Peer Review

In this post, I’m speaking to mental health professionals.

There are three categories of mental health professionals who might be involved in diagnosing and treating the pathology of attachment-based “parental alienation”

New and Learning:  If you are new to this domain of sub-specialty practice, welcome.  Read Bowlby, Beck, Millon, Minuchin. Read and read and read.  Foundations will help. If you need a consult, my email is drcraigchildress@gmail.com

Not New and Learning:  If you have been working in this sub-specialty area and have been struggling with diagnosing and treating the pathology of “parental alienation,” and you are seeking more information to learn and grow; welcome.  Read Bowlby, Beck, Millon, Minuchin. Read and read and read.  Foundations will help. If you need a consult, my email is drcraigchildress@gmail.com

Ignorant and Entrenched: If you have been working within this sub-specialty area and have no idea what you’re doing, and yet you have no interest in learning about the pathology that you’re diagnosing and treating and are rejecting the efforts of the targeted parent to help enlighten you regarding the pathology… I’m talking directly to you in this post…

This is important to understand… there is NOTHING NEW regarding the pathology of an attachment-based model of “parental alienation.” The component pathology of an attachment-based model of “parental alienation” is all well-established and scientifically validated pathology with substantial research support in the peer-reviewed literature.

The component pathology of attachment-based “parental alienation” is fully described in the works of psychology’s preeminent figures in attachment theory and intersubjectivity (e.g., Bowlby, Ainsworth, Mains, Ruth-Lyons, Bretherton, Sroufe, van IJzendoorn, Stern, Tronick, Fonagy, Shore);

In the work of psychology’s preeminent figures in personality disorder pathology (e.g., Millon, Kernberg, Beck, Linehan);

And in the work of psychology’s preeminent figures in family systems theory (e.g., Bowen, Minuchin, Haley).

The component pathology of attachment-based “parental alienation” is also amply supported throughout the research literature on attachment, personality disorders, and family systems processes.

There is absolutely NOTHING NEW regarding an attachment-based model of “parental alienation.”

The ONLY reason it might SEEM new to some mental health professionals is because they are either new to the practice in this domain of pathology, or because they are so incredibly ignorant about the established principles of professional psychology and what is already existent in the peer-reviewed research literature that it SEEMS new to them because of their profound level of professional ignorance.

But just because personality disorder pathology is new to you does not make personality disorder pathology something “new.”  Just because attachment system pathology is new to you does not make attachment system pathology something “new.”  Just because family systems constructs are new to you does not make family systems constructs something “new.”

All of the component pathology of an attachment-based model for the pathology of “parental alienation” is well-established in the peer-reviewed research literature and the works of the preeminent figures in professional psychology. It is nothing new.

It is only new to mental health professionals who are ignorant of what already exists in the established literature of professional psychology.

Up on my website is a checklist of all the component psychopathology that makes up an attachment-based model of “parental alienation”:

Attachment-Based Model of “Parental Alienation” Component Pathology

I would ask all mental health professionals to go down that checklist and identify what type of pathology they disagree with and believe doesn’t exist.

If they accept that all the component pathologies listed on that checklist exist, then they are essentially accepting an attachment-based model for the construct of “parental alienation,” as described in Foundations.

Peer-Review

To any mental health professional who is so astoundingly ignorant of existing psychological principles and constructs as to ask whether this “new theory” of Dr. Childress has been “peer-reviewed,” my response is:

Just because you are ignorant does not make this information something “new.”  It’s just “new” to you because you are so incredibly ignorant.  Read Bowlby and Beck and Millon and Kernberg and Minuchin and Haley, and…

In Chapter 11 of Foundations on Professional Competence, I list a whole set of literature from preeminent figures in professional psychology and from the peer-reviewed research literature (I’ve appended this list to the Reference section of this post). Read this set of “peer-reviewed” and established literature before you ask me such a stupid question.

The pathology described in an attachment-based model of “parental alienation” is not something ‘new” – you are just ignorant.

