The Myth of “Reunification Therapy”
The emperor has no clothes.
There is no such thing as “reunification therapy.”
There is psychoanalytic therapy (e.g., object relations therapy: Kohut, 1977; or self-psychology, Stolorow & Atwood, 1987),
There is humanistic-existential therapy (e.g., client-centered therapy, Rogers, 1961; or existential therapy, Yalom, 1980)
There is cognitive-behavioral therapy (e.g., CBT, Beck, 1976; with general “Learning Theory” defining child behavior therapy; Patterson, 1982)
There is family systems therapy (e.g., Structural Family Systems therapy, Minuchin, 1974; or Strategic Family Systems therapy, Haley, 1963, Madanes, 1981; or Humanistic family systems therapy, Satir 1967)
There are post-modern therapies (e.g., solution focused therapy, Berg, 1994; or narrative therapy, White and Epston, 1990)
But there is NO model of therapy that has ever been proposed for what constitutes “reunification therapy,” meaning that therapists can essentially do whatever they want under the label of “reunification therapy.”
If therapists wish to describe the type of therapy they are conducting, they should use actual and established models of psychotherapy rather than vague and imprecise descriptive terms that do not increase understanding but that give the appearance of credibility without the substance of credibility.
The construct of “reunification therapy” is a haven, and a cover, for professional ignorance and incompetence.
The construct of “reunification therapy” is a mythical entity of no defined substance. Any therapist that uses the term “reunification therapy” is a charlatan. There is no defined thing as “reunification therapy” and they know it. If they are doing family therapy, then they should say, “family therapy,” in which case a follow up question could be, which model of family therapy are they employing?
I recognize that this is a strong accusation on my part. This weblog post has a comment section. I challenge any therapist to provide a reference citation for what “reunification therapy” entails… <crickets> … there is none.
Professional psychology should be ashamed of itself for knowingly perpetuating the myth of “reunification therapy” by not challenging the use of this construct. There is NO SUCH CONSTRUCT as “reunification therapy” that has ever been defined within professional mental health.
If the therapist is doing family therapy, then the therapist should say this, which allows for the follow-up question of which model of family therapy is the therapist employing?
Establishment psychology blasts Gardner’s model of PAS as “junk science” yet allows the mythical construct of “reunification therapy” to go unchallenged. Professional psychology should be ashamed of itself.
If any therapist says that he or she does “reunification therapy” – run. That therapist is incompetent and is hiding his or her incompetence behind a mythical label. There is no such thing as “reunification therapy.”
If a therapist says that he or she does “reunification therapy,” ask for a citation reference regarding what “reunification therapy” is so that you can read up on “reunification therapy.” You will get no reference citation, because none exists. No model of “reunification therapy” has ever been proposed at any time, anywhere.
When engaging the services of a therapist to treat “parental alienation,” ask the therapist which of the five standard models of psychotherapy the therapist employs in “reunification therapy.”
Psychoanalytic – Psychodynamic
(generally “object relations”; Kohut)
Humanistic – Existential
(generally “client-centered”, Rogers, or existential therapy, Yalom, for adults; Ayers for humanistic “play therapy” with children, Oaklander for gestalt therapy with children)
(generally Beck for CBT; or “Learning Theory” involving operant and classical conditioning for child “behavior therapy”)
Family Systems Therapy
(generally Minuchin for Structural Family Systems therapy, occasionally others)
(generally Berg for solution focused therapy)
Sometimes the therapist may say “eclectic” or “integrative.” This means that the therapist applies several of the above models depending on the situation and needs of the client. If the therapist responds “I’m eclectic” or “I use an integrative approach,” ask which models they tend to prefer and which models they tend to integrate.
If the therapist cannot describe which models of psychotherapy they are employing, then they are just making things up based on their whims at the moment and calling it “psychotherapy.” Run.
If you are hiring an attorney to handle a divorce, you want a family law attorney not a corporate attorney. Ask. What area of law do you specialize in? If you are getting cosmetic surgery, you want a plastic surgeon not a cardiac surgeon. Ask. What type of surgery do you do? As a consumer, you may not know the technicalities of the various types of law or medicine – or psychotherapy models – but the professional should. A professionally competent psychotherapist should be able to explain to you the treatment model being used. This is a part of the INFORMED consent process.
You have the right to consent to therapy, and in order to consent to therapy you the right to be informed about what therapy will involve. How does the therapist conceptualize the issues? How is treatment going to resolve these issues? This is called the “treatment plan.” Ask for a written “treatment plan.”
I am a clinical psychologist… I know what is out there passing itself off as “psychotherapy”…
“The emperor has no clothes.”
Do not trust that the psychotherapist knows what he or she is doing. Your family and your child are too important. I would recommend that you become an informed consumer by learning about the various models of psychotherapy.
