Final Response to Dr. Mercer

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

23 thoughts on “Final Response to Dr. Mercer”

  1. Thank you, Dr. Childress. It is great to see a warrior mentality in a man who has spent the time and energy necessary to gather his weapons and sharpen them for battle. I wish I could have had you available 17 years ago. I lost the battle to salvage a relationship with my children, a daughter (17) and a son (20). I hope to find a way to use what I am learning from you to close this gap that exists. In the mean time, your knowledge has saved me from the depression that has been destroying my ability to be productive and happy for the past 17 years. Give ’em hell! Or, as Truman noted, give ’em the truth and let ’em think it is hell. You speak for millions!

  2. Excellent Dr Childress
    Ignorance breeds incompetence for so many of these professionals, It is akin to 13th century clerics and trying to convince them the world is not flat
    PA is real

  3. Regarding treatment, this raises a good question. Dr. Mercer clearly has personal issues that impede her ability to assess and recognize “the pathogen.” This a core impediment to treatment nationwide. I have a “Dr. Mercer” who’s work with my daughter for the past 22 months has entrenched the alienation and fostered my daughter’s confidence in making false allegations.

    As Dr. Childress has oft stated, the pathological dynamics here are not new. Any competent professional should be able to recognize them. A core problem to effective treatment is that therapists often don’t recognize them because they are either incompetent and/or have unresolved personal issues of their own which make them resistant to the science.

    I have filed a complaint with this state’s Board of Licensing about my daughter’s therapist. I have a strong case as this psychologist has resisted three other psychologist’s suggestions, and, because of court discovery we have documentation of this therapist’s contemptuous attitude towards me. However, although I did receive an acknowledgement to the complaint, we are well past the 30 days, when I’m supposed to find out about the investigation.

    Each state has it’s own procedure’s regarding complaints like this. From my reading on blogs, etc, they often have a reputation for doing nothing.

    I’m wondering what can happen to foment a change within the APA and state’s licensing boards to intervene in cases of incompetence and protect the children.

    Both Dr. Mercer and my daughter’s therapist have excellent reputations. However, excellent reputations are now owned, they are rented. Clearly both these individuals stopped paying rent a while back.

  4. Dear Dr. Childress,

    It is evident that Dr. Mercer has only head knowledge regarding this subject. There is no heart evident; meaning her personal experience and compassion level on this subject is minimal at best.

    Unless Dr. Mercer has witnessed a parents pain who has lost their child to the alienating parent she can’t know what she doesn’t know and book knowledge alone won’t give her what she needs.

    I have both personally experienced this in my own life as well as in my practice working with families and children.

    Dr. Mercer seems to come from a place which is combative and egocentric.

    Thanks for all you do! Emily Hastings http://www.emilyhastings.net

    Sent from my iPhone

    >

  5. I think you must know that I am talking about your “protective separation” method, not about family systems therapy. Am I to understand that you treated a 2 1/2- year-old in that way, or are you simply saying that you have at some time worked with a child that young in some way?

    As for being the arbiter of truth, I leave that claim to Chambless & Hollon and to others like the Cochrane and Campbell collaborations who have developed guidelines for evidentiary support. I merely apply the guidelines that have been accepted by APA and other professional groups. Regrettably, in states that use the Frye standard, these may not be applied in court.

    While we are suggesting reading lists to each other, I would recommend that you have a look at Lilienfeld et al’s “Science and pseudoscience in clinical psychology”. This edited book discusses in detail some of the issues related to evaluation of any proposed treatment.

    It’s clear to me that you do not have systematic evidence to support what you do. I don’t really need to explore that any further. What interests me more just now is the claim that encouraging a child’s rejection of a parent is not just bad manners and a bad example, but actual abuse that results in definite problems when the child reaches adulthood. The work by Amy Baker seems to me to get into affirming-the-consequent territory. But I’ll comment on this on my own blog when I get time.

  6. I do not understand this argument. For empirical testing there has to be a hypothesis to test. These hypotheses are almost always rational extensions from existing theories. That is exactly what we have here. The idea that one should not propose rational extensions of existing theories until they are empirically validated is ludicrous. I could see an argument that the extension was not rational or that the degree of empirical testing is overstated, but that does not seem to be the case here.

  7. Dr Childress. My children’s father doesn’t rage, but he has alienated me from my children and fits the description of the narcissistic/borderline parent in every other way. Would that then make him a covert narcissist? as he doesn’t really display overt signs of anger

    Sent from my Windows Phone ________________________________

  8. Your response , should make anyone Pause and rethink their motives and position. Very well written and so important to be able to shut these critics down. Thank you, for your caring of this under the radar abuse..

  9. I have just read the last Dr Mercer”s answer on her blog CHILDMYTHS (Sept 22, 10:51 AM) about perverse triangle, reversal relationship ad trauma reeneactment and I am stunned.
    Does she have systematic support and empirical work for statements that;
    ” the alienating parent may place the child as a comforter and emotional regulator of a positive nature”
    ” it’s very possible that in fact children don’t require both parents for good development” or
    “as you may know a original view of “the best intrests of child was that compete custody and authority should be given to one paret who would make all decision about contact with the other parent. This seems preety tough, but in some cases it seems to me the oly way to let a child just get on with his or her life.”

    1. I am very sorry for the mistakes.
      It should be:
      “as you may know an original view of “the best interests of child” was that complete custody and authority should be given to one parent who would make all decisions about contact with the other parent. This seems pretty tough, but in some cases it seems to me the only way to let a child just get on with his or her life.”