The Gardner Problem

Gardner took us down a very problematic road when he proposed a “new syndrome” which he called “parental alienation.” He saw a pathology, but then he was intellectually lazy in describing what that pathology entailed. Instead of working out what the pathology was, he took an intellectually lazy approach of proposing a “new syndrome” which he described through a set of anecdotal clinical indicators that he simply made up out of thin air, which he claimed represented the characteristic features of this proposed “new syndrome.”

His approach was intellectually lazy and professionally irresponsible.

The citadel of establishment psychology rejected his proposal of a “new syndrome” – as I believe they should have. The pathology Gardner identified is NOT a “new syndrome” – it is a manifestation of already understood and already clearly defined psychopathology within professional mental health.

I’m not saying that the pathology doesn’t exist. Oh, it very much exists. It’s just NOT a “new syndrome.” It is a manifestation of well-defined and established forms of existing psychopathology that can be fully understood within the standard and established psychological principles and constructs of professional psychology.

We don’t need a “new syndrome” to describe the pathology. We know exactly what it is…

At least if the mental health professional is competent in the relevant domains of professional psychology; the attachment system, personality disorder pathology; family systems constructs.  

If, however, you’re an ignorant and incompetent mental health professional who shouldn’t be working with this type of very serious psychopathology, then you likely don’t know what the pathology is. But that’s a ‘you problem.’ That’s not a pathology issue. The pathology is totally understood – but just not by you because of your ignorance.

Just because Gardner’s proposal that this pathology is a “new syndrome” isn’t correct, that doesn’t mean that he didn’t accurately identify the existence of the pathology, only that his definition of it was inadequate. It’s not a new syndrome, it’s the trans-generational transmission of attachment trauma from the childhood of the narcissistic/borderline parent to the current family relationships in the schema pattern of “abusive parent”/”victimized child”/”protective parent,” mediated by the narcissistic/borderline pathology of the allied and supposedly favored parent that involves the formation of a cross-generational parent-child coalition against the targeted parent which incorporates the splitting pathology of the narcissistic/borderline parent that seeks to make the ex-spouse an ex-parent, consistent with the inability of splitting pathology to accommodate ambiguity in relationships.

Is it a complicated pathology?  Yes, somewhat, on first encounter. But actually it’s so consistent that it becomes relatively simple once it’s understood, because it’s always the same; with only a few very predictable variations on the theme. It only seems complicated to someone who doesn’t know the component pathologies.

But the pathology itself is an entirely defined and understood manifestation of family systems pathology, personality disorder pathology, and attachment system pathology.

Splitting & the Cross-Generational Coalition

While there are a variety of ways to understand the multi-faceted pathology of “parental alienation” (as an attachment trauma reenactment pathology; as the projective displacement of personality pathology onto the targeted parent), one of the easiest levels to understand the pathology is as the addition of “splitting” pathology to the cross-generational coalition of the child with the narcissistic/borderline parent against the targeted parent (i.e., as the addition of personality disorder pathology to family systems pathology)

The addition of the “splitting” pathology, which is a distinctive and characteristic feature of both the narcissistic and borderline personality pathology, transfoms the already pathological cross-generational coalition (called a “perverse triangle” by Haley) into a particularly malignant and virulent form in which the child seeks to entirely terminate the targeted parent’s relationship with the child as a means to turn the ex-spouse into an ex-parent, consistent with the polarization and absence of ambiguity characteristic of the splitting pathology.

Splitting pathology is not something I am making up or proposing. It is established psychological pathology defined by the American Psychiatric Association and described by preeminent mental health professionals. According to the American Psychiatric Association, the definition of “splitting” is:

“Splitting. The individual deals with emotional conflict or internal or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images. Because ambivalent affects cannot be experienced simultaneously, more balanced views and expectations of self or others are excluded from emotional awareness. Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nuturant, and kind — or exclusively bad, hateful, angry, destructive, rejecting, or worthless.” (American Psychiatric Association, 2000, p. 813)

Take particular note of the statement, “because ambivalent affects cannot be experienced simultaneously…” By its very nature, splitting precludes ambivalence.   Splitting imposes a polarized certainty onto perceptions of other people that prevents “balanced views” of other people.

