Puzzles

I received the following question from a targeted parent and I thought my response may be of broader interest:

Dr. Childress, can you give an example of a question that you would put to a child that would indicate any of the narcissistic processes and the splitting dynamic from your 2nd set of diagnostic indicators in a child’s symptom display.


Response:

There isn’t a specific question, per se. Typically the display of the child will evidence narcissistic symptoms in response to my general question:

Dr. C:  “So, tell me. Why do you hate your mom (your dad) so much?”

and my follow-up questions asking for specific incidents to support the child’s general assertions.

As the child responds, the child will display an attitude of judgement of the parent from an elevated position above that of the parent.  As I ask about specifics, a sense of entitlement will become evident.

As I probe for empathy  (“How do you think it makes your mom feel that you don’t want to be with her?”), the child will evidence a complete absence of caring and empathy for the targeted parent’s experience of love and emotional suffering. Oftentimes the child will display a characteristic attitude that the targeted parent “deserves” to be rejected, or that the display of love and suffering by the targeted parent is “fake” or a lie.

When I inquire about the favored parent, on the other hand, the child provides a uniformly positive critique of the allied and supposedly favored parent, free from parent-child troubles.

The Puzzle

Think of it this way, clinical psychology is like putting together a puzzle. The parent tells you what they think the puzzle is, which may or may not be accurate. Sometimes the parent has no idea what the ultimate picture is, and the origins of the child’s behavior and angry outbursts are a total mystery to the parent.

I’ll then open the box and begin putting the puzzle pieces together to see what the picture is. Is this the trains in the mountain puzzle, or is it boats on the lake? I’ll start with the borders because they have straight edges (i.e., the general family context and general complaints). As I’m putting together the general structure, I’ll look for similar color patterns (i.e., emerging themes).

Gradually I’ll begin to recognize shapes in the picture that can help in locating specific pieces to complete a particular pattern. Eventually the picture emerges (typically even before all the pieces are in place). There may be some pieces missing here and there, but it’s clearly a picture of cats in the garden. It’s definitely not a locomotive. Nor is it a picture of boats on the lake.

There are three cats in the picture, one’s black with short hair, one’s grey and white stripes, and one’s black and white. I’m missing the pieces for this one’s ear, and I don’t have the pieces for the black cat’s left paw. They’re in a garden with red and yellow flowers, this portion of the garden is missing, as is this part of the fence. But it’s clearly cats in the garden, and it’s definitely not a locomotive or boats on the lake.

So when I conduct an initial clinical interview, the parent typically tells me what the puzzle is (i.e., they present me with the picture on the box top). The parent will say to me,

“Dr. Childress, can you help me with this problem?  I have a puzzle of a train in the mountains.”

I then open the box and start putting together the pieces to see if that’s true, if it’s really a train in the mountains, and also to determine which train in the mountains puzzle it is. Is it the one with the steam locomotive going across the canyon bridge, or is it the one with the modern locomotive coming out of the tunnel?

Dr. C: “So what does the child do? Can you give me an example? How do you respond when your child does that? How does the child respond to what you do? What’s going on in the surrounding family? How do you and the other parent get along?”

Gradually, I put the puzzle picture together. If it’s actually a train, I can begin asking questions that help me understand if it’s a steam engine or a modern locomotive. Is it traveling through farmlands or across mountains? Is there a bridge over the river, or is this the train with red and yellow boxcars?

The “Alienation” Puzzle

In attachment-based “parental alienation” the allied parent says to me,

Parent:  “Dr. Childress, I have a puzzle of a train in the mountains. See, look here, here’s some pieces from the puzzle. Here’s a piece with the train’s engine and smokestack. Here’s one of the engine’s wheels. This one is a puzzle piece showing one of the boxcars. And look at this picture on the box top. See, it’s of a train going through the mountains.

Sure enough, the picture on the box top is of a train in the mountains. And the puzzle pieces I’m shown are clearly from a locomotive.

