Bringing the Era of Gardnerian PAS to a Close

The pathology of “parental alienation” cannot simultaneously be a new syndrome that is unique within all of mental health and, at the same time, also be a manifestation of established and existing forms of pathology.  It is either one or the other.  But both cannot be true.

My position, detailed in Foundations, is that the pathology of “parental alienation” is the product of fully established, well-defined, and well-understood forms of existing pathology.

The challenge currently posed to the Gardnerian PAS experts is whether they accept this model of “parental alienation” as being a manifestation of existing forms of psychopathology, or whether they assert that an attachment-based model is wrong and that the pathology of “parental alienation” represents a new and unique form of pathology in all of mental health.

Both premises cannot simultaneously be true. The pathology cannot simultaneously be a new and unique form of psychopathology AND, at the same time, be a form of established and existing psychopathology. Both positions cannot simultaneously be true. These two positions are logically incompatible. Only one of these foundational premises is true. Whichever one is true, the other one is false.

My position is clear. The pathology of “parental alienation” is a manifestation of well-defined and existing forms of psychopathology involving family systems pathology, personality disorder pathology, and attachment trauma pathology, as described in Foundations.

Established Pathology: Diagnosis

An attachment-based model for the pathology of “parental alienation” produces a set of three definitive diagnostic indicators of the pathology that are derived from standard and established types of symptom features in professional psychology; attachment system suppression, personality disorder traits and/or phobic anxiety, and delusional beliefs. All of these diagnostic indicators are standard and well-defined forms of symptom features within professional psychology. Personality disorder traits, phobic anxiety symptoms, and delusional beliefs are all defined symptom constructs within the DSM diagnostic system, with substantial conceptual and research support in the surrounding literature of professional psychology. Attachment disorders are also a recognized DSM construct and there is substantial theoretical and research support surrounding the functioning and dysfunctioning of the attachment system.

The three definitive diagnostic indicators of attachment-based “parental alienation” are all well-defined and existing psychological constructs within professional psychology. The use of these three definitive diagnostic indicators produces a categorical identification of the pathology as being EITHER present or absent in any individual case. In subthreshold cases where the full diagnostic presentation is not met, Response-to-Intervention trials (such as an ABAB Single Case design) can be employed to further clarify the diagnostic presentation, along with the presence of associated clinical signs that can be used to provide additional confirmation of the diagnosis when the three diagnostic indicators are present.

A focused Diagnostic Checklist for Pathogenic Parenting derived from an attachment-based model of “parental alienation” is available from my website.

An Extended Diagnostic Checklist of attachment-based “parental alienation” pathology that includes the associated clinical signs is also available from my website.

The pathology described by an attachment-based model of “parental alienation” represents existing and well-accepted forms of established psychopathology within professional mental health to which all mental health professionals can be held accountable under Standards 2.01 and 9.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

2.01 Boundaries of Competence
(a) Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.

9.01 Bases for Assessments
(a) Psychologists base the opinions contained in their recommendations, reports and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings.

Failure to possess the necessary professional competence (Standard 2.01) to appropriately assess (Standard 9.01) for established forms of personality and attachment trauma pathology “sufficient to substantiate” the mental health professional’s “recommendations, reports, and diagnostic or evaluative statements,” which then causes harm to the client child and parent might then also represent a violation of Standard 3.04 regarding Avoiding Harm to the client;

3.04 Avoiding Harm
Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

Failure to consider the reasonable requests of the client for additional professional consultation regarding the pathology surrounding this particular “special population” of children and families who are evidencing a complex interrelationship of family systems, personality disorder, and attachment trauma pathology may represent a violation of Standards 3.09 regarding professional consultation and 2.03 regarding the professional obligation to maintain professional competence;

3.09 Cooperation with Other Professionals
When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately.

2.03 Maintaining Competence
Psychologists undertake ongoing efforts to develop and maintain their competence.

Mental health professionals are not allowed to be ignorant and incompetent, and they are not allowed to harm their clients as a result of ignorance and incompetence.

Unique New Syndrome: Diagnosis

The Gardnerian model of PAS proposes that the pathology of “parental alienation” represents a unique “new syndrome” within mental health which is identifiable by a set of eight uniquely developed diagnostic indicators that have no association with any other type of existing mental health pathology or symptom display. These eight clinical indicators of the new and unique pathology of “parental alienation” may or may not be present in any individual case and yield a dimensional diagnosis of mild, moderate, and severe forms, although no guidelines are provided for differentiating the differing levels of severity.

