An Alert: Going forward, I am going to begin using two phrases interchangeably to refer to identical psychopathology:
The first phrase is – attachment-based “parental alienation” – this refers to the psychopathology described and defined in Foundations.
The second phrase I am going to begin using from time-to-time to refer to exactly the same pathology is – attachment trauma reenactment pathology. In my view, this phrase represents a more precise label within clinical psychology for the nature of the pathology which is traditionally called “parental alienation.”
From a clinical psychology perspective, the symptom-set associated with “parental alienation” represents the manifestation of attachment trauma reenactment pathology. This is a technical professional psychology issue, not a general public issue.
I will continue to reference the construct of “parental alienation” in most of my discussions of the pathology so as not to disorient the general discussion (although I have obviously added the phrase “attachment-based” to the term “parental alienation” to differentiate the model of the pathology described in Foundations from the prior Gardnerian PAS model – we are shifting paradigms).
At the same time I will occasionally slip in the phrase “attachment trauma reenactment pathology” (probably in parentheses) to refer to exactly the same pathology. The pathology is described in Foundations, and I honestly don’t care what we label the pathology for convenience in our discussions of it.
I will discuss this shift in terminology more in my Diagnosis book due out in the fall, in which I will propose this label for the pathology relative to future revisions of the DSM diagnostic system. The pathology traditionally called “parental alienation” is a trauma pathogen involving the trans-generational transmission of attachment trauma from the childhood of the allied narcissistic/(borderline) parent to the current family relationships, mediated by the narcissistic/(borderline) personality pathology of this parent (which itself is a product of the childhood attachment trauma). The pathology belongs in the Trauma- and Stress-Related Disorders section of the DSM diagnostic system, with a very similar description as the DSM-IV TR diagnosis of Shared Psychotic Disorder (i.e., a shared delusional belief created within the trauma reenactment narrative).
So, with that bit of professional housekeeping out of the way…
Let me talk to attorneys out there.
Creating change in professional mental health can occur through a variety of channels. One channel is through malpractice lawsuits that establish expected standards of practice for all mental health professionals to follow.
By way of example, one such landmark case regarding a psychologist’s “duty to protect” relative to dangerous patients is the Tarasoff case. Let me be clear, I’m not saying “parental alienation” represents a dangerous patient, what I’m saying is that a similar type of lawsuit regarding a professionals “duty to protect” may be able to establish standards for mental health professionals relative to the psychological child abuse of “parental alienation” pathology. I offer the Tarasoff case only as an example of the type of option possibly available for changing the mental health response to the psychological child abuse of “parental alienation.”
Tarasoff vs Regents of the University of California.
In the Tarasoff case, a therapist’s patient made a threat against an identifiable person who was not in the therapy session. The therapist took action by notifying the campus police regarding the patient’s threat, and the campus police detained the patient for questioning and then released the patient. The patient later went on to murder the target of his threat. The family of the victim filed a lawsuit claiming that the therapist had a “duty to protect” the identified victim by warning the victim of the threat made against her by the patient. The therapist claimed that since the identified target of the threat was not his patient he had no “duty of care” for that person. In addition, the therapist had an established obligation to maintain patient confidentiality and the therapist discharged his duty to protect the potential victim by notifying the campus police of the threat made by the patient.
The court, however, found the following:
“When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more of various steps, depending upon the nature of the case. Thus it may call for him to warn the intended victim or others likely to apprise the victim of the danger, to notify the police, or to take whatever other steps are reasonably necessary under the circumstances.”
From this landmark case, a standard of practice was immediately established regarding the responsibilities of mental health professionals relative to the treatment of dangerous patients. Because of this case, there are now standard procedures regarding notifying potential victims which mental health professionals are trained in and must take relative to dangerous patients and threats made toward the general public.
My question to attorneys is… why couldn’t a similar legal route be used to establish “standard of care” responsibilities regarding the mental health professional’s “duty to protect” the child in cases of the psychological child abuse created by “parental alienation” pathology, in which prominent developmental, personality, and psychiatric symptomatology is being created in the child by the pathogenic parenting of a clearly and severely pathological parent? Doesn’t the mental health professional incur a “duty to protect” the child in these cases?
