Month: September 2015

Let the trumpets sound to rouse the warriors from their slumber. Let the drums of battle bring courage to our hearts. The battle comes. The time is now. Come bring your banner to the battlefield and join us, the time for our battle has arrived.

The pathogen sees us and it is evaluating our threat. It has sent its minion skirmishers out to test our mettle, and it has felt our resolve.

We will not waver, we will stand and fight with steadfast determination because we fight for your children. And when this battle day is finished, the minions of the pathogen will lie at our feet and your banners will fly from the citadel of establishment mental health. This is the battle to reclaim mental health as your ally, for you and your children. The citadel of establishment mental health belongs to you, not to the pathogen. Take it back.

I will stand in the center of this battlefield. The pathogen will attack me with savage viciousness that will seek not only to defeat the content of what I say, but will seek to destroy me personally. You’ve seen already how the pathogen weaves personal attacks into the assaults from its minions. Distortions and innuendo layered into personal attacks. And the pathogen is not constrained by any limits imposed by truth or accuracy or reality. You know this better than any, because you have personally felt the savage fury of its venom, its lies, and its distorted  falsehoods.

It will now bring this to me. It will attack me, not just the content of what I say. It will attack me personally. It will seek to destroy me at a personal level. It will search every crevice of my life, my family, my career, seeking some vulnerability that it can exploit to destroy me. Because I threaten to expose it.

I am ready.  I will stand and fight.  And we will prevail because we fight for your children.

I will not abandon you, I will not abandon your children. I will not waver. I will stand in the center of this battlefield and fight against this pathology with ferocity and steadfast resolve, but with different weapons than those used by the pathogen. We fight with weapons forged in truth and knowledge and love.

We are unstoppable. We fight for your children.

Let the drums of battle call forth our warriors. Steel your hearts and set fast your will. Wake your neighbors from their slumber and call them to us. The battle for your children has arrived.

The Battlefield

The minion of Mercer was right about only one thing, the battlefield of Gardnerian PAS is a swamp. When we fight on that battlefield the ground gives way beneath our feet, the marsh clings to our boots and we stumble and fall.  We cannot move and maneuver, we become bogged down, and the pathogen devastates our forces with archers from afar. This is not the battlefield on which we want to fight.

No. There will be no Gardnerian PAS battle flag on this battlefield. We fight under the banner of Foundations.

If someone brings the banner of Gardnerian PAS onto this battlefield, I will attack you myself.

Foundations provides us with the solid bedrock of established psychological principles and constructs on which we can firmly plant our feet. With Foundations, WE hold the high ground.

You saw how I dealt with the minion of Mercer.

“I will in no way defend the Gardnerian PAS model.” 

Immediately we are free from the swamp and have claimed the high ground.  Immediately ALL of the arguments against the Gardnerian PAS model are made irrelevant – completely and totally irrelevant.

The Pathogen: How do you diagnose…?

Dr. Childress:  The three diagnostic indicators in the child’s symptom display and the entire puzzle that forms the picture of three cats in the garden.

The Pathogen:  But what about authentic child abuse?

Dr. Childress:  An authentically abused child does not display five specific a-priori predicted narcissistic and borderline personality traits toward the authentically abusive parent.  The authentically abused child therefore does not meet Diagnostic Criterion 2 for an attachment-based model of “parental alienation.”

Stimulus Control:  Furthermore, in authentic parent-child conflict the child’s behavior is under the stimulus control of the parent’s behavior.  

You saw me weave these responses.  There are more. I’m ready.

The Pathogen:  Peer-reviewed research – show us the peer-reviewed research.

Dr. Childress: See Chapter 11 of Foundations or see my first response to Mercer.

What do you want peer-reviewed research about? The existence of personality disorders?  The existence of attachment trauma?  The existence of family systems theory?  What?  What – specifically – do you want peer reviewed research about?

The Pathogen:  Where is the peer-reviewed research about Dr. Childress’ model?

Dr. Childress:  It’s NOT my model. It’s Aaron Beck, it’s Theodore Millon, it’s John Bowlby and Mary Ainsworth.  It’s Salvador Minuchin.  It’s Jay Haley.  It’s Marsha Linehan and Otto Kernberg.

It is not me.  The attachment-based description of the pathology comes from the preeminent figures in mental heath.  If you have a problem with the model, take it up with them – because they’re the ones that said it, not me. 

You want their quotes regarding the pathology?  Here, let me tell you what they said.  Let me tell you how Jay Haley and Salvador Minuchin defined the cross-generational coalition.  Let me tell you how the American Psychiatric Association has defined the splitting pathology.  Let me tell you what Aaron Beck says about the pathology of the narcissistic and borderline personalty and what Theodore Millon says about the decompensation of the narcissistic personalty into delusional beliefs. Let me tell you about what Marsha Linehan has said about the “invalidating environment.”

It’s not me.  It’s not Dr. Childress.  It’s them.  It is the preeminent figures in mental health who have said this.

In his account of the Gallic wars, Julius Caesar said that you will win the battle when you choose where and when to fight. We fight this battle on the battlefield of our choosing. We fight on the battlefield of personality disorder pathology, attachment-trauma pathology, and family systems pathology. We fight this battle on the solid ground of established theoretical Foundations.

We are NOT asking mental health to accept anything. Because the principles and constructs on which our Foundations are grounded are ALREADY firmly established and accepted constructs within mental health.

Personality disorder pathology is already accepted, with an extensive peer-reviewed literature base.

Family systems pathology is already accepted, with an extensive peer-reviewed literature base,

Attachment trauma pathology is already accepted, with an extensive peer-reviewed literature base.

There is NOTHING for establishment mental health to accept or reject. It has already been accepted.

This is key for you to understand. For too long you have been forced by the Gardnerian PAS model to fight for a “new syndrome” to be accepted in mental health. No. This stops. The pathology is NOT a “new syndrome.” It is a manifestation of well-established and well-defined forms of already accepted psychopathology.

If you want to explain it quickly, here it is…

“It is the addition of the splitting pathology of a narcissistic/borderline parent (as defined by the American Psychiatric Association) to a cross-generational coalition of the child with one parent against the other parent (as defined by the preeminent family systems theorists, Jay Haley and Salvador Minuchin).

There. Done. That’s what the pathology is.

“It’s the addition of the splitting pathology of a narcissistic/borderline parent to a cross-generational coalition of the child with one parent against the other parent.”

If someone wants a more in-depth explanation, tell them to talk to me and I will provide it (or have them read Foundations). If they ask for “peer-reviewed” literature, tell them to talk to me and I’ll provide it, or refer them to my first response to Mercer, (or have them read Foundations – Chapter 11 on professional competence).

If they ask for the DSM-5 diagnosis of the family pathology it’s on pages 663-666 of the DSM-5; Borderline Personality Disorder, it’s on pages 669-672 of the DSM-5; Narcissistic Personality Disorder, and it’s on page 719 of the DSM-5; Child Psychological Abuse, Confirmed.

If they want the specific DSM-5 diagnosis of the pathology which is given to the child, it is

DSM-5 Diagnosis

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

See. The pathology is already in the DSM-5. There is nothing to accept or reject. ALL we need is professional competence. That’s it. That’s all we are seeking – and that’s also what we are requiring.

Under a Gardnerian PAS banner you must seek to have the citadel accept a “new syndrome” within mental health.  No.  This belief that we need to have something accepted by establishment mental health (by the DSM diagnostic system) is deeply embedded into the very fabric of your psyche. ROOT IT OUT.

Under the battle flag of Foundations, there is NOTHING that needs to be accepted by establishment mental health – because ALL of the constructs and principles on which Foundations are grounded are ALREADY well-accepted, well-defined, and well-established psychological principles and constructs.

Personality Disorder Pathology:  DSM-5; Millon; Beck; Kernberg; Linehan

Attachment Trauma Pathology:  Bowlby, Ainsworth, Mains, Sroufe, Fonagy, van der Kolk

Family Systems Pathology: Bowen, Minuchin, Haley

We are not asking establishment mental health to accept anything. They have already accepted everything.

What we are asking them for – we are REQUIRING of them – is to enforce their existing Standards for professional competence.

We have established ourselves on the high ground in this battle.  The high ground is ours.

We have claimed the battle flags of the APA Ethics Code.

Standard 2.01 – Professional Competence

Standard 9.01 – Professionally Competent Assessment

Standard 3.04 – Do No Harm

These battle flags of the APA ethics code are ours. 

These are the battle flags you will carry in your assault on the citadel of establishment mental health. We hold the high ground.

We are not asking them to accept anything.  We are requiring that they live up to their established Standards of practice.  We are seeking – we are requiring – professional competence in the assessment, diagnosis, and treatment of existing and established forms of personality disorder pathology, family systems pathology, and attachment trauma pathology.

And when the pathogenic parenting practices of a narcissistic/borderline parent are creating

Developmental Pathology:  Attachment system suppression

Personality Disorder Pathology:  Five narcissistic/borderline traits in the child’s symptom display

Psychiatric Pathology:  Shared psychotic delusional beliefs (and sometimes an additional phobic anxiety)

we are seeking – we are requiring – that mental health professionals fulfill their “duty to protect” by making the proper DSM-5 diagnosis of

V995.51 Child Psychological Abuse Confirmed. 

The pathology of “parental alienation” is already in the DSM-5. There is nothing for the DSM-5 to accept or reject.  The DSM-5 diagnosis for the pathology of an attachment-based model of “parental alienation” is V995.51 Child Psychological Abuse, Confirmed – p. 719.

All we are seeking is professional competence – we are demanding professional competence.

Battle Plans

In the coming days I will engage the pathogen in the center of the battlefield.  Once the battle is engaged, it will attack me with great viciousness and it will seek to destroy me personally – because I am a threat.

It will bring out its tried and true attacks:

That an attachment-based model represents a “new theory of Dr. Childress” – because this worked with Gardnerian PAS.

It won’t work this time.

It will seek to destroy me personally – because this worked with Richard Gardner and PAS

It won’t work this time.

It will throw out the buzz words of “peer-reviewed” – because this worked with Gardnerian PAS.

It won’t work this time.

It will claim that we’re sending children back to be with an abusive rejected parent – because this worked with Gardnerian PAS.

It won’t work this time.

I will stand, square in the middle of this battlefield, and I will engage the fight.