What happens when we add the splitting pathology of a narcissistic/borderline personality to a cross-generational coalition?

When, as a result of the divorce, the former husband become an ex-husband, the pathology of splitting REQUIRES that the ex-husband must also become an ex-father.  Ambiguity is impossible.  When the former wife becomes an ex-wife, the pathology of splitting REQUIRES that the ex-wife must also become an ex-mother.

The splitting pathology of the narcissistic/borderline personality structure “fails to integrate the positive and negative qualities of self and others into cohesive images” and as a result the person’s perceptions of others “alternates between polar opposites.” The ex-husband or ex-wife therefore becomes “exclusively bad, hateful, angry, destructive, rejecting, or worthless,” both as a former spouse and also as a parent. Exclusively bad, hateful, and worthless.

Ambivalence and ambiguity are an impossibility for the splitting pathology to experience. The horrible and exclusively bad ex-husband cannot simultaneously be a loving father for the child, the hateful and worthless ex-wife cannot simultaneously be a loving mother. This type of ambiguity and ambivalence is a neurological impossibility for the splitting pathology.  

When we add the splitting pathology to divorce, the ex-husband must become an ex-father; the ex-wife must become an ex-mother. No other alternative is allowed by the splitting pathology of the narcissistic/borderline personality.

This is not me just my making this up. This is the American Psychiatric Association’s definition of the spitting pathology which is a characteristic feature of both narcissistic and borderline personality pathology. I’m not proposing something new. I’m simply pointing out what happens when the spitting pathology of a narcissistic/borderline personality is added to a cross-generational coalition.

Nor is a cross-generational coalition my idea. It is an established construct described by the preeminent family systems theorists Jay Haley and Salvador Minuchin as a characteristic manifestation of the child’s “triangulation” into the spousal conflict. Jay Haley (1977) offers the following definition of the cross-generational coalition:

“The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two… In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer. By ‘coalition’ is meant a process of joint action which is against the third person… The coalition between the two persons is denied. That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition… In essence, the perverse triangle is one in which the separation of generations is breached in a covert way. When this occurs as a repetitive pattern, the system will be pathological.”  (Haley, 1977, p. 37)

Note the phrase, “the person of one generation forms a coalition with the person of the other generation… which is against the third person.” This is not me, this is Jay Haley, one of the preeminent figures in professional psychology and family systems therapy, who is defining this construct.

Salvador Minuchin, considered by many to be THE top figure in family systems therapy, also describes the cross-generational coalition:

“The rigid triangle can also take the form of a stable coalition. One of the parents joins the child in a rigidly bounded cross-generational coalition against the other parent.” (Minuchin, 1974, p. 102)

In his seminal book on the principles of family therapy, aptly titled Families and Family Therapy, Salvador Minuchin actually provides a specific case example of the impact of a cross-generational coalition on family relationships:

“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)

Holy cow. Isn’t that EXACTLY what we’re talking about in “parental alienation.” Minuchin’s book was written in 1974. Fully forty years ago. So why are we even talking about this?

To ALL mental health professionals out there, please describe for me what happens when the splitting pathology of a narcissistic/borderline personality parent is added to a cross-generational coalition?

Answer: The addition of splitting pathology to a cross-generational coalition will create a child-initiated cutoff (Bowen) in the child’s relationship with the targeted parent, as described by Minuchin (1974), thereby turning the ex-husband into an ex-father, the ex-wife into an ex-mother, consistent with the splitting pathology of the parent in the cross-generational coalition.

To me this is an absolute no-brainer. It’s a proverbial “duhhhh” moment. It is so incredibly obvious. This is not new. And yet for some unexplainable reason, the pathologies of splitting and the cross-generational coalition are either unknown to many mental health professionals or these professionals are simply too… I don’t know what else to call it but stupid… to add one and one together.

Splitting + cross-generational coalition = the child’s rejection of the parent as being “exclusively bad.” Pretty straightforward clinical psychology to me.