In the case of clearly evident child psychological abuse, why wouldn’t the mental health professional incur “an obligation to use reasonable care to protect the intended victim” of parental abuse by taking “one or more various steps, depending upon the nature of the case”? At the very least, making the appropriate DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.
This is where the paradigm shift to an attachment-based model for the construct of “parental alienation” alters the potentially available possibilities for a solution. A malpractice lawsuit is not possible under Gardner’s proposal of a “new syndrome” because the citadel of establishment mental health has rejected this proposal of a “new syndrome.”
But an attachment-based model is not proposing a “new syndrome” and has instead defined the pathology called “parental alienation” from entirely within standard and established psychological constructs and principles of the attachment system, personality disorders, and family systems constructs (i.e., attachment trauma reenactment pathology).
The construct of “parental alienation” doesn’t exist. Fine. The construct of personality disorders exists. The construct of the attachment system and attachment trauma exists. The construct of the trans-generational transmission of attachment trauma exists; of splitting and role-reversal relationships. These things all exist in the established research literature.
When serious parental pathology is responsible for inducing significant developmental, personality, and psychiatric psychopathology in the child through the highly aberrant and distorted parenting practices of a psychologically decompensating and delusional narcissistic/(borderline) parent, which then creates the child’s loss of an affectionally bonded relationship with a normal-range and affectionally available parent, why isn’t this a DSM-5 diagnosis of V995.51 Psychological Child Abuse, Confirmed?
The pathology of attachment-based “parental alienation” is child psychological abuse.
To argue that it is somehow acceptable for a parent to produce this level of psychopathology in a child is ludicrous. The serious level of psychopathology involved in an attachment-based model of “parental alienation,” as described in Foundations, reasonably represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.
This would seemingly engage a mental health professional’s “duty to protect” the victim of the psychological child abuse.
I’m not an attorney, I’m a psychologist. But it seems to me that if a mental health professional failed in this “duty to protect” the child from the clearly evident psychological abuse inflicted on the child by the parent (i.e., the pathogenic parenting that is producing serious psychopathology in the child) that this would seemingly represent malpractice because of the mental health professional’s failure to take “reasonable care to protect” the victim of child abuse (i.e., a failure in the professional’s “duty to protect”).
I’m not an attorney, I’m a psychologist, but it seems to me that a malpractice lawsuit may represent a method to create change in the response of the mental health system relative to the pathology of “parental alienation” (based on the definition of the “parental alienation” pathology provided by Foundations).
Malpractice is not an available option under the old Gardnerian PAS model because no such thing as “parental alienation” exists.
However, by reformulating the construct traditionally called “parental alienation” from entirely within standard and established psychological principles and constructs, an attachment-based model activates professional constructs and standards of practice to which ALL mental health professionals can be held accountable. Personality disorders exist, role-reversal relationships exist, splitting exists, delusions exist, attachment trauma exists, etc. These are established and accepted psychological constructs and principles that can be applied to the pathology, and to which mental health professionals can be held accountable in their assessment, diagnosis, and treatment.
The pathology traditionally called “parental alienation” is fully defined and described within standard and established psychological principles and constructs that are an established part of the professional knowledge-base to which ALL mental health professionals can be held accountable (especially if they are diagnosing and treating clients exhibiting these forms of pathology, i.e., attachment trauma pathology, personality disorder processes, family systems disturbances).
Within the reformulation and redefinition of the pathology traditionally called “parental alienation,” the issue for mental health professionals becomes one of child psychological abuse being inflicted on the child through the pathogenic parenting practices of a narcissistic/borderline parent by means of a role-reversal relationship in which the parent is inducing significant developmental, personality disorder, and psychiatric pathology in the child in order to meet the emotional and psychological needs of the parent.
Furthermore, the severe psychopathology that is being created by the pathogenic parenting of the narcissistic/borderline parent’s psychopathology is directly responsible for the child’s loss of an affectionally bonded relationship with a normal-range and affectionally available parent who would otherwise be available to support the child’s healthy development in response to the other parent’s evident psychopathology, and who could thereby mitigate the severe distortions to the child’s normal-range and healthy emotional and psychological development being created by the pathogenic parenting of the pathological parent.
The pathology of attachment-based “parental alienation” elevates the clinical considerations from those of parent-child conflict to prominent child protection concerns.