Your job is to storm the citadel of establishment mental health.  You are not asking them to accept anything – you are demanding professional competence in assessing, diagnosing, and treating established forms of accepted psychopathology; personality disorder pathology, family systems pathology, attachment-trauma pathology.

Make them argue that professional ignorance and incompetence are acceptable standards of practice.

Make them argue that narcissistic and borderline personalities don’t exist. 

Make them argue that inducing severe developmental, personality disorder, and psychotic psychiatric pathology in a child is acceptable, that this is NOT a form of psychological child abuse.

Make them argue this.  These are untenable positions for establishment mental health to take.  Make them take these positions or relent to your demands for professional competence in the assessment, diagnosis, and treatment of this pathology.

The pathology exists – we want them to acknowledge that fact.

The existence of cats (personality disorder pathology) does not nullify the existence of dogs (authentic child abuse); and not all animals are dogs.  Cats exist.  We just want them to acknowledge that cats (personality disorder  pathology) exists and adversely affects family functioning following a divorce.  That’s the structure of our position.

Make them acknowledge that personality disorder pathology exists and make them put the acknowledgement into their position statement on “parental alienation” pathology.

Break the pathogen’s veil of concealment.

Demand that the complexity of this pathology requires specialized professional knowledge and expertise to competently assess, diagnose, and treat.  Make them argue that professional ignorance and incompetence are acceptable standards of practice. They won’t be able to take this position. 

Demand that your children and families be acknowledged as a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

Storm the citadel of establishment mental health carrying the banner of Standard 2.01 of their own ethics code, the Ethical Principles of Psychologists and Code of Conduct that REQUIRES professional competence.  Make them either renunciate their own ethics code or else live up to their ethical principles and code of conduct.

Storm the citadel of establishment mental health carrying the banner of Standard 9.01 that requires assessment “sufficient to subtantiate” “the opinions contained in their recommendations, reports and diagnostic or evaluative statements, including forensic testimony.”  Make them live up to their ethical principles and established code of conduct.

This pathology is not some “new form of pathology.” It is the manifestation of narcissistic and borderline personalty pathology (as fully described in Foundations).  Every single mental health professional who is assessing, diagnosing, and treating this pathology MUST be professionally competent in the assessment, diagnosis, and treatment of narcissistic and borderline personality pathology as it is expressed in family relationships.

Accept nothing less.  Demand more.  This pathology is a manifestation of attachment trauma from the childhood of the narcissistic/borderline parent into the current family relationships, mediated by the personality disorder pathology that is itself a product of this childhood trauma.

Every single mental health professional who is assessing, diagnosing, and treating this pathology MUST be professionally competent in the assessment, diagnosis, and treatment of attachment trauma as manfested trans-generationally (through “schema” patterns; Beck et al., 2004).

Expect nothing less. And demand more. This pathology is a manifestation of the child’s triangulation into the spousal conflict through the formation of a cross-generational coalition with the allied parent against the targeted parent (a “perverse triangle”; Haley, 1977).  Every single mental health professional who is assessing, diagnosing, and treating this form of family pathology MUST be professionally competent in family systems theory and family therapy.

Expect nothing less.  Demand professional competence consistent with Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Storm the citadel of establishment mental health.  Take the citadel of establishment mental health – and plant your banners and those for your children upon the walls and turrets of the citadel. Reclaim establishment mental health as your ally against this family pathology and the psychological abuse of the child.

We want a change to the APA’s position statement that

1.)  Acknowledges the pathology exists, using whatever terminology they want.

2.)  Identifies the children and families experiencing this type of pathology as representing a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

The moment you take the citadel, the attacks on me will cease and the pathogen will flee from the field of battle to seek the dark crevices of the world in which to hide.

Wake Up

I am not your warrior, I am your weapon. Foundations empowers you to take the citadel of establishment mental health.  The time for battle has arrived 

Like great Ajax before the walls of Troy, I’ve seen Howie take on the pathogen over and over again with truth and power. Kay, like wise Ulysses, seeks to lead with wisdom and eloquence. Leadership will emerge from within your ranks.  Follow them.

Wake up your allies who are lulled into the slumber of their victimization.  You are victims no more.  The time for battle has come.  The time to recover your children is now. 

Google is wonderful.  The American Psychological Association has a website.  Each state has a professional psychological association.  Many large cities have professional psychological associations.  Look them up.  Who’s in charge?  What’s their address?  Alert your colleagues.  Make the citadel aware of you.  Demand professional competence.

Be Kind

Be kind, but be relentless. 

If you approach with anger you will trigger a defensive response.  You will trigger the release of brain chemicals in the listener which will take them into lower, more primitive brain systems for fight or flight, and which will shut off higher order cognitive processing and openness.

When we feel threatened we move into lower brain systems and essentially stop thinking.  We want others to think. Be kind, be relentless but be kind.

When you interact with others you represent all targeted parents and all of your supporters.  Represent us well. 

Kind is not weak. Kind is strong. Gandhi was an extraordinarily tough adversary.  But he fought without anger.  He fought with unrelenting love and kindness.

Our goal is to end division and argument.  Our goal is to bring both sides together.  Both sides are “equally valid poles” in the dialogue.  Many of those who are concerned about Gardnerian PAS are reasonable people who have valid concerns about discounting a child’s report of “abuse” and about overriding a child’s expressed reluctance to be with a parent.  Recognize that dogs exist.

And in your reasonableness and gentle understanding of their legitimate concerns, help them realize that cats (personality disorders) also exist.  We want to protect 100% of the children 100% of the time from ALL forms of child abuse.  Agree that Gardnerian PAS was an inadequate model.  Come together in a middle ground of agreement.

Dogs exist and cats exist.  The existence of one does not preclude the existence of the other.  Right now we’re talking about cats.

For the minions of the pathogen, offer them an opportunity to understand.  They may actually be reasonable people with valid concerns.  Your kindness and reasonableness will expose their motives.  If they respond with reason, offer dialogue. If they expose their narcissistic and borderline personalities, move on.

The hallmark of the narcissistic/borderline personality is the absence of empathy.  If there is no empathy, then there is pathology.

Avoid the splitting pathology of demonizing the other side.  There are no sides.  We are all on the same side of protecting children’s healthy emotional and psychological development.  Cats exist and dogs exist.  Lets work together to identify what animals are cats and what animals are dogs, 100% of the time.  It can be done.

My goal is to bring an end to the pathology of “parental alienation” by Christmas of 2016.  Join me in this goal.  It can be accomplished because we are merely seeking professional competence in the assessment, diagnosis, and treatment of already accepted and already established forms of pathology.

The time is now.  The battle to reclaim mental health as your ally has arrived.

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

I received the following Comment from Dr. Mercer.  Since it requires a more elaborated response than I can provide in the Comment section of this blog, I decided to respond as a post.

Here is the Comment from Dr. Mercer:

Can you tell me what was the age of the youngest child you have ever treated? Can you tell me how you ascertain whether or not there is a “good reason” for the child’s rejection? Can you tell me how often you find that you must tell a rejected parent that there seems to have been a reason for the child’s rejection, so you cannot use your treatment to address the problem?

I don’t have a treatment to suggest, and if I did that fact would be irrelevant to the empirical questions I’m asking. As I said to one of your advocates, the burden of proof is on you, not on me. But right now I’m not asking for proof, I’m just asking for a couple of details that I would think would be easy for you to supply. If you prefer not to answer, please just say so and save time for both of us.

---

My goodness, Dr. Mercer. I apologize. I thought you were interested in having a professional dialogue about a very serious form of psychopathology involving the child’s triangulation into the spousal conflict through a cross-generational coalition with a narcissistic/borderline parent that is inducing severe developmental, personality, and psychiatric psychopathology in the child. I’m sorry, I didn’t realize you just wanted a “couple of details” that you believe would be easy for me to supply.

Oh, by the way, have you read my book,

An Attachment-Based Model of Parental Alienation: Foundations

I devote all of Chapter 9 to Diagnosis.

You know, Dr. Mercer, I’m beginning to suspect that you don’t want to actually address the pathologies that affect children and families, but that you may have some sort of personal agenda you want to advance.

I’ve tried to address your questions at a well-balanced professional level of discussion, citing references for my statements and my concerns. You have not responded to any of this content material, but have become fixated on how early a narcissistic/borderline parent can distort a child’s functioning. Not only that, you have personalized it as to what is the youngest child I’ve ever treated. What’s it matter to the issues we’re discussing?

And you haven’t even read Foundations.  I’m not sure at this point that you actually want a professional level discussion.

So I apologize, I didn’t realize that you just wanted answers to a few specific “details” rather than a discussion of the broader constructs relevant to the pathology.

So here are my answers:

Detail 1:  “What was the age of the youngest child you have ever treated?”

Actually, I was the Clinical Director for an early childhood assessment and treatment center (ages 0-5) working primarily with children in the foster care system. So the youngest child I’ve personally treated was about 2 ½ years old, although I’ve supervised the treatment of a wide variety of ages, from infancy to five years old at the clinic.

In the area of early childhood, my specialty area is the preschool age range, from three to five years old.

I’m trained to clinical competence in the relationship-based interventions of Watch, Wait, and Wonder (used to improve the infant-mother bond) and Circle of Security (used to improve attachment bonding in preschool-age children).

I’m also trained to clinical competence in the DC-03 diagnostic system (an early childhood alternative to the DSM diagnositic system) and the ICDL-DMIC diagnostic system dealing with the assessment, diagnosis, and intervention for developmental and emotional disorders, autistic spectrum disorders, multisystem developmental disorders, regulatory disorders involving attention, learning and behavioral problems, cognitive, language, motor, and sensory disturbances.

Before developing my sub-specialty expertise in early childhood mental health, my primary focus was ADHD in school-age children and adolescents. One of the reasons I went into early childhood was to increase my professional understanding for the early childhood development of emotional-behavioral regulatory disorders (ADHD). My work with ADHD-spectrum issues spans the school-age and adolescent periods of child development.

My work with school-age kids and adolescents has involved extensive work with Oppositional Defiant Disorder (a co-morbid disorder with ADHD) and severe parent-child conflict. So I am well-familiar with “normal-range,” and by that I mean clinically “normal-range,” parent-child conflict (i.e., severe expressions of parent-child conflict associated with Oppositional Defiant Disorder).

