diagnosing “unicorns.”  But I’m going to be encouraging the rest of us to be diagnosing real pathology using the standard and established constructs and principles of professional psychology.

It is long-past overdue that professional psychology surrounding this attachment-related pathology returns to using standard and established constructs and principles for assessment, diagnosis, and treatment.

Assessment leads to diagnosis, and diagnosis guides treatment.

Diagnosis is the application of standard and established constructs and principles from professional psychology to a set of symptoms.

Assessment:

The Diagnostic Checklist for Pathogenic Parenting

Diagnosis:

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Treatment:

In all cases of child abuse – physical child abuse, sexual child abuse, and psychological child abuse – the standard of care is the professional duty to protect which requires the protective separation of the child from the abusive parent.  We then treat the impact that the child abuse has had on the child in order to recover and restore the normal-range and healthy development of the child.  Once the child’s normal-range and healthy development has been restored, the child’s relationship with the formerly abusive parent is reintroduced with sufficient safeguards to ensure that the child abuse does not resume once the child’s relationship with the formerly abusive parent is restored.  During the protective separation period, the abusive parent is typically required to obtain individual collateral therapy to gain insight into the causes of the prior abusive parenting practices.

All mental health professionals must decide if they are going to base their professional diagnoses of pathology on the standard and established constructs of professional psychology, or whether they are going to diagnose unicorns.  For my part, I will always base my professional diagnosis on the standard and established constructs of professional psychology in order to diagnose real pathologies that actually exist.  My clients deserve no less.  Targeted parents and their children deserve no less.

It is time we returned to the solid Foundations of professional practice, and stop diagnosing unicorns and pixies.

Assessment leads to diagnosis, and diagnosis guides treatment.

Diagnosis is the application of standard and established constructs and principles from professional psychology to a set of symptoms.

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

Best Practices Article in the Journal of Family Therapy

Standard

Assessment leads to diagnosis, and diagnosis guides treatment.

In proposing a new form of pathology – a “new syndrome” – Richard Gardner skipped the crucial step of diagnosis.  Diagnosis involves the application of standard and established psychological principles and constructs to the set of symptoms presented by the client.

In the medical field, it is vitally important to know if we’re treating cancer, or diabetes, or heart disease.  Different diagnoses will entail different treatments – different approaches to their solution.  Assessment leads to diagnosis, and diagnosis guides treatment.

Assessment:  If you have medical aches and pains and go to your physician, the first thing your physician will do is an assessment. The physician begins by identifying the range and type of symptoms you’re having (Where do you feel pain?  Is your pain sharp or blunt?  Is your pain continuous or intermittent?  Are there things that make your pain better?  Worse?).  The physician will also conduct a broad assessment of your various physical systems, check your blood pressure, your temperature, listen to your heart, look in your eyes, ears, and throat, probe various body areas to see how you respond).  The physician may even seek additional testing, such as blood work or an MRI.

Diagnosis:  Based on this assessment of your symptoms, your physician will diagnose the problem.  Assessment leads to diagnosis.

Treatment:  The treatment for your medical aches and pains will depend on the diagnosis.  If you’re diagnosed with diabetes, you’ll receive a treatment plan for diabetes.  If you’re diagnosed with cancer, you’ll receive a treatment plan for cancer.  If you’re diagnosed with heart disease, you’ll receive a treatment plan for heart disease.  Diagnosis guides treatment.

Assessment leads to diagnosis, and diagnosis guides treatment.  Get it?  Makes sense right?

Gardner skipped the diagnosis step.  He looked at a set of symptoms and proposed a whole new form of pathology unrelated to any other pathology in all of mental health – a “new syndrome.”  Instead of applying the standard and established constructs of professional psychology to the symptom set to accurately diagnose the pathology (pathological mourning; pathogenic parenting; the trans-generational transmission of attachment trauma, triangulation, cross-generational coalition), he just made up a whole new diagnosis: “Parental Alienation Syndrome.”

Establishment psychology looked at this proposal for a whole new form of pathology which was supposedly unique in all of mental health, and said, “Noooooo, we don’t think so.  We don’t think you’ve applied the professional rigor necessary to accurately diagnose the pathology.  Your “diagnosis” as a completely new and unique form of pathology isn’t justified.  You need to do a better job of diagnosis using standard and established constructs and principles.”

And for the past 30 years, establishment psychology has consistently and steadfastly provided this constructive feedback to the Gardnerians and their Gardner-based derivative diagnoses.

And for the past 30 years, the Gardnerian contingent has consistently and steadfastly refused to accept this constructive feedback, and they have continued to maintain that the symptom set represents an entirely new form of pathology unique in all of mental health.

In addition, the proposed symptom set used in the assessment of this supposedly new and unique form of pathology is so inherently vague and poorly defined that these proposed diagnostic indicators will often miss the diagnosis when it’s there and will sometimes identify the pathology as being present when it’s not there.  That’s kind of a problem when we’re trying to diagnose a pathology.  Assessment leads to diagnosis. But if the symptom set we’re using to assess for the presence of the pathology is so vague and poorly formulated that we sometimes wind up misdiagnosing the pathology, that’s not good.

If you are misdiagnosed as having diabetes when you actually have cancer, you will receive a treatment plan for diabetes and you will die from your misdiagnosed, and therefore untreated, cancer.  This is the problem we’re facing with the pathology traditionally called “parental alienation” in the popular culture.  The pathology is not being properly assessed because the identifying symptom set used in assessing Gardnerian “parental alienation” and the various proposed Gardnerian-based derivative models, is too vague and ill-formed that it leads to frequent misdiagnosis (typically under-diagnosis).

The primary misdiagnosis is failing to identify the pathology when it’s present, although the child protection and domestic violence safety advocates in establishment mental health also raise valid concerns that the vague and ill-formed symptom set used in the assessment of Gardnerian-based “parental alienation” will incorrectly identify authentic child abuse as being “parental alienation.”

The assessment, diagnosis, and treatment of a pathology begins with first defining what the pathology is.  We can then identify characteristic symptoms of the pathology by which it can be indentified and diagnosed, and then diagnosis guides treatment.

A recently published article in the Journal of Family Therapy by what appears to be Gardnerian-inspired researchers is entitled “Recommendations for Best Practice in Response to Parental Alienation: Findings from a Systematic Review” (Temper, Matthewson, Haines, & Cox, 2016) and it highlights exactly this fundamental problem of too quickly bypassing diagnosis, the application of standard and established constructs and principles to a set of symptoms.  So I’d like to take a moment to provide an analysis of this article in order to highlight the fundamental problem with the Gardnerian-based model of “parental alienation.”

First let me say, the authors actually did a very good job of what they did. The problem is that they are fundamentally standing on the insubstantial foundations of a flawed model of pathology.  That’s going to be a problem.  So the problem isn’t actually with what the authors did, it’s with the flawed foundational premise provided by a Gardnerian model of “parental alienation.”

Notice first that this article deals with treatment, not assessment, not diagnosis… treatment.

The primary problem with the construct of “parental alienation” is in its assessment and diagnosis.  Until we have solved these fundamental initial steps, until we have a diagnosis of the pathology from within standard and established constructs and principles, then we don’t have guidance regarding its treatment.  Diagnosis guides treatment.

Oh, but right, the Gardnerians are claiming that “parental alienation” represents an entirely unique new form of pathology, unrelated to any other pathology in all of mental health.  I strongly disagree, but let’s start with that premise, that the pathology of “parental alienation” represents an entirely unique new form of pathology in all of mental health, then the critical question becomes what is the definition of this unique new form of pathology?

So let’s examine the definition of this unique new form of pathology which is offered by the authors of this article.  In defining this unique new form of pathology, they claim that,

“The defining feature [of parental alienation] is an attempt by the alienating parent to eradicate the relationship between the child and the targeted parent without reasonable justification (Meier,2009).”

Interesting…  but actually… that’s incorrect.  Let me explain.   If the “defining feature” of the pathology of “parental alienation” is an “attempt” by the allied parent to eradicate the child’s relationship with the other parent, that could potentially lead to a very strange and bizarre diagnostic situation.

Say a parent attempts to eradicate the child’s relationship with the other parent but fails to accomplish this goal, and the child still remains affectionally bonded to the targeted parent.  According to the “defining feature” offered by the authors (supported apparently by Meier, 2009), this situation of the child’s continued affectional bonding to the targeted parent would still represent “parental alienation” because the parent attempted to eradicate the child’s relationship, but this attempt was simply unsuccessful.

Oops.  That’s a problem.  If a child can remain affectionally bonded to the targeted parent yet still be “alienated” – that would seem to represent a problematic definition of the pathology.  So either the authors are proposing a form of pathology in which the child can be non-symptomatic of any pathology yet still be diagnosed as having the pathology, which is weird, or the author’s didn’t think through their “defining feature” of the pathology very well.  I suspect it’s the latter, and I suspect that given the chance the authors might refine their definition somewhat.  Unfortunately, it’s in print now so that’s the “defining feature” they’re proposing.  I’m surprised that this wasn’t caught by the journal reviewers.  Sloppy work journal reviewers. Isn’t anyone doing any critical thinking about this?

Another highly problematic diagnostic implication of this definition of the pathology is that it requires that the mental health professional document the attempts by the alienating parent to eradicate the child’s relationship with the other parent rather than the child’s symptoms.  From an assessment and diagnosis perspective, this is almost impossible to do.  The allied “alienating” parent is hiding behind the child (“It’s not me, it’s the child.  I tell the child to go on visitations. I encourage the child to go on visitations with the other parent. But the child refuses.  It’s not me, it’s the child”).  Given this manipulative exploitation of the child as a symptomatic “human shield” for the covert and hidden influence of the narcissistic/(borderline) parent, how is the mental health professional to assess for and document the attempts by this parent to eradicate the child’s relationship with the other parent?

The term “attempt” also suggests a conscious volitional intent on the part of the allied parent to purposefully eradicate the child’s relationship with the other parent. What if the allied parent isn’t actually aware that he or she is alienating the child, but actually believes that the other parent is “abusive” of the child, and that the allied parent actually believes that he or she is only trying to “protect the child”?  Can we actually say the allied parent is “attempting” to eradicate the child’s relationship with the other parent when this parent is unaware of this motivation, and perceives himself or herself to simply be “listening to the child” and trying to “protect the child” from the other parent’s abusive parenting?

The authors of this article, however, actually believe that they have defined the pathology in a way that allows for its assessment and diagnosis. They’re wrong.  As a clinical psychologist I can tell you, it is nearly impossible to assess and diagnostically establish the definition of the pathology they assert (i.e., the “attempt” by the allied parent to eradicate the child’s relationship with the other parent). 