The pathology described within an attachment-based reformulation for the psychological processes traditionally called “parental alienation” (i.e., the trans-generational transmission of attachment trauma from the childhood of the allied and supposedly favored parent to the current family relationships, mediated by the narcissistic and/or borderline personality pathology of the allied parent through the formation of a cross-generational coalition with the child against the other parent), and the severely damaging impact of this pathology on the child’s normal-range emotional and psychological development, reasonably represents child psychological abuse.
In cases of child psychological abuse, the mental health professional is obligated to provide an accurate DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed and to take “reasonable” protective actions that are then documented in the patient’s record.
Failure to make an accurate diagnosis and to take appropriate steps to protect the child would represent a failure in the mental health professional’s “duty to protect” which would then continue to expose the child to ongoing psychological abuse by the pathogenic parent, and which would lead to the subsequent destruction of the child’s normal-range emotional and psychological development.
I am not an attorney. I am a psychologist. I can define the pathology, I cannot speak to the legal issues. But surely there must be attorneys out there among the community of targeted parents who are willing to examine this issue of possible professional malpractice, or else who can enlighten me as to why it is acceptable professional practice to ignore and misdiagnose the psychological abuse of children when this is an established DSM-5 diagnosis.
If I was an attorney rather than a psychologist, I might look to form a collaborative legal team of like-minded attorneys, and to then seek to locate a particularly egregious “test case” of professional incompetence and malpractice in the diagnosis and treatment of this pathology, where the psychopathology of the parent was clearly evident yet the mental health professional failed to make the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.
I wonder what would happen within the citadel of establishment mental health if a malpractice lawsuit was filed against a mental health professional relative to the pathology of “parental alienation” and the mental health professional’s failure in his or her duty to protect?
I wonder what would happen if two or three such lawsuits were filed against different mental health professionals in different jurisdictions?
I wonder if it might be possible to establish a landmark legal case similar to what was done in Tarasoff for patient dangerousness, only in this case it is the professional’s “duty to protect” relative to child psychological abuse by a clearly pathological parent who is inducing severe developmental, personality, and psychiatric symptoms in the child that devastate the child’s normal-range development?
I am not an attorney. I’m a psychologist. I can only define what the pathology is within the standard and established constructs and principles of professional clinical psychology.
But from where I sit as a psychologist, the legal issues seemingly parallel those of the Tarasoff ruling that defined the responsibilities for a mental health professional’s “duty to protect” relative to dangerous patients, only in this case it the the mental health professional’s obligations to “use reasonable care to protect” the child from the pathogenic parenting of a psychologically decompensating narcissistic/(borderline) parent.
But then, I’m not an attorney, I’m a psychologist. So I may not fully understand the legal issues involved in why it is legally acceptable professional practice to not provide an accurate DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed when the pathogenic parenting practices of a psychologically decompensating narcissistic/(borderline) parent are inducing significant developmental, personality, and psychiatric psychopathology in the child that is destroying the child’s normal-range emotional and psychological development.
Maybe there’s something I’m missing. Or maybe not.
This approach is NOT available under a Gardnerian paradigm. Because using a Gardnerian model, the construct of “parental alienation” doesn’t exist in professional psychology.
Holding mental health professionals accountable only becomes available under an attachment-based reformulation for the construct of “parental alienation” that defines the pathology from entirely within standard and established psychological principles and constructs (i.e., attachment trauma reenactment pathology).
Everyone has been lulled to sleep by the years of the Gardnerian model; i.e., that establishment mental health needs to accept a “new syndrome” and that we need to prove Gardnerian PAS in court. No. This is a mental health issue. The vulnerability of the pathogen is in achieving an accurate mental health diagnosis, which means defining the pathology entirely within standard and established psychological principles and constructs.
Attack the professional incompetence in the mental health system. But to do so, we need a definition of the pathology from entirely within standard and established constructs and principles to which all mental health professionals can be held accountable. Foundations provides this.
The paradigm shift to an attachment-based model redefines EVERYTHING, and opens up entirely new doors to the solution that are unavailable using the Gardnerian PAS paradigm.
Standard 2.01: Mental health professionals are prohibited from practicing outside the boundaries of their competence – Q: Is the mental health professional competent in the necessary domains of professional knowledge regarding personality disorders, attachment trauma, and family systems dynamics to competently and accurately assess, diagnose, and treat this type of pathology?