But if you don’t want to personally learn about the various available models of psychotherapy, then at least ask the treating therapist to explain his or her approach, and how the therapist sees this approach to psychotherapy as solving your specific problems with your child.
If your child had cancer, the doctor would explain to you the treatment options, such as surgery, chemotherapy, radiation, or some newer form of treatment. You would be presented with the available options and recommendations, and you would be able to ask questions in order for you to make an informed treatment decision. Psychotherapy is no different.
Your child is too important, and your relationship with your child is too important.
Application of Therapy Models to Attachment-Based “Parental Alienation”
Individual child therapy is NOT the appropriate treatment approach for attachment-based “parental alienation.” The issue in attachment-based “parental alienation” is interpersonal involving the parent-child relationship. Therapy sessions should be structured as conjoint parent-child relationship therapy. Some individual sessions with just the child or just the parent(s) may be appropriate (within a family systems model), but the focus is on treating the relationship.
Imagine a therapist conducting marital therapy but only seeing the wife individually. Marriage therapy involves the relationship. Marriage therapy sessions involve BOTH the husband and the wife to resolve their relationship issues. The same is true for the treatment of attachment-based “parental alienation.” The treatment focus is on the parent-child relationship and therapy sessions should involve BOTH relationship partners.
Individual therapy with the child is NOT the appropriate model for resolving attachment-based “parental alienation.”
Psychodynamic psychotherapy (generally object relations therapy) for attachment-based “parental alienation” is NOT the appropriate treatment model for attachment-based “”parental alienation.” It will be entirely ineffective for resolving the parent-child relationship, although it would be an appropriate model for treating the narcissistic/(borderline) personality dynamics of the alienating parent.
Psychodynamic psychotherapy is generally, if not always, individual therapy, and it does not have a theoretical structure for conjoint in-session relationship therapy. Could it be adapted to conjoint in-session relationship therapy? Perhaps, but I’ll leave that to others to propose such a model appropriate to treating the parent-child relationship issues of attachment-based “parental alienation.”
To Psychotherapists: Kohut does have some extremely important constructs related to empathic failure and narcissistic processes that are directly relevant to both the interpersonal trauma issues and the treatment of attachment-based “parental alienation” – it’s just that an individualistic object relations therapy model is not an appropriate treatment framework.
Kohutian theory, however, is directly relevant.
Humanistic-existential therapy, including all forms of non-directive client-centered and play therapy models, is CONTRA-INDICATED for the treatment of attachment-based “parental alienation.” Client-centered treatment models will collude with the psychopathology and will make things worse.
Humanistic-existential therapy assumes an authentic individual. However, in attachment-based “parental alienation” the child is being induced/(seduced) into a role-reversal relationship in which the child is being used as a “regulating other” by the narcissistic/(borderline) parent to regulate the parent’s psychopathology. The child’s psychological authenticity has been nullified, and continues to be nullified, by the psychopathology of the narcissistic/(borderline parent).
Under these conditions, humanistic-existential models of therapy are NOT appropriate and will only serve to collude with the psychopathology.
To Psychotherapists: Rogerian interpersonal conditions of empathy, unconditional positive regard, and genuineness remain vitally important components of the therapeutic relationship. It’s just that a non-directive therapy is not an appropriate treatment model for attachment-based “parental alienation.” The therapist needs to be an active interventionist, consistent with a Structural or Strategic Family Systems (or Humanistic, Satir) model of unbalancing family “homeostasis” to create interpersonal change within and across family relationships.
Empathy, unconditional positive regard, and genuineness remain vitally important components of the therapeutic relationship.
Humanistic-existential therapy tends to be individual therapy. The therapist will meet with the child individually and the parent will seldom be involved in therapy. Avoid humanistic-existential therapy, it will be harmful and will only make the situation worse.
Cognitive-behavioral therapy (CBT) involves altering distorted and false beliefs that are creating distorted emotional responses. With a skilled CBT therapist, this treatment model could be helpful in treating attachment based “parental alienation,” particularly to the extent that the therapist challenges the irrational beliefs of the child.
However, a comprehensive CBT model for treating the specific issues associated with the family dynamics of attachment-based “parental alienation” has yet to be proposed. Of central importance is that the CBT therapist reads the work of Arron Beck on personality disorders (Beck, et al., 2004). The quality of the CBT work will improve substantially to the extent that the therapist understands the underlying “schemas” of personality disorders and their interpersonal manifestations.
Child behavior therapy involves delivering positive and negative “consequences” for appropriate and inappropriate child behavior. While child behavior therapy has a good intention, it will likely only make matters worse.