As a clinical psychologist conducting a clinical assessment in my office, I can document the child’s symptoms, I can document the child’s conflicted relationship with the targeted parent.  I can document the child’s praise for and displays of affectionate bonding with the supposedly “favored” and allied parent.  But it is nearly impossible for me to document the “attempt” by the allied parent to eradicate the child’s relationship with the other parent. This happens out of sight and is hidden from view.

By contrast, in AB-PA the “defining feature” of “parental alienation” is the child’s rejection of a normal-range and affectionally available parent.  This “defining feature” is clearly evident in the child’s symptom display, and it immediately defines this form of pathology as an attachment-related pathology (i.e., the suppression of the child’s normal-range attachment bonding motivations toward a normal-range and affectionally available parent).  The diagnostic recognition of this form of pathology as an attachment-related form of pathology brings to bear all of the research regarding the functioning of the attachment system and attachment-related forms of parent-child relationship distortions, such as the construct of “pathological mourning” (Bowlby, 1980).  According to Bowlby,

“The deactivation of attachment behavior is a key feature of certain common variants of pathological mourning.” (Bowlby, 1980, p. 70; emphasis added)

Bowlby even links “disordered mourning” as being a symptom feature of personality pathology (such as the narcissistic/(borderline) personality pathology of the allied parent).

Disturbances of personality, which include a bias to respond to loss with disordered mourning, are seen as the outcome of one or more deviations in development that can originate or grow worse during any of the years of infancy, childhood and adolescence.” (Bowlby, 1980, p. 217; emphasis added)

According to an attachment-based model of “parental alienation” (AB-PA), the “disordered mourning” of the narcissistic/(borderline) parent surrounding the divorce is being transferred to the child through the aberrant and distorted parenting parenting practices of the narcissistic/(borderline) parent, and the child is now displaying a similar “pathological mourning” surrounding the divorce as evidenced in the “deactivation of attachment behavior” toward the normal-range and affectionally available parent. 

That’s called diagnosis.  Diagnosis is the application of standard and established constructs and principles from professional psychology to the symptom set.

Diagnosis then guides treatment. 

If the diagnosis is “disordered mourning” due to the pathogenic influence on the child of the narcissistic/(borderline) parent (who represents the “primary case” of pathological mourning), then the treatment is to help re-orient the child to the child’s experience of unprocessed and misunderstood sadness and grief surrounding the divorce and the breakup of the intact family structure, sadness and grief that is currently being expressed as anger toward the targeted-rejected parent (in the same way that the allied narcissistic/(borderline) is processing their own grief and sadness surrounding the divorce as “anger and resentment, loaded with revengeful wishes”).

“They [narcissists] are especially deficient in genuine feelings of sadness and mournful longing; their incapacity for experiencing depressive reactions is a basic feature of their personalities.  When abandoned or disappointed by other people they may show what on the surface looks like depression, but which on further examination emerges as anger and resentment, loaded with revengeful wishes, rather than real sadness for the loss of a person whom they appreciated.” (Kernberg, 1975, p. 229; emphasis added)

But I digress, we were talking about the “best practices” for the treatment of a new form of unique pathology – “parental alienation” – which is being proposed by the authors of the article.  So let’s continue by discussing the second half of the authors’ definition of this unique new form of pathology; i.e., that the eradication of the child’s relationship with the targeted parent is “without reasonable justification.”  The diagnostic question that immediately arises from this part of the definition is:

What is the operational definition for a “reasonable” justification for the parent-child conflict?

In my experience, the authors’ definition of the pathology provides the diagnosing mental health professional with far too much latitude and discretion for arbitrarily determining what represents a “reasonable” justification for the child’s hostility and the parent-child conflict.   This vaguely worded definition of the pathology absolutely invites professional incompetence. 

Far too often – way-way to often – I have seen incompetent mental health professionals conclude that the child’s hostility and rejection of the targeted parent, while acknowledged to be excessive and extreme, is nevertheless “reasonable” given a past parent-child incident, such as when, 2 years ago, the targeted parent called the police to intervene with the child’s hostility and threatening behavior, and the current mental health professional concludes that this incident from two years ago represents a “reasonable” justification for the child’s current anger and rejection.  Really?  An event two years ago provoked by the child’s hostility and threatening behavior represents a “reasonable justification” for the child’s current rejection of the targeted parent?  According to the assessing and diagnosing mental health professional it does. 

Or the mental health professional concludes that the frequent arguments between the child and targeted parent (which are acknowledged to be provoked by the child’s overt hostility and disrespect) represent a “reasonable” justification for the child’s desire to terminate visitations with the targeted parent. Really?  Yep, according to the diagnosing mental health professional, that’s a “reasonable” justification.  It astounds me what mental health professionals find as “reasonable justifications” for the child seeking to terminate a relationship with the targeted-rejected parent.

Common to this under-diagnosis of the pathology is the (false) belief system held by many mental health professionals that both parents are contributing to the family conflict.  While true in many cases of normal-range family conflict, this assumption is NOT true when the family includes one parent with significant narcissistic/(borderline) personality pathology.  A parent with narcissistic or borderline personality pathology is fully capable of single handedly creating ALL of the pathology and conflict evidenced in the family.

Yet far too many mental health professionals inappropriately apply standards of evaluation appropriate to normal-range families to the assessment of families containing a narcissistic or borderline parent.  When this occurs, the (false) belief that “both parents share responsibility” for contributing to the conflict leads the mental health professional to the erroneous conclusion that the cause of the child’s hostility and rejection toward the targeted parent is, to some degree, the fault of the targeted parent. This false assumption then leads the mental health professional to a micro-critical judgement of the parenting practices of the targeted parent, in which normal-range parenting is critiqued at such a micro-judgmental level that the supposed parental failures that are alleged by the child, no matter how distorted, untrue, or minor – are accepted by the mental health professional as “reasonable justifications” for the child’s rejection of the targeted parent.

As a clinical psychologist, my problem with this definition of the pathology offered by the authors is that it is so poorly formulated that it absolutely invites professional incompetence in the assessment and diagnosis of the pathology, resulting in extensive under-diagnosis of the attachment-related pathology of pathological mourning.

In addition, on the other side of the issue, child protection and domestic violence safety advocates take strong exception to the “without reasonable justification” definition of the pathology offered by the Gardnerians.  Their concern is that this form of definition provides the mental health professional with too much discretionary latitude to arbitrarily and unilaterally over-rule, discount, and invalidate the child’s reasons for not wanting to be in a relationship with an overly harsh or aggressive parent.  These child protection and domestic violence safety advocates question whose perception of “reasonable justification” takes precedence.  They place emphasis on the child’s rights of autonomous perception to define what constitutes a “reasonable justification” for the child’s reactions, whereas the Gardnerians place their emphasis on the mental health professionals’ supposed rights or obligation to overrule, discount, and invalidate the child’s expressed views and perceptions when the mental health professional believes these child perceptions are incorrect.

Note that the phrase “without reasonable justification” is a negative framing of the symptom as the absence of something – without something.  By contrast, the AB-PA model for the attachment-related pathology of “parental alienation” shifts this absence-framed “without reasonable justification” symptom proposed by the Gardnerians into a more specified and positive symptom format of established psychiatric terminology as the presence of an “encapsulated persecutory delusion” (diagnostic indicator 3; google “encapsulated delusion”).  An encapsulated persecutory delusion is an established psychiatric construct, and the assessment and diagnosis of an encapsulated persecutory delusion is well within the diagnostic scope of practice for ALL mental health professionals. 

If the mental health professional does not possess the knowledge and competence to diagnose an encapsulated delusional disorder, then that mental health professional has no business working with delusional disorders, simple as that – and AB-PA is a delusional disorder: ICD-10 diagnostic code F24 Shared Psychotic Disorder.

“A condition in which closely related persons, usually in the same family, share the same delusions.  A disorder in which a delusion develops in an individual in the context of a close relationship with another person who already has that established delusion.” ICD-10

According to an AB-PA model of the pathology, the presence in the child’s symptom display of an encapsulated persecutory delusion (a fixed and false belief that is maintained despite contrary evidence) is the product of the narcissistic/(borderline) parent creating and imposing on the child the (false) role in the parent’s own trauma reenactment narrative as the supposedly “victimized child” of a supposedly “abusive” targeted parent (i.e., the encapsulated persecutory delusion).  Once the child adopts the (false) role as the supposedly “victimized child,” the child’s role then automatically defines and imposes on the targeted parent the (false) role in the trauma reenactment narrative as the supposedly “abusive parent.”  The child’s (false) role as the  “victimized child” in the trauma reenactment narrative of the narcissistic/(borderline) parent also allows the allied narcissistic/(borderline) parent to adopt and conspicuously display to others the coveted role as the all-wonderful “protective parent” in the parent’s trauma reenactment narrative.

AB-PA not only identifies the symptom using standard and established psychological constructs and principles that are well within the professional diagnostic scope of ALL mental health professionals (in this case, an encapsulated persecutory delusion), an AB-PA model of the pathology also explains WHY that particular symptom is present in the child’s symptom display.

While the constructs of “without reasonable justification” and an “encapsulated persecutory delusion” are similar constructs, it is much more professionally grounded and professionally responsible practice to apply the standard and established constructs and principles of professional psychology to a symptom set (a process called diagnosis), rather than to make up new, vaguely defined symptoms to describe a proposed new form of pathology that is supposedly unique in all of mental health.

So this “without reasonable justification” portion of the definition for this proposed new and unique form of mental health pathology is problematic from both sides of the issue.  Its vague wording invites professional incompetence that results in the far too frequent under-diagnosis of the pathology, and it simultaneously over-empowers the mental health professional to arbitrarily discount and invalidate the perceptions of another human being (the child) who may have valid and “reasonable justifications” from their perception and feelings, that can then be arbitrarily deemed invalid and unreasonable justifications by the over-empowered and potentially biased mental health professional, who then misdiagnoses justified parent-child conflict as “parental alienation” when it’s not.

So while I understand that in the minds of the Gardnerians they believe they have adequately defined the pathology, in actual truth they haven’t, not from a clinical assessment and diagnosis perspective. That’s the constructive feedback that establishment psychology has been trying to give the Gardnerians for 30 years, that the Gardnerian-based definitions for “parental alienation” are beneath the level required for a professionally established form of pathology.  But the Gardnerians just don’t listen. 

I listened to the constructive feedback offered by establishment mental health.  I applied standard and established constructs and principles of professional psychology to the pathology – a procedure called diagnosis.  An Attachment-Based Model of Parental Alienation: Foundations is the result (AB-PA).  I have met the requirements of establishment mental health to define the pathology entirely from within standard and established psychological principles and constructs.  No “new form” of pathology proposal. An attachment-related, personality disorder-related pathology.  Pathogenic parenting.  Pathological mourning.  Here is a visual diagram of the attachment-related pathology commonly called “parental alienation”:

Diagram of AB-PA Pathology

Diagnosis is the application of standard and established psychological constructs and principles to a set of symptoms.