Standard 9.01: Mental health professionals must conduct assessments sufficient to substantiate their diagnosis – Q: Did the mental health professional conduct an adequate and sufficient assessment for the potential pathology associated with an attachment trauma reenactment pathology, and did the mental health professional document in the patient record the results of that assessment?
Standard 3.04: Mental health professionals are prohibited from actions that harm their clients – Q: Did the mental health professional’s failure to possess the necessary professional competence in the relevant domains of professional psychology and failure to adequately and sufficiently assess the pathology occurring in the family result in a misdiagnosis of the pathology and inappropriate treatment that caused harm to the child and to the targeted parent?
Duty to Protect: Did the mental health professional fulfill his or her professional obligation to protect the child from the psychological abuse inflicted on the child by the evident psychopathology and pathogenic parenting of the narcissistic/(borderline) parent?
The pathology traditionally termed “parental alienation” is a child protection issue. It is a form of child psychological abuse. Gardnerian PAS cannot make this case. An attachment-based model can.
Will the malpractice suit win? I don’t know. As I’ve said, I’m a psychologist, not an attorney. I can only define the pathology. However, from where I sit as a psychologist, I suspect that with the selection of the right “test case” there would probably be an exceedingly good chance of proving that the mental health professional failed in his or her “duty to protect” because of a misdiagnosis of the pathology as a direct consequence of their practicing beyond the boundaries of their competence regarding the pathology described in an attachment-based model of “parental alienation” (attachment trauma reenactment pathology).
Possibly a more conservative approach to a lawsuit might be to first file a licensing board complaint and wait for the licensing board to rule that the mental health professional was practicing beyond the boundaries of competence, and then to bring the malpractice lawsuit. But I suspect that with the right test case the legal team may be able to get boundaries of competence (Standard 2.01), inadequate assessment (Standard 9.01), and harm to the client (Standard 3.04) along with failure in the “duty to protect” all in a single case. But I’m not an attorney, I’m a psychologist.
The pathology of “parental alienation” is not a child custody issue; it is a child protection issue.
Foundations defines the pathology entirely within standard and established psychological constructs and principles.
There is no such thing as “parental alienation.” But we’re not talking about “parental alienation.” We’re talking about the trans-generational transmission of attachment-trauma through the formation of a cross-generational coalition of the parent with the child, that is mediated by the narcissistic/(borderline) psychopathology of the allied parent. Call it “parental alienation,” call it “pathogenic parenting,” call it “attachment trauma reenactment pathology.” I don’t care what you label it.
What’s in a name? that which we call a rose
By any other name would smell as sweet – Shakespeare
Or we can simply use one long paragraph-description each time we refer to the pathology. I don’t care. But no matter what we call it, the pathology as defined in Foundations is definitely child psychological abuse.
I am not an attorney. I am a psychologist. But surely there are attorneys out there in the targeted parent community, or their allies, who can put the pieces together. Standards 2.01, 9.01, 3.04 and “duty to protect” – massive damage to the child’s normal-range emotional and psychological development – massive trauma to the normal-range and affectionally available targeted parent – massive professional ignorance and incompetence. I find it hard to believe that you can’t make something out of that?
Wake Up and Fight
It is time to wake up from the slumber of Gardnerian PAS. An attachment-based reformulation for the pathology traditionally called “parental alienation” empowers you to fight back, to hold mental health professionals accountable for an appropriate assessment of the pathology and for an accurate diagnosis of the pathology.
Professional ignorance and incompetence is not allowed by existing standards of professional practice. The theoretical Foundations on which you can stand are rock solid. Bowlby, Beck, Millon, Minuchin, Kernberg… and on and on.
The paradigm is shifting.
Attachment-based “parental alienation,” pathogenic parenting, attachment trauma reenactment pathology… I don’t care what you call it… it is V995.51 Child Psychological Abuse, Confirmed.
What we want – what we expect – is that all mental health professionals who are working with this “special population” of children and families possess the appropriate specialized knowledge and expertise necessary and required for professionally competent practice. These domains of professional knowledge are specifically identified in Foundations; expertise in the attachment system; in personality disorders, and in family systems constructs.