The targeted parent will be directed by the therapist to establish reward and punishment contingencies and to deliver these “consequences” for the child’s “problem behavior.” In attachment-based “parental alienation,” however, the child will be unresponsive to rewards and “positive attention” and will instead frequently provoke negative consequences (punishments) that will then create increasingly negative and hostile parent-child exchanges, that will be used by the child (and by the narcissistic/(borderline) parent) as “evidence” of the targeted parent’s insensitivity to the child’s needs, and as reasons and justifications for the child’s wanting to terminate the child’s relationship with the targeted parent.
To Psychotherapists: The reason for this treatment failure is that the child’s behavior is not under the “stimulus control” of the behavior of the targeted-rejected parent. Instead, the child’s behavioral responses to the targeted-rejected parent are under the “stimulus control” of the child’s relationship with the allied and supposedly “favored parent.” The focus of behavior change must target the correct locus of the stimulus control for the child’s behavior in the relationship cues, reinforcers, and punishments within the child’s relationship with the allied and supposedly “favored” parent.
It is possible that high quality behavior therapy combined with cognitive restructuring can be helpful, particularly if the child is separated from the ongoing distorting influence of the narcissistic/(borderline) parent during the active phase of treatment. A key feature of effective behavior therapy will be focusing on a quality of the interaction called the “stimulus control” of the child’s behavior.
Currently, in attachment-based “parental alienation,” the stimulus control for the child’s distorted behavior toward the targeted-rejected parent is in the child’s relationship with the allied and supposedly “favored” narcissistic/(borderline) parent. Effective behavior therapy would need to alter the locus of this stimulus control away from the child’s relationship with the narcissistic/(borderline) parent and back onto the authentic source of stimulus control in the child’s relationship with the targeted parent.
Family systems therapy is the appropriate and indicated therapy model for treating attachment-based “parental alienation,” with Structural Family Systems theory being the primary indicated treatment framework, although a Strategic Family Systems model can also be effective. Family systems therapy involves multiple family members in the sessions (although it is highly unlikely that the involvement of the the narcissistic/(borderline) parent directly in the parent-child therapy sessions with the targeted parent will be warranted based on a variety of treatment considerations), and the family systems therapist will be an active participant in therapy. Initially, the therapist will seek to alter, disrupt, and “unbalance” the unhealthy “homeostasis” (relationship stability) within the family relationships in order to then re-structure family relationship patterns without the symptom present.
To Psychotherapists: There may be circumstances in which conjoint sessions with the targeted parent and the allied and supposedly “favored” parent could be productive. The family therapy issue is helping the family transition from an intact family structure to a separated family structure. The locus for the family’s difficulty is in the narcissistic and borderline vulnerabilities of one of the spousal partners. Helping the spousal relationship, and particularly this vulnerable spousal partner, effectively navigate the experience of loss and grief regarding the end of the marital bond can resolve the expression of pathology within the family. It is skilled family systems work, but it is possible in some cases.
If a conjoint-spousal intervention is attempted, the child should NOT be present for these conjoint parental sessions (the child must be de-triangulated from the spousal conflict), although the child can be made aware that these parental sessions are occurring as part of the therapy process. By the therapist taking over the caregiving role for the narcissistic/(borderline) parent, this may help release the child from the necessity of maintaining a role-reversal caregiving relationship for the vulnerable narcissistic/(borderline) parent.
However, a family systems approach with attachment-based “parental alienation” becomes challenging precisely because it will be effective. As the therapy creates change in the child’s symptoms, the allied and supposedly “favored” narcissistic/(borderline) parent will apply ever increasing psychological pressure on the child to resist the influence of therapy and remain symptomatic.
The resistant pressures applied on the child by the pathological narcissistic/(borderline) parent for the child to remain symptomatic, even as family systems therapy is applying treatment-related resolutions encouraging the child’s release of symptoms and the restoration of normal-range relationships within the family, will turn the child into a psychological battleground between the forces of effective therapy that are resolving the child’s symptomatic state and the continuing and increasing psychological pressures being applied on the child by the narcissistic/(borderline) parent to remain symptomatic.
Turning the child into a psychological battleground will be psychologically harmful to the child. The only way to resolve this dilemma is to either,
1) Terminate effective therapy and discontinue efforts to resolve the child’s psychopathology, thereby choosing to leave the child in a symptomatic state of a cut-off relationship with a normal-range and affectionally available parent that is the product of the distorted parenting practices of a narcissistic/(borderline) parent who is using the child in a role-reversal relationship to meet the needs of the pathological parent, or
2) Provide the child with a protective separation from the ongoing pathogenic influence of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery.
