Best Practices Article in the Journal of Family Therapy

Assessment leads to diagnosis, and diagnosis guides treatment.

In proposing a new form of pathology – a “new syndrome” – Richard Gardner skipped the crucial step of diagnosis.  Diagnosis involves the application of standard and established psychological principles and constructs to the set of symptoms presented by the client.

In the medical field, it is vitally important to know if we’re treating cancer, or diabetes, or heart disease.  Different diagnoses will entail different treatments – different approaches to their solution.  Assessment leads to diagnosis, and diagnosis guides treatment.

Assessment:  If you have medical aches and pains and go to your physician, the first thing your physician will do is an assessment. The physician begins by identifying the range and type of symptoms you’re having (Where do you feel pain?  Is your pain sharp or blunt?  Is your pain continuous or intermittent?  Are there things that make your pain better?  Worse?).  The physician will also conduct a broad assessment of your various physical systems, check your blood pressure, your temperature, listen to your heart, look in your eyes, ears, and throat, probe various body areas to see how you respond).  The physician may even seek additional testing, such as blood work or an MRI.

Diagnosis:  Based on this assessment of your symptoms, your physician will diagnose the problem.  Assessment leads to diagnosis.

Treatment:  The treatment for your medical aches and pains will depend on the diagnosis.  If you’re diagnosed with diabetes, you’ll receive a treatment plan for diabetes.  If you’re diagnosed with cancer, you’ll receive a treatment plan for cancer.  If you’re diagnosed with heart disease, you’ll receive a treatment plan for heart disease.  Diagnosis guides treatment.

Assessment leads to diagnosis, and diagnosis guides treatment.  Get it?  Makes sense right?

Gardner skipped the diagnosis step.  He looked at a set of symptoms and proposed a whole new form of pathology unrelated to any other pathology in all of mental health – a “new syndrome.”  Instead of applying the standard and established constructs of professional psychology to the symptom set to accurately diagnose the pathology (pathological mourning; pathogenic parenting; the trans-generational transmission of attachment trauma, triangulation, cross-generational coalition), he just made up a whole new diagnosis: “Parental Alienation Syndrome.”

Establishment psychology looked at this proposal for a whole new form of pathology which was supposedly unique in all of mental health, and said, “Noooooo, we don’t think so.  We don’t think you’ve applied the professional rigor necessary to accurately diagnose the pathology.  Your “diagnosis” as a completely new and unique form of pathology isn’t justified.  You need to do a better job of diagnosis using standard and established constructs and principles.”

And for the past 30 years, establishment psychology has consistently and steadfastly provided this constructive feedback to the Gardnerians and their Gardner-based derivative diagnoses.

And for the past 30 years, the Gardnerian contingent has consistently and steadfastly refused to accept this constructive feedback, and they have continued to maintain that the symptom set represents an entirely new form of pathology unique in all of mental health.

In addition, the proposed symptom set used in the assessment of this supposedly new and unique form of pathology is so inherently vague and poorly defined that these proposed diagnostic indicators will often miss the diagnosis when it’s there and will sometimes identify the pathology as being present when it’s not there.  That’s kind of a problem when we’re trying to diagnose a pathology.  Assessment leads to diagnosis. But if the symptom set we’re using to assess for the presence of the pathology is so vague and poorly formulated that we sometimes wind up misdiagnosing the pathology, that’s not good.

If you are misdiagnosed as having diabetes when you actually have cancer, you will receive a treatment plan for diabetes and you will die from your misdiagnosed, and therefore untreated, cancer.  This is the problem we’re facing with the pathology traditionally called “parental alienation” in the popular culture.  The pathology is not being properly assessed because the identifying symptom set used in assessing Gardnerian “parental alienation” and the various proposed Gardnerian-based derivative models, is too vague and ill-formed that it leads to frequent misdiagnosis (typically under-diagnosis).

The primary misdiagnosis is failing to identify the pathology when it’s present, although the child protection and domestic violence safety advocates in establishment mental health also raise valid concerns that the vague and ill-formed symptom set used in the assessment of Gardnerian-based “parental alienation” will incorrectly identify authentic child abuse as being “parental alienation.”

The assessment, diagnosis, and treatment of a pathology begins with first defining what the pathology is.  We can then identify characteristic symptoms of the pathology by which it can be indentified and diagnosed, and then diagnosis guides treatment.