My work in high-conflict divorce began in 2008 with a 10 year old child who had been rejecting a relationship with his mother for two years. The reason he offered for his rejection of his mother was that two years prior she was playing with him on the bed and she playfully held his feet over his head which compressed his diaphragm. He told his mom of his discomfort and she dropped his feet.  That’s why he doesn’t want to have anything to do with his mother for the rest of his life.  And nothing she can do will alter that. —— Yeah. Doesn’t make any sense does it? Didn’t make any sense to me either.

As I worked it out, it became evident the child was being triangulated into the spousal conflict by the father through the formation of a cross-generational coalition with the child against the mother. Standard family systems stuff.

Through a series of meetings with the father, it became evident that the father had prominent narcissistic personality traits with histrionic overtones. The father was angry at the mother for having rejected his self-perceived magnificence and he was using the child’s rejection of the mother as his weapon of revenge. The family process had domestic violence overtones, except instead of using his fists to beat the mother for leaving him, he was using the child.

The child was compliant, because the father would psychologically torment the child with irrational rages if the child deviated from the parentally desired behavior. If the child showed any signs of bonding to the mother, in fact, if the child did not make sufficient displays of rejecting his mother, then the father would subject the child to withering psychological torment.  By rejecting his mother, the child kept the father in a regulated emotional state and avoided the father’s rageful retaliation.

At the time I had never heard of “parental alienation.” But I immediately recognized the nature and severity of the pathology from within standard and established types of pathology; i.e., the child’s triangulation into the spousal conflict by the father through the formation of a cross-generational coalition with the father against the mother in which the child was being used as a regulatory object to stabilize the father’s pathology. When I started to treat the cross-generational coalition rather than validating the child’s rejection of his mother, the father terminated therapy. I decided to look into this more and discovered the construct of Parental Alienation Syndrome and the controversy surrounding it. This pathology is not a new “syndrome.” It is a manifestation of standard and established forms of pathology.

So I set about working out the pathology at a high-level of analysis. I anticipated that the narcissistic and borderline personality pathology with which we are dealing would attack any effort to disrupt the pathology with great vitriol and irrationally based accusations characteristic of the narcissistic/borderline process of splitting. So I needed to make sure that the theoretical foundations for the explanation of this pathology were rock solid. For seven years I’ve been uncovering the linkages within this pathology.

All the while I’ve been posting to my website and blog to make information available as quickly as possible to the parents and children suffering from this form of pathology. In my book, An Attachment-Based Model of Parental Alienation: Foundations, I describe the complexity of this pathology within three separate and distinct levels of analysis, the family systems level, the personality disorder level, and the attachment-trauma level, AND I integrate the analysis across all three levels, explaining how the childhood attachment trauma creates the narcissistic/borderline personality structure, and how the narcissistic/borderline personality structure creates the family systems pathology. No model of a pathology could explain the pathology both within and across three distinct levels of analysis unless it was accurate. The description of the pathology in Foundations is accurate.

You feel I have a “burden of proof,” Dr. Mercer? Foundations is my answer. I suggest you read it before developing opinions about my work.

Detail 2: “Can you tell me how you ascertain whether or not there is a “good reason” for the child’s rejection?”

This is a complex question. As the Clinical Director for an early childhood assessment and treatment center working with children in the foster care system I saw trauma and child abuse up close and personal. I know what authentic child abuse and trauma look like. Because of this, I also know what authentic child abuse trauma doesn’t look like.

This up close and personal experience with treating the sequelae of authentic child abuse trauma helps with the differential diagnosis of the child’s role-reversal relationship with a narcissistic/borderline parent who is using the child as a “regulatory object” to stabilize the parent’s pathology. There is a distinctive difference from the symptom presentation with authentic child abuse trauma.

Among a wide variety of indicators (differential diagnosis is not about any single puzzle piece, it is about the entire picture created by ALL the puzzle pieces) children exposed to authentic child abuse do not display five specific narcissistic/borderline personality symptoms in their symptom display, 1) grandiosity, 2) entitlement, 3) absence of empathy, 4) a haughty and arrogant attitude, and 5) splitting.

On the other hand, children who are in an enmeshed cross-generational coaltion with a narcissistic/borderline parent against the other parent do display all five of these specific narcissistic personalty traits. The only way a child acquires five specific a-priori predicted narcissistic/borderline personality symptoms is through an enmeshed psychological relationship with a narcissistic/borderline parent.  Do you disagree?  Do authentically abused children display a haughty and arrogant attitude of grandiose entitlement toward their abuser? Of course not.  They’re afraid of their abuser.

But differential diagnosis is not about any single indicator, it’s about the entire picture created by the symptoms and family processes. Another important indicator of authentic versus inauthentic parent-child conflict is the locus of “stimulus control” over the child’s behavior. The construct of “stimulus control” is a behavioral (learning theory) construct regarding the cueing of behavior. It is best understood by way of analogy:

Our driving behavior is under the “stimulus control” of traffic lights. When the light is green, we go. When the light is red, we stop. Yellow is a transitional warning. Our driving behavior is under the “control” of the “stimulus” of the traffic light.

In authentic parent-child conflict, the child’s behavior is under the stimulus control of the parent’s behavior.

In inauthentic parent-child conflict the child’s behavior is NOT under the stimulus control of the parent’s behavior.

Since our driving behavior is under the stimulus control of the traffic light, when we change the color of the traffic light we see a corresponding change in the driving behavior. If the child’s behavior is under the stimulus control of the parent’s behavior, then when we change the parent’s behavior we should see a corresponding change in the child’s behavior.

In inauthentic parent-child conflict, however, if we change the parent’s behavior we see no change in the child’s behavior. That’s because the stimulus control for the child’s behavior is in the behavior of the allied narcissistic/borderline parent and the role-reversal, “regulatory object” role of the child in stabilizing the parent’s pathology.

But this is still only another single puzzle piece of the entire puzzle picture. The puzzle “cats in the garden” isn’t this puzzle because of just a few specific pieces. The puzzle is “cats in the garden” because when we put ALL of the puzzle pieces together they display a picture of three cats, one orange cat, one grey cat, and one black and white cat, frolicking among flowers. There is a watering can over here and a fence post in this location. There is a butterfly above these yellow flowers. That’s what makes the puzzle “cats in the garden.”

Authentic trauma, which I diagnosed and treated while serving as the Clinical Director for an early childhood assessment and treatment center treating children in the foster care system, creates a puzzle picture of “boats on a lake.” Both puzzles contain blue pieces and red pieces and yellow pieces. But when we put ALL the puzzle pieces together, one creates a picture of cats frolicking in the garden, and the other creates a picture of boats on a lake.

I would also refer you to my blog post on parent-child conflict, Parenting and Protest Behavior.

Detail 3:  “Can you tell me how often you find that you must tell a rejected parent that there seems to have been a reason for the child’s rejection, so you cannot use your treatment to address the problem?”

First let me correct something, it’s not “my treatment,” it’s family systems therapy. 

Because of my expertise in the pathology of attachment-based “parental alienation” I am sometimes sought out by the targeted-rejected parent for help in resolving this pathology. In about 20% to 30% of these cases I have declined treatment or altered the treatment goal to address the pathology of the supposedly targeted parent because the narcissistic parent actually turned out to be the supposedly targeted-rejected parent. However, my personal experience should not be considered representative of the frequency of this in the general population because I am getting a self-selected sample of clientele in my private practice because of my expertise with this form of pathology.

Once we move beyond the current professional impasse of recognizing that both cats (personality disorder pathology) and dogs (authentic child abuse) exist, we can then begin to conduct research on this exact question. But before we reach that point we first have to recognize that both cats and dogs exist. The existence of cats does not nullify the existence of dogs; and not all animals are dogs. Cats exist.

So hopefully, I’ve addressed your “couple of details” that you think would be easy for me to supply an answer for.

And to you, Dr. Mercer, thank you for answering my previous question. It’s unfortunate that you don’t have any idea how to treat the pathology of a child’s cross-generational coalition with a narcissistic/borderline personality parent in which the child is used as a regulatory object to stabilize the parent’s pathology.

Are you aware that the premier family systems therapist Jay Haley refers to this type of pathology as a “perverse triangle”?  Do you know why he calls it “perverse”?

So I guess if you have no idea how to treat the pathology, then you don’t really have much of relevance to add to the discussion of the treatment for this type of pathology. That’s unfortunate. I guess you’ll just have to defer opinions regarding the treatment of this type of pathology to those of us who know what we’re doing.

Since I’ve addressed your “couple of details,” perhaps you could answer just one question for me. You suggest that I have some sort of “burden of proof.” What I’m wondering is how did you become the arbiter for truth in this? Was it posted on Craigslist, “Wanted: Arbiter of Truth” – or is it just a role you’ve assigned yourself?

Best wishes,

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

This is my response to Dr. Mercer regarding her desire to discuss treatment.

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Hello Dr. Mercer,

First, let me say it’s a pleasure to meet you and to engage you in this professional dialogue. Thank you for your response to my previous post.

Second, let me say, I am not a fan of the Gardnerian PAS model. I will in no way defend the Gardnerian PAS model. Needless to say, I suspect my criticisms of the PAS model have left me few friends among the current PAS advocates. Don’t care. The PAS model isn’t very good.

I’m a conservative clinical psychologist, and I believe we should remain within scientifically established psychological principles and constructs and work at the highest level of professional knowledge, based in the scientifically established literature.

Also, I’ve worked in the foster care system as the Clinical Director for a children’s assessment and treatment center, and I am experienced with authentic child abuse up close and personal. Whatever solutions we develop must protect 100% of children 100% of the time.

Based on your blog and Comment, I recognize your interest in moving into a discussion of treatment, but I would respectfully suggest that a discussion of treatment would be premature before we have an agreed understanding regarding the pathology we are trying to treat.

While I must plead ignorance regarding your work, I suspect you have a strong concern for protecting children from authentic child abuse and a strong reluctance to discount the reports from the children. If I’m correct in my assumptions, your position would be understandable and I would agree with it.

What I’m worried about is a very small population of children who are being parented by a narcissistic and/or borderline personality parent.

A 2008 study regarding the prevalence of Narcissistic Personality Disorder (Stinson, et al., 2008) estimates the prevalence of Narcissistic Personality Disorder at 6%.