  10. Dr C, please do not be dissuaded by the noise in the mental health community regarding your work (and I suspect you are not). You have never met me or my ex, but you have described the situation that transpired once I broached the topic of divorce albeit years before her planning was executed. It took her years to manipulate the kids… and it took the help of many binding sites of ignorance including mental health experts, but this operator followed the game plan perfectly (so detectable especially on the results demonstrated to the courts by our kids). You have it, and you have it precisely right. In my humble opinion being cognizant of our litigious society, many mental health experts have been duped… have “exposure” or just refuse to countenance their error and what it it has meant to all of those effected. That’s a heavy burden for them, and many on the other side (the alienated parents) are frustrated by the lack of balance or even a fair assessment of their experience in the system – pretty much in Europe and the US.

    So this is hard road. You really have the answer, please don’t falter, we are all standing with you.

    LJO

  11. I am halting my discussion over on the “child myths” blog. It has been several days since I made some more comments, but they have not been “approved” yet. Also, several of my posts over the last few weeks were never “approved”, and I thought I made some very excellent points in at least some of them. Furthermore, there have been delays, which meant that the blog was always recently updated with comments from the other side but not updated with my comments. That is no way to carry on a discussion.

    1. All of my comments have not been approved either. The last post from Dr Mercer ” Is Parental Alienation Child Abuse?” seems only to be a provocation as she never met any professionnal standarts in this blog.

  12. Dr Childress,

    I have been trying to better understand Dr. Mercer’s challenges to your proposed structure. I have been able to suss out one criticism that may lead to fruitful discussion. She seem’s to agree that observed evidence of child abuse should be of interest for those deciding child contact issues, but she seems to believe the phenomena you describe is not necessarily child abuse. The best I can tell, she is rejecting your argument that the phenomena is abuse without reviewing said argument, but instead upon her belief that new concepts in psychology should only be accepted when there is direct empirical support.

    My understanding of your work with regard to PA as child abuse is that (a) when a child is observed to have a severe disruption of his attachment system the child is damaged and (b) when the damage is caused by the behavior of a parent then the parent’s behavior constitutes abuse.

    With regard to (a) can you elaborate on the most direct empirical support? I would assume this would consist of studies showing a meaningful mathematical correlation between disruption of the attachment system and subsequent life problems published in a peer review journal.

    Best regards,

    Jimmy

    1. Hi Jimmy,

      Look to the three diagnostic indicators of the pathology. It’s not just a disruption to the attachment system. A disruption to the attachment system problematic, but that happens. It’s called an insecure attachment. But this is even worse than an insecure attachment. It’s a complete termination of the child’s attachment bonding motivations. But still, I wouldn’t go so far as to call that child abuse. But turning to diagnostic indicator 2, we have five narcissistic/borderline symptoms in the child’s symptom display. So the parent is producing a personality disorder in the child. Now I’m getting concerned. Especially since one of the prominent child symptoms is an absence of empathy, which is associated with the capacity for human cruelty. I’m also beginning to get concerned about the tran-generational transmission of this pathology to the children of the current child.

      But then we turn to the third diagnostic criteria, the presence in the child’s symptom display of a delusional belief. Now we have not only severe developmental pathology (attachment termination) and severe personality pathology, we have psychosis being induced by a parent. Okay. that clearly crosses the line for me. Attachment pathology AND personality pathology AND psychotic psychiatric pathology all being induced by the distorted parenting practices of a parent. We have to step in a do something to protect the healthy development of the child.

      If someone wants to argue that it’s okay to produce that level of pathology in a child they are welcome to make that argument. I’m going to argue that inducing severe developmental pathology AND severe personality pathology AND psychotic psychiatric pathology in a child because of distorted parenting practices becomes a child protection issue.

      Do we really need to wait 10 to 20 years until empirical studies demonstrate that inducing severe attachment pathology, personality pathology, and psychotic psychiatric pathology in a child produces problematic outcomes for the child, and for the children of these current children, and allow all of these children and their children to suffer from this pathology, or should we simply step in and within six to nine months solve everything and restore the child’s normal-range and healthy development?

      My argument is that we step in and solve things in six to nine months, and not sit back and allow the distorted parenting of one parent to produce severe developmental, personality disorder, and psychotic psychiatric pathology in a child.

      Craig Childress, Psy.D.

  13. Oh! I think I figured it out! I’m not a psychologist, so forgive me for my brain lag. Plus, I’m much better with analogies and illustrations than I am with trying to work through all the technical stuff.

    Let’s say I go to a Psychiatrist and he diagnoses me with a set of symptoms straight out of the DSM-5. He doesn’t see these symptoms together very often, but they are all in there and he knows which medications to try on me.

    Does this mean that, before he can write any prescriptions, he has to go around and make sure that the symptoms he has seen don’t add up to another possibility? Is he responsible for calling other Psychiatrists and verifying that those symptoms actually do require treatment? Does he have to start gathering empirical evidence that the medications he is about to prescribe are effective? Does he need to have his diagnosis peer reviewed before he can send me to the pharmacy?

    No.

    And that’s what this is all about.

    Again, sorry about the brain lag. This is why I love Dr Childress’ “Cats are not Dogs” and “Cats in the Garden” explanations so much. I’m better with analogies and illustrations.

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