A recently published article in the Journal of Family Therapy by what appears to be Gardnerian-inspired researchers is entitled “Recommendations for Best Practice in Response to Parental Alienation: Findings from a Systematic Review” (Temper, Matthewson, Haines, & Cox, 2016) and it highlights exactly this fundamental problem of too quickly bypassing diagnosis, the application of standard and established constructs and principles to a set of symptoms.  So I’d like to take a moment to provide an analysis of this article in order to highlight the fundamental problem with the Gardnerian-based model of “parental alienation.”

First let me say, the authors actually did a very good job of what they did. The problem is that they are fundamentally standing on the insubstantial foundations of a flawed model of pathology.  That’s going to be a problem.  So the problem isn’t actually with what the authors did, it’s with the flawed foundational premise provided by a Gardnerian model of “parental alienation.”

Notice first that this article deals with treatment, not assessment, not diagnosis… treatment.

The primary problem with the construct of “parental alienation” is in its assessment and diagnosis.  Until we have solved these fundamental initial steps, until we have a diagnosis of the pathology from within standard and established constructs and principles, then we don’t have guidance regarding its treatment.  Diagnosis guides treatment.

Oh, but right, the Gardnerians are claiming that “parental alienation” represents an entirely unique new form of pathology, unrelated to any other pathology in all of mental health.  I strongly disagree, but let’s start with that premise, that the pathology of “parental alienation” represents an entirely unique new form of pathology in all of mental health, then the critical question becomes what is the definition of this unique new form of pathology?

So let’s examine the definition of this unique new form of pathology which is offered by the authors of this article.  In defining this unique new form of pathology, they claim that,

“The defining feature [of parental alienation] is an attempt by the alienating parent to eradicate the relationship between the child and the targeted parent without reasonable justification (Meier,2009).”

Interesting…  but actually… that’s incorrect.  Let me explain.   If the “defining feature” of the pathology of “parental alienation” is an “attempt” by the allied parent to eradicate the child’s relationship with the other parent, that could potentially lead to a very strange and bizarre diagnostic situation.

Say a parent attempts to eradicate the child’s relationship with the other parent but fails to accomplish this goal, and the child still remains affectionally bonded to the targeted parent.  According to the “defining feature” offered by the authors (supported apparently by Meier, 2009), this situation of the child’s continued affectional bonding to the targeted parent would still represent “parental alienation” because the parent attempted to eradicate the child’s relationship, but this attempt was simply unsuccessful.

Oops.  That’s a problem.  If a child can remain affectionally bonded to the targeted parent yet still be “alienated” – that would seem to represent a problematic definition of the pathology.  So either the authors are proposing a form of pathology in which the child can be non-symptomatic of any pathology yet still be diagnosed as having the pathology, which is weird, or the author’s didn’t think through their “defining feature” of the pathology very well.  I suspect it’s the latter, and I suspect that given the chance the authors might refine their definition somewhat.  Unfortunately, it’s in print now so that’s the “defining feature” they’re proposing.  I’m surprised that this wasn’t caught by the journal reviewers.  Sloppy work journal reviewers. Isn’t anyone doing any critical thinking about this?

Another highly problematic diagnostic implication of this definition of the pathology is that it requires that the mental health professional document the attempts by the alienating parent to eradicate the child’s relationship with the other parent rather than the child’s symptoms.  From an assessment and diagnosis perspective, this is almost impossible to do.  The allied “alienating” parent is hiding behind the child (“It’s not me, it’s the child.  I tell the child to go on visitations. I encourage the child to go on visitations with the other parent. But the child refuses.  It’s not me, it’s the child”).  Given this manipulative exploitation of the child as a symptomatic “human shield” for the covert and hidden influence of the narcissistic/(borderline) parent, how is the mental health professional to assess for and document the attempts by this parent to eradicate the child’s relationship with the other parent?

The term “attempt” also suggests a conscious volitional intent on the part of the allied parent to purposefully eradicate the child’s relationship with the other parent. What if the allied parent isn’t actually aware that he or she is alienating the child, but actually believes that the other parent is “abusive” of the child, and that the allied parent actually believes that he or she is only trying to “protect the child”?  Can we actually say the allied parent is “attempting” to eradicate the child’s relationship with the other parent when this parent is unaware of this motivation, and perceives himself or herself to simply be “listening to the child” and trying to “protect the child” from the other parent’s abusive parenting?

The authors of this article, however, actually believe that they have defined the pathology in a way that allows for its assessment and diagnosis. They’re wrong.  As a clinical psychologist I can tell you, it is nearly impossible to assess and diagnostically establish the definition of the pathology they assert (i.e., the “attempt” by the allied parent to eradicate the child’s relationship with the other parent). 

