Diagnosing the Pathology

I recently received an email consultation request from a child custody evaluator who asked if I was also a custody evaluator.  I’m not.  I explained how I became involved in diagnosing and treating the pathology traditionally called “parental alienation” in the common culture.

I then explained how this pathology is not a “new syndrome” but is an expression of well-established, well-defined, and fully accepted forms of psychopathology within the field of professional psychology and how this form of pathology can be reliably diagnosed and differentiated from other forms of parent-child conflict 100% of the time.

My response to this child custody evaluator may be of broader interest to targeted parents and mental health professionals generally, so I am providing it as a post below.

My email response to a child custody evaluator:


Hello Dr., it’s a pleasure to meet you.

To answer your question, I’m not a child custody evaluator because I come out of the ADHD and Oppositional Defiant Disorder realm.  We could control the symptoms of ADHD but never cure them, so I kept working with a younger and younger age group in hopes that if we caught it early enough we could actually cure ADHD.  In the mid-1990s I dropped below the age of 5, which meant that I had to develop a secondary expertise in early childhood, which led to my background with the attachment system.

In 2007 I left my role as the Clinical Director for an early childhood assessment and treatment center working with children in the foster care system to enter private practice with the goal of writing books on a socio-neuro-developmental approach to child therapy and parent-child therapy.  That’s when I ran into my first case of “parental alienation.”

I had never even heard of “parental alienation” or Gardner before.  I immediately recognized the family systems cross-generational coalition, and what was readily apparent to me from my background with the attachment system was that the child’s display of the attachment system was inauthentic to how the attachment system actually works.

Children don’t reject parents.  Children who rejected parents were eaten by predators and their genes were removed from the gene pool.  Bad parenting actually produces an “insecure attachment” that MORE strongly motivates the child to bond to the bad parent.

What was also clearly (and disturbingly) evident was a prominent display by the child of an absence of normal-range empathy.  The absence of empathy is a narcissistic personality symptom not an Oppositional Defiant Disorder symptom.  I then looked for other narcissistic personality symptoms and noted that a variety of narcissistic symptoms were evident in the child’s symptom display; including splitting.

The child was in a cross-generational coalition (Munichin; Haley) with a narcissistic parent (Millon, Beck, Kernberg) against the other normal-range parent.

I met with dad in this particular case, who was the allied parent, and confirmed the diagnosis.  All this took about three to six sessions.  No big deal.  All standard family systems and DSM diagnostic stuff.  What astounded me was how the legal system was totally unable to address the pathology.

When I looked into it more I came across all the controversy surrounding Gardner and PAS.

What struck me first is that Garnder’s model of PAS is really bad.  The eight symptom identifiers are too vague and are not associated with any other form of pathology in all of mental health.  And there is no underlying theoretical formulation for the pathology, it simply exists ex nihilo (out of nothing).

This pathology is not a “new syndrome” – Gardner was simply a very poor diagnostician.  He too quickly abandoned standard and established psychological principles and constructs in proposing a “new syndrome” that was unique in all of mental health, with a proposed set of eight equally unique new symptom identifiers which he simply made up out of anecdotal clinical experience.

In proposing a unique “new syndrome,” Gardner took everyone down the wrong path.  He skipped the step of diagnosis.

So looking at the situation and what was needed, I decided to fix the step that Gardner skipped – diagnosis.  This meant that I had to define the pathology from entirely within standard and established psychological principles and constructs.

A child’s rejection of a normal-range parent is clearly an attachment-related disorder (i.e., a trans-generational transmission of attachment trauma – mediated by the narcissistic/(borderline) personality traits of the allied parent).

It involves a family systems cross-generational coalition (the child’s symptoms maintain a homeostatic balance in a family which is having difficulty transitioning from an intact family structure united by the marriage to a separated family structure united by the continuing parental roles with the children).

It involves the influence on the child by a narcissistic/(borderline) personality parent in which the child acquires the narcissistic personality traits (attitudes and beliefs) of the parent.