Because neither the American Psychological Association nor the American Psychiatric Association endorse the existence of this proposed “new syndrome” there are no established domains of knowledge required to establish professional competence relative to this model of the “parental alienation” pathology, so that Standards 2.01 and 9.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association do not apply and are not relevant to this model of the “parental alienation” pathology.

Choosing a Paradigm

The “new and unique syndrome” and “established and existing pathology” models provide starkly differing diagnostic indicators for identifying the pathology. The model chosen to conceptualize the pathology can be determined by which set of diagnostic indicators the mental health professional uses to diagnose the pathology.

So… the challenge currently presented to Amy Baker, Bill Bernet, Linda Gottlieb, Richard Sauber, Richard Warshak, and the other PAS experts, is which paradigm do you support? The two paradigms are mutually exclusive and result in vastly differing diagnostic indicators for the pathology. Both paradigms cannot simultaneously be true since the pathology of “parental alienation” cannot simultaneously be a new and unique syndrome AND a manifestation of established and existing forms of psychopathology. The foundational assertion of one paradigm is accurate, and the foundational assertion of the other paradigm is wrong.

So which paradigm do you choose? We will know which paradigm you choose by which set of diagnostic indicators for the pathology you choose. Do you use and advocate for the diagnostic indicators from an attachment-based model of the pathology, or do you use and advocate for the diagnostic indicators from a “new syndrome” model of the pathology?

If you believe that the pathology as described by an attachment-based model of “parental alienation” is wrong, then I invite you to describe in what way you believe the description of the pathology in Foundations is in error. There is a Checklist of Component Pathology available on my website that lists the set of component pathologies that make up an attachment-based model to help identity what areas you disagree with. Or you may disagree with how the model integrates these interrelated forms of pathology. Or you may have some other criticism regarding the content of an attachment formulation of the pathology. If you disagree with an attachment-based formulation for the pathology, I would invite your critique.

The time has come for the Gardnerian PAS experts to choose a paradigm. I have been alerting them that this day was coming.  Targeted parents and I are going into battle with the citadel of establishment mental health to create a paradigm shift that will produce an immediate solution to the pathology of “parental alienation.”  The time has come to choose and declare for a paradigm.  Both paradigms cannot simultaneously be true.

Unifying Mental Health

To achieve a solution to the pathology of “parental alienation” we must first protect the child.

In order to protect the child we must be able to efficiently obtain a court-ordered protective separation period in all cases to allow for the child’s treatment and recovery.

In order to obtain a court-ordered protective separation period we must have mental health as an ally; mental health must speak to the court with a single unified voice regarding the need for a protective separation.

In order for mental health to speak with a single unified voice to the court, we must end the division within mental health regarding the pathology of “parental alienation”

In order to end the division within mental health we must bring the two sides in the debate together into a single voice. The citadel of establishment mental has consistently rejected the “new syndrome” Gardnerian PAS model for 30 years, most recently in the DSM-5 revision in which they had full and ample opportunity to review the construct of Gardnerian PAS… and they rejected it.

To end the division and bring mental health together into a single voice we must accept the constructive criticisms offered by establishment mental health that the Gardnerian PAS model is conceptually flawed and offer them an alternative description of the pathology from entirely within standard and established psychological principles and constructs. No “new syndrome” proposal. That’s what an attachment-based model and Foundations does.

I did not develop an attachment-based model and write Foundations as an ego endeavor – I developed the model and wrote the book with the specific purpose of addressing the criticism levied by establishment mental health toward the “new syndrome” model of Gardnerian PAS in order to bring BOTH SIDES together into a compromise solution regarding the pathology of “parental alienation.”

The Compromise

Establishment Mental Health Compromise:

By presenting establishment mental health with an attachment-based model of “parental alienation” that addresses their criticisms of a “new syndrome” model, we are asking the citadel of establishment mental health to compromise and come together with our position by,

1)  Acknowledging that the pathology of “parental alienation” exists (using whatever terminology they wish – which I is why I’ve given them the alternative terminology of “pathogenic parenting” and “attachment-trauma reenactment pathology” – I don’t care what they call it, just acknowledge that the pathology exists), and

2)  Establish that this group of children and families represents a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

I believe this is a reasonable and temperate position for us to adopt.