As a clinical psychologist conducting a clinical assessment in my office, I can document the child’s symptoms, I can document the child’s conflicted relationship with the targeted parent.  I can document the child’s praise for and displays of affectionate bonding with the supposedly “favored” and allied parent.  But it is nearly impossible for me to document the “attempt” by the allied parent to eradicate the child’s relationship with the other parent. This happens out of sight and is hidden from view.

By contrast, in AB-PA the “defining feature” of “parental alienation” is the child’s rejection of a normal-range and affectionally available parent.  This “defining feature” is clearly evident in the child’s symptom display, and it immediately defines this form of pathology as an attachment-related pathology (i.e., the suppression of the child’s normal-range attachment bonding motivations toward a normal-range and affectionally available parent).  The diagnostic recognition of this form of pathology as an attachment-related form of pathology brings to bear all of the research regarding the functioning of the attachment system and attachment-related forms of parent-child relationship distortions, such as the construct of “pathological mourning” (Bowlby, 1980).  According to Bowlby,

“The deactivation of attachment behavior is a key feature of certain common variants of pathological mourning.” (Bowlby, 1980, p. 70; emphasis added)

Bowlby even links “disordered mourning” as being a symptom feature of personality pathology (such as the narcissistic/(borderline) personality pathology of the allied parent).

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; emphasis added)

According to an attachment-based model of “parental alienation” (AB-PA), the “disordered mourning” of the narcissistic/(borderline) parent surrounding the divorce is being transferred to the child through the aberrant and distorted parenting parenting practices of the narcissistic/(borderline) parent, and the child is now displaying a similar “pathological mourning” surrounding the divorce as evidenced in the “deactivation of attachment behavior” toward the normal-range and affectionally available parent. 

That’s called diagnosis.  Diagnosis is the application of standard and established constructs and principles from professional psychology to the symptom set.

Diagnosis then guides treatment. 

If the diagnosis is “disordered mourning” due to the pathogenic influence on the child of the narcissistic/(borderline) parent (who represents the “primary case” of pathological mourning), then the treatment is to help re-orient the child to the child’s experience of unprocessed and misunderstood sadness and grief surrounding the divorce and the breakup of the intact family structure, sadness and grief that is currently being expressed as anger toward the targeted-rejected parent (in the same way that the allied narcissistic/(borderline) is processing their own grief and sadness surrounding the divorce as “anger and resentment, loaded with revengeful wishes”).

“They [narcissists] 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, 1975, p. 229; emphasis added)

But I digress, we were talking about the “best practices” for the treatment of a new form of unique pathology – “parental alienation” – which is being proposed by the authors of the article.  So let’s continue by discussing the second half of the authors’ definition of this unique new form of pathology; i.e., that the eradication of the child’s relationship with the targeted parent is “without reasonable justification.”  The diagnostic question that immediately arises from this part of the definition is:

What is the operational definition for a “reasonable” justification for the parent-child conflict?

In my experience, the authors’ definition of the pathology provides the diagnosing mental health professional with far too much latitude and discretion for arbitrarily determining what represents a “reasonable” justification for the child’s hostility and the parent-child conflict.   This vaguely worded definition of the pathology absolutely invites professional incompetence. 

Far too often – way-way to often – I have seen incompetent mental health professionals conclude that the child’s hostility and rejection of the targeted parent, while acknowledged to be excessive and extreme, is nevertheless “reasonable” given a past parent-child incident, such as when, 2 years ago, the targeted parent called the police to intervene with the child’s hostility and threatening behavior, and the current mental health professional concludes that this incident from two years ago represents a “reasonable” justification for the child’s current anger and rejection.  Really?  An event two years ago provoked by the child’s hostility and threatening behavior represents a “reasonable justification” for the child’s current rejection of the targeted parent?  According to the assessing and diagnosing mental health professional it does. 

Or the mental health professional concludes that the frequent arguments between the child and targeted parent (which are acknowledged to be provoked by the child’s overt hostility and disrespect) represent a “reasonable” justification for the child’s desire to terminate visitations with the targeted parent. Really?  Yep, according to the diagnosing mental health professional, that’s a “reasonable” justification.  It astounds me what mental health professionals find as “reasonable justifications” for the child seeking to terminate a relationship with the targeted-rejected parent.