Once I worked out the pathology, I identified the most parsimonious set of child symptom identifiers that could reliably differentiate this form of pathology from ODD and other forms of parent-child and family conflict.

  • Attachment system suppression: indicative of the attachment-related core of the pathology.
  • Narcissistic personality traits in the child’s symptom display: indicative of the influence on the child by a narcissistic personality allied-parent.
  • A fixed and false belief (encapsulated delusion) regarding the supposedly “abusive” parenting of a normal-range (targeted) parent: indicative of the child’s incorporation into a false trauma reenactment role as the supposedly “victimized child,” reflecting the overall attachment trauma reenactment narrative the allied narcissistic/(borderline) parent.

False trauma reenactment narrative: “abusive parent”/”victimized child”/”protective parent”

No other pathology in all of mental health will produce this specific set of three child symptoms.  This specific set of child symptoms represents definitive diagnostic evidence of the child’s cross-generational coalition with a narcissistic parent and the child’s incorporation into this parent’s false attachment trauma reenactment narrative of “abusive parent”/”victimized child”/”protective parent” which is designed to stabilize the collapsing psychological structure of the narcissistic/(borderline) parent surrounding the rejection and abandonment inherent to divorce.

In clinical psychology, there is no such thing as “parental alienation.”  The correct clinical psychology term for this pathology is “pathogenic parenting” (patho=pathology; genic=genesis, creation).  Pathogenic parenting is the creation of significant psychopathology in the child as a result of aberrant and distorted parenting practices.

The construct of pathogenic parenting is an established construct in early childhood mental health and attachment-related pathology since the attachment system ONLY dysfunctions in response to pathogenic parenting (the term “pathogenic caregiving” was used in the DSM-IV diagnostic criteria for a Reactive Attachment Disorder).

Diagnosis guides treatment:

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Pathogenic parenting is not a child custody issue, it is a child protection issue.

All mental health professionals, including child custody evaluators, need to begin assessing for this pathology under Standard 9.01a of the APA ethics code:

9.01 Bases for Assessments

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

All mental health professionals, including child custody evaluators, need to begin making an accurate DSM-5 diagnosis of the pathology as V995.51 Child Psychological Abuse, Confirmed when the three definitive diagnostic indicators of severely pathogenic parenting are present in the child’s symptom display.

All mental health professionals have a “duty to protect” and all mental health professionals are mandated reporters of child abuse.  When a DSM-5 diagnosis of V995.51 is made, all mental health professionals incur a professional obligation under their duty to protect to take affirmative actions to protect the child, and these affirmative actions to protect the child must be documented in the patient record.

This obligation is in addition to any other function or role the mental health professional may have.

A failure to properly assess for the pathology may represent a violation of Standard 9.01a of the APA ethics code, and a failure to properly diagnose the pathology when the three diagnostic indicators of severely pathogenic parenting are present in the child’s symptom display may represent a violation of Standard 2.01a regarding boundaries of competence and the professional’s “duty to protect.”

Gardner was correct in identifying a form of pathology, but he was incorrect when he proposed that it represents a new form of pathology; a “new syndrome.”  It doesn’t.  It is a manifestation of well-established and fully accepted forms of pathology.

Gardner was a poor diagnostician.

I have simply corrected Gardner’s diagnostic inaccuracy.

I have submitted proposals for APA and AFCC presentations for the past two years without being accepted.  I will apply again this next round.  I suspect they just lump me in with PAS been-there-done-that sort of proposals.

I have presentations regarding the theoretical foundations of the pathology up online which I did for the Master’s Lecture Series of California Southern University:

Parental Alienation: An Attachment-Based Model (7/18/14)

Treatment of Attachment-Based Parental Alienation (11/21/14)

I am also attaching a Diagnostic Checklist of Pathogenic Parenting that is available on my website.

Diagnostic Checklist for Pathogenic Parenting

The pathology traditionally called “parental alienation” is readily solvable once we turn away from Gardnerian PAS and return to standard and established principles and constructs of professional psychology.

Diagnosis guides treatment.