So, let’s open the box and start putting the puzzle together. I never just accept the picture on the box top. I always put the puzzle together myself, just to make sure.

So, let’s put this picture together… hmmm that’s odd. The actual puzzle pieces in the box are much smaller than the locomotive pieces I was shown. You know what… those locomotive pieces don’t belong to this puzzle (i.e., the symptom display by the child is inauthentic).

So, let’s start with the edges… and… wait, this isn’t a locomotive puzzle. You know what… This looks like cats in the garden. Well if it’s cats in the garden, then there should be a red and yellow piece that goes right in this spot. Yep. There it is. And there should be another black and red piece that goes right here. Yep. There it is. And then there should be a kitten’s nose that goes right here. Yep. There it is. This isn’t train in the mountains, this is cats in the garden.

Well, I’ve still got some time left, let’s put together more of the puzzle just to make sure. This area should be red and yellow flowers, with this piece here and another one over here. Yep. This is the grey cat’s eye. Yep, it goes right here and fits with this. There’s the bee over here on the flower. Yep. We’re definitely looking at cats in the garden.

I see the picture made by the puzzle pieces, clear as day. We’re looking at three cats in the garden.

As I try to put together the puzzle train in the mountains, I realize that’s not the picture which is being revealed by the actual puzzle pieces,

The initial “presentation” is one of parent-child conflict caused by the targeted-rejected parent. However, as I collect the clinical data, the parent-child conflict is not being initiated by the parent’s problematic behavior, but is being initiated by, dare I say provoked by, the child.

Furthermore, the child’s attachment system display is not authentic. Child protest behavior is an “attachment behavior” designed to increase parental involvement (commonly referred to as seeking “negative attention”). In this situation, the child is showing “detachment behavior,” a motivated desire to sever the parent child bond. An authentic attachment system never shows “detachment behavior” except under an extremely limited set of severely abusive parenting (e.g., incest or chronic and severe parental violence), or in response to a cross-generational coalition with a narcissistic/(borderline) parent (i.e., attachment-based “parental alienation” – cats in the garden).

As I’m putting together the actual puzzle pieces, they form into the picture features of the cats in the garden puzzle. Once I begin to recognize the cats in the garden puzzle (typically because the puzzle piece of “detachment behavior” is so distinctive of cats in the garden), I then begin to look for three specific puzzle pieces in each of three different locations (i.e., the three diagnostic indicators of attachment-based “parental alienation”) because no other puzzle has all three of these pieces except cats in the garden.

Cats in the garden has a black and red piece here, a yellow and red piece that goes right here, and a piece with a kitten’s nose that goes right here (i.e., the three diagnostic indicators of attachment-based “parental alienation”).

Train in the mountains has a black and red piece here, just like cats in the garden, but train in the mountains doesn’t have the red and yellow piece here. Instead, train in the mountains has a green piece in that location. And train in the mountains definitely doesn’t have a kitten’s nose. So if there is a kitten’s nose in the puzzle, it definitely can’t be train in the mountains.

Boats on a lake has the same black and red piece and the same red and yellow piece (although the shapes of these pieces are different from the shapes of these pieces in cats in the garden), but boats on a lake doesn’t have a kitten’s nose either.

Dogs at play has a kitten’s nose over here, but not in the same location. And dogs at play does not have the black and red piece. And instead of the red and yellow piece, dogs at play has a red and green piece in that location.

Only cats in the garden has all three pieces. And even when there is overlap in the pieces shared by the different puzzles, the actual pieces are slightly different shapes, and in slightly different locations across the different puzzles.

So if you know what the different puzzles are, it’s actually pretty easy to spot train in the mountains, or boats on the lake, or cats in the garden. You just have to know what the pictures are and know what you’re looking for in each picture. That’s called “knowing what you’re doing.”

But even more importantly, I’m not making the diagnosis of cats in the garden based just on the three specific puzzle pieces alone, although I could because they’re so distinctive and definitive of cats in the garden. Instead, I go ahead and put together some more of the puzzle, and sure enough, the actual picture that emerges is of three cats sitting and playing in the garden.