Evidence of their compromise is a change in the Position Statement of the American Psychological Association on parental alienation to acknowledge that the pathology exists and that identifies these children and families as a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

Our Compromise:

In return, we give up the Gardnerian PAS model for the pathology that proposes that they accept a “new syndrome” in professional psychology.

But we cannot give up the Gardnerian PAS model as long as that is the ONLY model of the pathology. In order to give up the Gardnerian PAS model we must have an equivalent model with which to replace it. That’s the second reason I developed the attachment-based model;

The first reason was to provide establishment mental health with an acceptable alternative to the “new syndrome” proposal that they have repeatedly and consistently rejected,

The second reason was to provide advocates for the construct of “parental alienation” with an alternative and equivalent model of the pathology when they are asked to give up the Gardnerian PAS model as part of the compromise solution.

The purpose of the attachment-based model is to bring ALL of mental health together into a single united voice. 

The compromise that we must make to achieve a solution to the pathology of “parental alienation” is to sacrifice the “new syndrome” model of Gardnerian PAS in order to achieve this compromise with establishment mental health.  We cannot continue to demand that the solution to the pathology of “parental alienation” requires that establishment mental health accept a “new syndrome” model for the pathology.

In return:

We receive established standards for assessment and diagnosis to which ALL mental health professionals can be held accountable.

We receive a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed when the three diagnostic indicators are present in the child’s symptom display, and

We receive the consistent and unanimous professional recommendation for a period of protective separation during the active phase of the child’s treatment and recovery.

I’ve embedded all three of these into the fabric of an attachment-based model.

All we need to do in return is give up the Gardnerian PAS model and stop demanding that establishment mental accept a “new syndrome” in professional psychology.

But I know that is going to be hard for the Gardnerian PAS experts to do, to give up their beloved model of PAS. They have fought so long and hard, with such valor and determination, to have the Gardnerian PAS model accepted, and now they are being asked to give it up. Gardnerian PAS will never be accepted. Not because it is wrong, but because it is unnecessary. The pathology of “parental alienation” will be solved, but just not with the Gardnerian PAS model.

Emotionally and psychologically, I imagine that will be hard for the Gardnerian PAS experts to do.  To the extent that they have grown “attached” to the PAS model, they will grieve its loss. That’s totally understandable. But we must give up the Gardnerian PAS model as part of the compromise with establishment mental health in order to bring all of mental health together into a single voice.

Establishment mental health has consistently and steadfastly maintained that they will NOT accept the “new syndrome” model of Gardnerian PAS.  We need to stop being so rigid in our demand that they accept a “new syndrome” model as a condition to solving the pathology “parental alienation.”

I set about developing an attachment-based model specifically to serve as the compromise solution that can bring BOTH sides together and end the decades-long division in mental health regarding the pathology of “parental alienation.”

Advantages to an Attachment-Based Model

If you look at the attachment-based model, it has a whole lot of perks and advantages

Research:  An attachment-based model provides much improved operationally defined diagnostic indicators for research because they are dichotomous; they establish the pathology as being present or absent

Instead of research continually trying to support the Gardnerian eight symptoms, research can start to examine the different “types” of “parental alienation” – e.g., characteristic features of the borderline type vs. the narcissistic type; the characteristic features correlated with the narcissistic/antisocial type, what types of attachment-based “parental alienation” show false allegations of abuse and what types don’t.  And just look at all those associated clinical signs. What types of “parental alienation” show what types of associated clinical signs?

A whole wealth of research opportunities open up besides endlessly trying to support the Gardnerian symptom indicators once we move beyond the endless and unproductive debate of trying to force establishment mental health to accept a “new syndrome” model of the pathology.

And because an attachment-based model is founded in attachment system pathology, trauma pathology, and personality disorder pathology, a whole new set of researchers become available for the study of the pathology. Right now the pathology of “parental alienation” lives in the back-waters of professional mental health research; ADHD, autism, and substance abuse are at the forefront. But by linking the pathology of “parental alienation” to the trans-generational transmission of attachment trauma, the pathology of “parental alienation” is catapulted into the forefront of modern psychology. Attachment researchers, trauma researchers, personality disorder researchers all become available to study this pathology. Instead of a “new syndrome” that is “not accepted” within professional psychology, the pathology of “parental alienation” becomes front and center of professional study and discussion – the trans-generational transmission of attachment trauma.

DSM Diagnosis:  Heroic efforts have been made in the past to have the DSM committees accept a Gardnerian PAS model. But (I’m sorry to say it, but it’s true) the Gardnerian PAS model was weak. The conceptual weakness of the model did not do justice to the heroic efforts of the advocates trying to establish the pathology as a DSM disorder.