Common to this under-diagnosis of the pathology is the (false) belief system held by many mental health professionals that both parents are contributing to the family conflict.  While true in many cases of normal-range family conflict, this assumption is NOT true when the family includes one parent with significant narcissistic/(borderline) personality pathology.  A parent with narcissistic or borderline personality pathology is fully capable of single handedly creating ALL of the pathology and conflict evidenced in the family.

Yet far too many mental health professionals inappropriately apply standards of evaluation appropriate to normal-range families to the assessment of families containing a narcissistic or borderline parent.  When this occurs, the (false) belief that “both parents share responsibility” for contributing to the conflict leads the mental health professional to the erroneous conclusion that the cause of the child’s hostility and rejection toward the targeted parent is, to some degree, the fault of the targeted parent. This false assumption then leads the mental health professional to a micro-critical judgement of the parenting practices of the targeted parent, in which normal-range parenting is critiqued at such a micro-judgmental level that the supposed parental failures that are alleged by the child, no matter how distorted, untrue, or minor – are accepted by the mental health professional as “reasonable justifications” for the child’s rejection of the targeted parent.

As a clinical psychologist, my problem with this definition of the pathology offered by the authors is that it is so poorly formulated that it absolutely invites professional incompetence in the assessment and diagnosis of the pathology, resulting in extensive under-diagnosis of the attachment-related pathology of pathological mourning.

In addition, on the other side of the issue, child protection and domestic violence safety advocates take strong exception to the “without reasonable justification” definition of the pathology offered by the Gardnerians.  Their concern is that this form of definition provides the mental health professional with too much discretionary latitude to arbitrarily and unilaterally over-rule, discount, and invalidate the child’s reasons for not wanting to be in a relationship with an overly harsh or aggressive parent.  These child protection and domestic violence safety advocates question whose perception of “reasonable justification” takes precedence.  They place emphasis on the child’s rights of autonomous perception to define what constitutes a “reasonable justification” for the child’s reactions, whereas the Gardnerians place their emphasis on the mental health professionals’ supposed rights or obligation to overrule, discount, and invalidate the child’s expressed views and perceptions when the mental health professional believes these child perceptions are incorrect.

Note that the phrase “without reasonable justification” is a negative framing of the symptom as the absence of something – without something.  By contrast, the AB-PA model for the attachment-related pathology of “parental alienation” shifts this absence-framed “without reasonable justification” symptom proposed by the Gardnerians into a more specified and positive symptom format of established psychiatric terminology as the presence of an “encapsulated persecutory delusion” (diagnostic indicator 3; google “encapsulated delusion”).  An encapsulated persecutory delusion is an established psychiatric construct, and the assessment and diagnosis of an encapsulated persecutory delusion is well within the diagnostic scope of practice for ALL mental health professionals. 

If the mental health professional does not possess the knowledge and competence to diagnose an encapsulated delusional disorder, then that mental health professional has no business working with delusional disorders, simple as that – and AB-PA is a delusional disorder: ICD-10 diagnostic code F24 Shared Psychotic Disorder.

“A condition in which closely related persons, usually in the same family, share the same delusions.  A disorder in which a delusion develops in an individual in the context of a close relationship with another person who already has that established delusion.” ICD-10

According to an AB-PA model of the pathology, the presence in the child’s symptom display of an encapsulated persecutory delusion (a fixed and false belief that is maintained despite contrary evidence) is the product of the narcissistic/(borderline) parent creating and imposing on the child the (false) role in the parent’s own trauma reenactment narrative as the supposedly “victimized child” of a supposedly “abusive” targeted parent (i.e., the encapsulated persecutory delusion).  Once the child adopts the (false) role as the supposedly “victimized child,” the child’s role then automatically defines and imposes on the targeted parent the (false) role in the trauma reenactment narrative as the supposedly “abusive parent.”  The child’s (false) role as the  “victimized child” in the trauma reenactment narrative of the narcissistic/(borderline) parent also allows the allied narcissistic/(borderline) parent to adopt and conspicuously display to others the coveted role as the all-wonderful “protective parent” in the parent’s trauma reenactment narrative.

AB-PA not only identifies the symptom using standard and established psychological constructs and principles that are well within the professional diagnostic scope of ALL mental health professionals (in this case, an encapsulated persecutory delusion), an AB-PA model of the pathology also explains WHY that particular symptom is present in the child’s symptom display.

