The Solution

Any solution to “parental alienation” that requires that we prove “parental alienation” in Court is a failure.

1.  Financially Prohibitive: Proving “parental alienation” in Court is simply too expensive for the vast majority of targeted-rejected parents. The financial costs associated with proving “parental alienation” in Court places it beyond the means of 95% of targeted-rejected parents.

 Any solution that requires proving “parental alienation” in Court is only a solution for 5% of targeted-rejected parents. This is no solution.

2.  Requires Egregious Displays of Alienation: Proving “parental alienation” in Court is only possible in the most egregious cases of alienation. The more subtle cases of insidious alienation are nearly impossible to prove in Court.

Any solution that requires proving “parental alienation” in Court is only a solution for the limited number of targeted-parents who have sufficient financial resources and only in the most egregious cases. So now we’re down to 1-2% of the cases of “parental alienation.”

While proving “parental alienation” in Court may seem like a solution to professionals who work within the Court system. For those of us who work in the daily lives of people who cannot financially afford attorneys and child custody evaluations, it is no solution at all.

3.  Robbing the Child: The high financial costs of fighting “parental alienation” in Court robs the child of what should be his or her college education fund. Every dollar paid to an attorney or child custody evaluator harms the child by taking money from the child that should be going to his or her college education.

Any solution that requires proving “parental alienation” in Court harms the child by draining financial resources from the family that should be going toward the child.

4.  Too Slow: Proving “parental alienation” in Court can often take years of protracted legal battles.  During this time, important child developmental phases come and go, and are lost forever.  Lost childhood can never be reclaimed.  A mother only has 365 days of her child being 8 years old, that’s it.  And not a single lost day can ever be reclaimed.  A father only has a brief time with daddy’s little girl, with his princess. Once lost, this time never returns.

Years to enact a solution is simply too long.  Months are too long a timeframe.  Any solution to “parental alienation” should be able to be enacted within weeks in the life of the child. If we require months, so be it, but definitely not years.

Any solution that requires proving “parental alienation” in Court irrevocably harms the child by robbing the child of important and irretrievable developmental phases and experiences with a loving and affectionally available parent. It simply takes too long.

Of note is that I recently had the opportunity for a conversation with Ms. Dorcy Pruter (http://www.consciouscoparentinginstitute.com).  During our conversation she said she can enact the child’s restoration with the targeted-rejected parent in a matter of days, once the Court orders a protective separation of the child from the alienating parent, and based on my initial review of her approach during our conversation I suspect her treatment model can accomplish what she claims for it.  Just to be generous, I’ll give her some leeway and say weeks rather than days (yet days makes sense to me based on her description of the model), but the point is, in a very short time frame. Her approach seemingly has the proper components to accomplish what she claims for it.

Once we achieve a protective separation of the child from the ongoing pathogenic parenting of the narcissistic/(borderline) parent, restoration of a normal-range and affectionally bonded relationship with the targeted-rejected parent is relatively straightforward because we are working WITH the normal-range functioning of the child’s own attachment system.  The child’s authentic brain WANTS to bond to the targeted-rejected parent.  We just need to provide the setting, structure, and guidance to allow the child’s natural attachment bonding motivations to achieve completion. 

Once the child’s attachment bonding motivations are able to achieve completion, the child’s (misinterpreted) grief response resolves, and the impact on the child of the narcissistic/(borderline) parent’s distorted and pathogenic parenting practices is eliminated.  We have recovered the authentic child.  We then take steps to build the child’s “psychological immune system” relative to the pathogenic parenting of the narcissistic/(borderline) parent and then we can begin to restore the child’s relationship with the narcissistic/(borderline) parent.

If the narcissistic/(borderline) parent cooperates with the treatment process, that would be wonderful.  If not, then we need to take steps to ensure the child’s ongoing stability and balance in response to the narcissistic/(borderline) parent’s continuing pathogenic parenting.

The Solution

Any solution to “parental alienation” that requires that we prove “parental alienation” in Court is no solution at all because of the immense financial barriers, legal hurdles, and inherent harm to the child’s normal-range developmental trajectory associated with the long and arduous task of trying to prove “parental alienation” in Court.

An attachment-based model of “parental alienation” provides a solution. Once the paradigm shifts away from a Gardnerian PAS model to an attachment-based model, the solution becomes available immediately.

Phase 1

An attachment-based model of “parental alienation” immediately identifies a set of standards of practice for professional competence involving an advanced level of professional understanding for the attachment system (and intersubjective system), and a professionally advanced level of understanding for narcissistic/borderline personality dynamics, their characteristic displays, their underlying dynamics, and processes of their manifestation in family relationships.

Once the paradigm shifts to an attachment-based model of “parental alienation” these children and families become immediately identified as a “special population” requiring specialized professional knowledge, training, and expertise to diagnose and treat.

Phase 2

Once professional practice in this specialty field is limited to a qualified set of highly trained and knowledgeable experts, the diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation” is established in a clearly defined set of three Diagnostic Indicators (see Diagnostic Indicators and Associated Clinical Signs post), supported by an additional set of confirming clinical signs.

This set of three clearly defined and dichotomous (i.e., present or absent) Diagnostic Indicators has a corresponding DSM-5 diagnosis of:

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

(for an analysis of the DSM-5 diagnosis of an attachment-based model of “parental alienation” see “Childress, 2013: DSM-5 Diagnosis of ‘Parental Alienation’ Processes” on my website)

Phase 3

All specialized experts in High-Conflict Family Divorce (HCFD specialty practice) will make the same DSM-5 diagnosis in response to the identifiable set of three clearly defined and dichotomous (present-absent) Diagnostic Indicators of attachment-based “parental alienation” (i.e., pathogenic parenting). 

This means that all HCFD specialty psychologists will make a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Phase 4

In making the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, these HCFD specialty psychologists then engage a professional responsibility to take protective action for the child.  Chief among these protective steps, and an option that I strongly urge them to enact, is to make a child abuse report to Child Protective Services (CPS) regarding their diagnosis of Child Psychological Abuse, Confirmed.

Phase 5

CPS workers will initially not know how to deal with the influx of child abuse reports by this group of specialist psychologists who are providing a DSM-5 diagnosis of v995.51 Child Psychological Abuse, Confirmed along with their report.  CPS agencies will have one of three possible options,

1.  Ignore the reports (which is an unlikely response, especially as these reports continue to come in)

2.  Accept the DSM-5 diagnosis of the HCFD specialist and remove the child from the custody of the alienating (pathogenic) parent and place the child in the custody of the targeted, normal range and healthy parent (i;e;, engage a protective separation of the child from the psychopathology and pathogenic parenting practices of the narcissistic/(borderline) parent).

3.  Conduct their own investigation of possible child psychological abuse.

I suspect that CPS agencies will choose option 3. 

In the context of having a clinical psychologist who is expert in High-Conflict Family Divorce provide a confirmed DSM-5 diagnosis of Child Psychological Abuse, if the CPS system wants to conduct their own investigation then they will need to obtain similar training in the assessment of an attachment-based model of “parental alienation” upon which the psychologist’s diagnosis is based (i.e., CPS case workers will need to develop professional competence in the specialty practice area of identifying child psychological abuse that occurs within high-conflict family divorce settings) since this knowledge base serves as the foundation for the diagnosis of V995.51 Child Psychological Abuse, Confirmed made by the HCFD specialist psychologist.

So ALL CPS workers everywhere will receive training in an attachment-based model of “parental alienation” and the three definitive diagnostic indicators of pathogenic parenting associated with the child’s cross-generational coalition with a narcissistic/(borderline) parent against the other parent that is inducing significant developmental (Diagnostic Indicator 1), personality (Diagnostic Indicator 2), and psychiatric (Diagnostic Indicator 3) pathology in the child.

Phase 6

The Diagnostic Indicators for attachment-based “parental alienation” are clearly defined and dichotomous, either attachment-based “parental alienation” is present or absent.  Once CPS has a set of clearly defined dichotomous criteria by which to identify pathogenic parenting associated with an attachment-based model of “parental alienation,” they will become empowered and confident in removing the child from the care of pathogenic narcissistic/(borderline) parent in every case where the three Diagnostic Indicators are present.

The Solution

Once a case of pathogenic parenting associated with an attachment-based model of “parental alienation” enters the specialty practice of an HCFD specialist psychologist, a child abuse report will be filed with CPS that includes the psychologist’s diagnosis of V995.51 Child Psychological Abuse, Confirmed.  Once the report enters the CPS system, the CPS case worker will confirm the presence of the three Diagnostic Indicators of pathogenic parenting and will confirm the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, so that the diagnosis has now been confirmed by two independent assessments of mental health professionals expert in the family processes associated with high-conflict divorce.

CPS will then immediately remove the child from the custody of the alienating narcissistic/(borderline) parent (i.e., a protective separation of the child from the psychopathology of the pathogenic parent) and place the child with the normal-range and healthy targeted parent to allow for the treatment and resolution of the child’s symptoms.

This establishes the necessary protective separation conditions for a Pruter-style model of treatment that resolves the child’s symptoms within days or weeks.  Once the child’s symptoms have been resolved under the treatment guidance of an HCFD specialist psychologist, the child’s own “psychological immune system” can be strengthened to resist “reinfection” by the distorting pathology of the narcissistic/(borderline) parent, and the child’s relationship with the narcissistic/(borderline) parent can be reestablished.

Of note is that Ms. Pruter also indicated that she has a treatment protocol component for the alienating parent to complete as a requirement for their “reunification therapy” with the child.

This solution never enters the Court system.

  • It provides an immediate protective separation of the child from the psychopathology of the narcissistic/(borderline) parent.
  • It solves the family conflict in a matter of weeks and so restores the child to a normal-range developmental trajectory quickly.
  • It is relatively cost free to the parent so that it does not require an extensive parental financial investment of funds that should be allocated to the child’s future college education.

This is the solution.

If the case does enter the Court system, the judge can order a Treatment Needs Assessment report, which would be a targeted assessment by an HCFD specialist for the presence or absence of the three Diagnostic Indicators of pathogenic parenting associated with an attachment-based model of “parental alienation.”  The targeted Treatment Needs Assessment would be focused and so less extensive than a full child custody evaluation.  Since all child custody evaluators would have become HCFD specialists, this could be a secondary professional service available from them.

My estimate of a Treatment Needs Assessment is that it could be completed in four to six weeks and could provide a clear directive to the Court regarding the treatment needs of the child. If the three Diagnostic Indicators of pathogenic parenting associated with an attachment-based model of “parental alienation” are present, then the HCFD specialist psychologist conducting the assessment would make the appropriate DSM-5 diagnosis of the child (relative to the issue of pathogenic parenting) which would include the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Upon receiving the report from the HCFD psychologist that contains the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, the judge could order removal of the child from the custody of the narcissistic/(borderline) parent and placement of the child with the targeted, normal-range and healthy parent during the active phase of the child’s treatment and recovery.  Under the guidance of an HCFD specialty psychologist, the child and targeted parent could receive a Pruter-style treatment protocol that would restore their relationship within weeks, followed by building the child’s “psychological immune system” response to the distorted pathogenic parenting practices of the narcissistic/(borderline) parenting, culminating in “reunification therapy” between the child and the narcissistic/(borderline) parent.

This is the solution.

Enacting the Solution

I have created the solution.  All the dominoes are in line, and through my writings on my website and blog I have tipped the first domino.  In my view, it is just a matter of time now.

My estimate is the change in paradigm will take about 10 years.  The solution I have enacted has no natural allies.  Establishment mental health has little to no interest in “parental alienation.”  Their interest tends toward Attention Deficit Hyperactivity Disorder and the typical types of parent-child conflict.  “Parental alienation” isn’t really on their radar.  They are likely to simply equate an attachment-based model of “parental alienation” with the Gardnerian PAS model as being “controversial” (when actually an attachment-based model is not at all controversial – all of the constructs are standard and accepted psychological principles and constructs).

The Gardnerian PAS experts are likely to be reluctant to see the end of their favored paradigm for conceptualizing “parental alienation” because they have fought for it for so long and hard.  To see it simply disappear and be replaced by a new paradigm about which they are entirely unfamiliar will likely be hard for them. The Gardnerian PAS experts are likely to simply ignore an attachment-based model and to continue their efforts to seek Court-based solutions for the PAS model.

So an attachment-based paradigm for “parental alienation” will probably languish in obscurity for a while.  Eventually it will get picked up (for a variety of reasons, one of the primary reasons will be its promise for guiding future research efforts).  It will likely become established through the efforts of a new generation of psychologists and mental health professionals who will see the value in a paradigm shift because they have no prior attachment to the PAS model.  They will have an easier time letting go of the PAS model and adopting a new paradigm for describing and understanding “parental alienation” processes.

Eventually the paradigm will shift.  The moment it does the other dominoes will begin to fall.  There is actually a line of dominoes that will also begin to fall that will solve the issue of false allegations of child abuse that are such a troubling part of “parental alienation,” but I’ll leave a description of that line of dominoes for another post.

It’s just a matter of time.

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

All that Glitters…

In an attachment-based framework for understanding “parental alienation,” the child appears to present an emotionally bonded relationship with the allied and supposedly “favored” parent while rejecting a relationship with the other parent, allegedly because of problematic parenting practices by this other parent.

However, the display of an emotionally bonded relationship with the allied and supposedly “favored” parent actually represents a false presentation.  A professional level of understanding for how the attachment system works reveals that this apparent display of a bonded relationship actually represents the expected pattern associated with an insecure anxious-ambivalent attachment bond to the supposedly favored and allied parent.

Patterns of Attachment

Many people unfamiliar with the attachment system, including a great many mental health professionals who are ignorant of how the attachment system functions, believe that attachment is only relevant to early childhood bonding. This belief is entirely wrong. The basic patterns of attachment expectations (called “internal working models” by Bowlby and “schemas” by Beck) form during early childhood, but these patterns are used throughout the lifespan.

“Attachment behavior is in no way confined to children.  Although usually less readily aroused, we see it also in adolescents and adults of both sexes whenever they are anxious or under stress.” (Bowlby, 1980, p. 4)

The analogy would be to the language system. The basic grammar of language is acquired during early childhood, but language is then used throughout the lifespan to mediate social relationships.

Similarly, the basic “grammar” of the attachment system, the “internal working models” of attachment relationships, forms during early childhood, but then this “grammar” of the attachment system is used throughout the lifespan to mediate closely bonded relationships, including the marital relationship (Feeney & Noller, 1990; Hazan & Shaver, 1987; Roisman, Madsen, Hennighousen, Sroufe, & Collins, 2001; Simpson, 1990) and the child’s future relationships with his or her own children (Benoit & Parker, 1994; Bretherton, 1990; Fonagy, Steele, & Steele, 1991; Fonagy & Target, 2005; Jacobvitz, Morgan, Kretchmar & Morgan, 1991; Macfie, McElwain, Houts, and Cox, 2005; van Ijzendoorn, 1992).

The child’s bonding with parents is directly mediated by the attachment system.  Any display or disruption of the child’s bonding with parents, such as the overly close emotional bond the child has with the allied and supposedly “favored” parent and the child’s rejection of a relationship with the other parent, the targeted parent, are mediated by the child’s attachment system. Therefore, any professional assessment of the family dynamics involving these attachment-mediated relationships REQUIRES a professional level of understanding for how the attachment system functions and for its characteristic patterns of dysfunctioning in response to problematic parenting.

Failure to possess a professional level of understanding for how the attachment system functions and its characteristic patterns of dysfunctioning when diagnosing and treating such clearly evident disruptions to the child’s attachment system as are reflected in the child’s rejection of a relationship with one parent while seeking primary bonding to an allied and supposedly “favored” parent would be analogous to a physician diagnosing and treating cancer without possessing a professional level of knowledge of what cancer is and what the various forms of cancer are.

Physicians who don’t know what cancer is shouldn’t diagnose and treat cancer.  Psychologists who don’t understand the attachment system, including the characteristic features of its functioning and the characteristic patterns of its dysfunctioning, should NOT be diagnosing and treating disruptions to the child’s attachment bonding motivations.

This would seem self-evident, and it is REQUIRED by professional practice standards,

Standard 2.01a of the Ethical Principles of Psychologists and Code of Conduct addresses Boundaries of Competence and states, “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.”

Diagnosing and treating disruptions to the child’s attachment bonding motivations without possessing a professional level of understanding for what the attachment system is, how it functions, and its characteristic patterns of dysfunctioning would seem to represent practice beyond the boundaries of professional competence in violation of professional practice standards.

Secure Attachment Pattern

In a secure attachment, the child engages in relaxed exploratory behavior of venturing away from the parent to whom the child is securely attached. Periodically, the child will psychologically check back in with the parent to whom the child is securely attached, which is called “emotional recharging,” before once again engaging in exploratory behavior away from this parent.

In a pattern of secure attachment with a favored parent following the divorce, the child would enjoy the care and comfort of the favored parent but would also feel comfortable in engaging in the exploratory behavior of establishing an independent relationship with the other parent as well.

This is important to understand: A SECURE attachment to a bonded parent would be evidenced in the child’s comfort in separating from the bonded parent to form a relationship with the other parent as well.

Insecure (Anxious-Ambivalent) Attachment

In an insecure attachment to a parent, the child is preoccupied with bonding to the parent and expresses a high degree of reluctance to separate from the parent with whom the child is insecurely attached.

In an insecure anxious-ambivalent attachment style, also called a “preoccupied” attachment pattern, the child is hyper-focused on the child’s relationship with the insecurely attached parent and the child is reluctant to engage in normal-range exploratory behavior away from the parent.

Origins of these Patterns

This set of patterns becomes clear when we consider the origins of these attachment patterns.

The evolutionary origins of the attachment system is in the selective predation of children. The attachment system strongly motivates children’s bonding to parents in order to obtain parental protection from predators.

“The biological function of this behavior [i.e., attachment] is postulated to be protection, especially protection from predators.” (Bowlby, 1980, p. 3)

Children who are secure in their attachment bond to the parent feel sufficiently safe and protected to be comfortable engaging in exploratory behavior away from the parent, secure in their relationship with the parent.

Children who are insecure in their attachment bond to their parent become vulnerable to predation, so that the child’s attachment system motivates the child to become preoccupied on maintaining proximity to the parent to whom the child is insecurely attached, so that the child does NOT display normal-range exploratory behavior away from the parent.

Anxious-Ambivalent (Preoccupied) Attachment

In an insecure anxious-ambivalent attachment pattern the child may evidence a hyper-bonding motivation of seeking continual parental involvement through the child’s dependent and clingy behavior.  To those unfamiliar with the characteristic displays of secure and insecure attachment, the child’s dependent preoccupation on the parent may appear to represent a bonded parent-child relationship, when in actuality the child’s hyper-bonding focus on the parent represents a symptom of pathology in the parent-child relationship.

The formation of an insecure anxious-ambivalent (preoccupied) attachment is associated with inconsistent parental availability

In attachment-based “parental alienation” this inconsistent parental availability stems from the (hostile) rejection of the child by the narcissistic/(borderline) parent whenever the child evidences bonding motivations toward the other parent, and corresponding indulgent parental involvement whenever the child seeks to avoid the other parent.

The inconsistency of the conditional love offered by the narcissistic/(borderline) parent that is contingent on the child’s rejection of the other parent creates an insecure anxious-ambivalent attachment bond to the narcissistic/borderline parent that produces both the child’s preoccupied focus on maintaining the child’s relationship with the inconsistently available narcissistic/(borderline) parent, and the child’s expressed reluctance to separate from this parent to engage in normal-range exploratory behavior of forming an independent relationship with the other parent for fear of losing the insecurely attached relationship bond with the narcissistic/borderline parent.

What on the surface may appear to be a bonded relationship with the allied and supposedly “favored” parent actually represents a symptomatic expression of an INSECURE attachment bond to this parent.

Bonding to a Problematic Parent

The attachment system is a “goal corrected” motivational system, which means that when parenting is problematic and does not allow the child to form a secure attachment bond, the child nevertheless maintains the goal of forming an attachment bond to the problematic parent so that the child’s behaviors become distorted in an effort to achieve the goal of establishing an attachment bond in the context of the problematic parenting behavior.

“All seven of these MM monkeys [i.e., monkeys raised without mothers] were totally inadequate mothers… Initially, the MM monkeys tended to ignore or withdraw from their babies even when the infants were disengaged and screaming… Later the motherless monkeys ignored, rejected, and were physically abusive to their infants. A surprising phenomena was the universally persisting attempts by the infants to attach to the mother’s body regardless of neglect or physical punishment. When the infants failed to attach to the ventral surface of the mother, they would cling to the dorsal surface and attempt to move to the mother’s ventral surface. (Seay, Alexander, & Harlow, 1964, p. 353)

The distortions to the child’s behavior that result from the child’s ongoing efforts to achieve the goal of establishing an attached relationship with the parent in the context of the parent’s problematic parenting practices result in characteristic patterns of child behavior reflecting insecure attachment to the parent.

Children do NOT seek to sever a relationship with a problematic parent. 

Problematic parenting exposes the child to increased survival risk from predation and other environmental dangers.  Problematic parenting produces an INSECURE attachment, and the child actually becomes MORE STRONGLY motivated to bond to the problematic parent, producing the characteristic patterns of insecure attachment bonding.

Children who severed their relationship to problematic parents were exposed to increased predation and other environmental dangers.  These children died.

Children who became MORE STRONGLY motivated to bond to problematic parents had a higher likelihood of continuing to receive parental protection from predators.  These children survived.

“The paradoxical finding that the more punishment a juvenile receives the stronger becomes its attachment to the punishing figure, very difficult to explain in any other theory, is compatible with the view that the function of attachment behavior is protection from predators (Bowlby, 1969, pp. 226-227)

Over millions of years of evolution involving the selective predation of children, the attachment system developed a motivational response to problematic parenting that is “goal corrected” in which children become MORE STRONGLY motivated to bond to problematic parents.

“A potential evolutionary explanation suggests selection pressures supported infants that remained attached because it increased the probability of survival. From an adaptive point of view, perhaps it is better for an altricial animal to remain attached to an abusive caregiver than receive no care. (Raineki, Moriceau, & Sullivan, 2010, p. 1143)

Children do NOT seek to sever the attachment bond in response to problematic parenting. 

Instead, children become MORE highly motivated to form an attachment bond to the problematic parent. 

In attachment-based “parental alienation” the child is expressing a hyper-bonding motivation toward the allied and supposedly “favored” parent.  This, in itself, suggests that it is the parenting practices of the allied and supposedly “favored” parent that are problematic and so are provoking the child’s hyper-bonding motivation from an insecure attachment created by the problematic parenting of the allied and supposedly “favored” parent.

Attachment-Based “Parental Alienation”

The behavioral display in attachment-based “parental alienation” is that the child is preoccupied with maintaining continual proximity (i.e., full custody) to the allied and supposedly “favored” parent while rejecting normal-range exploratory behavior of establishing an independent relationship with the other parent.

This is the expected child behavioral display associated with an INSECURE anxious-ambivalent (preoccupied) attachment to the allied and supposedly “favored” parent.

So while it may superficially appear that the child is in a bonded relationship with the allied and supposedly “favored” parent, this relationship is actually a symptomatic expression of pathology.

All that glitters…

It is crucial that mental health professionals who are diagnosing and treating disruptions to children’s attachment bonding motivations, including and especially child custody evaluators, have a professional level of knowledge and expertise in the attachment system, its nature, its features, and its characteristic patterns of functioning and dysfunctioning.

Failure to possess a professional level of knowledge and expertise regarding the attachment system when diagnosing and treating a disruption to the child’s attachment system very likely represents practice beyond the boundaries of professional competence in violation of professional practice standards.

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

References

Attachment

Bowlby, J. (1969). Attachment and loss:  Vol. 1, Attachment. NY: Basic Books.

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

Raineki, C., Moriceau, S., Sullivan, R.M. (2010). Developing a neurobehavioral animal model of infant attachment to an abusive caregiver. Biological Psychiatry, 67, 1137-1145.

Seay, B. Alexander, B.K., and Harlow, H.F. (1964). Maternal behavior of socially deprived rhesus monkeys. Journal of Abnormal and Social Psychology, 69, 345-354

Attachment & the Marital Relationship

Feeney, J.A. and Noller, P. (1990). Attachment style as a predictor of adult romantic relationships. Journal of Personality and Social Psychology, 58, 281-291.

Hazan, C, and Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524.

Roisman, G.I., Madsen, K.H., Hennighousen, L. Sroufe, L.A., and Collins, W.A. (2001). The coherence of dyadic behavior across parent-child and romantic relationships as mediated by the internalized representation of experience. Attachment and Human Behavior, 3, 156-172.

Simpson, J.A. (1990). Influence of attachment styles on romantic relationships. Journal of Personality and Social Psychology, 59, 971-980.

Trans-Generational Transmission of Attachment

Benoit, D. and Parker, K.C.H. (1994). Stability and transmission of attachment across three generations. Child Development, 65, 1444-1456

Bretherton, I. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11, 237-252.

Fonagy, P., Steele, M. and Steele, H. (1991). Intergenerational patterns of attachment: Maternal representations during pregnancy and subsequent infant-mother attachments. Child Development, 62, 891-905.

Fonagy P. and Target M. (2005). Bridging the transmission gap: An end to an important mystery in attachment research? Attachment and Human Development, 7, 333-343.

Jacobvitz, D.B., Morgan, E., Kretchmar, M.D., and Morgan, Y. (1991). The transmission of mother-child boundary disturbances across three generations. Development and Psychopathology, 3, 513-527.

Macfie, J., McElwain, N.L., Houts, R.M., and Cox, M.J. (2005) Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment & Human Development, 7, 51-65

van Ijzendoorn, M.H. (1992) Intergenerational transmission of parenting: A review of studies in nonclinical populations. Developmental Review, 12, 76-99

Assessment of Parental Capacity

The central parenting quality that differentiates healthy from unhealthy parenting practices is the capacity for parental empathy.

Structured and firm parenting that is enacted with parental empathy for the child will be sensitive to both the child’s developmental need for structure and parental guidance, and for the child’s emerging individuation and self-expression (consistent with the child’s developmental period, i.e., infancy, early childhood, middle childhood, early adolescence, later adolescence).

Similarly, a parenting style that is more flexible and permissive which is enacted with parental empathy for the child will balance both the child’s need for autonomy and self-expression with the child’s developmental needs for limits and parental direction (consistent with the child’s developmental period).

The central parenting issue is not whether parents are structured and firm or flexible and permissive. The central defining feature of healthy parenting is the capacity for parental empathy.

Since the absence of parental empathy is a central defining characteristic of narcissistic and borderline personality organization, this means that the assessment for parental narcissistic and borderline personality traits becomes the central feature to be assessed for in all assessments of parental capacity.

Structured and firm parenting that lacks parental empathy for the child will be overly harsh, excessively punitive, and over-controlling, and will not allow the child sufficient latitude for the child’s emerging autonomy and individuation. Structured and firm parenting that lacks parental empathy for the child’s experience represents a narcissistic parenting style in which the parenting behavior reflects the parent’s needs for domination and control rather than the child’s need for reasonable limits and structure.

Flexible and permissive parenting that lacks parental empathy for the child will be too lax and disengaged and will not provide the child with appropriate structure and parental guidance. The child will be allowed too much autonomy that is beyond the child’s maturational level.  Lax and permissive parenting that lacks parental empathy for the child’s needs reflects a narcissistic parental self-focus on the parent’s own need to avoid conflict through the self-indulgent gratification of desires.

“The patient with NPD [Narcissistic Personality Disorder] often has a low tolerance for frustration and expects not only to have wishes easily gratified but also to remain in a steady state of positive reinforcement.” (Beck et al., 2004)

Problematic Parenting is the Absence of Parental Empathy

Problematic parenting emerges from the absence of parental empathy for the child’s experience that then interferes with the parent’s ability to recognize and respond to the child’s authentic needs.  Instead of responding to the child’s emotional and psychological needs, the absence of parental empathy for the child’s authentic experience leads the problematic parent to impose his or her own needs upon the parenting interaction rather than responding to the child’s needs for structure and parental guidance or for flexible parent-child dialogue and negotiation.

The absence of parental empathy arises from a narcissistic parental stance by the parent that places primacy on the expression of the parent’s own emotional and psychological needs over responding to the child’s authentic emotional, psychological, and developmental needs. This can result in the parent projecting onto the child the parent’s imagined needs for the child that are then used to justify for the parent the expression of the parent’s own emotional and psychological needs.

For example, a parent whose own emotional regulation of anxiety requires the parent to adopt a “protective parent” role for a supposedly “vulnerable child” will induce the child to become dependent and needy in order to allow the parent to enact the parent’s own need to be the “protective parent.”

Alternatively, the parent who needs to express anger and domination of the child, perhaps as an expression of the parent’s own emotionally traumatic experiences as a child, will then induce the child into becoming the “disobedient child” which the parent then uses to justify the expression of anger and punishment toward the child.

In problematic parenting, the child is being used to regulate the parent’s own emotional needs as the result of a parental failure of empathy that is a product of a narcissistic parental orientation toward the experience of the child.  Whereas in healthy parenting, the parent empathically attunes to the child’s needs and responds in a way that serves to regulate the child’s needs, either for parental guidance and structure or for parental dialogue and flexible support.

Often, the absence of parental empathy that originates from a narcissistic self-focused stance of the parent, that then produces problematic parenting responses that are misattuned to the child’s needs, is the product of the parent’s own family of origin experiences and so represent a trans-generational replication of parent-child experiences from the parent’s own upbringing and childhood.

We tend to parent our children in ways that are based on the patterns we develop from our own childhood experiences with our parents, so that the failure of parental empathy in one generation establishes the relationship template for the failure of parental empathy toward the next generation.

At its core, problematic parenting represents the absence of parental empathy for the child’s authentic needs that involves a narcissistic stance by the parent in which the parent’s behavior is a reflection of the parent’s own emotional and psychological needs rather than an empathically attuned response to the authentic emotional and psychological needs of the child.

Assessing Parenting Capacity

The central feature of parental capacity is parental empathy for the child’s experience that allows the parent to register and respond to the child’s authentic emotional, psychological and developmental needs.

Narcissistic and borderline personality organizations are characterologically INCAPABLE of empathy.

To the extent that narcissistic and borderline personality organizations are characterologically incapable of empathy, THE primary and central feature in all assessments of parental capacity should be the assessment for narcissistic and borderline personality traits of the parent.  Given the primary and central importance of parental empathy for healthy child development, all other parent-child factors (except direct child safety issues) should be secondary considerations relative to an assessment of parental capacity.

All mental health professionals involved in assessing parental capacity should therefore have a high level of professional expertise in recognizing both the features and the underlying personality dynamics of narcissistic and borderline personality organizations (e.g., Beck et al. 2004; Kernberg, 1975; Linehan, 1993; Millon, 2011).  A high level of professional expertise in narcissistic and borderline personality dynamics would represent a defining feature of professional competence regarding the assessment of parenting capacity.

Several factors in the assessment of possible narcissistic and borderline parental features would represent primary areas of prominent concern:

1.  Any evidence of the splitting dynamic (see Key Concept: Splitting post).  Splitting is a very distinctive interpersonal feature of both narcissistic and borderline personality processes (note: narcissistic and borderline personality organizations are variants of the same underlying personality organization; Kernberg, 1975).  Any evidence of splitting, either with a parent or in the child’s symptom display, should be of great concern and should trigger a more focused and targeted assessment for signs of parental narcissistic or borderline dynamics.

2.  Prominent indicators of a parental attitude of entitlement as evidenced by a repeated disregard for Court orders or the rights of the other parent.

“They [narcissists] are above the rules that govern other people… Unlike the antisocial personality, they do not have a cynical view of rules that govern human conduct; they simply consider themselves exempt from them.” (Beck et al., 2004,pp. 43-44)

 “Out of their vehement certainty of judgment, boundary violations of all sorts may occur, as narcissists are quite comfortable taking control and dictating orders (“I know what’s right for them”) but quite uncomfortable accepting influence from others” (Beck et al., 2004, p. 215)

“Narcissistic individuals also use power and entitlement as evidence of superiority… As a means of demonstrating their power, narcissists may alter boundaries, make unilateral decisions, control others, and determine exceptions to rules that apply to other, ordinary people.” (Beck et al., 2004, 251)

3. The incapacity to experience empathy.

Assessing the Capacity for Empathy

In assessing parental empathy, two domains in clinical questioning of the parent can reveal the capacity of the parent for empathic resonance with another person’s experience,

1.  The parent’s capacity for empathy for the other parent’s experience.

2.  The parent’s capacity for empathy regarding children’s love for both parents and developmental need for the child to have both parents in the life of the child.

Parental Empathy for the Other Parent

The clinical interview with the parent can engage a series of questions embedded into the clinical interview designed to elicit a response of empathy and understanding for the other parent’s experience.  While anger and judgment of the other parent may be present, there should at least be the capacity to understand the other person’s perspective from the other person’s point of view.

The narcissistic/borderline parent is unable to fake having empathy because the narcissistic/borderline personality lacks the capacity for empathy and so does not know when a normal-range empathic response is called for.  The narcissistic/borderline parent is entirely engaged in justifying the legitimacy of his or her anger (and the child’s anger) toward the other parent and so will reject all invitations by the clinical interviewer for demonstrating normal-range empathy for the other parent as a person.

Instead of empathy, the narcissistic parent will adopt a judgmental stance toward the other parent by asserting that the other parent “deserves” to suffer because the other parent is inherently a bad human being (a belief that represents a manifestation of the “all-bad” polarization of the splitting dynamic).

“If others fail to satisfy the narcissist’s “needs,” including the need to look good, or be free from inconvenience, then others “deserve to be punished”… Even when punishing others out of intolerance or entitlement, the narcissist sees this as “a lesson they need, for their own good” (Beck et al., 2004, p. 252).

The borderline personality parent will similarly blame the other parent rather than show any capacity for empathy, but will do so in a slightly different style from the more narcissistically organized parent.  Instead of empathy for the other parent, the borderline personality style will turn the focus back onto themselves (i.e. a narcissistic self-focus) by adopting a victimization stance relative to the other parent.  So invitations to show empathy for the experience of the other parent will produce a response from the borderline parent of justifying the borderline’s anger toward the other parent as being warranted by the borderline parent’s supposed victimization by the other parent.

Narcissistic Style: The narcissistic style parent responds to clinical invitations to display empathy for the other parent’s experience with a harsh judgmental attitude that the other parent “deserves” his or her suffering.

Borderline Style: The borderline style parent responds to clinical invitations to display empathy for the other parent’s experience by entirely disregarding the experience of the other parent and returning the focus back onto the borderline parent’s own self-experience of supposed victimization by the other parent.

Normal-Range: Normal-range parents display balance. Normal-range parents will at least display a capacity for empathy by acknowledging and understanding the legitimacy of the other parent’s experience from the other person’s perspective, although this may then be followed by their offering a complementary context of the situation from their own perspective.

Parental Empathy for the Child’s Bond to the Other Parent

Children love their parents. Both parents. Even bad parents.

Children love their parents and children want their parents’ love in return.

When children do not receive the love of their parents, children become sad. Children may also become frustrated when they cannot achieve their parents’ love, so sometimes children become sad AND angry when they cannot get the love of their parents. But children always WANT the love of their parents.

And children always love their parents. Even bad parents. That’s just the way the attachment system works.

Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.

“I define an “affectional bond” as a relatively long-enduring tie in which the partner is important as a unique individual and is interchangeable with none other. In an affectional bond, there is a desire to maintain closeness to the partner. In older children and adults, that closeness may to some extent be sustained over time and distance and during absences, but nevertheless there is at least an intermittent desire to reestablish proximity and interaction, and pleasure – often joy – upon reunion. Inexplicable separation tends to cause distress, and permanent loss would cause grief.

“An “attachment” is an affectional bond, and hence an attachment figure is never wholly interchangeable with or replaceable by another, even though there may be others to whom one is also attached. In attachments, as in other affectional bonds, there is a need to maintain proximity, distress upon inexplicable separation, pleasure and joy upon reunion, and grief at loss.” (p. 711)

The attachment system is a primary motivational system similar to other primary motivational systems for eating and reproduction.  It developed over millions of years of evolution involving the selective predation of children.  Predators are seeking the old, the weak, and the young. 

Children are prey animals.

Children who bonded to parents, i.e., to specific individual people, received parental protection from predators.  Children who bonded less strongly to parents fell prey to predators (and other environmental dangers).  Over millions of years of the increased survival advantage provided to children from bonding to their parents, a very strong and resilient primary motivational system developed that strongly motivates children’s bonding to parents.

Children love their parents. Both parents. Even bad parents.

Bad parents expose the child to predation and to other environmental dangers. Children who rejected bad parents died. Children who were MORE STRONGLY motivated to bond to bad parents had a better chance of survival than children who rejected bad parents. Over millions of years of evolution involving the selective survival advantage provided to children from an INCREASED motivation to bond to bad parents, the attachment system expresses an INCREASED child motivation toward bonding to bad parents.

Children love their parents. Both parents. Even bad parents.

Furthermore, except in a limited number of extraordinary circumstances, children benefit from relationships with both parents.

Those exceptional circumstances are:

1.  Child sexual abuse by a parent

2.  Parental physical violence as expressed in physical abuse of the child that endangers the child’s safety

3.  Parental emotional and psychological violence as expressed in psychological abuse of the child that endangers the child’s healthy emotional and psychological development

4.  Parental neglect that endangers the child’s safety

5.  Current parental alcohol or substance abuse that could reasonably expose the child to neglect or parenting behaviors that endanger the child’s safety or emotional and psychological development.

Except in these extraordinary circumstances, children benefit from relationships with both parents.

Children love both parents. Children want the love of both parents.

Every possible effort should be made to allow children to love both parents and to provide the child with the opportunity to be loved by both parents.

The Father-Son Relationship: A boy’s relationship with his father provides important gender-identity self-esteem, and the boy’s relationship with his father provides the son with gender related role modeling that is important for the son’s healthy maturation.

The Father-Daughter Relationship: A daughter’s relationship with her father provides her with important cross-gender self-esteem, every daughter should be her father’s princess, which will become an important self-esteem template for her in her choice of a marital partner.

The Mother-Son Relationship: The boy’s mother provides him with an invaluable source of nurturing love, and the mother-son relationship template will become important to the boy’s later choice of a marital partner.

The Mother-Daughter Relationship: A daughter’s relationship with her mother is one of the most wonderful and complex. It provides the daughter with important gender-identity self-esteem and gender role modeling that is vital for her healthy development.  The mother-daughter relationship becomes particularly impactful at the birth of the daughter’s first child, when she transitions from being a daughter in one relationship to being a mother herself in another relationship.

The understanding that children love their parents, both parents, and that they want to be loved by both parents is self-evident to everyone with normal-range empathy, because we all have an attachment system and we have all lived up close and personal with our own attachment system.  We all recognize from our own personal experience how the attachment system works relative children’s love for parents.

Children love their parents, both parents, even bad parents, and children want to be loved BY their parents.

And a child’s relationship with both parents is valuable and important for the child’s healthy development.

However, when the narcissistic and borderline personality parent is invited to demonstrate empathy for the child’s needs relative to the other parent, the narcissistic/borderline parent evidences a complete vacancy of empathic capacity.  For the narcissistic/borderline parent, relationships are superficial… and disposable.  And the psychological consistency demanded by the splitting dynamic (see Key Concept: Splitting post) requires that the ex-spouse also becomes an ex-parent.

Invitations to the narcissistic/borderline parent to show empathy for the other parent and for the child’s love for the other parent will be met with a profound vacancy of empathic capacity, and the capacity for empathy is THE central and primary feature of parental capacity.

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

References

Personality Disorder

Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.

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

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

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

Attachment

Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.

Assessing Parenting

Children’s Response to Problematic Parenting

In “parental alienation,” the proposal put forward by the child’s symptomatic rejection of a parent is that the parenting practices of the targeted-rejected parent are so problematic that they reasonably account for the child’s rejection of a relationship with the targeted parent. This allegation then invites an assessment of the parenting practices of the targeted-rejected parent to determine if the parenting of the targeted parent is sufficiently problematic as to account for the child’s symptomatic rejection of a relationship with this parent.

The question then emerges as to the features of problematic parenting that produce a child’s rejection of a parent.

It is extremely rare for a child to reject a parent.  This is because of a specific primary motivational system in the brain called the “attachment system.”

The attachment system is a neuro-biologically embedded primary motivational system in the brain that compels children to form strong affectional bonds to their parents. As a primary motivational system, the attachment system is analogous to other primary motivational systems for hunger and reproduction in the obligating power of its motivational directives.

The attachment system developed as a primary motivational system across millions of years of evolution as a direct consequence of the selective predation of children.  Predators target the old, the weak, and the young.  Children are prey animals.

Children who formed strong attachment bonds to parents were able to receive parental protection from predators, so that genes promoting the formation of strong child attachment bonds to parents were passed on in the collective gene pool.

Whereas children who formed weak, or even moderate attachment bonds to parents were less likely to receive parental protection from predators (and from other environmental dangers) and so these children were differentially more likely to fall prey to predators (and other dangers), thereby selectively removing genes for weak or even moderate child bonding to parents from the collective gene pool.

Over millions of years of evolution involving the selective predation of children, a very powerful and resilient primary motivational system developed that strongly promotes children’s emotional and psychological bonding to parents.

Because the attachment system confers significant survival advantage to children it is a very strong and resilient system that does not dysfunction easily.  It takes SEVERELY problematic parenting to terminate the attachment bonding motivation of children.

For example, the response of children to bad, or even abusive parenting is to develop an “insecure attachment” because the inadequate parental care of the bad and abusive parent exposes the child to potential predation (and other environmental dangers), so that the child becomes MORE motivated to form an attachment bond to the parent.

The response of children to bad parenting is to be MORE strongly motivated to seek attachment bonding with the abusive parent.

I want to be entirely clear on this, because this is how the authentic child brain works, the response of children to bad parenting is to be MORE strongly motivated to seek attachment bonding with the abusive parent.

While adults may sever adult relationships in response to poor treatment by the other person (such as in divorce), children DO NOT sever their relationship with a parent because of poor parenting.  In fact, bad and abusive parenting produces an INSECURE attachment that MORE STRONGLY motivates children toward bonding to the bad and abusive parent.

So while a husband or wife may divorce their spouse for bad treatment during the marriage, exactly the opposite is true for children’s relationships with their parents.

While on the surface this may seem counter-intuitive and we would expect children exposed to abusive parenting to seek to sever the attachment bonds to the abusive parent, but it’s actually the reverse.  No matter how problematic the parenting of the bad parent may be, the bad parenting is still better than even the best predator.

Children who rejected a relationship with a bad parent were more likely to die from neglect, starvation, predation, or environmental dangers than children who responded to the bad parenting by increasing their efforts to form an attached relationship bond to the bad parent.  Children who become MORE motivated to bond to the bad parent survive.  Children who become less motivated to bond to the bad parent don’t.

“All seven of these MM monkeys [i.e., Motherless Monkeys who were raised without mothers] were totally inadequate mothers… Initially, the MM monkeys tended to ignore or withdraw from their babies even when the infants were disengaged and screaming… Later the motherless monkeys ignored, rejected, and were physically abusive to their infants…A surprising phenomena was the universally persisting attempts by the infants to attach to the mother’s body regardless of neglect or physical punishment. When the infants failed to attach to the ventral surface of the mother, they would cling to the dorsal surface and attempt to move to the mother’s ventral surface.” (Seay, Alexander, Harlow, 1964, p. 353)

Seay, B. Alexander, B.K., and Harlow, H.F. (1964). Maternal behavior of socially deprived rhesus monkeys. Journal of Abnormal and Social Psychology, 69, 345-354


“The paradoxical finding that the more punishment a juvenile receives the stronger becomes its attachment to the punishing figure, very difficult to explain in any other theory, is compatible with the view that the function of attachment behavior is protection from predators.” (Bowlby, 1969, 226-227)

Bowlby, J. (1969). Attachment and loss. Attachment, Vol. 1. NY: Basic Books.


“A potential evolutionary explanation suggests selection pressures supported infants that remained attached because it increased the probability of survival.  From an adaptive point of view, perhaps it is better for an altricial animal to remain attached to an abusive caregiver than receive no care. (Raineki, Moriceau, Sullivan, 2010, p. 1143)

Raineki, C., Moriceau, S., Sullivan, R.M. (2010). Developing a neurobehavioral animal model of infant attachment to an abusive caregiver. Biological Psychiatry, 67, 1137-1145.

While these survival features may not be relevant in a parent-child relationship that occurs today, in the 21st Century, the advances in our civilization over the past several thousand years are not relevant to the functioning of the attachment system that evolved across a span of millions of years and that is neuro-biologically embedded into the brain as a primary motivational system.

Problematic and abusive parenting produces an INSECURE ATTACHMENT that MORE STRONGLY motivates the child to seek attachment bonding to the abusive parent.

John Bowlby, who first identified and described the attachment system, referred to the attachment system as a “goal corrected” motivational system, meaning that in response to problematic parenting the attachment system maintains its goal of forming an attached relationship bond with the parent, so that the child’s behaviors then become distorted in an effort to achieve this goal to the greatest extent possible in the context of the problematic parenting.

Avoidance of Aversive Parenting

Problematic parenting may lead children to avoid the painful parenting of the problematic parent, but it does not result in a termination of the child’s attachment bonding motivations toward the parent. The attachment system of the child CONTINUES to motivate the child to want to form an attached parent-child bond, but the problematic parenting prevents the formation of this attached bond

The frustrated motivation of the child to form an affectional attachment bond with the parent increases the child’s distress at not being able to form an attachment bond with the parent, and this increased distress creates the child’s “protest behavior” – see Parenting and Protest Behavior – to elicit the involvement of the parent.

In authentic parent-child conflict created by problematic parenting, the child’s “protest behavior” emerges from a frustrated effort to FORM a parent-child bond, it is NOT from a desire to SEVER the parent-child bond.

Change the problematic parenting that acts as a barrier to the formation of the affectional parent-child bond, and the protest behavior that is being caused by the child’s distress at not being able to form an affectional parent-child relationship goes away. 

That’s called “therapy.”

Resolve the features of the problematic parenting, and the child’s CONTINUING attachment bonding motivation will allow the formation of an affectionally attached parent-child relationship.

Problematic parenting may produce an avoidance response in the child, but NOT a termination of the attachment bonding motivation itself.

The attachment system is a primary motivational system, just like the hunger system.  When we don’t eat, we experience the distress of hunger.  But just because we are experiencing distress caused by not eating, that doesn’t mean that we don’t want to eat.  In fact, we want to eat even MORE when we’re hungry.

When the child’s desire for affectional attachment bonding with a parent is unfulfilled, the child experiences emotional distress (and so emits protest behavior).  But just because the child is experiencing distress and emitting protest behavior, that doesn’t mean that the fundamental motivational system for attachment bonding isn’t still active.  In fact, it’s even MORE active.

Just because we’re experiencing the distress of being hungry doesn’t mean that we don’t want to eat, and in an authentic parent-child relationship just because the child is experiencing distress at an unfulfilled attachment bond with the parent doesn’t mean that the child doesn’t want an attachment bond with the parent.

A child desire to terminate the child’s relationship with a parent is extremely unusual and is not at all a normal response to problematic parenting.

The primary motivational system still remains active even if we are in distress at our inability to satisfy the motivational press.

Parent-Child Conflict

Parent-child conflict is normal and developmentally healthy (see, Parenting and Protest Behavior). 

In some cases, child vulnerabilities or problematic parenting practices may elevate the severity of parent-child conflicts into unhealthy levels of excessive and extreme child displays of protest behavior.

Under no circumstances, however, is parent-child conflict ever lethal to the parent-child relationship, meaning that in no circumstances does parent-child conflict result in the termination of the child’s attachment motivations toward the parent.  No matter how bad the parent is, a bad parent is still far better than the predator.

Exceptions:

There are several exceptions, however, that CAN transmute parent-child conflict into a lethal strain that motivates the child to terminate the child’s relationship with the parent.  These exceptions are what should be assessed for in evaluating the parenting of the targeted parent that could be producing a termination of the child’s attachment bonding motivations.

  • Sexual abuse/incest

Parental sexual abuse of the child immediately and completely terminates the child’s attachment bonding motivations toward that parent.

The complete termination of the child’s attachment bonding motivation toward a parent is a very characteristic and singularly unique feature of the attachment system in response to incest.

The presence in “parental alienation” of the child’s motivated desire to entirely terminate a relationship with a parent, which is a singularly distinctive feature of the attachment system’s response to incest, suggests the possible presence of sexual abuse “source code” in the “files” of the attachment system that is being trans-generationally transmitted through distorted parenting practices from the original entry of the sexual abuse into the family system a generation or two prior to the current “parental alienation” iteration of the attachment system distortions.

  • Chronic parental violence expressed in physical child abuse

Years of excessive parental violence as expressed though physical abuse of the child, such as beatings with fists, belts, switches, or electrical cords, can sometimes result in the termination of the child’s attachment bonding motivations toward the violent parent.

When it occurs, the termination of children’s attachment bonding motivations toward a parent because of chronic parental violence toward the child tends to occur during early or middle adolescence (between the ages of 12-16).

  • Chronic parental violence expressed in spousal domestic abuse

Years of excessive parental violence as expressed though physical spousal abuse can sometimes result in the termination of the child’s attachment bonding motivations toward the violent parent.  In other cases, the child may develop an identification with the aggressor in which the child joins in the abuse directed toward the victimized parent/spouse.

When it occurs, the termination of children’s attachment bonding motivations toward a parent because of the chronic domestic violence directed by this parent toward the child’s other parent tends to occur during early or middle adolescence (between the ages of 12-16), at which time the child may stand up to the violent parent in an effort to protect the victimized parent.

  • Chronic parental alcoholism or substance abuse addiction

Most often, chronic parental alcoholism or substance abuse addiction creates a role-reversal parentification of the child into a caretaking role relative to the inadequate and addicted parent.  In some cases, after years of a dysfunctional parent-child relationship created by the alcoholic or substance addicted parent, the child may seek to terminate the parent-child relationship with the addicted parent.

When the child terminates the attached relationship with an addicted parent, the attachment bonding motivation remains active but is severed as a product of the parent’s continuing addiction-related dysfunctions, so that should the parent ever enter recovery and become non-addicted, the child’s attachment bonding motivation can become reactivated toward reconciliation in seeking and forming a parent-child bond.

When it occurs, the child’s efforts to terminate the parent-child relationship with an alcoholic or substance addicted parent tends to occur during the child’s early adulthood (between the ages 18-30).

Attachment-Based “Parental Alienation”

The only other family dynamic that can produce a lethal strain of parent-child conflict in which the child seeks to entirely terminate the child’s relationship with a parent occurs in a cross-generational parent-child coalition of the child with a narcissistic/(borderline) parent.

The addition of parental narcissistic/(borderline) psychopathology to a cross-generational parent-child coalition against the other parent can transmute the child’s conflicts with the other parent into a particularly malignant and virulent form of parent-child conflict in which the child seeks to entirely terminate the child’s relationship with the targeted parent.

The termination of the child’s attachment bonding motivations toward a normal-range and affectionally available parent as a result of a cross-generational parent-child coalition of the child with a narcissistic/(borderline) parent (i.e., attachment-based “parental alienation”) will be evident in a specific set of three characteristic and definitive diagnostic indicators in the child’s symptom display (see post, Diagnostic Indicators and Associated Clinical Signs).

In none of the other lethal strains of parent-child conflict (i.e., incest, chronic physical child abuse, chronic domestic violence, chronic parental alcoholism or substance addiction) will the child’s symptoms in seeking a child-initiated cutoff in the parent-child relationship evidence the specific set of three characteristic and definitive diagnostic indicators associated with an attachment-based model of “parental alienation.”

Assessment of Parenting

1.)  Targeted Parent:  If the child’s symptoms are evidencing a motivated desire from the child to terminate the child’s relationship with a parent, then the parenting behavior of the targeted parent should be assessed for the presence of the severely dysfunctional parenting that can sometimes result in the termination of the child’s attachment bonding motivations toward a parent,

  • Incest
  • Chronic physical abuse of the child (years)
  • Chronic domestic violence (years)
  • Chronic alcoholism or substance addiction (years)

The presence of these parenting behaviors would indicate pathogenic parenting by the targeted-rejected parent as the causal agent in the termination of the child’s attachment bonding motivations toward this parent.

2.)  Allied Parent: If the child’s symptoms are evidencing a motivated desire from the child to terminate the child’s relationship with a parent, then the parenting behavior of the supposedly allied and “favored” parent should be assessed for the presence of the three characteristic and definitive diagnostic indicators in the child’s symptom display of the child’s triangulation into the spousal conflict through a cross-generational coalition of the child with a narcissistic/(borderline) parent (i.e. attachment-based “parental alienation”),

  • Attachment System Distortion: The child seeks to terminate the child’s relationship with a normal-range and affectionally available parent.
  • Personality Disorder Symptoms: The child’s symptoms evidence a specific set of five narcissistic and borderline personality traits.
  • Delusional Belief: The child’s symptoms evidence an intransigently held fixed and false belief in the supposedly (abusive) parental inadequacy of the targeted-rejected parent.

The presence of this specific set of child symptoms would represent definitive diagnostic evidence for pathogenic parenting by the allied and supposedly “favored” parent as the causal agent for the termination of the child’s attachment bonding motivations toward the targeted-rejected parent.

3.)  Avoidance of Aversive Parenting: If the child is seeking to avoid aversive parenting by a parent, then the child’s attachment system remains active so that altering the aversive parenting practices of the parent that are creating the child’s avoidance of this parent will allow the formation of an affectionally bonded parent-child relationship.

If the child’s complaints regarding the problematic parenting behavior of the targeted-rejected parent are credible and confirmed through clinical interviews and observation, such as,

  • Overly intrusive, over-anxious parenting
  • Overly sad, depressed, and dependent parenting
  • Overly angry, hostile, critical, and punitive parenting
  • Overly controlling parenting relative to adolescent development

Then the problematic parenting practices should be specifically identified and therapy to change the identified problematic parenting practices should be initiated. Changes made in the parenting responses provided to the child will produce changes to the child’s behavior. 

If changes to the parenting behavior of the targeted parent do not produce corresponding changes in the child’s behavior, then the diagnosis of the parent-child relationship problems as representing the child’s efforts to avoid aversive parenting practices is in error (i.e., the child’s responses to the targeted parent are not under the “stimulus control” of the parent’s behavior, suggesting the presence of a cross-generational coalition of the child with the allied and supposedly “favored” parent against the other parent.

Note on Normal-Range Parenting:

There is wide variability in normal-range parenting, from lax and permissive parenting to more structured and firm parenting. Both ends of the parenting continuum can be normal-range and both approaches to parenting can produce healthy child development.

Parents have the fundamental right to establish family values through their approach to parenting. Some parents will value the improved relationship features available from parenting along the more lax and permissive spectrum of parenting practices, while other parents will value the improved child maturation of personal responsibility available from parenting along the more structured and firm end of the parenting continuum.

The decisions regarding the establishment of family values through parenting practices is the legitimate right of parents and is embedded within cultural values.

Broad latitude should be granted to parents in establishing family values through their parenting with their children.

It is only when parenting reaches the extremes on either end of the spectrum, either excessively lax and permissive parenting so as to represent child neglect, or excessively structured and firm parenting so as to represent emotional or physical child abuse, should broader societal standards for appropriate parenting be applied.

If we place parenting behavior along a continuum from 1 to 100, with lax and permissive parenting at the lower end of the spectrum and structured and firm parenting at the higher end, then normal-range parenting would fall between 20 and 80 on this scale.

Each style of parenting has positive and negative features, so that professional psychology tends to recommend parenting that falls in the mid-range spectrum (been 40 and 60 on a 100 point scale) that employs a balance of both reasonable parent-child dialogue and reasonable parent-imposed structure.

The relative balance of these two features, parent-child dialogue and parentally imposed structure, changes with the child’s increasing maturation, so that the amount of structure we provide to younger children, such as with a 5 or 6 year old child, is greater than the parental structure we would apply for older children, such as with a 15 or 16 year old adolescent who is preparing for entry into young adulthood.

As parenting practices move toward the more prominent use of a lax and permissive parenting approach over a structured and firm parenting style (20-40 on the 100 point scale), or toward the more prominent use of a structured and firm parenting style over a lax and permissive approach (60-80 on the 100 point scale) more problematic family issues can begin to emerge based on the parenting style employed, yet parenting from these more distinctively pronounced frameworks nevertheless remains normal-range and within the parental rights and legitimate prerogatives of the parent.

Broad latitude should be granted to parents in the establishment of values within their families.

Except in cases of prominent parental neglect or abuse, parents have a legitimate right to establish family values through their parenting practices, and it is up to children to adjust to parental values and expectations. Adjusting to parental rules, values, and expectations is an important part of child maturational development.  As long as the parenting practices are broadly normal-range (i.e., between 20 and 80 on a 100 point scale), then the rights and legitimate prerogatives of the parent should be respected and supported, and it is up to the child to adjust and adapt to the parenting approach.

If desired, therapeutic dialogue with the parent can be engaged regarding possible parenting approaches within the mid-range of the parenting spectrum that use a balanced blend of reasonable dialogue and reasonable structure, but such therapeutic dialogue should not undermine the legitimate parental right and the legitimate authority of the parent to establish family values that are consistent with the parent’s values as long as the parenting practices employed are broadly normal-range.

Healthy child development REQUIRES that the child adjust and adapt to imposed restrictions on the “degrees of freedom” available to the child that “constrain their children’s behavior in a way that promotes transitions to more highly organized, complex phases of organization.” (Cherkes-Julkowski & Mitlina, 1999, p. 7; see Parenting and Protest Behavior).  As long as parenting practices are broadly normal-range, healthy child development requires that the child adjust and adapt to the values of the parent as expressed in the parenting practices.

Reasonable parent-child dialogue that provides some restrictions on the child’s developing brain systems “while at the same time allowing enough degrees of freedom for the child to self-organize according to her or his own periodicities” (Cherkes-Julkowski & Mitlina, 1999, p. 14; see Parenting and Protest Behavior) can be encouraged, it nevertheless remains centrally important to healthy child development to support the legitimate rights, authority, and leadership of the parent in determining and establishing family values through the choice of parental responses and parenting practices.

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

References

Cherkes-Julkowski, M. and Mitlina, N. (1999). Self-Organization of mother-child instructional dyads and latter attention. Journal of Learning Disability, 32(1), 6-21.

Parenting and Protest Behavior

Preface

Let me begin this post by acknowledging that it is technical.  I need the material described in this post as a foundation for later discussion of parenting.


The child’s symptomatic rejection of a relationship with a parent inherently accuses the targeted-rejected parent of poor parenting practices, which then requires that we assess the parenting practices of the targeted parent to determine if they represent normal-range parenting practices or whether the parenting of the targeted-rejected parent is sufficiently problematic as to account for the child’s rejection of a relationship with this parent.

Yet by what criteria do we assess parenting?  In my next series of blog posts I plan to address this issue.

My professional background is in ADHD and parent-child conflicts generally, not in “parental alienation.” In addition, I am a bit of an odd-bird professionally because I have a secondary expertise in early childhood mental health (ages 0-5).  Acquiring this expertise in early childhood mental health required that I develop a professional-level understanding for the various brain systems and how they develop, since brain systems are coming online all over the place in early childhood.

To work professionally in early childhood requires a fairly sophisticated understanding for how the brain works, and this foundational understanding for how the brain works has profound implications regarding our approach to parenting and parent-child conflict generally.

In order for me to address the issue of parenting, I need to first lay some foundational groundwork in the current scientific evidence regarding parenting and brain development during childhood that I can then refer to in my future discussions regarding the criteria by which we can assess parenting.

This blog post lays one of those foundational bricks regarding the scientific evidence concerning parenting and the neuro-development of the brain during childhood that I will need in future discussions of assessing parenting.

Parent-Child Conflict is Developmentally Normal, Healthy, and Necessary

Context: Understanding Child Development

Parent-child conflict is both normal and developmentally healthy. It is only when there are distortions in how parent-child conflict is addressed that the developmental consequences of parent-child conflict elevates to problematic levels.

The issue is NOT that parent-child conflict occurs, parent-child conflict is SUPPOSED to occur, the issue is how we respond to it.

To understand the developmental origins of normal range parent child-conflict requires an understanding for the context for how the brain develops during childhood.

We Build What We Use

The brain develops based on the principle of “we build what we use.” Whenever we use a brain system or pathway, that system or pathway becomes stronger, more sensitive, and more efficient.

The technical term for this process is called “canalization,” like building canals or channels in the brain, only these are not actually physical channels in the brain, but instead are chemical “channels,” chemical “grooves” in the brain that are created by structural changes in the molecules along the used pathway that make it more likely for that set of neurons, for that set of brain cells, to fire in that pattern again in the future. The technical term for these use-dependent chemical changes is “long-term potentiation.”

Brain cells that are used together also grow additional interconnections, called synapses, along the pathway that has been used in a process called “synaptogenesis.” This increase in the number of brain connections along used pathways makes it more likely that the used pathway will fire in that same pattern in the future.

Key Construct: We build what we use

The renowned neuroscientist, Donald Hebb (1949), referred to this as “neurons that fire together, wire together.”

The Brain is the Cause

Behavior is a symptom. The brain is the cause.

The organized and integrated functioning of the various brain systems produces organized and integrated behavior. Organized and integrated behavior is socially pleasant and cooperative.

When the integrated functioning of brain systems becomes disorganized and dysregulated for whatever reason, such as when emotions become too intense or too painful, or when there is a conflict between differing motivational goals, then this produces disorganized and dysregulated behavior.

Disorganized and dysregulated behavior is referred to as “protest behavior” and can be reflected in children becoming defiant and uncooperative, evidencing behavior that is too rigid and inflexible or that is too fluid and disorganized, and in emotional expressions that are too extreme such as angry tantrums in response to frustration.  All of these “protest behaviors” reflect disorganized and dysregulated behavior that is the product of disorganization and dysregulation in the functioning of the underlying brain systems.

Key Construct: A disorganized and dysregulated brain produces disorganized and dsyregulated behavior.

Key Construct: Disorganized and dsyregulated behavior is called “protest behavior”

Protest behavior is annoying to the parent, who then wants to make the child’s protest behavior stop.

In this way, the child’s protest behavior elicits the involvement of the parent who is motivated (i.e., annoyed by the protest behavior) to help the child regain an organized and well-regulated state (i.e., to make the protest behavior stop).

For mental health professionals:

Protest behavior is “designed” by nature to elicit the involvement of a more mature nervous system (i.e., the parent) who then mediates the transition of the child from a disorganized-dysregulated state back into an organized and well regulated state.

There are a variety of ways of transitioning the child back into an organized and well-regulated state. Essentially these approaches involve the use of either discipline or guidance strategies.

Discipline uses coercive strategies involving punishment to activate the child’s fear system and so induce submissive behavior in the child. The submissive override available through the activation of the fear system organizes the child’s brain networks into a submissive state and so eliminates the protest behavior that was emerging from a disorganized and dysregulated brain state.