Gardner skipped the step of diagnosis by proposing a new form of pathology – a “new syndrome” – and for 30 years this professional negligence in skipping the step of diagnosis (i.e., the application of standard and established psychological constructs and principles to a set of symptoms) has resulted in professional gridlock in the assessment, diagnosis, and treatment of this attachment-related family pathology that has incapacitated and disabled the mental health response to the pathology.

Furthermore, as evidenced in the current article, even after 30 years as the dominant paradigm defining the pathology of “parental alienation,” the definition of the pathology proposed by Gardner-based models has yet to achieve any established standardization, so that the definition offered by the authors of an article in 2016 proposes an irrational “defining feature” of the pathology that can lead to the bizarre diagnostic situation of the pathology being diagnosed as being present (an attempt by the parent to eradicate the child’s relationship with the other parent) in the complete absence of any symptoms being evidenced by the child (the attempt by the parent failed and the child remains affectionally bonded to the targeted parent).

While I’m certain that the authors of the article can revise their “defining feature” of the pathology in light of its diagnostic irrationality, that they would need to revise such a basic and fundamental thing as the proposed “defining feature” of the pathology after 30 years of the Gardnerian paradigm reveals the chaotic nature of the definitional and diagnostic state of affairs surrounding the Gardnerian-based model of the pathology.

And as far as my critique, I’m still only on the first paragraph – the first paragraph – of the article.

There are two more critiques that I will make quickly.  But simply because I am limiting my discussion of these two critique points does not mean they are not important. They are very important. 

The first has to do with the authors too quickly moving into treatment surrounding a Gardnerian-based model of their proposed new form of pathology (“parental alienation”) without having worked through the diagnostic issues.  Gardner skipped the diagnosis step (the application of standard and established constructs and principles to a set of symptoms), and the authors of this article are making a similar fundamental error.  Diagnosis guides treatment.

From an AB-PA model, the pathology traditionally called “parental alienation” in the popular culture represents a form of pathology called pathogenic parenting (patho=pathology; genic=genesis, creation).  Pathogenic parenting represents the creation of significant psychopathology in the child through aberrant and distorted parenting practices.  It is a standard construct used in both developmental psychology and clinical psychology.

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

There is absolutely no doubt in professional psychology as to what represents the standard of care and best practices surrounding the treatment response to child abuse. It’s not even a question.

In all cases of child abuse – physical child abuse, sexual child abuse, and psychological child abuse – the standard of care is the professional duty to protect, and best practice is to protectively separate the child from the abusive parent, to then treat the impact that the child abuse has had on the child in order to recover and restore the normal-range and healthy development of the child, and then to reunite the child with the formerly abusive parent with sufficient safeguards to ensure that the child abuse does not resume once the child’s relationship with the formerly abusive parent is restored.  During the protective separation period, the abusive parent is typically required to obtain individual collateral therapy to gain insight into the causes of the prior abusive parenting practices.

Best practice surrounding the mental health response to child abuse is not even an issue.

So then why did the authors go to all that trouble to try to identify best practice parameters for responding to a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed?  Because they skipped the step of diagnosis (the application of standard and established constructs and principles of professional psychology to a set of symptoms) and the authors too quickly rushed into treatment.  But diagnosis guides treatment.  If you skip the diagnosis step and just jump into treatment, all sorts of bad things happen,  Assessment leads to diagnosis, and diagnosis guides treatment.

Do the authors actually believe that the standard of care representing best practice for the treatment of child abuse is somehow in doubt, and that their review of research was necessary in order to elucidate best practice guidelines for responding to child abuse?  While the authors did a wonderful job in their literature review, they also seem to display a disturbing absence of critical thinking.  And how did this absence of critical thinking get past the journal reviewers?  Must not be a very good journal <poke>.

There is simply no need for a review article on best practices for responding to child abuse.

Let me put this question to all targeted parents out there: Is there any question in your mind that the pathology of “parental alienation” is child psychological abuse?  Me neither.

But because the authors are relying on a Gardnerian model for the definition of the pathology, the authors, like Gardner, have skipped the crucial and fundamental step of diagnosis (i.e., the application of standard and established psychological constructs and principles to the set of symptoms).  Instead, they propose an entirely new and unique form of pathology they call “parental alienation” with an ill-formed definition and questionable diagnostic indicators (the authors did not address the diagnostic indicators for their proposed new form of pathology). This led the authors to conduct a completely unnecessary study to essentially explore what are the best practice guidelines for responding to child abuse.  Completely and totally unnecessary. 

Best practice guidelines for responding to child abuse are already abundantly clear and evident to every mental health professional.  It’s called the “duty to protect.”  This is is an established professional obligation.

Assessment leads to diagnosis. Diagnosis guides treatment. The steps are not complicated people.

Diagnosis is the application of standard and established constructs and principles of professional psychology to a set of symptoms.

Don’t skip the step of diagnosis.  It will get you into trouble.  Diagnosis guides treatment.

Honestly, I don’t know what’s so difficult about this for Gardnerians to understand.  Stop trying to take an easy way out to avoid the proper professional diagnosis of pathology.  One more time: diagnosis involves the application of standard and established principles of professional psychology to a set of symptoms.  Stop trying to avoid the proper professional diagnosis by proposing a new form of pathology that is supposedly unique in all of mental health.  Its not a new form of pathology.  It’s an attachment-related pathology mediated by the personality disorder pathology of the parent which is itself a product of this parent’s own childhood attachment trauma.

Just look what I was able to accomplish earlier just by simply identifying the pathology of a child’s rejection of a normal-range and affectionally available parent as being an attachment related disorder.  This immediately led to the diagnosis of disordered mourning, which then led to the treatment intervention of re-orienting the child to the child’s misunderstood and unprocessed sadness and grief surrounding the divorce that is being twisted into angry and hostile pathology by the aberrant and distorted parenting practices of the allied narcissistic/(borderline) parent.  Diagnosis guides treatment.

I honestly don’t know what is so hard to grasp about this. Assessment leads to diagnosis, and diagnosis guides treatment.

Final point: The authors offer a caveat to their proposed definition of parental alienation (apparently supported by some other professionals):

“It is important to note that a child rejecting a parent on reasonable grounds, such as in response to parental abuse or neglect, constitutes estrangement (Garber, 2011) not parental alienation (Gardner, 2001; Reay, 2015)”

This caveat highlights once again the fundamental definition problem surrounding phrases like “without reasonable justification” and “on reasonable grounds” – what constitutes the diagnostic definition of the term “reasonable”?  This caveat, while seemingly laudable, raises the diagnostic question, are there other “reasonable grounds” besides “parental abuse or neglect” that justify “a child rejecting a parent”?  If so, what are they?  This is a critically important diagnostic issue.

For diagnostic purposes, if the Gardnerians wish to define a new and unique form of psychopathology that proposes “reasonable grounds” for a child’s rejection of a parent, then they need to define what are the “reasonable grounds” for rejecting a parent besides parental abuse or neglect.  Are there any?  Or is it just “parental abuse or neglect”?

For example, is it “reasonable grounds” for a child to reject a parent who is exceedingly harsh, punitive, and verbally demeaning of the child? 

How about a parent who is highly harsh, punitive, and verbally demeaning?  Would that be “reasonable grounds” for “a child to reject a parent” who is highly harsh, punitive, and verbally demeaning?

How about a parent who is moderately harsh, punitive, and verbally demeaning?  Or how about a parent who is somewhat harsh, punitive, and verbally demeaning?

Can you begin to see the problematic diagnostic issues.  Then lets go a bit further…

How do we operationally define the terms exceedingly, and highly, and moderately, and somewhat? How about on a 1 to 10 scale, with 10 being exceedingly harsh, punitive, and verbally demeaning of the child.  At what point does a child’s rejection of a parent pass from being “reasonable” estrangement to “parental alienation”?  Seven?  Five?  Why seven and not four?

Can you see where we can begin to get into some very problematic diagnostic issues?

I just think this whole “new syndrome” new form of pathology thing is ill-conceived from the start.  Gardner’s correctly identified the existence of a pathology, but he skipped the step of diagnosis and too quickly jumped into the conceptually lazy approach of proposing a “new syndrome,” and his Gardnerian PAS followers are continuing to maintain this fundamental error, despite the abundant constructive feedback they’ve received from establishment psychology.

In AB-PA, I have listened to the constructive feedback offered by establishment psychology, and I have applied the standard and established constructs and principles of professional psychology to the diagnosis of the pathology of “parental alienation.”  I have corrected the step skipped by Gardner so that the mental health system can get back on track. 

Assessment (the Diagnostic Checklist for Pathogenic Parenting) leads to diagnosis (V995.51 Child Psychological Abuse, Confirmed), and diagnosis guides treatment (a protective separation of the child from the abusive parent and recovery of the child’s normal-range and healthy development).

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

References

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. NY: Basic.

Kernberg, O.F. (1975). Borderline conditions and pathological narcissism.. New York: Aronson.

Templer, K., Matthewson, M., Haines, J. and Cox, G. (2016). Recommendations for best practice in response to parental alienation: Findings from a systematic review. Journal of Family Therapy, doi:10.1111/1467-6427.12137

The Child Custody Industry in Mental Health

Standard

There is no validity whatsoever to the conclusions and recommendations reached by child custody evaluations.  None.  Zero.

Different custody evaluators can reach entirely different conclusions and recommendations based on the same data (no inter-rater reliability), there is no definition as to what constitutes the “best interests” of the child, and child custody evaluators are free to apply, misapply, or not apply any, some, or none of the constructs and principles of professional psychology.

The conclusions and recommendations offered by child custody evaluations are no more valid than a monkey throwing darts at a dartboard.

Disagree?  Provide me with one citation that demonstrates that the conclusions and recommendations reached by child custody evaluations are any more valid than a monkey throwing darts at a dartboard. <crickets>

The conclusions and recommendations of child custody evaluations are simply made up out of thin air.  Child custody evaluators spend lots and lots of time collecting data (all at $250 to $300 an hour – very lucrative), and they spend lots and lots of time writing, documenting the content of the data they’ve collected (again, all at $250 to $300 an hour – very lucrative), but as for the conclusions and recommendations they reach… well they just make those up.

Seriously, no exaggeration.  They just entirely make up whatever conclusions and recommendations they want.

Q: “Don’t they base their conclusions and recommendations on the data they’ve collected?”

A:  Nope.  They just make up whatever conclusions and recommendations they want based on their personal biases and their idiosyncratic base of knowledge – or lack of knowledge, and then they fit these conclusions and recommendation over the data.