1 + 1 = 2. I don’t know what part of that is difficult to understand.

So please, don’t ask me if “my theory” has been “peer-reviewed.” First, it’s not “my theory” it is established psychological fact. It’s just that you are too ignorant about what exists to know that. Second, all of the pathology described in an attachment-based model of “parental alienation” has been amply and overwhelmingly peer-reviewed. Again, just because it seems “new” to you does not make it “new,” it just makes you ignorant. Before you ask me if “my theory” is “peer-reviewed” read the existing literature listed in the Reference section of this post and in Chapter 11 of Foundations which deals with Professional Competence.

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

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.

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

Bowlby, J. (1973). Attachment and Loss: Vol. 2. Separation: Anxiety and Anger. NY: Basic Books.

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

Fonagy, P., Target, M., Gergely, G., Allen, J.G., and Bateman, A. W. (2003). The developmental roots of Borderline Personality Disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23, 412-459.

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.

Fonagy, P., Luyten, P., and Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47-69.

Lyons-Ruth, K., Bronfman, E. and Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. In J. Vondra & D. Barnett (Eds.) Atypical patterns of infant attachment: Theory, research, and current directions. Monographs of the Society for Research in Child Development, 64, (3, Serial No. 258).

Main, M. and Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M.T. Greenberg, D. Cicchetti, & E.M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). Chicago: University of Chicago Press.

van IJzendoorn, M.H., Schuengel, C., and Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249.

Kerig, P.K. (2005). Revisiting the construct of boundary dissolution: A multidimensional perspective. Journal of Emotional Abuse, 5, 5-42.

Macfie, J. Fitzpatrick, K.L., Rivas, E.M. and Cox, M.J. (2008). Independent influences upon mother-toddler role-reversal: Infant-mother attachment disorganization and role reversal in mother’s childhood. Attachment and Human Development, 10, 29-39

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.

Pearlman, C.A. and Courtois, C.A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18, 449-459.

Prager, J. (2003). Lost childhood, lost generations: the intergenerational transmission of trauma. Journal of Human Rights, 2, 173-181.

Shaffer, A., and Sroufe, L. A. (2005). The developmental and adaptational implications of generational boundary dissolution: Findings from a prospective, longitudinal study. Journal of Emotional Abuse. 5(2/3), 67-84.

Sroufe, L. A. (2005). Attachment and development:  A prospective, longitudinal study from birth to adulthood, Attachment and Human Development, 7, 349-367.

Bacciagaluppi, M. (1985). Inversion of parent-child relationships: A contribution to attachment theory. British Journal of Medical Psychology, 58, 369-373.

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

Brennan, K.A. and Shaver, P.R. (1998). Attachment styles and personality disorders: Their connections to each other and to parental divorce, parental death, and perceptions of parental caregiving. Journal of Personality 66, 835-878.

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

Sable, P. (1997). Attachment, detachment and borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training, 34(2), 171-181.

Cassidy, J., and Berlin, L. J. (1994). The insecure/ambivalent pattern of attachment: Theory and research. Child Development, 65, 971−991.

Mikulincer, M., Gillath, O., and Shaver, P.R. (2002). Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality and Social Psychology, 83, 881-895.

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.

van der Kolk, B.A. (1987). The separation cry and the trauma response: Developmental issues in the psychobiology of attachment and separation. In B.A. van der Kolk (Ed.) Psychological Trauma (31-62). Washington, D.C.: American Psychiatric Press, Inc.

van der Kolk, B.A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411

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

Holmes, J. (2004). Disorganized attachment and borderline personality disorder: a clinical perspective. Attachment & Human Development, 6(2), 181-190.

Lopez, F. G., Fuendeling, J., Thomas, K., and Sagula, D. (1997). An attachment-theoretical perspective on the use of splitting defenses. Counseling Psychology Quarterly, 10, 461-472.

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

Cozolino, L. (2006): The neuroscience of human relationships: Attachment and the developing social brain. WW Norton & Company, New York.