While the constructs of “without reasonable justification” and an “encapsulated persecutory delusion” are similar constructs, it is much more professionally grounded and professionally responsible practice to apply the standard and established constructs and principles of professional psychology to a symptom set (a process called diagnosis), rather than to make up new, vaguely defined symptoms to describe a proposed new form of pathology that is supposedly unique in all of mental health.

So this “without reasonable justification” portion of the definition for this proposed new and unique form of mental health pathology is problematic from both sides of the issue.  Its vague wording invites professional incompetence that results in the far too frequent under-diagnosis of the pathology, and it simultaneously over-empowers the mental health professional to arbitrarily discount and invalidate the perceptions of another human being (the child) who may have valid and “reasonable justifications” from their perception and feelings, that can then be arbitrarily deemed invalid and unreasonable justifications by the over-empowered and potentially biased mental health professional, who then misdiagnoses justified parent-child conflict as “parental alienation” when it’s not.

So while I understand that in the minds of the Gardnerians they believe they have adequately defined the pathology, in actual truth they haven’t, not from a clinical assessment and diagnosis perspective. That’s the constructive feedback that establishment psychology has been trying to give the Gardnerians for 30 years, that the Gardnerian-based definitions for “parental alienation” are beneath the level required for a professionally established form of pathology.  But the Gardnerians just don’t listen. 

I listened to the constructive feedback offered by establishment mental health.  I applied standard and established constructs and principles of professional psychology to the pathology – a procedure called diagnosis.  An Attachment-Based Model of Parental Alienation: Foundations is the result (AB-PA).  I have met the requirements of establishment mental health to define the pathology entirely from within standard and established psychological principles and constructs.  No “new form” of pathology proposal. An attachment-related, personality disorder-related pathology.  Pathogenic parenting.  Pathological mourning.  Here is a visual diagram of the attachment-related pathology commonly called “parental alienation”:

Diagram of AB-PA Pathology

Diagnosis is the application of standard and established psychological constructs and principles to a set of symptoms.

Gardner skipped the step of diagnosis by proposing a new form of pathology – a “new syndrome” – and for 30 years this professional negligence in skipping the step of diagnosis (i.e., the application of standard and established psychological constructs and principles to a set of symptoms) has resulted in professional gridlock in the assessment, diagnosis, and treatment of this attachment-related family pathology that has incapacitated and disabled the mental health response to the pathology.

Furthermore, as evidenced in the current article, even after 30 years as the dominant paradigm defining the pathology of “parental alienation,” the definition of the pathology proposed by Gardner-based models has yet to achieve any established standardization, so that the definition offered by the authors of an article in 2016 proposes an irrational “defining feature” of the pathology that can lead to the bizarre diagnostic situation of the pathology being diagnosed as being present (an attempt by the parent to eradicate the child’s relationship with the other parent) in the complete absence of any symptoms being evidenced by the child (the attempt by the parent failed and the child remains affectionally bonded to the targeted parent).

While I’m certain that the authors of the article can revise their “defining feature” of the pathology in light of its diagnostic irrationality, that they would need to revise such a basic and fundamental thing as the proposed “defining feature” of the pathology after 30 years of the Gardnerian paradigm reveals the chaotic nature of the definitional and diagnostic state of affairs surrounding the Gardnerian-based model of the pathology.

And as far as my critique, I’m still only on the first paragraph – the first paragraph – of the article.

There are two more critiques that I will make quickly.  But simply because I am limiting my discussion of these two critique points does not mean they are not important. They are very important. 

The first has to do with the authors too quickly moving into treatment surrounding a Gardnerian-based model of their proposed new form of pathology (“parental alienation”) without having worked through the diagnostic issues.  Gardner skipped the diagnosis step (the application of standard and established constructs and principles to a set of symptoms), and the authors of this article are making a similar fundamental error.  Diagnosis guides treatment.

From an AB-PA model, the pathology traditionally called “parental alienation” in the popular culture represents a form of pathology called pathogenic parenting (patho=pathology; genic=genesis, creation).  Pathogenic parenting represents the creation of significant psychopathology in the child through aberrant and distorted parenting practices.  It is a standard construct used in both developmental psychology and clinical psychology.

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.

There is absolutely no doubt in professional psychology as to what represents the standard of care and best practices surrounding the treatment response to child abuse. It’s not even a question.