We want, and we expect, all mental health professionals to make the appropriate and warranted DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed whenever the three diagnostic indicators of the pathology are present in the child’s symptom display (call it attachment-based “parental alienation,” call it pathogenic parenting, call it attachment trauma reenactment pathology).
- The three diagnostic indicators are noted in Professional Consultation
- They are described in Foundations
- They are offered in a Diagnostic Checklist form on my website
As you are all probably aware, I’m not an attorney, I’m a psychologist. But as a psychologist, I wonder what sort of damages might be sought in a case of malpractice involving the misdiagnosis of child abuse? And I’m wondering, might the mental health professional’s malpractice insurance carrier settle the case before trial because they determine it will cost them more financially to fight the case than it will cost them to simply settle the case? (and if they go to trial they might lose)
I don’t know these things, I’m not an attorney, I’m a psychologist.
What I do know, is that we will not abandon a single child to the pathology of “parental alienation.” It stops. Today. Now.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857
10 thoughts on “I’m Not An Attorney. I’m a Psychologist.”
I’m not a psychologist, but I think the new phrase is more descriptive and prescriptive!
I am not attorney either, but I find the idea of taking it into a civil court to be highly creative and potentially highly promising.
It removes it from the nightmare known as Family Court.
It removes it from the purview of prosecutors, who are SO busy they basically do not prepare for any cases, except possibly some murder cases that are in the newspaper.
I am forwarding this on to some contacts.
And of course, my previous comment comes from a concern about the massive harm to children that so few seem to be able to or want to understand.
My question is: Even if these ignorant therapists were to perform the diagnostic tests as prescribed in Foundations, would it not cause more harm than good? Reason being that due to their lack of knowledge, expertise and/or ignorance as well as pride, they would in any case not identify the indicators, thereby nullifying any claim to Attachment based PA.
Thus, requesting them to do the test might not be sufficient as they lack the expertise to perform such tests. Should they not rather just be tasked to show whether or not they possess the required expertise for such cases, and if not, requested to be removed from the case? Should they refuse to (which is probably what they’ll do), to find your own expert to refute their therapy and recommendations?
The other more critical question then is how to establish these cases as a “special population” due to the need for specific expert skills in the relevant areas?
I’m not an attorney currently, but I used to practice and teach law, including defending doctors in malpractice cases (a form of negligence). The issue in these cases is some version of whether the doctor met the standard of care for that community, or whether the doctor acted as an ordinary, reasonably skillful and careful doctor in that community would have, under the same circumstances. And there’s a battle of expert witness doctors, each testifying what an ordinary, reasonably skillful and careful doctor in that community would or would not do.
So to prevail in such a malpractice case you’d need to prove that an ordinary, reasonably skillful and careful doctor in that community would diagnose and treat according to the new paradigm set out by Dr. Childress. That’s a tall order. More likely the defense attorney would present witnesses testifying that the ordinary reasonable skillful and careful doctor in that community has never heard of Dr. Childress and his new theories, much less practices competently in accord with those theories. I’d anticipate the argument that, yes, the new paradigm is constructed from established concepts, but in a new and untested, nonpeer-reviewed, “novel” way. Certainly not widely recognized enough to become the current “standard of care” which all doctors are then obligated to follow.
I want to do everything I can to make this new paradigm usable in court, but I think mental health has to be won over first.
Everyone is so lulled to sleep by the “new paradigm” idea of Gardner that they don’t see it. I’m not suggesting something “new.” Personality disorders exist. Would a reasonable psychologist assess for and diagnose personality disorder processes in the family when the child’s symptom display evidences personality disorder processes? A competent psychologist would.
When I came across my first case of “parental alienation” seven years ago after a career in ADHD I had never heard of “parental alienation” but I immediately diagnosed the personality disorder processes. It was clear as day. The child’s absence of empathy was the key that led to the assessment for grandiosity, entitlement, splitting. So yes, a reasonable psychologist should be able to recognize and diagnose personality disorders within families… if they are competent.
Exactly the same thing is true for the attachment system and for family systems constructs. These are NOT new. They are not because of me. Personality disorders exist. The attachment system exists. Family systems theory exists. These exist independent of me. I am not proposing anything “new.”