It’s not the three puzzle pieces that make it cats in the garden. It’s the actual picture itself that makes it cats in the garden. The three puzzle pieces (the three diagnostic indicators of attachment-based “parental alienation”) are just easily identifiable definitive markers for cats in the garden. It’s the actual picture of three cats sitting among flowers that makes the puzzle cats in the garden.

The Original Question

So then, to answer the question about what specific questions I ask to elicit the child’s narcissistic symptoms, the primary question is to ask the child about the child’s reasons for rejecting the targeted parent. I ask the child to explain it to me.

Puzzle Analogy

If the puzzle picture is of the train in the mountains, then the child’s explanation for the parent-child conflict is going to be some variant of xyz.

If, on the other hand, the puzzle picture is of boats on the lake, then child’s explanation for the parent-child conflict is going to be a variant of abc.

If the puzzle is of cats in the garden, then the child’s explanation for the parent-child conflict is going to be qrs.

I always start with what I’m told the puzzle is. So if I’m told the puzzle is dogs at play, that’s what I start with and I begin to put together the puzzle picture of dogs at play. Sometimes the puzzle turns out to be one of the other dog puzzles, such as dog on the fire engine or hunting dog with duck. But which dog puzzle becomes evident as I put the puzzle pieces together.

Once you know the various puzzles, it’s pretty straightforward determining which exact puzzle it is (i.e., whether it’s an ADHD spectrum issue, or a parenting problem issue, or an autism-spectrum issue, or sensory-motor sensitivities, etc.). Each puzzle has distinctive features.

If the puzzle pieces don’t actually fit the initial presentation of the picture by the parent (this isn’t a dogs puzzle, this is one of the boat series) I then readjust to unravel the actual puzzle picture from of the actual puzzle pieces. As a clinical psychologist, I really don’t care if its dogs at play or boats on the lake, or train in the mountains. I just want to know which puzzle we’re dealing with so that we know how to fix things.

That’s what clinical child and family therapy does. It fixes things. But first we need to know if the puzzle is dogs at play or boats on the lake. If we try to fix dogs at play but the actual puzzle is train in the mountains, our efforts are going to be entirely ineffective. Determining which puzzle were working with is called “diagnosis.”

So, in putting together the puzzle I’ll start by asking the child,

Dr. C:  “So tell me, why don’t you want to be with your mom?” (or dad)?

Child responses to boats on the lake puzzles have one set of characteristics. Child responses from the train in the mountains puzzle have a different set of characteristics. Cats in the garden… holy cow, the child’s responses in cats in the garden are highly distinctive. It’s incredibly easy to spot cats in the garden (i.e., attachment-based “parental alienation”).

Q: So why do so many mental health professions not diagnose cats in the garden?

A: Because they don’t even know this puzzle exists. They think everything is train in the mountains. So when the allied parent and child show them the box top of the train in the mountains picture, and the child displays the three over-sized puzzle pieces of the locomotive, the ignorance of these mental health professionals just accepts that it’s the train in the mountains puzzle.

Q: But don’t they see that it’s not a train, it’s cats?

A: No. Because they don’t put the actual puzzle together. They just accept that the picture on the box top is the actual puzzle. Kinda lazy if you ask me. And it results in a wrong diagnosis, which then results in incorrect and ineffective treatment. They’re treating train in the mountains, when the actual puzzle is cats in the garden. Pointless and ineffective treatment.

Plus, these mental health professionals don’t even know there is such a thing as the cats in the garden puzzle. That’s why I wrote Foundations. This book explains the cats in the garden puzzle. Once mental health professionals read Foundations, they will go “Hey, this isn’t train in the mountains. This is cats in the garden.” Until they read Foundations, however, they’ll just go on diagnosing and treating train in the mountains no matter what the actual puzzle is.

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

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