A 2008 study regarding the prevalence of Borderline Personality Disorder (Grant, et al., 2008) estimates the prevalence of Borderline Personality Disorder at 6%.

I’m not going to quibble on numbers, but my point is it’s a small, but not insubstantial, group of families. This pathology, the narcissistic and borderline personality pathology, is also likely to be highly represented in high-conflict divorce. The association of this type of personality pathology with disorganized attachment would mean that these spouses/parents have no organized strategy for repairing relationship breaches, such as encountered in the divorce. In addition, the divorce hits dead center on the narcissistic vulnerability of primal self-inadequacy (rejection of the narcissistic personality spouse by the attachment figure of the other spouse), and dead center on the core borderline vulnerability of abandonment fears (by the attachment figure of the other spouse).

So a more florid display of narcissistic and borderline personality pathology surrounding divorce should be expected. So the clinical question becomes, what would that display look like?

In discussing the narcissistic and borderline personality structure, Otto Kernberg notes that,

“They are especially deficient in genuine feelings of sadness and mournful longing; their incapacity for experiencing depressive reactions is a basic feature of their personalities. When abandoned or disappointed by other people they may show what on the surface looks like depression, but which on further examination emerges as anger and resentment, loaded with revengeful wishes, rather than real sadness for the loss of a person whom they appreciated.” (Kernberg, 1977, p. 229)

The divorce experience is a loss, so it will produce a grief response. But if the narcissistic/borderline personality structure is characterologically unable to process sadness and grief, but instead translates it into “anger and resentment, loaded with revengeful wishes” then what we may be looking at is what Bowlby called disordered or pathological mourning.

“Disturbances of personality, which include a bias to respond to loss with disordered mourning, are seen as the outcome of one or more deviations in development that can originate or grow worse during any of the years of infancy, childhood and adolescence.” (Bowlby, 1980, p. 217)

I don’t want to go too technical in our discussion at this point, but I don’t feel I’m cherry-picking Bowlby. It think that attachment theory and personality disorder pathology can add considerably to the quality of the discussion that has thus far been dominated by a woefully inadequate proposal of PAS. Personally, I’m going to be leaving the construct of PAS behind as an interesting historical curiosity, and I intend to engage in a more scientifically and clinically anchored discussion of the pathology.

As I said in my post Cats Are Not Dogs, there is a genuine pathology, and it is linked to the pathology of a narcissistic and borderline personality parent. That’s the group of parents and their children that I am concerned about. Not all animals are cats. Not all animals are dogs. And the existence of cats does not discount the existence of dogs. Both cats and dogs have four legs, fur, and a tail. So we don’t want to get them confused. But there are also differences; cats have retractable claws, dogs don’t; dogs bark, cats meow. So once we know what we’re looking for, then we can begin to identify the specific features that clinically differentiate cats and dogs.

Recognizing that you may reasonably disagree with the order of my listing of extremely bad parenting, I would rank order my list of worst possible parents as:

1. Sexual abuse – incest
2. Narcissistic and borderline personality parent
3. Physical abuse
4. Neglect and depression
5. Actively bipolar and schizophrenic

Reasonable people can disagree on the specific order of this list, and even trying to develop a list at this extreme level of pathology may be a fool’s errand. But my point is that narcissistic and borderline personality parents are extremely bad parents.

In this regard, you may also be interested in a wonderful study by Moor and Silvern (2006) regarding the mediating role of parental empathic failure in the subsequent outcome from various forms of childhood trauma exposure. They describe in their study that,

“Only insofar as parents fail in their capacity for empathic attunement and responsiveness can they objectify their children, consider them narcissistic extensions of themselves, and abuse them. It is the parents’ view of their children as vehicles for satisfaction of their own needs, accompanied by the simultaneous disregard for those of the child, that make the victimization possible.” (p. 104)

“An empathically responsive environment precludes abuse and objectification of children. Correspondingly, the act of child abuse by parents is viewed in itself as an outgrowth of parental failure of empathy and a narcissistic stance towards one’s own children. Deficiency of empathic responsiveness prevents such self-centered parents from comprehending the impact of their acts, and in combination with their fragility and need for self-stabilization, predisposes them to exploit children in this way.” (p. 94-95)

“The indication that posttraumatic symptoms were no longer associated with child abuse, across all categories, after statistically controlling for the effect of perceived parental empathy might appear surprising at first, as trauma symptoms are commonly conceived of as connected to specifically terrorizing aspects of maltreatment (e.g., Wind & Silvern, 1994). However, this finding is, in fact, entirely consistent with both Kohut’s (1977) and Winnicott’s (1988) conception of the traumatic nature of parental empathic failure. In this view, parental failure of empathy is predicted to amount to a traumatic experience in itself over time, and subsequently to result in trauma-related stress. Interestingly, even though this theoretical conceptualization of trauma differs in substantial ways from the modern use of the term, it was still nonetheless captured by the present measures.” (p. 197)

The characterological incapacity for empathy and the role-reversal violation of psychological boundaries associated with the narcissistic/borderline personality pathology is what has me so deeply concerned for the children of these parents (Fonagy, Luyten, & Strathearn, 2011).

Splitting and Triangulation Through the Cross-Generational Coalition

Returning to the narcissistic/borderline parent’s response to divorce, what happens when the splitting pathology of the narcissistic/borderline parent is added to a role-reversal cross-generational coalition as defined by Minuchin (1974) and Haley (1977)? The pathology of splitting cannot accommodate to ambiguity (Juni, 1995). It polarizes perceptions into extremes of all-good or all-bad. This polarization does not involve an actual physical separation of brain networks, but rather a neurological cross-inhibition of these networks.

The borderline personality structure has its origins in disorganized attachment involving incompatible motivational directives for attachment bonding and avoidance. According to Aaron Beck and his colleagues (2004),

“Various studies have found that patients with BPD are characterized by disorganized attachment representations (Fonagy et al., 1996; Patrick et al, 1994). Such attachment representations appear to be typical for persons with unresolved childhood traumas, especially when parental figures were involved, with direct, frightening behavior by the parent. Disorganized attachment is considered to result from an unresolvable situation for the child when “the parent is at the same time the source of fright as well as the potential haven of safety” (van IJzendoorn, Schuengel, & Bakermans-Kranburg, 1999, p. 226).” (p. 191)

The pathology of splitting arises to resolve the simultaneous activation of attachment bonding motivations (“haven of safety”) and avoidance motivation (“source of fright”) created by a parent who is “at the same time the source of fright and the potential haven of safety” (creating the disorganized attachment).

Splitting involves the intense neurological cross-inhibition of attachment bonding and avoidance motivations, so that a single coherent motivational directive can be achieved. When one motivating system is on, the other motivating system is entirely turned off (cross-inhibited), so that only one or the other of these motivational systems can be active at any given time, which produces the characteristic polarization of perception into extremes of idealization or devaluation, and the complete absence of ambiguity (i.e., of both networks being on simultaneously which would modulate the perception of the other person).

With the divorce, the spouse becomes an ex-spouse, i.e., the representational networks for the spouse switch from the attachment bonding motivational system to the avoidance motivating system. Since the pathology of splitting cannot accommodate to ambiguity, only one of these motivational networks can be active at any given time, and with the divorce that network for the other spouse/(parent) is the avoidance motivating system. The attachment-bonding networks are entirely turned off (neurologically inhibited). Which means that the narcissistic/borderline parent cannot perceptually register the continuing attachment bond between the child and the other parent because the attachment bonding system in the brain of the narcissistic/borderline parent is being entirely shut down (cross-inhibited by the avoidance system).

This leads to a characteristic feature of this pathology, that the narcissistic/borderline parent cannot recognize, cannot perceptually register, that a normal child’s attachment system would want a relationship with the other parent (the parent who the narcissistic/borderline parent now perceives as being the embodiment of evil because of the splitting pathology).

With the divorce, the spouse has become an ex-spouse, so they must also become an ex-parent. There is no other possibility allowed by the neural networks of the splitting pathology. The ex-husband MUST become an ex-father; the ex-wife an ex-mother. This is a neurologically imposed imperative created by the splitting pathology.

The narcissistic/borderline personality parent accomplishes this goal by engaging the child into a cross-generational coalition (i.e., a role-reversal relationship as a “regulatory object” for the parent) in which the child is induced into rejecting the other parent (actually, the child is induced into adopting a trauma reenactment role of “victimized child” but I don’t want to get too far afield; I describe the symptom induction process in Foundations).

What we’re essentially looking at in the pathology traditionally called “parental alienation” is the manifestation of narcissistic and borderline personality pathology into the family relationships as a consequence of the divorce.

This whole dynamic is much more involved and complex, and I would refer you to Foundations for a complete description of the pathology. My point is that the pathology exists. The pathology of narcissistic and borderline personality disorder exists. And it is this pathology that is creating the child’s symptom display which is traditionally called “parental alienation.” The legions of parents who are claiming that they have been completely cut off from relationships with their children because of the pathological parenting of their ex-spouse are not delusional. The pathology exists as a manifestation into the family processes of narcissistic and borderline personality disorder pathology of the allied and supposedly “favored” parent.

That’s not to say that children do not also reject relationships with parents because of authentic child abuse and domestic violence. Just because cats exist doesn’t nullify the existence of dogs. Both cats and dogs exist.

But right now, I’m discussing cats, not dogs. We can discuss dogs once we recognize the existence of cats. The existence of dogs, while actual, does not nullify the existence of cats. Cats exist. Narcissistic and borderline personality pathology exists.

Treatment

So, returning to your initial desire to discuss treatment, the question becomes what is the treatment for a child’s role-reversal pathology as a regulatory object for a narcissistic/borderline parent? In this regard, my primary concerns would include both the “invalidating environment” described by Linehan (1993) and the role-reversal pathology (Kerig, 2005) in which the child is used as a regulatory object to stabilize the parent’s pathology, both of which are associated with narcissistic and borderline psychopathology.