Gardner’s proposal for a “new syndrome” got everyone thinking down a wrong road. The pathology is NOT a “new” syndrome proposed by Gardner or by Childress. It is a manifestation of already well defined pathology. In his 1974 book on family therapy, the renowned family therapist Salvador Minuchin described the impact of a “cross-generational” coalition: “The parents were divorced six months earlier and the father is now living alone. Two of the children who were very attached to their father, now refuse any contact with him. The younger children visit their father but express great unhappiness with the situation” (Minuchin, 1974,p. 101). Isn’t that exactly the description of “parental alienation” by the preeminent family systems theorist Salvador Minuchin in 1974?
Personality disorders, the attachment system, and family systems theory do not exist because of Childress, they exist because of Kernberg, and Beck, and Bowlby, and Sroufe, and Millon, and Minuchin, and Haley. It doesn’t matter if the psychologist has never heard of me, they should have heard of these other preeminent figures in the field of psychology… unless they are practicing beyond the boundaries of their competence in treating personality disorder, attachment system, and family systems pathology.
And that’s where I can direct the plaintiff’s attorney directly to the source material of Beck, and Kernberg, and Millon, and Bowlby, and Linehan, and Minuchin, and Haley, and… We’re not prosecuting the case on me… we’re prosecuting it on these preeminent figures in established psychology. My name and the words “parental alienation” will never appear in any of the proceedings.
I’m not proposing something new, I’m just connecting the dots for the ignorant and incompetent. When I encountered my first case of this pathology in 2008 I had never heard of Gardner or “parental alienation.” Yet I identified the pathology of the cross-generational coalition and personality disorder with the father within three sessions, one with the just mom who was the targeted parent, one with the mom and child, and one with just the narcissistic/(histrionic) dad. Three sessions and I had identified the cross-generational coalition of the child with a narcissistic/(histrionic) dad in which a role-reversal relationship of the child as a regulatory object for the father was artificially inducing the suppression of the child’s normal-range attachment bonding motivations toward his mother. Three sessions was all it took. Because I knew Bowlby, and Kernberg, and Linehan, and Minuchin. It was only six months later that I learned there was a construct called “parental alienation” proposed by Gardner.
Second. The moment the therapist is given my booklet Professional Consultation they have heard of me. And, once the attachment-based model becomes more widely known, then even the argument you propose becomes invalid. The sooner the paradigm shifts the sooner we have a solution. In my view, malpractice is totally reasonable, not because of me but because of Bowlby, and Millon, and Beck, and Kernberg, and Linehan, and Sroufe, and Mains, and Minuchin, and Haley, and…
I want to identify the weak link in your argument here so we can shore it up before it gets attacked when I or another target parent raise it in court. We claim that diagnosing 3 specific traits in a child is conclusive proof of child psychological abuse, confirmed. This is the usable essence of the paradigm here. Has anyone other than Dr. Childress claimed or established this? If not, it needs to be strengthened / buttressed.
In Foundations I have described in detail where each one of these symptoms come from. How the child’s attachment bonding motivations are being suppressed, how the child acquires narcissistic personality symptoms directed selectively toward the targeted parent, and how the child acquires a delusional belief regarding the supposedly abusive parental inadequacy of the targeted-rejected parent. I’ve done my job.
If someone thinks that these three symptoms can be produced by some other process other than than the pathology I describe in Foundations, the burden of proof is on them to describe some form of pathology or process that produces not only each individual symptom set, but also the combination of all three symptoms.
The only process that will produce all three symptoms in the child’s symptom display is the pathology I describe in Foundations. I’ve done my job. If you think something else can produce this symptom set then it’s up to you to describe that process.
I personally have never seen these three symptoms in any thing other than parental alienation. More significantly, I have asked some traditional parental alienation naysayers if they have seen it any other place, but no one has come forward.
Your observation is correct. There is no other pathology that will produce this set of symptom indicators.
In identifying these diagnostic indicators I first worked from the theoretical formulation, identifying the nature of the pathology first, before then proceeding to identifying the unique and distinctive clinical features of this pathology. You will notice in my blog post on the diagnostic indicators and associated clinical signs that there are many associated clinical signs, yet none of these reached the level of a diagnostic indicator, since some of them were not present in all cases and some of them could be created by other forms of pathology.