First, there is no natural constituency within the DSM committees for a “new syndrome” of “parental alienation,” and the eight symptom indicators by which the “new syndrome” is identified have no association with any established form of pathology or symptoms. They are unique to the “new syndrome” of “parental alienation.”

An attachment-based model, however, has an established constituency within the DSM committees, in fact several. The primary constituency is the Trauma- and Stress-Related Disorders committee which already houses the other two attachment-related diagnoses. We’d be asking them for a third attachment-related disorder – the trans-generational transmission of attachment trauma (disorganized attachment) mediated by the personality disorder dynamics of the parent which are also the product of the attachment trauma (disorganized attachment). This is a very strong argument and we can immediately pull on all of the existing research on the trans-generational transmission of attachment trauma AND the research linking childhood attachment trauma to the development of personality disorders.

And the construct of attachment trauma reenactment is as old and fundamental as Freud’s construct of the “transference.”

Second, we won’t be asking for something “new” – what we will be asking for in the DSM-5.1 revision is the RETURN to the DSM diagnostic system of a previous DSM diagnosis of Shared Psychotic Disorder (a shared delusional belief), only this time the diagnosis is not in the psychotic section, it’s in the Trauma- and Stress-Related Disorders section of the DSM-5.1 (the trauma and stress-related people get a new disorder – yay for them, congratulations) under the name “Shared Delusional Disorder,” or better still “Attachment-Trauma Reenactment Disorder.” The diagnostic criteria can pretty much remain exactly as they were for the DSM-IV TR diagnosis of Shared Psychotic Disorder, and since this is a previously accepted DSM-IV TR diagnosis we’re in a pretty strong position.

We’d like the addition of two phrases “pathogenic parenting” and “role-reversal relationship” to the general description of the pathology, but we can live without those phrases if need be. The diagnostic criteria could remain identical to the DSM-IV TR diagnostic criteria for a Shared Psychotic Disorder, although if they changed to the three diagnostic indicators of attachment-based “parental alienation” that would be a home run. But the diagnostic criteria for the DSM-IV TR Shared Psychotic Disorder are fine.

And in support of this DSM-5.1 proposal we can pull on the wealth of existing attachment trauma research and personality disorder research as support. 

Overall, this is a much, much stronger DSM case to present for the future DSM-5.1 revision than a continual return, once again, to the “new syndrome” Gardnerian PAS model that has already been turned down for the DSM-5.

Treatment:  I’m already on record as a critic of the ineffective practice of “reunification therapy” as currently practiced by most mental health professionals, and as being a full supporter of the brief intensive interventions currently being developed for the resolution of the “parental alienation” pathology. Once we reach this treatment phase of the solution we can work out the development of a consistent and effective brief and intensive intervention to restore the child’s normal-range functioning within the first few days of the protective separation period, and we can work out a defined model for the subsequent recovery stabilization therapy during the remainder of the protective separation period. We know what the solution needs to be, we just need a consistent diagnosis of the pathology and a protective separation of the child from the pathogenic parenting of the narcissistic/(borderline) parent.

Compromise

All this compromise solution requires from us is that we give up the “new syndrome” proposal of the Gardnerian PAS model.  Establishment mental health has made it abundantly clear, they will not accept the “new syndrome” model of Gardnerian PAS.  It’s time to let that model go.

Recognizing this, I set about developing an alternate model that defines the pathology solely through established and accepted psychological principles and constructs, which could serve as an acceptable alternative to establishment mental health and also serve as a replacement paradigm for the Gardnerian model.

In return for our giving up the Gardnerian PAS model, we achieve the power to enforce the diagnosis of the “parental alienation” pathology under Standards 2.01 and 9.01 of the APA ethics code, a consistent DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed applied to the pathology of “parental alienation,” and a consistent recommendation to the court for a period of protective separation from the pathology of the narcissistic/(borderline) parent (and ultimately a protective separation enacted by child protective services).

This is a good compromise that works to the benefit of the children and families we serve. It is time to bring the divisive conflict in mental health to a close in order to resolve the pathology of “parental alienation” for the children and targeted parents who need the solution today, not in ten years. If this requires that we give up the Gardnerian PAS model as part of a compromise solution within establishment mental health, then this is what we need to do.