Siegel, D. (1999). The developing mind: Toward a neurobiology of interpersonal experience (New York: Guilford Press, 1999)

Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J., and Rizzolatti, G. (2005). Grasping the intentions of others with one’s own mirror neuron system. Plos Biology, 3(3), e79.

Kaplan, J. T., and Iacoboni, M. (2006). Getting a grip on other minds: Mirror neurons, intention understanding, and cognitive empathy. Social Neuroscience, 1(3/4), 175-183.

Fraiberg, S., Adelson, E., and Shapiro, V. (1975). Ghosts in the nursery. Journal of the American Academy of Child and Adolescent Psychiatry, 14, 387–421.

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

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

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

Moor, A. and Silvern, L. (2006). Identifying pathways linking child abuse to psychological outcome: The mediating role of perceived parental failure of empathy. Journal of Emotional Abuse, 6, 91-112.

Trippany, R.L., Helm, H.M. and Simpson, L. (2006). Trauma reenactment: Rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counseling, 28, 95-110.

Rappoport, A. (2005). Co-narcissism: How we accommodate to narcissistic parents. The Therapist.

Carlson, E.A., Edgeland, B., and Sroufe, L.A. (2009). A prospective investigation of the development of borderline personality symptoms. Development and Psychopathology, 21, 1311-1334.

Juni, S. (1995). Triangulation as splitting in the service of ambivalence. Current Psychology: Research and Reviews, 14, 91-111.

Barnow, S. Aldinger, M., Arens, E.A., Ulrich, I., Spitzer, C., Grabe, H., Stopsack, M. (2013). Maternal transmission of borderline personality disorder symptoms in the community-based Griefswald Family Study. Journal of Personality Disorders, 27, 806-819,

Dutton, D. G., Denny-Keys, M. K., and Sells, J. R. (2011). Parental personality disorder and its effects on children: A review of current literature. Journal of Child Custody, 8, 268-283.

Fruzzetti, A.E., Shenk, C. and Hoffman, P. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17, 1007-1030.

Garety, P. A. and Freeman D. (1999) Cognitive approaches to delusions: A critical review of theories and evidence. The British Journal of Clinical Psychology; 38, 113-154.

Hodges, S. (2003). Borderline personality disorder and posttraumatic stress disorder: Time for integration? Journal of Counseling and Development, 81, 409-417.

Levy, K.N. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, p. 959-986

Stepp, S. D., Whalen, D. J., Pilkonis, P. A., Hipwell, A. E., and Levine, M. D. (2011). Children of mothers with Borderline Personality Disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders: Theory, Research, and Treatment. 1-16.

Svrakic, D.M. (1990). Functional dynamics of the narcissistic personality. American Journal of Psychiatry. 44, 189-203.

Widiger, T.A. and Trull, T.J. (2007). Plate tectonics in the classification of personality disorder: Shifting to a dimensional model. American Psychologist, 62, 71-83.

Minuchin, S. (1974). Families and family therapy. Harvard University Press.

P.S.  Peer-review is typically only applied to research studies not theoretical formulations.  Theoretical formulations are typically presented in a book format because the material has to be described in greater detail than is allowed in a 10 to 20-page journal article.  Satir, Rogers, Adler, Minuchin, Kohut, Kernberg, etc. all present their theoretical models in book format.  The “peer-review” of research studies is to ensure the proper research methodology, not theoretical formulations.  For example, Satir’s model of humanistic family therapy described in her book Peoplemaking is not “peer-reviewed.”  Roger’s model of client-centered therapy in his book On Becoming a Person is not “peer-reviewed.”  There is no way I can describe the pathology I discuss in Foundations in a 15-page journal article.  That’s an impossibility.  So there is no way it can be “peer-reviewed” (it’s such an ignorant question).  Peer review is for research studies published in journal articles, not theoretical formulations.  Theoretical formulations are published in book format, mental health professionals then read the book and critique its proposals, whether it’s Satir, or Rogers, or Kohut, or Childress.  That’s the “peer-review” process for theoretical material.