The attachment system suppression is actually quite distinctive, and with sufficient expertise in the nature and functioning of the attachment system the diagnosis can be made on the characteristic display of this symptom alone. The only other pathology that creates the attachment system display evidenced in “parental alienation” is incest. In my analysis of the information structures of this pathogen I have also noted other fragments that are also highly characteristic of the incest pathogen. My analysis of the information structures of this pathogen leads me to believe that the pathogen was likely created by incest trauma a generation or two prior to the current trauma reenactment, and that what we are witnessing in attachment-based “parental alienation” represents the trans-generational transmission of an incest pathogen that entered the family system a generation or two before. The incest of several generations earlier distorted the information structures of the attachment system of that victim, who then became the parent of the narcissistic/borderline personality parent as a child. So the first generational iteration is the sexual abuse victimization of the child, the second generational iteration is the creation of narcissistic/borderline personality traits in the child (i.e., disorganized attachment). The third generational iteration is the attachment trauma reenactment pathology of “parental alienation.” The pathogen is a trauma pathogen, and most likely a sexual abuse trauma pathogen.
This model has variants, so its not a hard-and-fast rule. I’ve also noted some domestic violence pathogen fragment in the information structures of some forms of attachment-based “parental alienation,” particularly the narcissistic/(antisocial) personality variant.
In developing the Diagnostic Indicators, I decided not to require the level of sophisticated understanding of the attachment system to be able to diagnose the pathology on this symptom alone. I then worked with various combinations of indicators which ultimately led my to the three I report.
You’ll notice in my early work I also identified a variety of personality disorder pathology symptoms that can also be displayed in various forms. So there can be a narcissistic/(borderline)/(paranoid) variant, and a narcissistic/(borderline)/(antisocial) variant, a narcissitic/(borderline)/(histrionic) variant, and I’ve also seen a narcissistic/(borderline)/(obsessive compulsive) variant. Everyone who works with personality disorder pathology (and by everyone I mean the top experts such as Millon and Beck and Kernberg, etc.) acknowledge that blends of personalty disorders are more the norm than the exception, which is why the DSM-5 toyed with the idea of entirely restructuring their personalty disorder section.
In addition, even though I tried to keep the identifiers to a minimum, you’ll notice I had to add an anxiety variant. This variant tends to be produced by a borderline-style allied parent, and I suspect it is the product of sexual abuse victimization of this parent as a child (possibly sexual molestation rather than parental incest) that significantly elevates this parent’s threat perception within the attachment system (the brain system mediating love and bonding and the motivational networks for parental protection of children). I tried to find a way to avoid a diagnostic variant, but it just couldn’t be done. Fortunately – as if anything about this pathology is “fortunate” – the anxiety pathology of this variant meets DSM criteria for a Specific Phobia, and it is just a “switch out” of Diagnostic Indicator 2; the personalty disorder symptoms for the anxiety symptoms, with Diagnostic Indicators 1 and 3 remaining the same.
But diagnosis is not simply identifying the distinctive features of the pathology, it is identifying the entire picture formed by the overall pattern of symptoms. It’s like putting together a puzzle. While I can identity the puzzle as “Cats in the Garden” by the presence of three distinctive puzzle pieces, it’s not Cats in the Garden because of these three pieces, the puzzle is of Cats in the Garden because that’s what picture is created when we put ALL of the puzzle pieces together. We see three cats, the flowers, there’s pail over here, etc. And it’s definitely not the puzzles “Train in the Mountains” or “Boats on a Lake” or “Horses in the Field.”
Once we achieve the designation of these children and families – your children and families – as a “special population” requiring specialized professional knowledge and expertise to appropriately assess, diagnose, and treat, then ALL of the mental health professionals working with this group of children and families will be highly expert in diagnosing not only Cats in the Garden, but all the variant displays of this puzzle, the four cats variant, the one with two cats and a puppy, etc. But all of these variants will contain the underlying themes of the pathology.
Diagnosis is like putting together a puzzle piece by piece. The diagnosis is not necessarily because of the key select symptom features (specific puzzle pieces), although these features MUST be present. The diagnosis is based on what overall picture is created when we put ALL of the puzzle pieces together. Oh look, I see three cats surrounded by flowers… this is Cats in the Garden.
Thanks for your support of my work, Howie.