Best wishes,

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

7 thoughts on “Diagnosing the Pathology”

  1. This is pure gold.

    I would be very interested in knowing how well this response was received by the evaluator. It would be great to hear about more professionals jumping on-board.

    Thank you, Dr. Childress, for all of your miraculous work.

  2. Thank you, Dr Childress, on behalf of all of us parents who see our children being abused in this terrible way and can only do so much to try to he!p them because very few can be persuaded of the reality of this insidious pathology. Your crystal clear explanation of the proper diagnosis (and elsewhere the treatment) and passionate pursuit of it being accepted by the legal and mental health powers-that-be is an absolute gift to us and of course to our children. Your relentless search for truth is inspiring. May God bless you and your work.

  3. Brilliant. Now if the APA would accept/adopt this model we would have a chance of the court system(s) being open to it. I know in my case, the court would not even consider PAS, due in part to “it’s not even in the DSM”. What an uphill battle this has been, and still is.

    1. Actually, we don’t need the APA to accept anything. It would be more efficient if they provided leadership, but that is secondary.

      Mental health professionals are not allowed to be incompetent. They are required by professional standards of practice to properly assess and diagnose pathology. APA Standard 9.01a requires that they properly assess for pathology sufficient to substantiate their diagnostic statements and Standard 2.01a requires that they possess the necessary professional competence in the relevant domains of pathology.

      Failure to properly assess for the pathology and accurately diagnose the pathology would be grounds for a licensing board complaint and potentially a malpractice lawsuit. In addition, failure to possess the necessary competence that then harms the client would be a violation of Standard 3.01 of the APA ethics code. In addition, failure to properly assess, diagnose, and respond to child abuse may represent a violation of the mental health professionals “duty to protect.”

      All of these issues represent legitimate grounds for potential licensing board complaints and malpractice lawsuits. Targeted parents need to begin holding mental health professionals accountable for professional competence in the assessment and diagnosis of pathology.

      The goal is not to punish any particular mental health professional, the goal is to provoke a system-wide “risk management” response from all mental health professionals of becoming competent, assessing for the pathology, and accurately diagnosing the pathology in order to avoid a licensing board complaint and malpractice lawsuit.

      We cannot hold mental health professionals accountable to the construct of “parental alienation.” We can hold them accountable to established psychological constructs and principles, which is why Foundations is so important. It provides the theoretical Foundations in established psychological principles and constructs that allows targeted parents to begin holding mental health professionals accountable.

      I’ll have more to say on this shortly. But we don’t need anyone to accept anything. All of the principles and constructs are already fully established and fully accepted. We simply need to enforce existing standards of professional practice.

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

      1. And by the way, the pathology of “parental alienation” is in the DSM-5, on page 719. It’s a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

        Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse.

        All we need is for the involved mental health professionals to begin assessing for the three diagnostic indicators of pathogenic parenting by an allied narcissistic/(borderline) personality parent and making an accurate diagnosis of the pathology when the three diagnostic indicators of pathogenic parenting are present in the child’s symptom display.

        Pathogenic parenting – producing pathology in the child through aberrant and distorted parenting practices. The key is to focus on the child’s symptom display.

        No other pathology in all of mental health will produce this specific set of three diagnostic indicators other than pathogenic parenting by an allied narcissistic/(borderline) parent (as described in Foundations).

        All we need is for mental health professionals to begin assessing for the pathology and making an accurate diagnosis of the pathology when the three diagnostic indicators are present in the child’s symptom display.

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

  4. Dear Dr. Childress, This response has a certain confident and friendly “ring” to it. The Alliance would like your permission to include it (minus any personal references) in the toolkits we are assembling for targeted parents to present to their lawyers, mental health providers and the schools. These include your published works as they pertain to each domain embedded in the Adverse Childhood Experiences (ACEs) and trauma informed models. I think it is really strange that there are large movements in pediatrics, schools and family and juvenile courts to become trauma informed, but nothing I can find within professional mental health. They should be leading this nation in healing from this toxic interpersonal trauma, but they seem confused at best.
    Kay

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