Linehan and Koerner (1993) describe the invalidating environment,

“A defining characteristic of the invalidating environment is the tendency of the family to respond erratically or inappropriately to private experience and, in particular, to be insensitive (i.e., nonresponsive) to private experience… Invalidating environments contribute to emotional dysregulation by: 1) failing to teach the child to label and modulate arousal, 2) failing to teach the child to tolerate stress, 3) failing to teach the child to trust his or her own emotional responses as valid interpretations of events, and 4) actively teaching the child to invalidate his or her own experiences by making it necessary for the child to scan the environment for cues about how to act and feel.” (p. 111-112)

In their description of the invalidating environment, Fruzzetti, Shenk, and Hoffman, (2005) note the nullification of the child’s self-authenticity,

“In extremely invalidating environments, parents or caregivers do not teach children to discriminate effectively between what they feel and what the caregivers feel, what the child wants and what the caregiver wants (or wants the child to want), what the child thinks and what the caregiver thinks.” (p. 1021)

In the Journal of Emotional Abuse, Kerig (2005) describes the pathology of the role-reversal relationship and notes the nullification of the child’s self-authenticity,

“Rather than telling the child directly what to do or think, as does the behaviorally controlling parent, the psychologically controlling parent uses indirect hints and responds with guilt induction or withdrawal of love if the child refuses to comply. In short, an intrusive parent strives to manipulate the child’s thoughts and feelings in such a way that the child’s psyche will conform to the parent’s wishes.” (p. 12)

“In order to carve out an island of safety and responsivity in an unpredictable, harsh, and depriving parent-child relationship, children of highly maladaptive parents may become precocious caretakers who are adept at reading the cues and meeting the needs of those around them. The ensuing preoccupied attachment with the parent interferes with the child’s development of important ego functions, such as self organization, affect regulation, and emotional object constancy.” (p. 14)

Rappoport (2005) describes the parenting of a narcissistic personality,

“To the extent that parents are narcissistic, they are controlling, blaming, self-absorbed, intolerant of others’ views, unaware of their children’s needs and of the effects of their behavior on their children, and require that the children see them as the parents wish to be seen. They may also demand certain behavior from their children because they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents’ emotional needs.” (p. 2)

In describing the co-narcissist’s relationship with a narcissistic personality, Rappoport (2005) describes the nullification of the other person’s self-experience,

“In a narcissistic encounter, there is, psychologically, only one person present. The co-narcissist disappears for both people, and only the narcissistic person’s experience is important.” (p. 3)

In the family systems literature, the construct would be psychological enmeshment. In the child development literature it would involve the construct of shared “intersubjectivity.”

Ultimately, the role of intersubjectivity is going to become central to understanding the pathology, and the works of Stern, Tronick, Trevarthan, Fonagy, and others is going to become prominent to understanding the pathology and important for understanding treatment.

Stern (2004), for example, describes the neurological underpinnings of shared psychological experience,

“Our nervous systems are constructed to be captured by the nervous systems of others. Our intentions are modified or born in a shifting dialogue with the felt intentions of others. Our feelings are shaped by the intentions, thoughts, and feelings of others. And our thoughts are cocreated in dialogue, even when it is only with ourselves. In short, our mental life is cocreated. This continuous cocreative dialogue with other minds is what I am calling the intersubjective matrix… The idea of a one-person psychology or of purely intrapsychic phenomena are no longer tenable in this light.” (p. 76)

Tronick (2003) refers to this shared psychological state as a “dyadic state of consciousness,”

“When mutual regulation is particularly successful, that is when the age-appropriate forms of meaning (e.g., affects, relational intentions, representations; see Tronick 2002c, d) from one individual’s state of consciousness are coordinated with the meanings of another’s state of consciousness — I have hypothesized that a dyadic state of consciousness emerges.” (p. 475)

The mirror neuron network represents the neurological substrate for this shared psychological state (Iacoboni, et al, 2005; Kaplan & Iacoboni, 2006).

The concern surrounding the pathological parenting of a narcissistic/borderline parent is that the child is being used in a role-reversal relationship as a regulatory object to stabilize the pathology of the narcissistic/borderline parent, and that this role-reversal pathology has nullified the child’s self-authenticity in order to meet the needs of the narcissistic/borderline parent.

So if you wish to begin a discussion of treatment, then I would pose the question to you as to what you propose the treatment to be for the role-reversal pathology of a child’s cross-generational coalition with a narcissistic/borderline parent in which the child is being used as a regulatory object to stabilize the pathology of the narcissistic/borderline parent?

In order to engage the discussion of treatment, we need to first understand what the pathology is that we are treating.

In my view, a discussion of treatment is a bit premature, but if you want a beginning orientation to my basic views, I would refer you to my blog post, On Unicorns, the Tooth Fairy, and Reunification Therapy in which I discuss a general orientation to therapy for this type of narcissistic/borderline personality pathology within the family from multiple perspectives.

In your blog you drew from one possible idea I’ve put foward, a strategic family systems intervention, for treating the pathology of a role-reversal relationship with a narcissistic/borderline parent in which the child is being used as a regulatory object to stabilize… you know that’s an awfully long sentence to write each time I have to refer to this pathology… isn’t there some shorter label we can give to this type of pathology?

Hmmm… people in the general population appear to be calling it “parental alienation.” The problem is, if I call it “parental alienation” then everyone is going to think I’m talking about a Gardnerian model of PAS, and I’m not. But if I label this pathology something different, then people won’t realize that I’m talking about the same type of pathology they are, of a child’s induced rejection of a parent which they’re calling “parental alienation.”

Okay, how about this. I’ll use the term “parental alienation” but I’ll put it in quotes to indicate that it’s not an actually defined pathology, and then I’ll add the words attachment-based to differentiate this description of the pathology from the Gardnerian PAS model.

So that’s what I’ve done. Going forward, Dr. Mercer, if you’d like to refer to the pathology of a narcissistic/borderline parent inducing a role-reversal relationship… on and on long sentence… by some other label, I’m open to that. My preference, based on my analysis of the pathology in Foundations, would be “attachment-trauma reenactment pathology.” But if you want to call it “Bob” – that’s fine by me.

I don’t care what we call it, we just need to recognize that narcissistic and borderline personality disorders exist and that this form of pathology becomes highly activated surrounding divorce (i.e., the loss of the attachment figure and direct hits on the core vulnerabilities of the narcissistic/borderline parent), and that a narcissistic/borderline parent has an extremely devastating impact on child development. Cats exist. Dogs exist. They both exist.

Parallel Process

One of the dangerous features of working with borderline personality pathology is the parallel process of splitting that can occur among the mental health professionals working with the borderline pathology. Marsha Linehan (1993) refers to this parallel process as “staff splitting.”

“Staff splitting,” as mentioned earlier, is a much-discussed phenomenon in which professionals treating borderline patients begin arguing and fighting about a patient, the treatment plan, or the behavior of the other professionals with the patient… arguments among staff members and differences in points of view, traditionally associated with staff splitting, are seen as failures in synthesis and interpersonal process among the staff rather than as a patient’s problem… Therapist disagreements over a patient are treated as potentially equally valid poles of a dialectic. Thus, the starting point for dialogue is the recognition that a polarity has arisen, together with an implicit (if not explicit) assumption that resolution will require working toward synthesis.” (p. 432)

I am concerned that the parallel process of splitting has infected previous discussions of this pathology surrounding the Gardnerian PAS model, in which hyperbolic exaggerations have been used to characterize reasonable and responsible mental health professionals as somehow being unethical and as seeking the abuse of children.

In moving forward with professionally responsible dialogue, I would desperately want to avoid the parallel process of “staff splitting” described by Linehan. “Sides” are a manifestation of the splitting pathology. There are no sides. We all want to protect children from child abuse. 100% of children 100% of the time. The critics of Gardnerian PAS want to protect children from an authentically abusive parent (dogs exist). The supporters of the “parental alienation” construct want to protect children from the pathology of a narcissistic/borderline parent – although they have not been describing it in this way – (cats exist).

In her wisdom, Marsha Linehan has pointed to the door out from the parallel process of splitting. Each side in the dialogue represents “equally valid poles in a dialectic” and “the starting point for dialogue is the recognition that a polarity has arisen, together with an implicit (if not explicit) assumption that resolution will require working toward synthesis.”

Working toward a reasonable, professionally sound, and scientifically supported synthesis for addressing all forms of emotional, psychological, physical, and sexual abuse of children is what I seek in proposing an attachment-based reformulation for the pathology traditionally called “parental alienation.”

Best wishes,

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

References

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

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

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

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.

Grant, B.F., Chou, S.P., Goldstein, R.B., Huang, B., Stinson, F.S., Saha, T.D., Smith, S.M., Dawson, D.A., Pulay, A.J., Pickering, R.P., and Ruan, W.J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69, 533-545.

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

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

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

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

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford

Linehan, M. M. & Koerner, K. (1993). Behavioral theory of borderline personality disorder. In J. Paris (Ed.), Borderline Personality Disorder: Etiology and Treatment. Washington, D.C.: American Psychiatric Press, 103-21.

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

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.

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

Stern, D. (2004). The Present Moment in Psychotherapy and Everyday Life. New York: W.W. Norton & Co.

Stinson, F.S., Dawson, D.A., Goldstein, R.B., Chou, S.P., Huang, B., Smith, S.M., Ruan, W.J., Pulay, A.J., Saha, T.D., Pickering, R.P., and Grant, B.F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV Narcissistic Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69, 1033-1045.

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.

This post is a response to Jean Mercer’s analysis of an attachment-based model of “parental alienation” on her blog:

Craig Childress Tries to Drag Attachment Theory Into the Parental Alienation Swamp

I had originally intended to post this response to Dr. Mercer in the Comment section of her blog, but unfortunately the Comment section too severely restricts the number of characters so that my response becomes impractical in that format.

So I instead decided to turn to my blog to respond, and then simply note on Dr. Mercer’s blog that I had responded over here.  Dueling blogs, if you will.  I have posted to the Comment section of Dr. Mercer’s blog the following:

Dr. Mercer, thank you for taking the time to review my work and offer your opinions. I was going to post my response in the Comment section of your blog, but the character limitations of that format are simply too restrictive to allow me a proper response to the issues you raise. So instead, I decided to respond on my blog at drcraigchildressblog.org. Hopefully this will lead to a productive professional dialogue that does justice to the complex issues and family struggles of the children and families we treat. Best wishes, Craig Childress, Psy.D.

So the following is my initial response to Dr. Mercer’s blog which she entitled “Craig Childress Tries to Drag Attachment Theory Into the Parental Alienation Swamp.”