In all cases of child abuse – physical child abuse, sexual child abuse, and psychological child abuse – the standard of care is the professional duty to protect, and best practice is to protectively separate the child from the abusive parent, to then treat the impact that the child abuse has had on the child in order to recover and restore the normal-range and healthy development of the child, and then to reunite the child with the formerly abusive parent with sufficient safeguards to ensure that the child abuse does not resume once the child’s relationship with the formerly abusive parent is restored.  During the protective separation period, the abusive parent is typically required to obtain individual collateral therapy to gain insight into the causes of the prior abusive parenting practices.

Best practice surrounding the mental health response to child abuse is not even an issue.

So then why did the authors go to all that trouble to try to identify best practice parameters for responding to a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed?  Because they skipped the step of diagnosis (the application of standard and established constructs and principles of professional psychology to a set of symptoms) and the authors too quickly rushed into treatment.  But diagnosis guides treatment.  If you skip the diagnosis step and just jump into treatment, all sorts of bad things happen,  Assessment leads to diagnosis, and diagnosis guides treatment.

Do the authors actually believe that the standard of care representing best practice for the treatment of child abuse is somehow in doubt, and that their review of research was necessary in order to elucidate best practice guidelines for responding to child abuse?  While the authors did a wonderful job in their literature review, they also seem to display a disturbing absence of critical thinking.  And how did this absence of critical thinking get past the journal reviewers?  Must not be a very good journal <poke>.

There is simply no need for a review article on best practices for responding to child abuse.

Let me put this question to all targeted parents out there: Is there any question in your mind that the pathology of “parental alienation” is child psychological abuse?  Me neither.

But because the authors are relying on a Gardnerian model for the definition of the pathology, the authors, like Gardner, have skipped the crucial and fundamental step of diagnosis (i.e., the application of standard and established psychological constructs and principles to the set of symptoms).  Instead, they propose an entirely new and unique form of pathology they call “parental alienation” with an ill-formed definition and questionable diagnostic indicators (the authors did not address the diagnostic indicators for their proposed new form of pathology). This led the authors to conduct a completely unnecessary study to essentially explore what are the best practice guidelines for responding to child abuse.  Completely and totally unnecessary. 

Best practice guidelines for responding to child abuse are already abundantly clear and evident to every mental health professional.  It’s called the “duty to protect.”  This is is an established professional obligation.

Assessment leads to diagnosis. Diagnosis guides treatment. The steps are not complicated people.

Diagnosis is the application of standard and established constructs and principles of professional psychology to a set of symptoms.

Don’t skip the step of diagnosis.  It will get you into trouble.  Diagnosis guides treatment.

Honestly, I don’t know what’s so difficult about this for Gardnerians to understand.  Stop trying to take an easy way out to avoid the proper professional diagnosis of pathology.  One more time: diagnosis involves the application of standard and established principles of professional psychology to a set of symptoms.  Stop trying to avoid the proper professional diagnosis by proposing a new form of pathology that is supposedly unique in all of mental health.  Its not a new form of pathology.  It’s an attachment-related pathology mediated by the personality disorder pathology of the parent which is itself a product of this parent’s own childhood attachment trauma.

Just look what I was able to accomplish earlier just by simply identifying the pathology of a child’s rejection of a normal-range and affectionally available parent as being an attachment related disorder.  This immediately led to the diagnosis of disordered mourning, which then led to the treatment intervention of re-orienting the child to the child’s misunderstood and unprocessed sadness and grief surrounding the divorce that is being twisted into angry and hostile pathology by the aberrant and distorted parenting practices of the allied narcissistic/(borderline) parent.  Diagnosis guides treatment.

I honestly don’t know what is so hard to grasp about this. Assessment leads to diagnosis, and diagnosis guides treatment.

Final point: The authors offer a caveat to their proposed definition of parental alienation (apparently supported by some other professionals):

“It is important to note that a child rejecting a parent on reasonable grounds, such as in response to parental abuse or neglect, constitutes estrangement (Garber, 2011) not parental alienation (Gardner, 2001; Reay, 2015)”

This caveat highlights once again the fundamental definition problem surrounding phrases like “without reasonable justification” and “on reasonable grounds” – what constitutes the diagnostic definition of the term “reasonable”?  This caveat, while seemingly laudable, raises the diagnostic question, are there other “reasonable grounds” besides “parental abuse or neglect” that justify “a child rejecting a parent”?  If so, what are they?  This is a critically important diagnostic issue.

For diagnostic purposes, if the Gardnerians wish to define a new and unique form of psychopathology that proposes “reasonable grounds” for a child’s rejection of a parent, then they need to define what are the “reasonable grounds” for rejecting a parent besides parental abuse or neglect.  Are there any?  Or is it just “parental abuse or neglect”?