Moving Forward

I know I’m an “outsider” who comes to “parental alienation” from the fields of ADHD and early childhood mental health, I know I’m not part of the “inner club” of established Gardnerian PAS experts, and I know I have likely ruffled some professional feathers by my direct challenges of the Gardnerian PAS paradigm.  But I’m also aware of how attached some of you may have become to the Gardnerian PAS model, and I’m aware of how hard it must be for you to let it go, so my challenges have been to alert you that the solution will require that we let go of the Gardnerian PAS model.

We must let it go to achieve the compromise solution that is so desperately needed by the children and their targeted parents.  They cannot wait 5 or 10 years of our trying to force establishment mental health to accept a “new syndrome” model; which they will likely never accept.  These children and families need the solution today. 

We must bring an end to the division within mental health, and the citadel of establishment mental health will NOT accept a “new syndrome” model. To end the division, we must let go of the Gardnerian PAS model. Once we switch to an “existing pathology” attachment-based model for “parental alienation,” the solution becomes available immediately.  Today.  This instant.  Because under the “existing pathology” model of “parental alienation” (the attachment-based model as described in Foundations) we are not asking establishment psychology to accept anything, we are requiring professional competence under Standards 2.01 and 9.01 of the APA ethics code.

So to the Gardnerian PAS experts… I am not your enemy.  But, at the same time, the solution to the pathology of “parental alienation” will require that we let go of the Gardnerian PAS model and switch to an attachment-based model of the pathology that will be acceptable to the citadel of establishment mental health.

But also understand this, because an attachment-based model is not proposing something “new,” there is nothing for establishment mental health to accept or reject. They are not being given the option to accept or reject an attachment-based model of “parental alienation” because the pathology is fully described, in detail, by already established and already accepted psychological principles and constructs.

By proposing a “new syndrome” the Gardnerian model allowed establishment mental health to “reject” the existence of the pathology.  In developing an alternate model I have learned that lesson, and an attachment-based model is not asking them to accept or reject anything. The pathology of “parental alienation” is entirely described through established and accepted forms of existing pathology. There is nothing to accept or reject. The pathology exists, and Foundations describes what it is.

The Coming Battle

In the months ahead, targeted parents and I will be going to battle with establishment mental health to have standards of practice and professional competence in the assessment and diagnosis of the pathology enforced in all cases of the pathology, as reflected in a consistent DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed when the three diagnostic indicators of the pathology are present in the child’s symptom display.  And we will begin to demand a change to the APA Position Statement on the pathology of “parental alienation” to 1) acknowledge that the pathology exists (using whatever name for the pathology they wish), and 2) that establishes this group of children and families as a “special population” requiring specialized professional knowledge and expertise to appropriately assess, diagnose, and treat.

I’m asking you, the Gardnerian PAS experts, to join us in this coming battle. But there will be no Gardnerian battle flag on the battlefield. This battle will be fought under the battle flag of Foundations. Our goal is to bring all of mental health together into a single effective voice that can solve the pathology of “parental alienation.”

Establishment mental health will NOT accept a “new syndrome” Gardnerian PAS model. In order to bring all of mental health together into a single voice to solve the pathology of “parental alienation,” our part of the compromise is to give up the Gardnerian PAS model and stop demanding that establishment mental health accept a unique “new syndrome” in professional psychology.

I ask you to look at the attachment-based replacement. It has everything we need

It has a requirement for professional expertise and competence from the diagnosing and treating mental health professionals.

If provides clear and effective dichotomous diagnostic indicators to which all mental health professional can be held accountable.

It requires that all mental health professionals consistently give a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed in every case where the three diagnostic indicators are present.

It requires a period of the child’s protective separation from the pathology of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery.

And it supports brief intensive interventions at the start of the protective separation period followed by ongoing recovery stabilization therapy (the model for which we can develop through our collaborative voice of professional expertise).

I am not your enemy.  But we must give up the Gardnerian model to achieve the solution. I’m asking you to join us.  My goal is to achieve the solution to the pathology of “parental alienation” by Christmas of 2016 because I am a single psychologist, without power and without influence, working alone to create massive systems changes in the broken mental health and legal systems. With your help, I am confident that we can accelerate this time frame for achieving a solution to the pathology of “parental alienation.”

The paradigm shift is coming.  The time to declare for a paradigm has arrived.  We will know the paradigm you choose by the diagnostic indicators you select.

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

“It is better to be on hand with ten men than absent with ten thousand” – Tamerlane