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First, Dr. Mercer, thank you for your time in reviewing my work, although, based on your analysis of my work, I’m not certain that you’ve read my book, Foundations, yet, which offers a more complete elaboration of the attachment-based foundations to the pathology of “parental alienation” than is provided in my various online writings (although I prefer the more accurate clinical term for the pathology of attachment-trauma reenactment pathology).

Thank you also for crediting me with these ideas. Unfortunately, I cannot take credit for the ideas contained in an attachment-based model as they all represent ideas and constructs derived from the foremost figures in professional psychology, including Theodore Millon, Aaron Beck, John Bowlby, Murray Bowen, Otto Kernberg, Bessel van der Kolk, Salvador Minuchin, Marsha Linehan, Alan Sroufe, Mary Mains, Jay Haley, and Peter Fonagy, among others, and from the established research literature.

In your analysis of my work, you requested a list of references for an attachment-based reformulation for the pathology of “parental alienation,” which leads me to believe that you have not yet read Foundations since I include this list of references in Chapter 11 of Foundations when I discuss the domains of required knowledge necessary for professional competence in the assessment, diagnosis, and treatment of this pathology. So in response to your request, I am including a list of references that I cite in Chapter 11.

I would imagine that since you have decided to critique my work, you have read Foundations in order to offer an informed opinion, and so you have likewise read the material I cited in Chapter 11 and are knowledgeable in the relevant areas of developmental pathology involved in an attachment-based formulation for the pathology traditionally called “parental alienation.” If you have not yet had the opportunity to read the relevant material I cite below, then when you do I would welcome the opportunity to engage in a well-informed discussion of the pathology.

But before turning to the references you requested, let me correct two misrepresentations of me in your analysis, first I am not on faculty at California Southern University. My online lectures for them were part of an invited Master’s Lecture Series that they invited me to present because of my professional knowledge in this area of pathology. Second, your characterization of my treatment recommendations were somewhat distorted, not so much as to be outright misrepresentations, just enough however to be mischaracterizations. I don’t want to distract from the present issue of providing you with the references you requested, so we can address the treatment related issues in future professional dialogue.

In our future discussions of treatment, my hope is that we can engage in a serious professional dialogue rather than relying on rhetorical devices such as setting up a straw-man line of argument.  The nature of the pathology and the family tragedy that is created by a narcissistic and borderline personality parent is too serious for anything but the most sober and reasoned of professional dialogues.

Essentially, the pathology we are treating is a reenactment of childhood attachment-trauma from the childhood of the allied and supposedly favored narcissistic/borderline parent into the current family relationships.  This reenactment of childhood attachment trauma is mediated by the narcissistic and borderline personality pathology of the allied parent, which is itself a product of the childhood trauma.

I am confident that you are not going to deny the existence of narcissistic and borderline personality pathology, as these are both well-established pathologies in both the DSM-5 diagnostic system and the professional literature.

The pathology of both the narcissistic and borderline personality involves a characteristic psychological process called “splitting.” Hopefully, you are not going to deny the pathology of spitting since this pathology was explicitly defined by the American Psychiatric Association in the DSM-IV TR.

The pathology traditionally called “parental alienation” simply represents the addition of the splitting pathology of a narcissistic/borderline personality parent to a cross-generational coalition (as independently defined by the preeminent family systems theorists Salvador Minuchin and Jay Haley) of the child with the narcissistic/borderline parent against the other parent. Hopefully, you are not going to deny a central and well-established tenet of family systems therapy of the child’s triangulation into the spousal conflict.

(I discuss all of this in detail in Foundations.)

So while you graciously attributed the ideas of an attachment-based model to me, I must decline the attribution since the constructs of an attachment-based model of the pathology traditionally called “parental alienation” are actually derived from the most preeminent figures in professional psychology. So here is the reference list you requested, please refer to the following list of references for the original source material for an attachment-based formulation of the pathology

Following this reference list, I provide direct quotes regarding the reenactment of trauma, direct quotes regarding the psychological decompensation of the narcissisistic personality structure into delusional beliefs, direct quotes regarding the triangulation of the child into the spousal conflict through a cross-generational coalition with one parent against the other parent, the definition of the splitting pathology from the American Psychiatric Association, and direct quotes regarding the “invalidating environment.”

I look forward to a sober and professional dialogue that will best serve the children and families we treat.

Best wishes,

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

References for an Attachment-Based Model of “Parental Alienation”

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.

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.

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

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.

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.

Direct Quotes Regarding Trauma Renactment:

“When the trauma fails to be integrated into the totality of a person’s life experiences, the victim remains fixated on the trauma. Despite avoidance of emotional involvement, traumatic memories cannot be avoided: even when pushed out of waking consciousness, they come back in the form of reenactments, nightmares, or feelings related to the trauma… Recurrences may continue throughout life during periods of stress.” (van der Kolk, 1987, p. 5)

van der Kolk, B.A. (1987). The psychological consequences of overwhelming life experiences. In B.A. van der Kolk (Ed.) Psychological Trauma (1-30). Washington, D.C.: American Psychiatric Press, Inc.

“Victims of trauma respond to contemporary stimuli as if the trauma had returned, without conscious awareness that past injury rather than current stress is the basis of their physiologic emergency responses. The hyperarousal interferes with their ability to make calm and rational assessments and prevents resolution and integration of the trauma.” (van der Kolk, 1989, p. 226)

“People who have been exposed to highly stressful stimuli develop long-term potentiation of memory tracts that are reactivated at times of subsequent arousal. This activation explains how current stress is experienced as a return of the trauma; it causes a return to earlier behavior patterns.” (van der Kolk, 1989, p.226)

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.

“No variables, it is held, have more far-reaching effects on personality development than have a child’s experiences within his family: for, starting during the first months of his relations with his mother figure, and extending through the years of childhood and adolescence in his relations with both parents, he builds up working models of how attachment figures are likely to behave towards him in any of a variety of situations; and on those models are based all his expectations, and therefore all his plans for the rest of his life.” (Bowlby, 1973, p. 369)

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. NY: Basic.

“Evaluation of the particular demands of a situation precedes and triggers an adaptive (or maladaptive) strategy. How a situation is evaluated depends in part, at least, on the relevant underlying beliefs. These beliefs are embedded in more or less stable structures, labeled “schemas,” that select and synthesize incoming data.” (Beck et al., 2004, p. 17)

“When schemas are latent, they are not participating in information processing; when activated they channel cognitive processing from the earliest to the final stages… When hypervalent, these idiosyncratic schemas displace and probably inhibit other schemas that may be more adaptive or more appropriate for a given situation. They consequently introduce a systematic bias into information processing… In personality disorders, the schemas are part of normal, everyday processing of information.”  (Beck et al., 2004, p. 27)

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

“Reenactments of the traumatic past are common in the treatment of this population and frequently represent either explicit or coded repetitions of the unprocessed trauma in an attempt at mastery. Reenactments can be expressed psychologically, relationally, and somatically and may occur with conscious intent or with little awareness. One primary transference-countertransference dynamic involves reenactment of familiar roles of victim-perpetrator-rescuer-bystander in the therapy relationship. Therapist and client play out these roles, often in complementary fashion with one another, as they relive various aspects of the client’s early attachment relationships.” (Pearlman & Courtois, 2005, p. 455)

Pearlman, C.A., Courtois, C.A. (2005). Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma. Journal of Traumatic Stress, 18, 449-459.

“The conceptualization of the core pathology of BPD [borderline personality disorder] as stemming from a highly frightened, abused child who is left alone in a malevolent world, longing for safety and help but distrustful because of fear of further abuse and abandonment, is highly related to the model developed by Young (McGinn & Young, 1996)… Young elaborated on an idea, in the 1980s introduced by Aaron Beck in clinical workshops (D.M. Clark, personal communication), that some pathological states of patients with BPD are a sort of regression into intense emotional states experienced as a child. Young conceptualized such states as schema modes…” (Beck et al., 2004, p. 199)

“Young hypothesized that four schema modes are central to BPD: the abandoned child mode (the present author suggests to label it the abused and abandoned child); the angry/impulsive child mode; the punitive parent mode, and the detached protector mode… The abused and abandoned child mode denotes the desperate state the patient may be in related to (threatened) abandonment and abuse the patient has experienced as a child. Typical core beliefs are that other people are malevolent, cannot be trusted, and will abandon or punish you, especially when you become intimate with them.” (Beck et al., 2004, p. 199)

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

“Freud suggests that overwhelming experience is taken up into what passes as normal ego and as permanent trends within it; and, in this manner, passes trauma from one generation to the next. In this way, trauma expresses itself as time standing still. Traumatic guilt – for a time buried except through the character formation of one generation after the next – finds expression in an unconscious reenactment of the past in the present.” (Prager, 2003, p. 176)

“Trauma, as a wound that never heals, succeeds in transforming the subsequent world into its own image, secure in its capacity to re-create the experience for time immemorial. It succeeds in passing the experience from one generation to the next. The present is lived as if it were the past. The result is that the next generation is deprived of its sense of social location and its capacity to creatively define itself autonomously from the former… when time becomes distorted as a result of overwhelming events, the natural distance between generations, demarcated by the passing of time and changing experience, becomes obscured. (Prager, 2003, p. 176)

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

Direct Quotes Regarding the Decompensation of the Narcissistic Personality into Delusional Beliefs

“Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders. Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs. Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking. Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions. Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence. They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up. Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast. Rarely physically abusive, anger among narcissists usually takes the form of oral vituperation and argumentativeness. This may be seen in a flow of irrational and caustic comments in which others are upbraided and denounced as stupid and beneath contempt. These onslaughts usually have little objective justification, are often colored by delusions, and may be directed in a wild, hit-or-miss fashion in which the narcissist lashes out at those who have failed to acknowledge the exalted status in which he or she demands to be seen.” (Millon, 2011, p. 407-408; emphasis added)

“Deficient in social controls and self-discipline, the tendency of CEN narcissists to fantasize and distort may speed up. The air of grandiosity may become more flagrant. They may find hidden and deprecatory meanings in the incidental behavior of others, becoming convinced of others malicious motives, claims upon them, and attempts to undo them. As their behaviors and thoughts transgress the line of reality, their alienation will mount, and they may seek to protect their phantom image of superiority more vigorously and vigilantly than ever. Trapped by the consequences of their own actions, they may become bewildered and frightened as the downward spiral progresses through its inexorable course. No longer in touch with reality, they begin to accuse others and hold them responsible for their own shame and failures. They may build a “logic” based on the irrelevant and entirely circumstantial evidence and ultimately construct a delusion system to protect themselves from unbearable reality.” (Millon, 2011, p. 415; emphasis added)