Family systems therapy will be effective, but this becomes a problem because the effectiveness of family systems therapy will be met with active resistance by the pathology of the narcissistic/(borderline) parent who will place increasing psychological pressure on the child to remain symptomatic. Turning the child into a psychological battleground between the goals of therapy and the pathology of the narcissistic/(borderline) parent is not recommended. But the only alternative is to terminate effective therapy.
There is a third alternative, which is to conduct entirely pointless ineffective “therapy” that lasts for years and produces absolutely no change (except the further strengthening and entrenchment of the child’s hostile rejection of the parent), and unfortunately this is far too often the type of “therapy” currently being employed with attachment-based “parental alienation.”
Usually the ineffective mode of therapy is a non-directive “wing-it” style of Humanistic-oriented therapy, typically involving “validating the child’s feelings” in an apparent hope by the therapist that this will have some sort of magical “self-actualizing” impact on the child that will somehow stop the parent-child conflict. The “wing-it” component sometimes involves encouraging the targeted-rejected parent to apologize to the child for supposed past parental failures. That these alleged “parental failures” in the past never actually occurred or are gross distortions of the actual events doesn’t seem to be relevant to the therapist in the “wing-it” style of “therapy,” and the therapist-elicited parental apologies to the child never produce the hoped for change in child attitude or behavior.
The Required Therapeutic Context for Effective Therapy
Therapy must begin with the child’s protective separation from the psychopathology of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery.
We cannot ask the child to change and to relinquish the symptoms if we cannot first protect the child from the psychological retaliation of the narcissistic/(borderline) parent for any change the child makes.
An additional problem with the family systems models of psychotherapy is that there are a limited number of trained and knowledgeable family systems therapists available. Family systems therapy is sophisticated, and so requires a high level of professional knowledge and skill. Only a limited number of therapists will seek out the post-graduate training necessary to become professionally competent in family systems therapy.
In the absence of established knowledge and formal training in family systems models of therapy, many therapists simply choose to “wing it” and do whatever they think is best under any given circumstances. Unfortunately, this is more common than one might imagine. Many therapists are simply not competent to be doing family-related therapy.
Another limitation is that few child therapists and family systems therapists have experience treating personality disorders.
Most therapists in general, adult therapists included, have very limited experience and exposure to treating narcissistic personality disorders because narcissistic personalities very rarely present for therapy. Narcissistic personalities do not desire self-insight and would much rather maintain their grandiose self-opinion and judge others to be inferior rather than to engage in self-reflection regarding their own possible inadequacy. Borderline personalities will present to therapy because of the chaotic drama in their lives and intense depression, but most therapists do not treat borderline patients and those that do tend to be adult-oriented therapists who work from individual models of psychotherapy.
For child therapists, the lack of exposure to narcissistic and borderline personality processes is even more acute, since personality disorders are rarely a feature of child therapy. Most child therapists lack professional knowledge related to recognizing and treating personality disorder dynamics.
However, narcissistic and borderline personality features are prominent components of attachment-based “parental alienation” so that family systems therapy with attachment-based “parental alienation” will be improved considerably to the extent that the therapist is knowledgeable about personality disorders, such as Beck et al. (2004) and/or Millon (2011).
Post-modern therapies would represent an intriguing application of social constructionism to the pathology of attachment-based parental alienation, but it is unclear how the principles of solution-focused or narrative psychology could be applied to the distorted family processes involved in attachment-based “parental alienation.” I would invite solution focused therapists and narrative therapists to attempt the application of their theoretical frameworks to the treatment of the trans-generational transmission of attachment trauma associated with the pathology of attachment-based “parental alienation.”
I suspect that there are intriguing applications of these models to the issues in attachment-based “parental alienation,” but I’m unsure on how to actualize this application since, while I am familiar with the theoretical constructs of these models, they are not directly within my area of professional expertise.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857
Psychoanalytic – Psychodynamic Therapy
Kohut, H. (1977). The Restoration of the Self. New York: International Universities Press.
Stolorow, R., Brandchaft, B., and Atwood, G. (1987). Psychoanalytic Treatment: An Intersubjective Approach. Hillsdale, NJ: The Analytic Press.
Rogers, C.R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston: Houghton Mifflin.
Yalom, I.D., Existential Psychotherapy. New York: Basic Books, 1980.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: Meridian.
Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.
Family Systems Therapy
Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.
Haley, J. (1963). Strategies of psychotherapy. New York: Grune and Stratton.
Madanes, C. (1981) Strategic Family Therapy. San Francisco: Jossey-Bass Inc.,
Satir, V. (1967). Conjoint Family Therapy: A Guide to theory and technique. Palo Alto, California: Science and Behavior Books, Inc.
Berg, Insoo Kim (1994) Family Based Services: A solution-focused approach. New York: Norton.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W. W. Norton.
Personality Disorder Dynamics
Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.
Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley.