Is Reunification Therapy a Defined Construct

I received a Comment response from Dr. Reay to my blog post “There is No Such Thing as Reunification Therapy,” and rather than my responding as a Comment I would like to respond as a separate blog post, since I believe the discussion surrounding a professional definition for the construct of “reunification therapy”  is important.

Comment from Dr. Reay:

Hi Dr. Childress

With all due respect, I am going to challenge your argument that there is no such thing as Reunification Therapy as well as some other arguments in your blog. Although I can’t speak for them, I will take the chance and assume that Dr. Randy Rand, Dr. Dierdre Rand, Dr. Richard Warshak, Dr. Douglas Darnall and Linda Gottlieb may not necessarily buy your argument either. It would be most interesting to find out their thoughts. I will send you a copy via private email on the Family Reflections Reunification model and program. This article has been peer-reviewed and accepted for publication in the American Journal of Family Therapy, Volume 43(2) this spring.

Regards,
Dr. Kathleen M. Reay,
Founder & Clinical Director of the
Family Reflections Reunification Program Inc.
http://www.familyreflectionsprogram.com

First, let me thank you Dr. Reay, for challenging my assertion.  If professional psychology is to conduct “reunification therapy” then a defined model is needed for what “reunification therapy” entails, so I welcome the opportunity to learn.  

You cite a set of professionals I would refer to as the Gardnerian PAS contingent (in contrast to the “DSMite” critics of the construct of “parental alienation”).  First, in my view the Gardnerian PAS model is woefully inadequate as a theoretical model for the development of a treatment approach. But let’s put that aside and look at the people you cite.

Dr. Warshak maintains that the “Family Bridges” program is psycho-educational, not psychotherapy, and while he touts the benefits of his intervention model, he has not presented the specifics of what the Family Bridges model is sufficiently for it to be reviewed as a model for psychotherapy. He says its good. I’ll trust him that its good. I just don’t know what it is at a level of specificity necessary for me to either evaluate it or replicate it as a model of psychotherapy.  And he says its psycho-educational not psychotherapy.

Linda Gottlieb’s approach is wonderful. She does family systems therapy. Family systems therapy is spot on the appropriate therapy model for addressing “parental alienation,” which essentially involves the child’s triangulation into the spousal conflict through the formation of a cross-generational coalition with a narcissistic/(borderline) parent. The addition of parental narcissistic/(borderline) psychopathology transmutes the family relationship processes into a particularly malignant and virulent form of cross-generational parent-child coalition that seeks to entirely terminate the other parent’s relationship with the child. Linda Gottlieb does family systems therapy. In common parlance she may describe what she does as “reunification therapy” but she then defines what “reunification therapy” is from within family systems constructs. The “reunification therapy” of Linda Gottlieb is family systems therapy. Its wonderful. Everyone should listen to Linda Gottlieb.

But let’s look at this a bit deeper. If, for example, we set a standard of practice for treating this “special population” of children and families that all therapists working with this “special population” need to be professionally familiar with the constructs of Structural Family Systems therapy, there is then a set of literature that sufficiently defines the constructs of Structural Family Systems therapy to allow us to hold these therapists accountable for knowing a certain domain of content.

If we make the same statement about “reunification therapy,” that all therapists treating this “special population” of children and families must be professionally familiar with the constructs of “reunification therapy,” where are these constructs of “reunification therapy” sufficiently defined so that we can hold therapists accountable for this content domain of knowledge?  That’s my point.

If therapists say they’re doing client-centered therapy, then there are constructs of self-actualization, empathy, genuiness, unconditional positive regard, false-self, conditions of worth, etc. that all become relevant to treatment.

If therapists say they’re doing object relations therapy then there are issues of self-object functions, mirroring, idealization, twinship, empathic failures, transmuting internalizations, etc.. that all become relevant to treatment.

If therapists say they’re doing Adlerian psychotherapy, then there are issues of inferiority and mastery, self-esteem threats, safeguarding strategies, lifestyles, etc. that all become relevant to treatment.

If therapists say they’re doing Gestalt therapy, then there are issues of contact, boundaries, awareness, the present moment, responsibility, empty chair techniques, etc. that all become relevant to treatment.

If therapists say they’re doing cognitive-behavioral therapy then there are constructs of schemas, irrational beliefs, cueing antecedants, contingency management, etc. that all become relevant to treatment.

Where are the principles relevant to “reunification therapy” described and defined? This isn’t a rhetorical question. I’ve looked and looked and I can’t find any.

Randy Rand, Dierdre Rand, and Douglas Darnall are also wonderful. They present strong arguments in support for the Gardnerian model of PAS. Unfortunately, while Gardner accurately identified the presence of an authentic clinical phenomenon, in my view he too quickly abandoned the professional rigor necessary for defining the clinical phenomenon he identified from within standard and established psychological principles and constructs. Instead, he proposed a “new syndrome” based on the child’s display of a set of anecdotal clinical indicators.

From my perspective as a clinical psychologist, “parental alienation” isn’t a “new syndrome,” it is simply a highly malignant form of the established family systems construct of the child’s triangulation into the spousal conflict through the formation of a cross-generational parent-child coalition against the other parent, referred to as a “rigid triangle” by Minuchin (1974, p. 102) and as a “perverse triangle” by Haley (1977, p. 37).

If anyone wants to argue that “parental alienation” represents a “new syndrome” I would argue that it is first incumbent upon them to describe why the defined and established family systems constructs of the child’s triangulation into the spousal conflict through the formation of a cross-generational coalition with one parent against the other parent do not adequately and better account for the child’s symptom display and family processes (that would include the family systems constructs of the emergence of pathological symptoms in response to inadequate accommodation of the family to a developmental transition, of homeostatic balance being maintained in a pathological family system by the function of the symptom, and of psychological boundary diffusion through an enmeshed parent-child relationship). 

I would even argue that some Strategic Family Systems constructs regarding power dynamics within the family relative to the function served by the symptom are highly relevant considerations.

In my view, family systems theory adequately accounts for the clinical symptom display traditionally referred to as “parental alienation.”  Add narcissistic/(borderline) personality pathology to the cross-generational parent-child coalition and we have the display of “severe parental alienation.”  Without the addition of narcissistic/(borderline) personality pathology we have the display of mild and moderate “parental alienation.”  Family systems theory adequately addresses the clinical phenomenon.

We don’t need a “new syndrome” to describe what “parental alienation” is. Nor do we even need the term “parental alienation.” The proper clinical term is “pathogenic parenting” (patho=pathological; genic=genesis, creation). Pathogenic parenting is the creation of significant psychopathology in the child through aberrant and distorted parenting practices. It is a construct most often used in reference to distortions to the child’s attachment system. The attachment system does not spontaneously dysfunction, it distorts only in response to pathogenic parenting practices.

Furthermore, I would argue that the central symptom associated with “parental alienation,” the child’s rejection of a relationship with a normal-range and affectionally available parent, represents a severe distortion to the normal-range functioning of the child’s attachment system. Why then are we looking to create a “new syndrome” rather than applying sufficient professional rigor to identifying what’s going on with the child’s attachment system?

So while Randy Rand, Dierdre Rand, and Douglas Darnall are all wonderful and powerful advocates for a PAS model of “parental alienation,” I think the PAS model represents a failed paradigm across a number of levels. It has been available for 30 years and has given us our current situation of no actualizable solution for the family tragedy of “parental alienation.” A fundamental paradigm shift is needed to a theoretically defined model of “parental alienation” that is based entirely within established psychological constructs and principles so that we can achieve an actualizable solution for targeted parents, and more importantly for the children. That’s what I’ve tried to accomplish with an attachment-based model for the construct of “parental alienation.”

And while Randy Rand, Dierdre Rand, and Douglas Darnall are all wonderful advocates for the PAS model, I have not found where they describe a model for what “reunification therapy” is.

I look forward with eager anticipation to learning of your definition for “reunification therapy” in your article due for publication this spring. Yay!  It is about time that someone defined the construct of “reunification therapy” with enough specificity to allow for professional critique and replication. I am optimistic that once we have your definition for the construct of “reunification therapy” then other therapists across the country who are interested in doing “reunification therapy” will be able to replicate your approach to conducting “reunification therapy.”

I realize there might be space limitations to a published article that may limit your ability to describe your model for “reunification therapy” in sufficient detail to fully allow for professional review, critique, and replication. If this is the case, then I await with eager anticipation the publication on your website of the specific protocol used in your model of “reunification therapy” that will allow for its professional review and replication by other therapists.

Until such time as somebody offers a specific description for what “reunification therapy” entails, however, I’m going to stand by my criticism of the construct as being absent any defined meaning.

If there is no definition for the meaning of a construct, then the construct is without meaning.

I know that my criticism as “snake oil” is harsh, but keep in mind the source for the metaphor.  In the late 1800’s “doctors” would travel around to local communities selling “medicine” for “what ails ya.”  When asked about the specific ingredients of their “patent medicine,” however, the salesmen would claim that the ingredients were a “trade secret” and couldn’t be disclosed, hence the term “snake oil” since the ingredients could be anything. 

If we don’t have a specific definition for what the construct of “reunification therapy” entails, then a therapist in North Carolina can make something up and call it “reunification therapy,” and a therapist in Arizona can make up something entirely different and call it “reunification therapy,” and a therapist in Oregon can make up a third different thing and call it “reunification therapy.”  The term “reunification therapy” then becomes a cover, a smokescreen, that allows therapists to make stuff up and do whatever they want, under the appearance to the general public of professional practice because they’re doing something called “reunification therapy.”

And as long as no one in mental health challenges this highly questionable professional practice of using the term “reunification therapy” which lacks defined meaning as a means of giving appearance to the general public of professional psychotherapy that lacks professional foundation in established psychological models of psychotherapy, then the term “reunification therapy” will continue to be presented to the general public as if it has meaning when, in truth, it is absent any defined meaning as a psychotherapeutic approach.

Kohut offers a coherent description for what object-relations therapy is. Rogers describes what client-centered therapy entails. Beck describes the components of cognitive-behavioral therapy.

Let’s say I’m going to teach my graduate students how to do “reunification therapy.”  What specifically do I teach them in order for them to know how to do “reunification therapy?”  Or say I have to supervise an intern in conducting “reunification therapy,” what principles and constructs are relevant to their work?  I know the answers to these questions for all the other models of psychotherapy.  But I can’t find any information defining the construct of “reunification therapy.”

I have searched and searched for the defined meaning of “reunification therapy” and found nothing but vague descriptions about “de-programming” the child based on assertions that the child is “brainwashed,” both of which are extraordinarily questionable and discomforting constructs in clinical psychology. None of the major theorists in psychology, Freud, Adler, Jung, Kohut, Winnicott, Bowlby, Fairburn, Rogers, Yalom, Perls, Frankl, May, Maslow, Skinner, Beck, Ellis, Minuchin, Haley, Bowen, Satir, Madanes, Berg, Parham, none of them discuss “brainwashing” and “deprogramming” as tenets of psychotherapy.

What school of psychotherapy does “reunification therapy” fit into?  Is it a psychoanalytic model?  Is it a cognitive-behavioral model?  Is it an entirely new school of psychotherapy?  Does it rely on family systems constructs for understanding the problem?  Does it rely on social constructionist principles?  How do the principles of “reunification therapy” fit with the principles of object relations therapy, or humanistic client centered therapy?  What are the overlaps?  What are the differences?

Suppose I had a graduate student or intern ask me these questions, what’s my answer? Before I can answer these questions I need someone who says they’re doing “reunification therapy” to describe for me what “reunification therapy” is.

I don’t think that’s too much to ask. If you’re going to use a term for a new category of psychotherapy, define the principles that are used in that new category of psychotherapy.  So it is with great anticipation and relief that I will finally learn from your upcoming article what the principles of “reunification therapy” are, so that these principles can then be used to define a standard of professional practice when therapists say they do “reunification therapy” similar to the standards we can apply when therapists say they do client-centered therapy, or object relations therapy, or cognitive behavioral therapy, or Gestalt therapy, or structural family systems therapy, or solution focused therapy.  I am glad we will finally have a defined model for what “reunification therapy” is.

I think the work of Richard Warshak, Randy Rand, Dierdre Rand, and Douglas Darnell is great, and everyone should listen to Linda Gottlieb. I also think that the PAS model, while a laudable effort by Richard Gardner, is insufficiently grounded in established psychological constructs and principles to serve as a foundation for creating an actualizable solution for targeted parents and their children. In my view, a paradigm shift is needed to a new model for defining the construct of “parental alienation” that is based entirely within standard and established psychological principles and constructs, and I’d recommend we base that new model in the attachment system since a child’s rejection of a relationship with a normal-range and affectionally available parent represents a profound distortion to the normal-range functioning of the child’s attachment system.  There is substantial evidence that the development of narcissistic and borderline personality processes are also related to distortions in the development of the attachment system, so that the potential transmission of attachment trauma from the childhood of the “alienating” parent to the current family relationships would seemingly provide a fruitful line of exploration.

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

References

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

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