Slip-Cover Analogy:  It’s kind of like making a slip-cover for a couch.  The slip-cover has the basic couch shape, but the question is whether the actual couch is a green couch, or a red couch, or a leather couch?  Who knows.  The “color” is decided by the evaluator who is making the slip-cover, and it’s whatever color the custody evaluator decides, irrespective of the actual color of the couch.  If the evaluator wants a blue couch, then the evaluator simply makes a blue slip-cover for the couch.  If the evaluator wants it to be a red couch, no problem, the evaluator simply makes a red slip-cover.  What color the couch actually is… well, we’ll just never know.

Child custody evaluators are 100% free to apply, misapply, or not apply any, some, or none of the established constructs and principles of professional psychology to the data.  There is no standardization to the interpretation of the data, not even any standardization related to the application of established constructs and principles of professional psychology to the interpretation of the data.

Seriously, I kid you not.  They just make up their conclusions in any way they want.  I am absolutely stone cold serious about that.  No exaggeration.  As a consultant for attorneys, I’ve read these evaluations.  The evaluators just make it up.  The reporting on the data is fine, it’s their conclusions and recommendations that they simply make up willy-nilly, any way they want.

Do they apply the constructs and principles of attachment theory to an attachment related family pathology?  Nope.  Apparently there’s no need.

Do they apply family systems constructs and principles to family conflicts and problems?  Nope.  Apparently, there’s no need to do that either.

How about applying the fundamentals of the DSM diagnostic system to pathology evidenced in the family?  Nope.  No need.  In fact, the professional practice Standards of the APA and AFCC actually encourage child custody evaluators NOT to tell the court about the presence of any DSM-related pathology evidenced by the parents because a diagnostic label might be “prejudicial” to that parent’s efforts to obtain custody of the child.  Go figure.  Isn’t intentionally withholding relevant diagnostic information from the Court just as prejudicial in the opposite direction, against the normal-range parent?  Oh well, even DSM diagnostic information is not applied to the data.

How about applying standard personality disorder constructs such as narcissistic, borderline, or the evidenced-based Dark Triad personality pathology (Paulhus & Williams, 2002) to understanding the family’s interaction patterns?  Nope.  No need.

How about applying the principles of parental “psychological control” of the child (Barber, 2002), or parental “boundary violations” with the child (Kerig, 2005), or an “invalidating environment” created by distorted parenting practices (Linehan, 1993)?  Nope.  No need.

How about simply defining what the construct of the child’s “best interests” means and how that will be determined?  Nope.  No need to do that either.

So then my question to child custody evaluators would be:

Q:  Then what ARE the principles and constructs from professional psychology that you are systematically applying as the basis for interpreting the data and reaching your conclusions and recommendations?

A:  Whatever we feel like.  We actually don’t have to use any constructs or principles from professional psychology.  We are 100% free to just do whatever we want with regard to interpreting the data.  We just reach any conclusion we want, and then we make recommendations.

Q:  So you reach whatever conclusions you feel like regarding the family processes and the child’s best interests without necessarily applying any of the established constructs and principles of professional psychology in any systematic way to your analysis?

A:  Yep.  And you know the best part?  The Court then seals the report so that no one ever reviews the accuracy of the conclusions we’ve reached and the recommendations we’ve made.  Pretty sweet deal, eh?  And even if the report is ever reviewed, it’s only reviewed by another forensic psychologist who is in the same racket, er, field, of also conducting child custody evaluations, and they only review the report as to whether the proper data collection procedures were followed, NOT whether the conclusions were accurate and the recommendations were warranted by the data.

There is no scientifically or theoretically established foundation for the conclusions and recommendations reached by child custody evaluators.  Zero.  None.

Prior Blogs on this topic:  

Cross Examining Child Custody Evaluations
A Solution to Assessing the Best Interests of the Child
An Alternative Assessment to Child Custody Evaluations

Q:  So Dr. Childress, if there is zero scientifically established validity to the conclusions and recommendations reached by child custody evaluations, then why does the practice of child custody evaluation continue?

A:  Good question. I’ll get to that… so follow along.

Clinical vs Forensic Psychology

Did you know that clinical psychologists are prohibited from offering opinions regarding child custody?  Why is that?

After six months or a year of doing family therapy, we know the family dynamics pretty well.  If an opinion regarding the “best interests” of the child surrounding the child’s custody is desired, wouldn’t the clinical psychologist who’s been involved in treating the family be in the best position to offer this opinion?

I’ve been trying to find the justification for prohibiting clinical psychologists from offering opinions regarding child custody, and what seems to be offered is that clinical psychologists are somehow made to be “biased” by their role as therapists, and that this supposed “bias” would entail a “multiple role” if the clinical psychologist is then asked to provide a professional opinion regarding the child’s “best interests.”  Therefore, a supposedly “objective” child custody evaluation is needed to avoid the supposed “bias” of the clinical psychologist.

Oh my God.  Let me at that justification…

The “multiple roles” argument is a false construction designed to invalidate the opinions of the treating clinical psychologist and justify a bogus assessment procedure that costs between $20,000 to $40,000.

First off, let’s get something straight… ALL psychologists are supposed to function without bias and in the best interests of our clients.  To accuse clinical psychologists of bias is unfounded, unwarranted, and frankly, insulting.  All capable and competent clinical psychologists conduct our assessments, diagnoses, and treatment without bias.  Assessing and diagnosing family dysfunction is our profession.  It is NOT a “multiple role.”

Second, whenever I’ve encountered this justification it is always built on a straw-man presentation of what therapy is.  The author proposing this “multiple role” argument always creates a false definition of what therapy entails and then uses this false definition to frame a straw-man argument that clinical psychologists are inherently biased by their role and therefore cannot reach an “objective” opinion regarding the functioning of the family or best interests of the child.  False.  False definition of therapy.  False attribution of inherent bias.  False argument.

Capable and competent family therapists do NOT simply passively accept what the family members tell us.  Are you kidding me?  Family therapists assess the family’s functioning through a variety of procedures in which we apply standard and established constructs of family systems therapy – laid out by such preeminent family systems theorists as Murray Bowen, Virginia Satir, Salvador Minuchin, Jay Haley, Cloe Madanes, and others – and we use these standard and established principles of family functioning to reach an accurate diagnosis of the family’s problematic functioning in order to develop a treatment plan to fix it.

A capable and competent family systems therapist does NOT simply passively accept what the family members say.  A family systems therapist analyzes the family structure and family interaction patterns, and then intervenes in selective ways to alter the unhealthy structures and interaction patterns within the family.  Bias?  That’s called knowledge.  I know exactly what is going on and I know exactly how to fix it.  That’s my profession, that’s my expertise.

It’s not “bias” – it’s knowledge.

Family systems therapists understand the family extremely well.  Better than the family understands itself.  We understand the family norms governing the interaction patterns in the family.  We understand the underlying anxieties of the family members in their struggles for intimacy in the context of establishing their independent autonomy.  We understand how the needs, emotions, and conflicts of various family members are being deflected, triangulated, and diverted within the family.  That’s the basis of our work.  In order to change the dysfunctional family system, we must first understand the functioning of the dysfunctional family system.  Bias?  It’s called knowledge.

I can counter and dismantle-in-detail this false “multiple roles” justification for prohibiting clinical psychologists from offering an opinion regarding the “best interests” of the child surrounding custody and visitation.  It is a bogus and false justification.

If this supposed “bias” and “multiple roles” justification (which, by the way, assumes in it’s very framing that there are two roles) is bogus, then what’s the real reason for prohibiting clinical psychologists from offering an opinion regarding the best interests of the child surrounding child custody and visitation?

The secret to understanding the underlying motivation for prohibiting clinical psychologists from offering an opinion regarding the child’s best interests is found in de-constructing the “multiple roles” argument.  It’s sneaky.  By merely proposing that there are “multiple roles” they are CREATING separate roles.  According to this (false) line of argument, one role is “subjective” (the therapist) and one role is “objective” (the evaluator).  Sneaky.

Doesn’t the Court want an “objective” opinion?  Then the Court obviously wants a child custody evaluation by an “objective” custody evaluator.

But let me reframe this false dichotomy:  It’s not about subjective and objective; it’s about knowledgeable and ignorant.  The clinical psychologist is knowledgeable of the family dynamics based on months and months of family systems assessment sessions involving detailed interaction with the family’s structures and relationship patterns.  The clinical psychologist knows the family.  Knowing something is called being “knowledgeable.”

The child custody evaluator, on the other hand, starts from a position of complete ignorance regarding the family’s functioning (in which ignorance is framed as being “objective”), and then begins to collect information in an effort to develop the knowledge already possessed by the clinical psychologist regarding the family.  The custody evaluator begins gathering history and symptom information from interviews with the family members (who may be presenting self-serving reports regarding the family relationships), and the custody evaluator interviews family friends of the parents (who offer biased reports that support their friend), the custody evaluator may also conduct artificial and painfully superficial “family observation” sessions, and the custody evaluator administers tests of questionable value (such as applying tests developed for other purposes, such as the MMPI, to the custody situation, or using self-report instruments that are prone to self-serving bias in reporting).

All of this rigamarole in data collection is under the guise that a “multi-method” approach to data collection makes the interpretation of the data valid.  No… it doesn’t.  Data collection and data interpretation are two different processes.  A multi-method approach to data collection provides a lot of data from multiple persepectives.  That’s all.  The next – and separate – question is how is this data set INTERPRETED?  That is the critical question regarding the conclusions and recommendations reached by child custody evaluations.  How is the data set interpreted?

Not knowing something is not being “objective,” not knowing something is called being “ignorant.”  Child custody evaluators aren’t any more “objective” than the clinical psychologists.  Child custody evaluators are simply moving from a place of ignorance to the place of knowledge already possessed by the family therapist.  That’s not “objective,” that’s just moving from ignorance to knowledge.

The child custody evaluator is essentially trying to develop, from a standing-start, the knowledge of the family dynamics that the treating clinical psychologist already has in spades.

It’s not an objective–subjective dichotomy; it’s an ignorance–knowledge dichotomy.

Furthermore, once the child custody evaluator “objectively” collects the data,  the interpretation of the data by the custody evaluator to reach their conclusions and recommendations is entirely – 100% – subjective.  The child custody evaluator is NOT required to systematically apply any of the principles or constructs from professional psychology to the interpretation of the data.  The child custody evaluator is 100% free to apply, misapply, or not apply any, some, or none of the principles and constructs of professional psychology to the data.

The clinical psychologist, on the other hand, has systematically applied a variety of standard and established constructs and principles of professional psychology to the data of the family system – family systems constructs; attachment system constructs; boundary violations; personality pathology; self-psychology and psychoanalytic constructs; cognitive-behavioral constructs, developmental psychology principles, parenting skills assessment.  That’s what we do – that’s what clinical psychology is – the application of standard and established psychological principles and constructs to a data set of symptoms and interaction patterns within the family.