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

Direct Quotes on 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)

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

“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)

“An inappropriately rigid cross-generational subsystem of mother and son versus father appears, and the boundary around this coalition of mother and son excludes the father. A cross-generational dysfunctional transactional pattern has developed.” (Minuchin, 1974, p. 61-62)

“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)

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

Definition of Splitting Pathology

“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)

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

“They tend to see reality in polarized categories of “either-or,” rather than “all,” and within a very fixed frame of reference. For example, it is not uncommon for such individuals to believe that the smallest fault makes it impossible the person to be “good” inside. Their rigid cognitive style further limits their abilities to entertain ideas of future change and transition, resulting in feelings of being in an interminable painful situation. Things once defined do not change. Once a person is “flawed,” for instance, that person will remain flawed forever.” (p. 35)

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford

Direct Quotes Regarding the Invalidating Environment

“A defining characteristic of the invalidating environment is the tendency of the family to respond erratically or inappropriately to private experience and, in particular, to be insensitive (i.e., nonresponsive) to private experience… Invalidating environments contribute to emotional dysregulation by: 1) failing to teach the child to label and modulate arousal, 2) failing to teach the child to tolerate stress, 3) failing to teach the child to trust his or her own emotional responses as valid interpretations of events, and 4) actively teaching the child to invalidate his or her own experiences by making it necessary for the child to scan the environment for cues about how to act and feel.” (Linehan & Koerner, 1993, p. 111-112)

Linehan, M. M. & Koerner, K. (1993). Behavioral theory of borderline personality disorder. In J. Paris (Ed.), Borderline Personality Disorder: Etiology and Treatment. Washington, D.C.: American Psychiatric Press, 103-121.

“In extremely invalidating environments, parents or caregivers do not teach children to discriminate effectively between what they feel and what the caregivers feel, what the child wants and what the caregiver wants (or wants the child to want), what the child thinks and what the caregiver thinks.” (Fruzzetti, Shenk, & Hoffman, 2005, p. 1021)

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.

Dr. Childress Comment: Far more important than these direct quotes from the works of preeminent mental health professionals, is the surrounding context of information in which these quotes are embedded.  If we are to properly assess, diagnose, and treat the pathologies that affect children and families, it is vital to have a substantial base of information regarding the nature of these pathologies.

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

Cats and dogs are similar.  Both have fur, four legs, and a tail, and both live with us.

But cats are not dogs.  They are different species of animal.

Furthermore not all animals are a dog. Neither are all animals cats. There are both cats and dogs. They both exist as separate species of animals. While they are similar to each other, they are distinctly different species of animals.

And we can tell the difference between cats and dogs. Even though both have fur, four legs, and a tail, it’s actually pretty easy to tell if the animal we’re looking at is a cat or a dog.  Try it if you don’t believe me… See, it’s pretty easy.  Cats and dogs look fundamentally different.

I recently received the following critical Comment to my blog post regarding my Online Seminar on Attachment-Based “Parental Alienation” (it seems the pathogen has located me, which is a good thing).

“You think you’re pretty smart eh?  Have you been physically and psychologically beaten on before?  Interrogated?  Your parenthood been fabricated?  Shame on you for dismissing women abuse!”

This is a common type of argument levied against the existence of the “parental alienation” pathology.  The argument is that to identify the pathology of “parental alienation” is to somehow deny the legitimacy of authentic domestic violence and child abuse. We can even see the remnants of this argument in the Position Statement on Parental Alienation of the American Psychological Association, which begins with a cautionary statement that all allegations of domestic violence need to be taken seriously.

But this is a spurious argument offered up by the allies of the pathogen. Cats are not dogs.  They are different animals.

Just because cats exist (i.e., the delusional reenactment of childhood attachment trauma into current family relationships) does not in any way discount or nullify the existence of dogs (authentic domestic violence and child abuse).  Dogs exist… and cats exist.  Dogs are not cats, and cats are not dogs.

And we can actually tell the difference between cats and dogs.

Authentic violence against women and children exists. The trans-generational transmission of childhood trauma into current family relationships through the personality disorder pathology of the parent, that is itself a product of the childhood trauma, also exists.  Dogs exist and cats exist.

They are two different species of similar types of animal (trauma). Actual violence against women and children is the enactment of trauma in this generation of children and families. The pathology of attachment-based “parental alienation” is the enactment of similar pathology, just one generation removed. The trauma was enacted in the childhood of the current narcissistic/borderline parent and is now being reenacted in the current family relationships in the delusional attachment-trauma pattern of “abusive parent”/”victimized child”/”protective parent.”

But just because cats exist (trauma reenactment) doesn’t mean that dogs don’t also exist (authentic domestic violence and child abuse).  Both types of animal exist.  Both dogs AND cats exist.

And it’s actually pretty easy to tell the difference between dogs and cats once you know what to look for.

The folks who are concerned about domestic violence and child abuse are worried that if we identify the pathology of “parental alienation” as existing (cats) then all animals will become cats and we will no longer identify authentic cases of domestic violence and child abuse (dogs). That’s a valid concern, but it’s also ridiculous.

It’s incredibly easy to tell what’s a cat and what’s a dog. First off, cats have retractable claws and climb trees, dogs don’t. Dogs bark, cats don’t (cats purr). And cats look fundamentally different than dogs. I doubt if anyone over the age of three actually gets confused if the animal in question is a dog or a cat.

Similarly, the pathology of a delusional reenactment of childhood trauma has distinctly different characteristic indicators from authentic violence against women and children. Authentic violence against women and children presents with one set of characteristic indicators while the delusional reenactment of childhood attachment trauma presents with an entirely different set of characteristic indicators. It’s actually pretty easy to tell the difference between cats and dogs once you know what to look for.

The three diagnostic indicators of attachment-based “parental alienation” (Foundations) can reliably and consistently differentiate the delusional trauma reenactment pathology of “parental alienation” from authentic incidents of domestic violence and child abuse (cats have retractable claws – dogs don’t, etc.). Plus, with all of the associated clinical signs, the two forms of pathology look fundamentally different (cats don’t look like dogs).

Not everything is a cat.  Authentic domestic violence and child abuse exists.

Not everything is a dog.  The reenactment of childhood attachment trauma into current family relationships also exists.

The renowned expert in trauma, Bessel van der Kolk, describes the reenactment of childhood trauma into current relationships:

“When the trauma fails to be integrated into the totality of a person’s life experiences, the victim remains fixated on the trauma. Despite avoidance of emotional involvement, traumatic memories cannot be avoided: even when pushed out of waking consciousness, they come back in the form of reenactments, nightmares, or feelings related to the trauma… Recurrences may continue throughout life during periods of stress.” (van der Kolk, 1987, p. 5)

van der Kolk, B.A. (1987). The psychological consequences of overwhelming life experiences. In B.A. van der Kolk (Ed.) Psychological Trauma (1-30). Washington, D.C.: American Psychiatric Press, Inc.

“Victims of trauma respond to contemporary stimuli as if the trauma had returned, without conscious awareness that past injury rather than current stress is the basis of their physiologic emergency responses. The hyperarousal interferes with their ability to make calm and rational assessments and prevents resolution and integration of the trauma.” (van der Kolk, 1989, p. 226)

“People who have been exposed to highly stressful stimuli develop long-term potentiation of memory tracts that are reactivated at times of subsequent arousal. This activation explains how current stress is experienced as a return of the trauma; it causes a return to earlier behavior patterns.” (van der Kolk, 1989, p.226)

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.

Sigmund Freud called this reenactment of childhood trauma “transference” (the patient would “transfer” childhood patterns of relationship onto the analyst).

John Bowlby calls these internalized patterns of relationship expectations “internal working models,” and he describes how we reenact these childhood patterns throughout our lifespan,

“No variables, it is held, have more far-reaching effects on personality development than have a child’s experiences within his family: for, starting during the first months of his relations with his mother figure, and extending through the years of childhood and adolescence in his relations with both parents, he builds up working models of how attachment figures are likely to behave towards him in any of a variety of situations; and on those models are based all his expectations, and therefore all his plans for the rest of his life.” (Bowlby, 1973, p. 369).

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. NY: Basic.

The renowned psychiatrist, Aaron Beck, refers to these patterns as “schemas.”  Beck and his colleagues describe how these schemas influence our interpretation of events and relationships,

Evaluation of the particular demands of a situation precedes and triggers an adaptive (or maladaptive) strategy. How a situation is evaluated depends in part, at least, on the relevant underlying beliefs. These beliefs are embedded in more or less stable structures, labeled “schemas,” that select and synthesize incoming data.” (Beck et al., 2004, p. 17)

“When schemas are latent, they are not participating in information processing; when activated they channel cognitive processing from the earliest to the final stages… When hypervalent, these idiosyncratic schemas displace and probably inhibit other schemas that may be more adaptive or more appropriate for a given situation. They consequently introduce a systematic bias into information processing… In personality disorders, the schemas are part of normal, everyday processing of information.”  (Beck et al., 2004, p. 27)

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

Pearlman and Courtois (2005) describe the pattern of the trauma reenactment narrative.

Reenactments of the traumatic past are common in the treatment of this population and frequently represent either explicit or coded repetitions of the unprocessed trauma in an attempt at mastery. Reenactments can be expressed psychologically, relationally, and somatically and may occur with conscious intent or with little awareness. One primary transference-countertransference dynamic involves reenactment of familiar roles of victim-perpetrator-rescuer-bystander in the therapy relationship. Therapist and client play out these roles, often in complementary fashion with one another, as they relive various aspects of the client’s early attachment relationships. (p. 455)

Pearlman, C.A., Courtois, C.A. (2005). Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma. Journal of Traumatic Stress, 18, 449-459.