For example, is it “reasonable grounds” for a child to reject a parent who is exceedingly harsh, punitive, and verbally demeaning of the child? 

How about a parent who is highly harsh, punitive, and verbally demeaning?  Would that be “reasonable grounds” for “a child to reject a parent” who is highly harsh, punitive, and verbally demeaning?

How about a parent who is moderately harsh, punitive, and verbally demeaning?  Or how about a parent who is somewhat harsh, punitive, and verbally demeaning?

Can you begin to see the problematic diagnostic issues.  Then lets go a bit further…

How do we operationally define the terms exceedingly, and highly, and moderately, and somewhat? How about on a 1 to 10 scale, with 10 being exceedingly harsh, punitive, and verbally demeaning of the child.  At what point does a child’s rejection of a parent pass from being “reasonable” estrangement to “parental alienation”?  Seven?  Five?  Why seven and not four?

Can you see where we can begin to get into some very problematic diagnostic issues?

I just think this whole “new syndrome” new form of pathology thing is ill-conceived from the start.  Gardner’s correctly identified the existence of a pathology, but he skipped the step of diagnosis and too quickly jumped into the conceptually lazy approach of proposing a “new syndrome,” and his Gardnerian PAS followers are continuing to maintain this fundamental error, despite the abundant constructive feedback they’ve received from establishment psychology.

In AB-PA, I have listened to the constructive feedback offered by establishment psychology, and I have applied the standard and established constructs and principles of professional psychology to the diagnosis of the pathology of “parental alienation.”  I have corrected the step skipped by Gardner so that the mental health system can get back on track. 

Assessment (the Diagnostic Checklist for Pathogenic Parenting) leads to diagnosis (V995.51 Child Psychological Abuse, Confirmed), and diagnosis guides treatment (a protective separation of the child from the abusive parent and recovery of the child’s normal-range and healthy development).

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

References

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

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

Templer, K., Matthewson, M., Haines, J. and Cox, G. (2016). Recommendations for best practice in response to parental alienation: Findings from a systematic review. Journal of Family Therapy, doi:10.1111/1467-6427.12137

6 thoughts on “Best Practices Article in the Journal of Family Therapy”

  1. Enmeshment psychology. WHY do these “experts” have to come together and hunker down at the feet of Gardner? WHY? It deeply disturbs me.
    I cannot fathom WHY parents tolerate this!
    My only belief is that it is habit, or worse, exploitation of children and target parents who are desperate for relief.

    1. Thank you,
      Yes, the child custody industry is partly exploitation. Trying to break into the disturbed minds of these so-called mental health experts is impossible because it is their income. It is their car payment. It is their child’s college fund.
      We are the parents who are burdened with the task of educating these people who say, quite frankly, “NO THANK YOU.” It is near impossible when your children are still under the age of accountability, because you have to walk on eggshells with any adult having to do with them and their preferred parent. So it is up to those parents not attached to a ball and chain to educate.
      Someday, ONE DAY, it won’t be like this.
      Keep strong fellow warriors,
      Suz

  2. Thank for the article. I would love to see a follow up article and your professional
    ‘deep dive” on the treatment of Pathological Mourning. My personal situation reflects exactly as you articulated perfectly, wrong or no diagnosis will and has lead to poor and misguided treatment. I believe my kids are suffering and their mother has said of a 10 and 12 year old, that they are “old enough” to make their own decisions. She is letting them cope on their own. The therapist has further perpetuated a reinforcement of my children’s anger and resentment toward me by inadequate and ineffective treatment.

    1. The “child should decide” symptom features is actually an Associated Clinical Sign identified on the Diagnostic Checklist for Pathogenic Parenting, ACS-2 Enhancing Child Empowerment to Reject the Other Parent, and in Foundations I describe why this associated feature is present – as a corrective change to the original trauma experience through reenactment of the trauma.

      In the original childhood trauma experience of the narcissistic-borderline parent “the child” (the narcissistic-borderline parent as a child) was powerless and vulnerable to stop the abuse. In the current reenactment of this trauma schema pattern, the narcissistic-borderline parent changes this feature of the childhood trauma experience – the child is now EMPOWERED to reject the supposedly “abusive” targeted parent. This corrective change to the childhood trauma represents the goal of the trauma reenactment – an effort to psychologically work through and process the earlier childhood trauma experience through these corrective changes to the experience.