It’s not objective versus subjective; it’s ignorant versus knowledgeable.

So, since the “multiple roles” argument is a spurious and false creation based on a straw-man definition regarding what therapy entails, then what is the actual reason that clinical psychologists are prohibited from offering an opinion regarding the best interests of the child surrounding custody and visitation?

The Forensic Psychology Lobby

The reason clinical psychologists are prohibited from offering child custody opinions is because the forensic psychology lobby in professional psychology organizations is very strong (Division 41 of the APA: The American Psychology-Law Society – The AFCC: the Association of Family and Conciliation Courts), and the forensic psychology lobby is seeking to restrict trade in order to mandate the very lucrative practice of child custody evaluations for its membership, and clinical psychologists just haven’t felt it was important enough to us to argue about the prohibition. 

Clinical psychologists are risk-averse, and we don’t like high-conflict divorce (it’s too dangerous).  Working with narcissistic and borderline personalities (the Dark Triad and Vulnerable Dark Triad personality) is fraught with dangers, and there’s always at least one narcissistic or borderline personality in all high-conflict divorce.  If there wasn’t at least one narcissistic or borderline personalty, then it wouldn’t be high-conflict, because normal-range parents would have empathy for their children and would never put their children through a high-conflict divorce.  A high-conflict divorce requires that at least one parent has no empathy for the children.  Clinical psychologists generally stay away from child custody and the legal entanglements surrounding high-conflict divorce because it’s all too dangerous.  Clinical psychology is more than happy to cede high-conflict divorce over to forensic psychology.

The problem is, we shouldn’t have done that.  Because the child custody reports produced by the procedures of forensic psychology are horrific.

Personally, I’ve always felt that this restriction on my ability to state a professional opinion is… well… an unconstitutional abrogation of my free speech rights – or a restraint of trade – or something.  To say that clinical psychologists cannot form or offer an opinion regarding the child’s best interests surrounding custody unless we do a formal child custody evaluation is bizarre.  We form an opinion – we have an opinion – we’re just prohibited from telling anyone.  Sounds like a restraint of trade to me, but what do I know.

But as long as I was in the ADHD and childhood trauma fields, what did I care.  I wasn’t involved in treating high-conflict divorce.  In fact, I swore to myself that I would never do high-conflict divorce.  Too dangerous.  So I just assumed that the practice of child custody evaluations was professionally competent.  After all, there’s a whole division of the APA (Division 41) that’s devoted to forensic psychology.  Surely they know what they’re doing. But that’s the secret hidden behind the veil of these custody reports being sealed by the Court.  They are horrific.  Really – really bad.  But they never receive outside review regarding their findings and conclusions.  When they are reviewed, which is infrequently because of the financial expense involved in a second review, they are only reviewed by ANOTHER forensic child custody evaluator who only reviews the evaluation to see if the proper data collection procedures were followed, NOT regarding whether the conclusions and recommendations reached were accurate.  But this internal review within forensic psychology represents a fundamental conflict of interest.  It’s all an inside club making $20,000 to $40,000 per evaluation.

In truth, the conclusions and recommendations of child custody evaluations are no more valid that a monkey throwing darts at a dartboard.  Seriously.  That’s no exaggeration.  If there is any doubt about this, simply ask for any citation to the research literature demonstrating that the conclusions and recommendations of child custody evaluations are any more valid that a monkey throwing darts at a dartboard.  There is none.  Zero.

So consider this…

Child custody evaluations cost between $20,000 to $40,000.  An alternative, structured Treatment Needs Assessment by a clinical psychologist would cost around $2,000 (An Alternative Assessment to Child Custody Evaluations).

So why are clinical psychologists prohibited from forming or offering child custody opinions and recommendations under threat of losing our license?  It’s seems pretty goll darn obvious to me. $20,000 to $40,000 as compared to $2,000. 

The Court doesn’t know this.  They’re trusting professional psychology (the APA and AFCC).  The licensing board doesn’t know this.  They’re trusting professional psychology (the APA and AFCC).  Even the general APA doesn’t know this, because they’re trusting the forensic psychology lobby – and it’s an inherent conflict of interest for the forensic psychology lobby since the forensic psychology lobby is working for its membership who are making $20,000 to $40,000 for each child custody evaluation.  It’s in the monetary best interests of their constituents to restrict trade so as to require child custody evaluations.

Spurious Multiple Roles

When the time comes to dismantle the arguments that opinions regarding child custody should only be made in the context of a formal custody evaluation and that the clinical psychologist role biases the clinical psychologist, I can dismantle these arguments in detail.   A key point to notice is that the moment the forensic psychology lobby raises the argument of “multiple roles” they have actually created the “multiple roles.”   The very premise of “multiple roles” is false.  There are no “multiple roles.”  This “multiple role” argument is a spurious argument designed to justify the separate role of a forensic child custody evaluator at $20,000 to $40,000 an evaluation.

In clinical psychology, an assessment begins with the referral question.  In this case, what is the question the Court wants answered? 

Referral Question:  Should the Court order a 60-40%; 70-30%; 80-20%; 90-10%; or a 50-50% custody timeshare schedule with this specific family?

A:  The answer to that question is… this referral question is beyond the scope of scientifically and theoretically supported professional practice.  There is no scientifically or theoretically established foundation or knowledge base in professional psychology that would allow a supported opinion regarding that question. 

The best that professional psychology can offer is based on the foundational premise that children benefit from a complex relationship with both parents (A Solution to Assessing the Best Interests of the Child).  Based on this foundational premise, that children benefit from a complex relationship with both parents, the only professionally supported recommendation from professional psychology would be for a 50-50% custody timeshare schedule (except in cases of child abuse which would warrant a child protection response).  There is no scientifically or theoretically supported information in all of professional psychology that would allow for a fine-grained differentiation of the alternative timeshare options for any specific family.

Referral Question: When there is significant family conflict surrounding the 50-50% custody timeshare (a high-conflict family), how should this family conflict for this specific family be resolved? (this is a treatment-related referral question, not a child custody issue.)

A:  A clinical psychologist should conduct a Treatment Needs Assessment regarding the treatment plan needed to resolve the family conflict, and the clinical psychologist should provide a report to the Court regarding the treatment-related needs of the family.

Q:  Can a Treatment Needs Assessment be completed by the treating clinical psychologist?

A:  Yes – if this is within the boundaries of professional competence for this clinical psychologist.

Q:  What about potential bias of the treating clinical psychologist?

A:  It is a professional expectation that psychologists in all role-relationships avoid bias and should always work in the best interests of their clients.  The effects of possible bias are limited in a Treatment Needs Assessment by the structured and targeted collection of relevant information and by the application of all of the standard and established constructs and principles of clinical psychology to the interpretation of the data, including the functioning of the attachment system when assessing attachment-related pathology, the potential impact of parental personality disorder pathology on family interactions, and standard and established family systems constructs and principles.

Q:  Can a Treatment Needs Assessment be completed by an independent clinical psychologist?

A:  Yes – if this is within the boundaries of professional competence for this clinical psychologist.

Q:  Does it make a difference if a Treatment Needs Assessment is conducted by the treating family therapist or by an independent family therapist?

A:  No.  All psychologists should function without bias and at the highest level of their craft, and all psychologists should always function in the best interests of their clients.  If either party in the spousal conflict feels uncomfortable with the treating therapist conducting a Treatment Needs Assessment then this is weird, since the treating therapist has already conducted an informal treatment needs assessment as part of developing a treatment plan (assessment leads to diagnosis, and diagnosis guides treatment).  But if either party feels uncomfortable, it’s no problem to have an independent Treatment Needs Assessment conducted by an “outside” clinical psychologist (a second opinion, if you will).

A Treatment Needs Assessment by a Clinical Psychologist: $2,000 – $3,000

A Child Custody Evaluation by a Forensic Psychologist: $20,000 – $40,000

In truth, any professional recommendation for custody other than a 50-50% child custody timeshare is beyond the scope of scientifically and theoretically grounded professional practice. 

Q:  So Dr. Childress, why do we continue with the practice of child custody evaluations? 

A:  Because Courts, and lawyers, and parents don’t know psychology.  They assume that psychologists must know what they’re doing, and because the Courts, and lawyers, and parents don’t know psychology, they can’t know that it’s all made up – after all, look at all the data that was collected, and how long and detailed the report is.

But I’m a psychologist who, because of my role as a professional psychological consultant to attorneys in these matters, has been let in behind the veil of secrecy of these sealed child custody evaluations.  I’ve read these child custody evaluations.  They are bad, bad, bad.  Horrifically, stunningly bad.  They just 100% make up their conclusions and recommendations.  I am stone cold serious.  They are bad.

They gather lots and lots of interviews, and review lots and lots of records, and talk to lots of collateral informants, and do home visits, and administer tests of various sorts – all at $250 to $300 an hour for each hour spent in gathering information.  Very lucrative.  They then spend hours and hours writing their reports, documenting the content of all of the interviews, documenting the content of all the records they reviewed, documenting the content of all their collateral contact interviews, documenting in detail their home visit observations, and reporting on the test scores obtained from testing, – page after page of documenting – documenting – documenting – all that writing time billed at $250 to $300 an hour spent writing page after page of documenting the data – 50, 100, 150 pages of writing time.  Very lucrative.

Q:  But certainly their conclusions and recommendations are based on this data, aren’t they?

A:  Nope.  They then just make up their conclusions and recommendations in whatever way they want.  Like a furniture slip-cover of their own construction, designed to roughly resemble the piece of furniture being covered, but not necessarily reflecting the actual color of the underlying furniture.  The slip-cover that’s constructed by the custody evaluator can be blue, or green, or yellow, while the actual furniture is red.

When it comes to interpreting what the data means and forming recommendations, custody evaluators are 100% free to apply, misapply, or not apply any, some, or none of the established constructs and principles of professional psychology to the interpretation of the data in whatever way they want.  They just make it up.

And, in truth, they only spend about two or three hours writing up the conclusions and recommendations section of the report (what is that, around a $1,000 worth of time?) and they bill $30,000 for all the time they spent collecting data and documenting the data they collected in their exhaustive report.

It’s a racket, pure and simple.  And by offering Guidelines for the practice of child custody evaluations (AFCC Guidelines; APA Guidelines), the AFCC and APA provide their imprimatur of credibility to the practice of child custody evaluations.  In providing Guidelines for the practice of child custody evaluations, the AFCC and APA effectively become the organizing syndicates for the racket, and the custody evaluators represent the soldiers raking in the money – money extorted from desperate parents via the legal system, extorted by Court order.  I find that amazing.  An extortion syndicate by Court order.

It’s the professionally sanctioned financial exploitation of an immensely vulnerable population that I find most repugnant and professionally abhorrent.