Prager (2003) also describes the pathology of trauma reenactment,

“Freud suggests that overwhelming experience is taken up into what passes as normal ego and as permanent trends within it; and, in this manner, passes trauma from one generation to the next. In this way, trauma expresses itself as time standing still. Traumatic guilt – for a time buried except through the character formation of one generation after the next – finds expression in an unconscious reenactment of the past in the present. (p. 176)

Trauma, as a wound that never heals, succeeds in transforming the subsequent world into its own image, secure in its capacity to re-create the experience for time immemorial. It succeeds in passing the experience from one generation to the next. The present is lived as if it were the past. The result is that the next generation is deprived of its sense of social location and its capacity to creatively define itself autonomously from the former… when time becomes distorted as a result of overwhelming events, the natural distance between generations, demarcated by the passing of time and changing experience, becomes obscured. (p. 176)

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

The trauma-reenactment pathology of attachment-based “parental alienation” exists.  Cats exist.

This is not to deny that dogs ALSO exist.  Both cats and dogs exist.

To equate the existence of cats (trauma reenactment pathology) with the denial of dogs (authentic domestic violence and child abuse) is stupid.  We are NOT saying that dogs don’t exist.  We are simply saying that cats are NOT dogs.  These are two different animals.

It is the critics of the construct of “parental alienation” who are saying that EVERYTHING is a dog, and that cats don’t exist (“parental alienation” doesn’t exist).

All we are trying to do is get establishment mental health to acknowledge what Freud, van der Kolk, Bowlby, Beck, and others ALREADY acknowledge, that BOTH cats AND dogs exist. They are different animals. Not everything is a dog.

And once we recognize that BOTH cats and dogs exist, it actually becomes pretty easy to tell them apart. But we first need to recognize that there are two different types of animal. Each has fur, four legs, and a tail. But they are different.  Cats are not dogs.

So as we run into this type of distorted argument, in which the person we’re talking to refuses to acknowledge that cats exist because they’re afraid that this denies the existence of dogs, just reassure them that’s not the case, that there are two different types of animal, both with fur, both with four legs, and both with a tail, but that they are entirely different species of animals, and that it’s actually really easy to tell them apart (i.e., the three diagnostic indicators and associated clinical signs of attachment-based “parental alienation”).

Both cats and dogs exist. Both the pathology of trauma reenactment and the pathology of family violence exist. One does not exclude the existence of the other.

All that we are asking for is a change to the APA Position Statement on “parental alienation” to

1.)  Acknowledge that the pathology exists (cats exist)

2.)  Recognize the children and families evidencing the signs of this pathology as representing a “special population” of children and families who require specialized professional knowledge and expertise to competently assess, diagnose, and treat.

(Since both cats and dogs have fur, four legs, and a tail, we want to make sure we don’t misidentify a cat as being a dog, or a dog as being a cat. So we want to require that only experts in cats and dogs identify the animal in question using advanced DNA tests that will determine whether the animal is a cat or a dog).

Once you know what to look for, the difference between cats and dogs is pretty distinctive.

So if anyone runs into this argument that “parental alienation” misidentifies authentic child abuse and domestic violence, just politely reassure the other person that we are talking about different animals. Cats are not dogs.

We’d be happy to talk about the many species of dogs, but that is not addressing the point we are raising that not all animals are dogs. Some animals are cats. We would like to discuss cats, and we need to talk about cats (i.e., the reenactment of childhood attachment trauma into the current family relationships, mediated by the narcissistic and borderline personality pathology of the allied parent that is itself a result of the childhood attachment trauma).

We can discuss dogs at some other time.  Right now we’re discussing cats.

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

I received a Comment from Michelle Jones, LCSW to my blog post Bringing the Era of Gardnerian PAS to a Close.

I found her Comment so articulate and spot-on accurate that I decided to repost it here as a blog.  In my view, her description of the situation is exactly correct.

As preface let me say that the only thing I care about is bringing an end to the family tragedy of “parental alienation.”  And we can accomplish that.  We can bring this family nightmare to an end.  Today.  This instant.  The pathology of “parental alienation” is not some type of new and unique pathology. It is a manifestation of established, well-defined, and well-understood forms of psychopathology that ALL mental health professionals should ALREADY be knowledgeable in, especially if they are working with this type of pathology.

An attachment-based model of “parental alienation” is NOT me… it’s Kernberg, it’s Millon, it’s Beck, it’s Bowlby, it’s Ainsworth, it’s Haley, it’s Minuchin,… it is the work of the preeminent figures in all of psychology. 

All I did was bring this work together and apply it to the pathology commonly referred to as “parental alienation.”  It’s not “my theory.”  It is the fundamental principles within established forms of psychopathology.  Read Kernberg, read Millon, read Beck, read, Bowlby, read… it’s all there.

There is NOTHING new in Foundations.  It is all established and well-defined forms of pathology.

Here is the comment of Michelle Jones, LCSW.  I am in 100% agreement with her.  Solving the pathology of “parental alienation” is the central issue, and it is the ONLY issue.

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From Michelle Jones, LCSW:

As a mental health therapist, I am making this reply directed to mental health therapists. It is difficult for most people to rise above their current situation and see the bigger view of themselves within the context of their own era of history.  Looking back, it’s much easier to see.  As they say, “Hindsight is 20/20.”

When Joseph Lister proved that using antiseptics in surgery could reduce the number of post op infections, you would think the people at that time of history would have shouted for joy that such progress could be made.  Instead it challenged their paradigms and actually caused insult to many of the professionals at the time.  Looking back, we see the ignorance and the extreme shortsightedness of the accepted thinking of that day.  And of course today we all believe in the reality of microbiology and the need for sterile technique, but historically, the idea took some getting used to.  It actually took about a decade for people to start taking Lister seriously.  Further, without Lister’s clear and accurate assessment that “germs” caused infections (and not bad air), there was no way to justify or standardize the use of antiseptics.

We are now in a critical time of change in the history of parental alienation treatment.  I believe it is mandatory to accurately define the pathology of parental alienation in an indisputable, scientifically-based manner, as you have done Dr. Childress–so that we can justify and prescribe the necessary treatments.  We, as mental health therapists should know that our interventions are only as good as our assessments. If we do not accurately identify the pathology, then we cannot justify the necessary and appropriate interventions.

This should not be a debate about whose opinion or construct is better than whose, this should be an objective, scientific and moral endeavor to raise the professional standard of practice across the field of mental health.  If we as professionals truly believe in “doing no harm,” and our focus is truly on helping children and families, who are the foundation of our society, then we need to lay down our egos, and our outdated paradigms, and with integrity and humility, seek truth, even if it challenges us personally.

I am not criticizing Gardner, nor those who have supported the PAS model.  You have all done so much good in the world, and I sincerely appreciate your efforts.  I own and have read most of your books.  What I am asking is, “Is the PAS paradigm really working to the extent that it justifies and allows the needed solutions?”  Gardner did a lot of good to raise awareness, and at great personal expense.  His behavioral observations were accurate, but his theoretical constructs were not complete.  That’s okay.  If he were alive today, I believe he would shout, “That’s okay, just do something that works and stops the abuse!”  After reading many of his articles and books, I truly believe his motives were pure.  But his character and his contributions are not under question and we shouldn’t allow ourselves to be distracted by whether or not we should be loyal to Richard Gardner.  Adopting the constructs of an attachment-based model of parental alienation has nothing to do with being loyal or disloyal to Gardner or the groundwork he laid, it’s about the next step in history and addressing the urgency of bringing about solutions to the devastating problem of parental alienation.

As you have stated, Dr. Childress, staff splitting is a symptom of what happens to the treatment team when working with patients with personality disorders.  Divide and conquer is their MO.  I have spent years working with patients in residential treatment centers (many with personality disorders) and the clinicians would meet once or twice a week in treatment team to collaborate so that we could unite and do effective therapy.  The patients could not be helped without unified treatment interventions.

If we are going to effectively treat parental alienation or pathogenic parenting, it will require the same thing, uniting as a treatment team and implementing appropriate interventions with strict boundaries so that change can actually happen.  How do we determine the needed boundaries and interventions?  Only by first properly and accurately identifying the pathology.  Dr. Childress has painstakingly done this for us in Foundations.  I urge all mental health professionals to read Foundations and see if it fits with the established and accepted therapeutic theories we were trained in. Let’s unite in the spirit of peace and cooperation and reach consensus on the best treatment standards for parental alienation.  And then, let’s unitedly take action.

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I agree 100% with everything Ms. Jones said.

This is only about a scientifically-based description of the pathology so we can move forward in its diagnosis and treatment.  The pathology is NOT a new and unique syndrome, it is a manifestation of entirely understandable and defined forms of psychopathology. 

It is time to end the unnecessary and paralyzing debate in professional psychology and come together in the service of children and families caught in this particular form of pathology.

The focal goal of our efforts needs to be a change in the APA Position Statement on Parental Alienation so that it,

1.)  Acknowledges that the pathology exists, using whatever name establishment mental health wishes to use (“parental alienation,” “pathogenic parenting,” “attachment-trauma reenactment pathology” – or some other label for the pathology).

The pathology of “parental alienation” exists.

2.)  Formally recognize the children and families evidencing this type of pathology as representing a “special population” who require specialized professional knowledge and expertise (in attachment theory, personality disorder pathology, and family systems theory) in order to competently assess, diagnose and treat.

The complex nature of the pathology defines these children and families as a special population who require specialized professional knowledge and expertise to competently assess, diagnose, and treat.

I believe this to be a reasonable and temperate demand on our part.  All we are asking for is professional competence in established domains of professional psychology.

In order to achieve professional competence in established domains of professional psychology, we must first be able to define the pathology within established and existing forms of psychopathology.

That’s what Foundations does.  It establishes the foundations for professional competence. 

It is time to end the divisive and damaging debate within professional psychology and come together, all of us, to meet the very real needs of the children and families experiencing this type of tragic psychopathology.

Thank you for your support Michelle.  Your banner is on the battlefield in support of the children and families who need us.

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

Foundations is not “my theory.”  Here is the source material:

Central References:  Books

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.

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.

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

• If a mental heath professional is assessing, diagnosing, or treating this population of children and families and has not read these texts by the most preeminent figures in attachment theory, personality disorder pathology, and family systems theory, then the mental health professional is very likely to be practicing beyond the boundaries of his or her professional competence in violation of Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Additional Central References: Research

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

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.

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.

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

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

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.

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.

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

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.

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

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.

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.

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

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.

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

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.

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.

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

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.

Additional Supporting Research

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.

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.

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

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

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

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

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.

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.

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.

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.

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.

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,

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.

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.

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.

Additional Supporting Books

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)