Guidance strategies use social negotiation strategies to reorganize and re-regulate brain systems. Authority based guidance strategies are social communications of parental authority that trigger child cooperation with the socially expressed authority of the parent. This social communication of parental authority is predicated on prior (and possibly current) parental use of discipline strategies. The difference is that the communication of authority within a guidance-based approach is sufficient to engage the child’s cooperation without the need for a threatened application of punishment (i.e., the activation of the fear system override); the social communication of authority is sufficient to enlist social cooperation.

Guidance-based strategies also include social negotiation in which reasonable parent-child dialogue is engaged to encourage the child’s socially responsible communication of distress and the child’s consideration of the social and environmental context, in which a mutual goal can be achieved of meeting the child’s needs within the context of social and environmental restrictions.

A disorganized-dysregulated brain produces disorganized-dysregulated behavior (i.e., protest behavior) that elicits the involvement of the parent (because protest behavior is annoying and the parent wants to make it stop). The involved parent then uses discipline and guidance-based strategies to transition the child back into an organized and regulated brain state (i.e., protest behavior stops).

Now this is important to understand…

Through this process of the parent’s mediation of the child’s state transition from a disorganized-dysregulated state to an organized and regulated state, ALL OF THE BRAIN NETWORKS that were used as part of this state transition from a disorganized-dysregulated state to an organized and regulated state become stronger, more sensitive, and more efficient as a result of USE-DEPENDENT processes (i.e.. long-term potentiation and synaptogenesis).

In the scientific literature, the parent’s mediation of the child’s state transition from a disorganized-dysregulated state to an organized and regulated state is called “scaffolding.”

The parent “scaffolds” the child’s transition from a disorganized-dysregulated state to an organized and regulated state, and in doing so BUILDS the neural pathways in the child’s brain for making this transition. We build what we use.

Do this once, do this twice, do this five thousand times, and eventually the pathway is grooved in the child’s brain (i.e., “canalized”) for making this transition, so that the next time the child’s brain begins to enter this type of disorganized and dsyregulated brain state, the child can slip back into an organized and regulated brain state on his or her own without the parent’s active involvement, because the parent has BUILT the transition networks for this phase-state transition.

The capacity for the child to make this phase-state transition from a disorganized-dysregulated brain state (emitting disorganized-dysregulated behavior; i.e., protest behavior) back into an organized and regulated state (emitting organized and regulated behavior; i.e., socially calm and cooperative behavior) as a result of prior scaffolding of the neuro-development of this transition network is called the development of the child’s capacity for “self-regulation.”

The capacity for child “self-regulation” is initially mediated by the “scaffolding” support of the parent, whose involvement is elicited by the child’s “protest behavior” (i.e., disorganized-dysregulated behavior that is the product of a disorganized and dsyregulated brain state in response to a developmental challenge that the child cannot independently master).

Important Points:

1.)  Children are supposed to be annoying.

When a child is faced with a developmental challenge that he or she cannot independently master, the effective integration of the underlying brain systems begins to become disorganized and dsysregulated (such as from too intense or too painful an emotional state, or from conflicts in motivational goals). As the effective integration of the brain begins to break down into a disorganized and dsyregulated state, the child begins to display disorganized and dsyregulated behavior (i.e., “protest behavior”) as a consequence of the underlying disorganized and dsyregulated brain state.

The protest behavior is “designed” to elicit the involvement of the parent who then scaffolds the child’s transition back into an organized and regulated brain state (and organized and regulated behavior) through the well-modulated use of discipline and guidance strategies. In doing this, the parent builds the networks in the child’s brain (through use-dependent neural processes) for managing the developmental challenge that the child initially faced and that was threatening the collapse of the organized and integrated functioning of the child’s brain systems.

That’s EXACTLY how things are SUPPOSED to work.

The child’s protest behavior is not a “problem” – we only perceive it to be a “problem” because we find protest behavior annoying. But protest behavior is supposed to be annoying in order to elicit our involvement.

The child, or more accurately, the child’s brain, is doing EXACTLY what it is supposed to be doing. A disorganized and dsyregulated brain produces disorganized and dsyregulated behavior to elicit the involvement of a more mature nervous system to help re-regulate the brain and in the process of re-regulation to BUILD through use-dependent processes of “canalization” the neural capacity to manage the developmental challenge.

These developmentally vital relationship exchanges are called “breech-and-repair” sequences.

2.)  The issue is not that children are annoying, of course they’re annoying, they’re supposed to annoy us whenever they are having trouble and need our help.  The issue is not that children’s protest behavior is annoying, the issue is how do we respond to their protest behavior?

That becomes the central question of parenting.

Parent-child conflict is normal and natural.  Minor parent-child “breech-and-repair” sequences are developmentally essential for the healthy maturation of the child’s brain systems. It is what is SUPPOSED to occur.

Parenting involves an ongoing dance of consolidating the relationship through affectionate bonding, followed by minor “breech-and-repair” sequences of helping the child navigate developmentally challenging situations.

Vygotsky called these developmental challenges the “zone of proximal development”

Kohut called the normal-range breech-and-repair sequences providing the child with “optimal frustration” that builds the child’s “self-structure.”

3.)  Protest behavior is neuro-biologically “designed” to elicit the parent’s involvement.

Protest behavior (i.e., angry-oppositional behavior, inflexible-defiant behavior, angry tantrums, fearful-timid behavior, etc.) is an “attachment behavior” designed to elicit GREATER parental involvement. That’s how the brain works.

Protest behavior is NEVER a “detachment behavior” designed to DECREASE parental involvement. That is NOT how the brain works.

A disorganized brain creates disorganized behavior (i.e., protest behavior) that elicits greater parental involvement in order to mediate (“scaffold”) the brain’s transition back into an organized and regulated state, and thereby build all of the brain networks associated with this phase-state transition from a disorganized-dysregulated state to an organized and regulated state.

A Complex Self-Organizing System

I’m going to close this post with a somewhat technical construct that I need to establish relative to criteria for evaluating parenting.  Placing restrictions on children that force the child to accommodate to the restriction is developmentally vital for the healthy maturation of brain systems.  In addition, these imposed restrictions must be well-modulated to the child’s own rhythms and “periodicities.”

The brain is a complex self-organizing system.  As such, its maturation benefits from some external restrictions (challenges) being placed upon its “degrees of freedom” so that in accommodating to these restrictions the integrated functioning of the various brain systems will be forced to organize their integration at a higher maturational level. 

If no restrictions are placed on the degrees of freedom afforded to the developing brain then there is little impetus for it to develop into a higher organizational level, and the elaboration and integration of its brain systems remains flaccid and immature,

See Vygotsky’s construct of “zone of proximal development”

At the same time, if these imposed restrictions on the degrees of freedom afforded to the brain’s functioning are too rigid and inflexibly applied, then the organized functioning of the brain will collapse into chaos.

The restrictions placed on the integrated functioning of the developing brain of the child must be well-modulated and responsive to the child’s own rhythms and “periodicities.”

“A controlling parameter effectively limits the degrees of freedom within the system and thus constrains the system to assemble itself in more stable and productive ways. Mothers/instructors can act as communication partners/control parameters who constrain their children’s behavior in a way that promotes transitions to more highly organized, complex phases of organization.” (Cherkes-Julkowski & Mitlina, 1999, p. 7)

“Constraints must be well modulated. Strong constraints could infuse excessive amounts of energy, causing extreme perturbation, wildly chaotic activity, and a resultant rapid fall to a less organized, more entropic state. On the other hand, constraints that are too weak may provide little impetus for higher order development (Nicolis & Prigogine, 1989; Schmidt et al., 1990).” (Cherkes-Julkowski & Mitlina, 1999, p. 7)

“Well developing dyads move together as intentions move in a more gradual progression back and forth between the instructional intention and the child’s intention.” (Cherkes-Julkowski & Mitlina, 1999, p. 13-14)

“Effective instruction would begin with a goal not too disparate from the child’s and pursue it flexibly, with ample acknowledgment of the child’s intention. This is tantamount to providing weak constraint, one that provides some reduction of response parameters while at the same time allowing enough degrees of freedom for the child to self-organize according to her or his own periodicities.” (Cherkes-Julkowski & Mitlina, 1999, p. 14)

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

References

Cherkes-Julkowski, M. and Mitlina, N. (1999). Self-Organization of mother-child instructional dyads and latter attention. Journal of Learning Disability, 32(1), 6-21.

Brain Development References

Hebb, D.O. (1949). The organization of behavior. New York: Wiley & Sons

LeDoux, J. (2002). Synaptic Self: How Our Brains Become Who We Are. London: Penguin Books.

Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., & Vigilante, D. (1995). Childhood Trauma, the Neurobiology of Adaptation, and “Use-dependent” Development of the Brain: How “States” Become “Traits”. Infant Mental Health Journal, 16(4), 271-291.

Shore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Earlbaum.

Shore, A.N. (1996). The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Development and Psychopathology, 8, 59-87.

Trevarthen, C. (2001). The neurobiology of early communication: Intersubjective regulations in human brain development. In Kalverboer, A.F. and Gramsbergen, A. (Eds) Handbook of Brain and Behaviour in Human Development. London: Kluwer Academic Publishers

Tronick, E.Z. (2003). Of course all relationships are unique: How co-creative processes generate unique mother-infant and patient-therapist relationships and change other relationships. Psychoanalytic Inquiry, 23, 473-491.