The forensic psychology lobby prohibits clinical psychologists from offering opinions on child custody so that Courts are forced to order expensive child custody evaluations – based on the professional standards of the APA and AFCC (as codified in the official Guidelines written by the powerful forensic psychology lobby).  Then these evaluations are sealed by the Court so that they are never subject to review, and if they are challenged they must be challenged by another forensic evaluator who comments on whether the appropriate procedures for data collection were followed, not on whether an accurate interpretation of the data was made.  Yet having another forensic child custody evaluator review the work of the original forensic child custody evaluator – besides being prohibitively expensive – represents an inherent conflict of interest.  They “review” themselves.  The fox is in charge of the hen house.

The Solution is Standard Clinical Psychology

The “multiple roles” argument is 100% bulls***.   All psychologists in any capacity should function without bias.  We are professionals.  All psychologists in any capacity should serve the best interests of the client.  To ascribe to clinical psychologists that we are inherently biased because of our role as treating psychologists is complete 100% cow pucky.

It is an artificially imposed dichotomy framed as “subjective” versus “objective” – but this dichotomy is actually knowledgeable versus ignorant.  Ignorant is not “objective,” ignorant is just ignorant.

The treating clinical psychologist – or any clinical psychologist applying the principles of clinical psychology, including clinical assessment principles, knowledge of the attachment system, knowledge of family systems constructs, knowledge of personality disorder pathology – is knowledgeable.

The child custody evaluator, on the other hand, is completely ignorant regarding the family’s structure and relationship patterns (in which this ignorance is framed as the supposed virtue of “objectivity”) and is then trying to get up to speed regarding understanding the family from the baseline of complete and total ignorance – and the child custody evaluator is trying to overcome this starting point of complete ignorance (supposedly granting them “objectivity”) without being required by professional standards of practice to apply in any systematic way any of the principles and constructs of professional psychology.

Holy cow.  Just let me do a clinical assessment.  Assessment – diagnosis – treatment.  Assessment leads to diagnosis, and diagnosis guides treatment.  It’s what clinical psychologists do.  It’s our craft.  It’s our profession.

And by “me” I’m referring to the generic “me” – i.e., a competent clinical psychologist.  Any clinical psychologist with a modicum of specific instruction can conduct a Treatment Needs Assessment.  It’s just a focused variant of a standard clinical assessment – history and symptom information (using Applied Behavioral Analysis “behavior chain” sequences and identifying the “stimulus control” for the behavior), add the Diagnostic Checklist for Pathogenic Parenting and the Parenting Practices Rating Scale, and apply standard constructs and principles from attachment theory regarding attachment related pathology, from personality disorder literature to personality disorder pathology evidenced in the family, and from the family systems literature regarding the functioning of this particular family system.  Standard clinical psychology stuff.

If you want to know what’s going on, let me (i.e., any competent clinical psychologist) conduct a clinical assessment.  This will lead to a clinical diagnosis regarding the issues, and the clinical psychologist can tell you exactly what needs to happen for treatment (i.e., the treatment plan).  This is standard clinical psychology stuff.

In cases of alleged “parental alienation,” if you want me (or any competent clinical psychologist) to determine whether there is psychological child abuse (pathogenic parenting) that warrants a child protection response, that can be accomplished through a focused Treatment Needs Assessment.

However, if you want me to determine which spouse in the inter-spousal conflict is the “better parent” who should be awarded a larger share of the “custody prize” of the child… Sorry, can’t help you there.  Doing that is beyond the professional scope of scientifically and theoretically grounded professional practice.

If you want to divide up the “custody prize” of the child amidst an inter-spousal dispute, the best I can tell you, based on the totality of the scientific and theoretical literature, is that children benefit from complex relationships with both parents.  Based on this scientifically and theoretically grounded understanding, the only recommendation I can offer regarding a child custody timeshare schedule is a 50-50% custody timeshare shared between both parents (unless there is child abuse that warrants a child protection response).

If there is family conflict surroundiing the 50-50% custody timeshare, that is a treatment related issue, not a child custody issue (unless there is child abuse that warrants a child protection response).

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

References Cited

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

Kerig, P.K. (2005). Revisiting the construct of boundary dissolution: A multidimensional perspective. Journal of Emotional Abuse, 5, 5-42.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder.  New York, NY: Guilford

Paulhus, D. L., & Williams, K. M. (2002). The dark triad of personality: Narcissism, Machiavellianism, and psychopathy. Journal of Research in Personality, 36, 556–563.

An Open Letter to the Parental Alienation Study Group (PASG):

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An Open Letter to the Parental Alienation Study Group (PASG):


Don’t you see my path?

In order to leverage the solution to “parental alienation” we must be able to hold all mental health professionals accountable for an accurate assessment of the pathology, and an accurate diagnosis of the pathology.

We do this through the DSM-5.  The DSM-5 diagnosis we seek in ALL cases of “parental alienation” is V995.51 Child Psychological Abuse, Confirmed.  The attachment-related pathology of “parental alienation” is not a child custody issue, it is a child protection issue.  That is the definitional change that will lead to the solution.

I have laid the Foundations for this diagnosis.  I have identified three definitive diagnostic indicators for the pathology.  These three diagnostic indicators are all established symptoms that are within the diagnostic scope of practice for ALL mental health professionals: 1) attachment-related symptoms, 2) personality disorder features, 3) an encapsulated persecutory delusion.

By shifting the construct from “parental alienation” to pathogenic parenting, I have taken control of the construct-language in order to compel professional competence from ALL mental health professionals; from all court-involved therapists; from all child custody evaluators.

Don’t you see what I’m doing?   I am compelling professional competence.

I then created the Diagnostic Checklist for Pathogenic Parenting to act as the leverage point to achieve professional competence from ALL mental health professionals in the assessment and diagnosis of the pathology.  The term “pathogenic care” was used in the DSM-IV TR relative to an attachment-related disorder (Reactive Attachment Disorder).  It is an established construct in professional psychology that cannot be denied by any mental health professional.  The attachment system is an established and fully accepted construct in professional psychology.  Personality disorder pathology is an established and fully accepted construct in professional psychology.  Delusional psychiatric pathology is an established and fully accepted construct in professional psychology.  Incompetent mental health professionals are trapped.  They have no choice except to become competent.  They must assess for the pathology.

Standard 9.01a of the APA ethics code requires that:

9.01 Bases for Assessments
(a) Psychologists base the opinions contained in their recommendations, reports and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings.

Standard 9.01a explicitly requires that diagnostic statements and forensic testimony must be based on “information and techniques sufficient to substantiate their findings.”  Standard 9.01a is the anvil.  The Diagnostic Checklist for Pathogenic Parenting is the hammer.  And from this hammer and anvil we forge the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Here is the sound of the hammer falling upon the anvil:

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and an encapsulated persecutory delusion in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Hear it?  The sound of the hammer against the anvil creating the DSM-5 diagnosis of Child Psychological Abuse?

The anvil of Standard 9.01a of the APA ethics code and the hammer of the Diagnostic Checklist for Pathogenic Parenting forges the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.  And ALL mental health professionals can then be held accountable for this standard of professional practice.  Pathogenic parenting is a fully established and fully accepted psychological construct (referenced in the DSM-IV TR regarding an attachment-related pathology).

Don’t you see what I’m doing?  Don’t you see how I’m leveraging the construct of pathogenic parenting into a confirmed DSM-5 diagnosis of child psychological abuse?

Don’t you want a confirmed DSM-5 diagnosis of Child Psychological Abuse from every single mental health professional who comes into contact with this form of attachment-related pathology?

Don’t you see how useful this will be in solving “parental alienation”?

For those of you who might argue that this approach doesn’t solve everything… can we at least get this first step in place of having ALL mental health professionals assess for the pathology using a standardized assessment protocol, and having ALL mental health professionals acknowledge that the attachment-related pathology of pathogenic parenting is Child Psychological Abuse.

Let’s get this first step.  It is an immense step forward.

And notice the Associated Clinical Signs that are listed on the Diagnostic Checklist for Pathogenic Parenting.  The use of the Diagnostic Checklist for Pathogenic Parenting opens up this whole domain of discussion regarding the Associated Clinical Signs of the pathology.

Don’t you see what I’m doing?

I’m now shifting to preparing the battlefield for the second phase, the assessment phase once all mental health professionals – all court-involved therapists, all child custody evaluators – begin incorporating the Diagnostic Checklist for Pathogenic Parenting into their clinical assessments.

The Diagnostic Checklist for Pathogenic Parenting documents the pathology.  I am now beginning to provide structure for the assessment process itself.  In recent essays posted to my website and referenced in my blog (Alternative Assessment to Child Custody Evaluations), I describe a three-phase assessment procedure for conducting the clinical assessment interviews for pathogenic parenting in the family:

  1. Initial interviews with each parent and the child individually
  2. Joint parent-child assessment sessions
  3. Confirming clinical interviews with each parent individually

I have also described a clinical interview process for identifying the “behavior-chain” sequence (from Applied Behavioral Analysis; ABA) surrounding specific parent-child conflict events and I have introduced the construct of “stimulus control” (also from Applied Behavioral Analysis; ABA) into the assessment process.  I have also provided a Parent-Child Relationship Rating Scale for documenting a Single-Case ABAB intervention assessment and treatment protocol.

All of this lays the groundwork for evidence-based practice. Don’t you see what I’m doing?

I have also structured the documentation of the targeted parent’s normal-range parenting practices using the Parenting Practices Rating Scale.  Documentation.  Evidence-based practice.

And, I have provided a structured template on my website for the report which is produced by the assessment (a Treatment Needs Assessment).  A simple and direct report based on the referral question and documented evidence.  Sub-threshold symptoms result in a Response-to-Intervention assessment (RTI).  Evidence-based practice.

Don’t you see what I’m doing?  We don’t need an expensive child custody evaluation.  We need a simpler Treatment Needs Assessment – 6 to 8 clinical interview sessions, the Diagnostic Checklist for Pathogenic Parenting to document the child’s symptoms, the Parenting Practices Rating Scale to document the normal-range parenting of the targeted parent, a confirmed DSM-5 Diagnosis of Child Psychological Abuse, and a simple direct report to… to whom?

To the Court.  Don’t you want to give the targeted parent this straightforward report to provide to the Court with a confirmed DSM-5 diagnosis of Child Psychological Abuse?

To CPS.  Don’t you want the mental health professional to send this straightforward report to CPS along with a suspected child abuse report made by the mental health professional?  A simple, direct report providing a confirmed DSM-5 diagnosis of Child Psychological Abuse.

This is an immense step forward from where we have been regarding the assessment and diagnosis of “parental alienation.”

Once we have achieved this ground on the battlefield, this will serve as our new footing from which we can launch further into enacting a complete solution to the attachment-related pathology of “parental alienation.”  In our battle to solve the attachment-related pathology of “parental alienation” we are attacking specific key points on the battlefield with focused precision.  We are seeking to take these key strategic points on the battlefield – the APA ethics code, the DSM-5 diagnosis of Child Psychological Abuse, a structured and standardized assessment protocol which establishes a “standard of practice” for the assessment and diagnosis of the pathology.

Once we achieve these key strategic points on the battlefield – the APA ethics code, a standardized assessment protocol for all mental health professionals, a confirmed DSM-5 diagnosis of Child Psychological Abuse and the general recognition of the pathology as child abuse – then we turn to obtaining “special population” status for these children and families, requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat; and we will also then turn to the Child Protective Services system to implement standardized assessment protocols to identify the psychological child abuse of “parental alienation” (pathogenic parenting; the Diagnostic Checklist for Pathogenic Parenting – and the Associated Clinical Signs).

Gardnerian PAS offers none of this.  The eight diagnostic indicators of Gardnerian PAS offer none of this.  This solution is only available by a paradigm shift to the three diagnostic indicators of attachment-based “parental alienation” (AB-PA).

Gardnerian PAS does not provide a standardized assessment protocol to which all mental health professionals can be held accountable.  AB-PA does.

Gardnerian PAS does not provide a confirmed DSM-5 diagnosis of Child Psychological Abuse.  AB-PA does.

Gardnerian PAS does not lead directly to the protective separation of the child from the psychologically abusive parent as the required intervention.  AB-PA does.

Gardnerian PAS does not produce the succinct clarity of a Treatment Needs Assessment report as a replacement for a child custody evaluation.  AB-PA does.

AB-PA represents a substantial move forward in solving the attachment-related pathology of “parental alienation.”  Achieving this ground on the battlefield requires a paradigm shift to the three diagnostic indicators of AB-PA.

Gardnerian PAS must die.  The eight diagnostic indicators of Gardnerian PAS must die.  A paradigm shift must occur.  A paradigm shift will occur.  A paradigm shift is occurring.

I am asking you to join me, to bring all of our voices into a single combined voice to enact the paradigm shift.  This is not a child custody issue.  It is a child protection issue.

The solution is available today; this instant.  All that’s required is the paradigm shift.

The use of the Diagnostic Checklist for Pathogenic Parenting is available today; this instant.  All that’s required is the paradigm shift.

The DSM-5 diagnosis of Child Psychological Abuse, Confirmed from all mental health professionals, all court-involved therapists, and all child custody evaluators is available today; this instant.  All that’s required is the paradigm shift.

The focused Treatment Needs Assessment report is available today; this instant.  All that’s required is the paradigm shift.

Don’t you see the map of the battlefield we’re fighting on?  The APA ethics code.  A DSM-5 diagnosis of Child Psychological Abuse.  Evidence-based practice.  Accountability for professional competence.  Don’t you see how we are systematically taking each of these points on the battlefield.  Don’t you see the strategy?

I’m asking you to join me, to join us.  Children and families are suffering, and every day without a solution is one day too long. The solution is available today; this instant.  All that’s required is the paradigm shift to the three diagnostic indicators of AB-PA.

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

An Alternative Assessment to Child Custody Evaluations

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Reliability:  The stability of the conclusions and findings of an assessment procedure.

Validity:  The truth or accuracy of the conclusions and findings resulting from an assessment procedure.


There is no established validity to the conclusions and recommendations reached by child custody evaluations.  There is no scientific evidence documenting the construct validity, content validity, predictive validity, convergent validity, or divergent validity for the conclusions and recommendations reached by child custody evaluations. 

There is no established inter-rater reliability regarding the conclusions and recommendations reached by child custody evaluations.  This means that the conclusions and recommendations reached by any individual child custody evaluation are merely the opinions of this one person – the one psychologist conducting the evaluation – and the conclusions and recommendations reached by this one individual psychologist may not be matched by the conclusions and recommendations reached by another psychologist given the same set of information.

Two different child custody evaluators looking at the same exact data may reach wildly different conclusions and recommendations. There is no established inter-rater reliability regarding the conclusions and recommendations reached by child custody evaluations.

If the conclusions and recommendations from an assessment procedure are not stable – are not reliable – from one evaluator to the next, then the conclusions and recommendations cannot be valid. 

If one day my assessment procedure determines that you are 6’2″ tall, and the next day my assessment procedure determines that you are 4’8″ tall, then my assessment procedure is not a valid (truthful-accurate) measure of your height, because your height is stable but my results are not – and because my results are not reliable (stable), they cannot be a valid (accurate-truthful) measure of your height. Are you 4’8″ tall?  6’2″ tall?  Or somewhere in between?  Who knows.

This is a basic and foundational premise of assessment which is known by every psychologist.

If the conclusions and recommendations reached by one child custody evaluator based on a set of data can be markedly different from the conclusions and recommendations reached by a different child custody evaluator looking at the same data (inter-rater reliability), then the assessment procedure of child custody evaluations is not reliable – the findings are not stable across evaluators.  And if the conclusions and recommendations reached by child custody evaluations are not reliable (stable across evaluators; inter-rater reliability), then they cannot, by definition, be valid (accurate-truthful).

The conclusions and recommendations offered by child custody evaluations merely reflect the personal biases of the individual evaluator, not the actual truth or accuracy of the situation – because the findings, conclusions, and recommendations can change from one evaluator to the next.

The conclusions and recommendations reached by child custody evaluations are no more valid than those reached by a monkey throwing darts at a dart board.

If any mental health professional disagrees with this statement, there is a Comment section to the blog.  I invite any mental health professional to cite for me a single research study demonstrating that the conclusions and recommendations reached by child custody evaluations are any more valid than a monkey throwing darts at a dartboard.

A single citation… <crickets>   Just one.  <crickets>

The Emperor Has No Clothes.

Child custody evaluations violate all of the professionally established standards of practice for the development of an assessment procedure.

While there are professional standards describing how child custody evaluation data should be collected and the role-relationships of the custody evaluator to the Court and the various family members (APA; AFCC), these professional standards do not define the key constructs assessed by child custody evaluations and they do not describe standardized procedures for how the data should be interpreted.

And it’s the interpretation of the data that is key to developing the conclusions and recommendations.

Child custody evaluators are completely free to arbitrarily apply, misapply, or not apply any, some, or none of the established principles and constructs of professional psychology to the interpretation of the data.

No Operational Definitions of Key Constructs:  There are no operational definitions for the key constructs of “best interests of the child” and “parental capacity.”

No Inter-Rater Reliability:  There is no established inter-rater reliability for the conclusions and recommendations reached by child custody evaluations.

No Established Validity:  There is no scientifically established construct validity, content validity, predictive validity, convergent validity, or divergent validity for the conclusions and recommendations reached by child custody evaluations.

Child custody evaluations do not employ any systematic or standardized approach to the interpretation of the data obtained by the evaluation.

The interpretation of data by child custody evaluators is based entirely – entirely – on the idiosyncratic content of the evaluator’s highly variable base of knowledge – or their lack of knowledge – and their conclusions and recommendations are entirely – entirely – subject to the personal prejudices and personal biases of each individual evaluator.

Caveat: Except in cases of child abuse which would warrant a child protection response…

There is no scientific or theoretical foundation which would allow professional psychology to render an opinion regarding the “best interests of the child,” since the very concept of “best interests of the child” is undefined and fundamentally undefinable given the overwhelming complexity of the parent-child relationship and the overwhelming complexity of individual idiosyncratic life-factors affecting the interpersonal family relationships occurring across time, individual circumstances, and the complexity of child maturation and development.

Caveat:  Except in cases of child abuse which would warrant a child protection response…

There is no scientific or theoretical foundation which would allow professional psychology to render an opinion regarding whether a 60-40% custody time-share is in the “best interests of the child” relative to a 70-30% custody time-share, relative to an 80-20% custody time-share, relative to a 90-10% custody time-share, relative to a 50-50% custody time-share.  There is NO scientific or theoretical foundation on which to form such an opinion.

Any opinion offered regarding the relative merits of differing custody time-share alternatives are NOT based in any scientifically or theoretically established psychological principles and constructs, and such opinions are based solely in the personal beliefs, prejudices, and biases of the individual evaluator.  Different mental health professionals examining the same data can reach entirely different conclusions and recommendations based on their personal beliefs, prejudices, and biases, because there is no scientifically or theoretically established foundation for the formation of an opinion regarding the long-term “best interests of the child.”

Children benefit from complex relationships with both parents.

Since there is no scientifically or theoretically established foundation that would allow for a professionally responsible opinion regarding the long-term “best interests of the child” that would result from a 60-40%, 70-30%, 80-20%, 90-10%, or 50-50% child custody time-share in any individual situation, the ONLY professionally responsible opinion that can be provided by professional mental health in all cases concerning child custody time-share (with the exception of child abuse, which would warrant a child protection response) is a recommendation for shared 50%-50% custody time-share based on the foundational principle that children benefit from a complex relationship with both parents.

If the parents wish to cooperatively develop an alternative custody time-share schedule, that is their right and their prerogative as parents.  But the ONLY professionally responsible opinion available which would be grounded in a scientifically and theoretically supported foundation – given the immense complexity of the changing and idiosyncratic life-factors and relationship factors involved – is for a shared 50-50% custody time-share based on the foundational principle that children benefit from a complex relationship with both parents.

Any other professional opinion exceeds the scope of scientifically and theoretically grounded professional practice.

Addressing Family Conflict

If family conflict emerges from a 50-50% custody time-share, this is a treatment-related issue NOT a child custody issue.

Professional psychology should scrupulously avoid being drawn into the spousal conflict surrounding divorce by accepting an inappropriate professional role of acting as arbiter in the spousal dispute as to which spouse is the “better parent” who should be awarded the “custody prize” of the child.

Awarding the “custody prize” of the child to the spouse who is deemed to be the “better parent” is a dramatically inappropriate role for professional psychology to undertake, and it is a role that exceeds the scope of scientifically and theoretically grounded professional practice.

The practice of child custody evaluations violate all aspects of scientifically and professionally supported assessment practice (reliability, validity, definitions of key constructs), the conclusions and recommendations produced by child custody evaluations are based entirely on the ideosyncratic beliefs, personal biases, and highly variable knowledge base of the individual evaluator, and the conclusions and recommendations offered exceed the scope of scientifically and theoretically grounded professional practice.

Children benefit from a complex relationship with both parents.

Differing complex relationships will produce differing complex outcomes of uncertain specificity.  These complex and uncertain outcomes will emerge within the context of uncertain and changing life circumstances and the inherently complex variability of the surrounding life context.  These changing and inherently complex life circumstances develop over time and they interact with the child’s own developmental maturation and the ever-changing maturation and growth of the parent-child relationship.

Except in cases of child abuse, it is fundamentally and completely impossible to determine the relative long-term “best interests of the child” that will result from a 60-40%, 70-30%, 80-20%, 90-10%, or 50-50% custody timeshare, and any attempt to do so is grossly misguided, ill-informed, and beyond the scope of scientifically and theoretically grounded professional practice.

If the Court wishes the input of professional psychology regarding child custody surrounding family conflict, such as the emergence of attachment-related pathology in the parent-child relationship evidenced in the child’s refusal to cooperate with the 50-50% custody time-share schedule, this is a treatment-related question regarding the resolution of attachment-related pathology, not a child custody question.

This treatment-related question before the Court can best be addressed by a structured and focused Treatment Needs Assessment procedure rather than by the more elaborate, expensive, unreliable, biased, and scientifically unsupported assessment procedure of a child custody evaluation.

The question before the Court is whether the attachment-related pathology being evidenced in the family represents a child abuse issue that warrants a change in custody as a child protection response.

If the family issues do not rise to the level of child abuse and so do not warrant a child protection response involving the child’s protective separation from the abusive parent, then the family conflict becomes a treatment-related issue, not a child custody issue, and the Court would then benefit from professional mental health guidance regarding the treatment-related needs of the child and family.

Children benefit from a complex relationship with both parents. Altering child custody time-share from a shared 50-50% standard is only warranted under two circumstances:

Child Abuse:  In cases of child abuse, a protective separation of the child from the abusive parent represents an appropriate child protection response.  Treatment should then focus on healing the psychological and emotional impact of the abuse on the child, and then on restoring the child’s relationship with the formerly abusive parent with sufficient safeguards to ensure that the child abuse does not resume once contact with the formerly abusive parent is restored.

Mutual Parental Cooperation:  Parents may choose to cooperate in developing an alternative custody time-share schedule regarding their children.  This is their right and prerogative as parents.

Treatment Needs Assessment

Diagnostic Checklist for Pathogenic Parenting

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

When the issue before the Court is the attachment-related pathology of AB-PA (alleged pathogenic parenting by a narcissistic or borderline personality parent), the appropriate assessment methodology would be a Treatment Needs Assessment that specifically evaluates for the presence of pathogenic parenting by an allied narcissistic/(borderline) parent which would represent a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

A DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed would warrant a child protection response of a Court-ordered protective separation of the child from the psychologically abusive parenting practices of the allied narcissistic/(borderline) parent, and the implementation of a treatment protocol to resolve the child’s attachment-related pathology created by the pathogenic parenting of the narcissistic/(borderline) parent.

A Treatment Needs Assessment protocol represents this type of focused clinical assessment designed to specifically address the referral question of concern: 

Is there psychological child abuse (or other forms of child abuse) that would warrant a Court-ordered protective separation of the child from the abusive parent during the period of the child’s treatment and recovery stabilization.

A targeted Treatment Needs Assessment for pathogenic parenting associated with AB-PA can typically be completed in six to eight clinical assessment sessions that specifically assess for the three diagnostic indicators of pathogenic parenting in the child’s symptom display (Diagnostic Checklist for Pathogenic Parenting) within the context of the surrounding family dynamics (e.g., triangulation; cross-generational coalition; emotional cutoffs; inverted hierarchy; displays of selective parental incompetence by the allied parent; stimulus control features to the parent-child conflict).

The Treatment Needs Assessment would produce a focused clinical assessment report directed specifically toward the referral question. 

I have posted to my website a brief overview of the treatment-related decision-making surrounding a Treatment Needs Assessment along with two examples for the type of report that can be produced by this focused clinical assessment procedure (Treatment Needs Assessment Report Examples).  The first example report would be for a positive finding of the three diagnostic indicators of pathogenic parenting.  The second example report would be for a sub-threshold finding in which some diagnostic criteria for pathogenic parenting are present, but the child does not meet all three criteria for a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

The clinical assessment procedure itself is divided into three phases:

Individual Sessions:  The initial phase of assessment involves clinical assessment sessions with each parent individually, and with the child individually as appropriate, to collect history and symptom information from each family member’s perspective. This phase involves the collection of specific behavior-chain sequences surrounding incidents of parent-child conflict (Behavior Chain Assessment of Parent-Child Conflict).

Joint Parent-Child Sessions:  The symptom features of the parent-child relationship are then directly assessed in joint parent-child sessions which may include collaborative behavior-chain assessments as well as focused Response-to-Intervention probes of the relationship dynamic.

Confirmation Sessions:  The clinical symptom evidence developed during the initial sessions with each parent and the joint parent-child relationship sessions is then further confirmed in follow-up sessions with each parent individually.  These follow-up confirmation sessions explore the schema patterns evidenced by the parents relative to the information obtained in the prior clinical assessment sessions.

Based on this focused set of clinical assessments, the child’s symptom pattern can be documented (Diagnostic Checklist for Pathogenic Parenting) as well as the potentially problematic or normal-range parenting practices of the targeted-rejected parent (Parenting Practices Rating Scale).

Three outcomes are possible from this focused Treatment Needs Assessment:

1.)  AB-PA is Present:  The full set of three diagnostic indicators of pathogenic parenting associated with AB-PA are present in the child’s symptom display.  This outcome warrants the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed and the initiation of a child protection response and appropriate treatment.

2.)  Sub-Threshold:  Some of the symptoms of pathogenic parenting are evident in the child’s symptom display, but the child’s symptom pattern is sub-threshold for a diagnosis of Child Psychological Abuse (pathogenic parenting).  In this case, a 6-month Response-to-Intervention trial can be initiated to clarify the diagnosis of the family pathology.

  • If changes to the parenting practices of the targeted-rejected parent produce corresponding changes in the child’s response to this parent (i.e., evidence that the child’s behavior is under the “stimulus control” of the parent’s behavior), then the parent-child conflict is relatively authentic to this relationship and standard family systems therapy can help resolve the family conflict.
  • If changes to the parenting practices of the targeted-rejected parent do not produce corresponding changes in the child’s response to this parent, then the child’s behavior is not under the “stimulus control” of the parent’s behavior.  This represents diagnostically relevant evidence for a cross-generational coalition with the allied and supposedly “favored” parent as being the cause of the child’s conflict with the targeted-rejected parent (i.e., that the source of “stimulus control” for the child’s conflict with the targeted parent is the response the child receives from the allied and supposedly “favored” parent surrounding the child’s conflict with the other parent – Inauthentic Conflict Indicators).  Appropriate family systems therapy should then be initiated to resolve the family pathology of a cross-generational coalition of the allied parent and child against the targeted parent. 
  • If the parenting practices of the allied parent who is in a cross-generational coalition with the child against the other parent are creating significant psychopathology in the child, then the pathogenic parenting by the allied parent may represent a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, which would then warrant a child protection response.

3.)  AB-PA is Not Present:  The three diagnostic indicators of pathogenic parenting are not present in the child’s symptom display.  The parent-child conflict is therefore not due to pathogenic parenting by an allied narcissistic/(borderline) parent, and parenting factors from the targeted parent are likely contributing to the emergence of the parent-child conflict.  The problematic parenting of the targeted parent should be documented on the Parenting Practices Rating Scale, and improving these problematic parenting practices will become the focus of treatment.  Standard family therapy and parenting skill instruction can help resolve the family conflict and no change in the 50-50% child custody time-share is warranted.

An appropriate assessment leads to an accurate diagnosis, and diagnosis guides treatment.

Definition of Constructs:  Pathogenic parenting is a defined construct in both clinical and developmental psychology (patho=pathological; genic=genesis, creation).  Pathogenic parenting is the creation of significant pathology in the child through aberrant and distorted parenting practices.  Pathogenic parenting is operationally defined in the Treatment Needs Assessment as the presence in the child’s symptom display of three established forms of pathology, 1) attachment-related pathology, 2) personality disorder pathology, and 3) delusional-psychiatric pathology (the Diagnostic Checklist for Pathogenic Parenting).  All of these symptom indicators are within the diagnostic scope of practice for all mental health professionals.

Inter-Rater Reliability:  Standardizing the collection, documentation, and interpretation of data by using the Diagnostic Checklist for Pathogenic Parenting and the Parenting Practices Rating Scale will substantially improve the inter-rater reliability of the assessment.  Going forward, the standardized structure afforded by the use of these documentation checklists will allow research to be conducted to confirm the inter-rater reliability (with a specific reliability coefficient) for the identification of the three diagnostic indicators of pathogenic parenting and for the assessment and documentation of parenting practices.  Inter-rater reliability can also be improved with training.

Construct Validity:  An Attachment-Based Model of Parental Alienation: Foundations offers support for the construct validity of the Diagnostic Checklist for Pathogenic Parenting.  Again, going forward, the standardized structure afforded by the use of the Diagnostic Checklist for Pathogenic Parenting and the Parenting Practices Rating Scale will also allow research to be conducted to establish other forms of validity, such as content validity for the three diagnostic indicators, convergent validity relative to other related forms of family pathology (such as enmeshment and the Dark Triad personality), and divergent validity for unrelated forms of family pathology (such as autism-spectrum or ADHD-spectrum parent-child conflicts).  Predictive validity can also be assessed through longer-term follow-up with cases that have been assessed, diagnosed, and treated using an AB-PA model of the pathology.  Incorporating the 12 Associated Clinical Signs identified on the Diagnostic Checklist for Pathogenic Parenting into research can also lead to the possible identification of differing forms of the pathology and potentially to increased professional insight into the functioning of the attachment system and the trans-generational transmission of attachment trauma.

Standardization of Diagnostic Interpretation:  Unlike the vaguely defined construct of “parental alienation” currently in use by many mental health professionals, the definition of pathology employed by the Treatment Needs Assessment using the Diagnostic Checklist for Pathogenic Parenting and the AB-PA model of pathology as described and defined in An Attachment-Based Model of Parental Alienation: Foundations provides a standardized approach to the interpretation of child symptoms using standard and established psychological principles and constructs.

Cost and Time Benefits:  A typical child custody evaluation can cost between 20 to 30 thousand dollars and can take between six to nine months to complete.  This places child custody evaluations beyond the affordability of many families.  In addition, the time delays surrounding the completion of a child custody evaluation allow the child’s symptomatology to become ever more entrenched with each passing day.  To the extent that the pathogenic parenting by the allied narcissistic/(borderline) parent represents a DSM-5 diagnosis of Child Psychological Abuse, Confirmed, the delay of six to nine months in enacting an appropriate child protection response is excessive.  A more focused Treatment Needs Assessment can be completed within six to eight weeks for a probable cost of under $2,000.  The increased timeliness of the report’s completion within six to eight weeks of referral allows for a quicker child protection response that more actively addresses and resolves the child’s psychological abuse.

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