      The “child should decide” feature is an Associated Clinical Sign of the attachment-related pathology. A professionally competent assessment should then look for the three primary diagnostic indicators, as well as the potential presence of any additional Associated Clinical Signs of the attachment-related pathology.

  3. Dear Craig,
    Thank you for highlighting our article in the Journal of Family Therapy. I’d like to clarify that our article was not intended to appear as though it is taking a Gardnerian-based approach to parental alienation. We did not take this approach to our article at all. The focus of the article is to try and establish some best practice guidelines in response to parental alienation. In this article we have tried not to enter the debate on how best to conceptualize parental alienation. This is because we have a second article due to be published soon focusing on the assessment and identification of parental alienation. In this article we reject the Gardnerian approach and propose an alternative view that is not too dissimilar to your position.
    Regards,
    Mandy.

    1. Thank you for your response and clarification, and I look forward to your upcoming article. From my perspective, however, as long as you act as if there was something called “parental alienation” then you are standing on the foundations of Gardnerian PAS.

      In truth, there is no such thing as “parental alienation.” The pathology of “parental alienation” doesn’t exist. It’s a mythical form of pathology. The term “parental alienation” is NOT a defined construct in clinical psychology.

      So when your article attempts to identify best practice for “parental alienation,” in my view it’s essentially trying to identify best practice for treating unicorns. There’s no such thing as unicorns, and in clinical psychology there’s no such thing as “parental alienation.”

      The term “parental alienation” is a common-culture term, not a clinical psychology construct, and not a clinical psychology form of pathology. In professional clinical psychology, “parental alienation” doesn’t exist.

      The whole construct of “parental alienation” is based on Gardner’s proposal of a unique “new syndrome” – and this “unique new form of pathology” proposal has simply dropped the term syndrome but continues to propose a unique new form of pathology using essentially the same Gardnerian-based definitions and diagnostic indicators as if a unique “new form” of pathology exists.

      The pathology commonly identified as “parental alienation” CANNOT simultaneously be a new form of pathology AND an established form of pathology. That is a logical impossibility. It’s either one or the other. You have to choose. It CANNOT be both. If it’s an established form of pathology, then the construct of “parental alienation” doesn’t exist, and as a mental health professional you should stop using the term “parental alienation” in professional usage and begin referring to the pathology by its more accurate terminology and constructs. If you continue to use the construct of “parental alienation” then you will be proposing that the pathology represents a “new form” of pathology that requires a new construct – “parental alienation” – and it will then be incumbent upon you to describe why NONE of the established constructs and principles from professional psychology more accurately describe the pathology, and why this unique new form of pathology REQUIRES it’s own unique new applelation.

      All mental health professionals must choose. “Parental alienation” doesn’t exist (replaced by an attachment-related construction of the pathology), or the pathology of “parental alienation” is a “new form” of pathology that is unique in all of mental health (a Gardnerian proposal) and is NOT a manifestation of any other pathology in all of mental health – it’s NOT an attachment-related pathology, it’s NOT a family systems pathology, it’s NOT a personality disorder pathology.

      Both cannot be true. It is a logical impossibility for both to be true simultaneously (an established form of pathology AND a unique new form of pathology). All mental health professionals must choose.

      There is no such thing as “parental alienation.” There is no such thing as unicorns. I’m on the attachment side. I’m declaring that it is an attachment-related pathology. Gardnerian “parental alienation” is a unicorn.

      If a mental health professional wishes to propose a new form of pathology called “parental alienation” then it becomes incumbent upon this mental health professional to define the pathology in detail, and to also justify why this new form of pathology called “parental alienation” is NOT better accounted for by established constructs such as triangulation, cross-generational coalition, personality pathology within the family, the trans-generational transmission of attachment trauma, an attachment-trauma reenactment narrative, pathological mourning.

      Before accepting the existence of unicorns, it is incumbent on the mental health professional proposing the existence of unicorns to defend why we need unicorns at all – that the supposed unicorns aren’t just ordinary horses with sticks taped to their foreheads.

      As things move forward, I will be increasingly calling on all professionally RESPONSIBLE mental health professionals to STOP using the term “parental alienation” in professional discourse. It can still be used in the popular culture of targeted parents and legal professionals, but ALL responsible mental health professionals should STOP using the construct in our professional discussion. There is NO NEW PATHOLOGY unique in all of mental health. The pathology called “parental alienation” can be fully understood without resorting to creating a mythical form of “new pathology.”

      When mental health professionals stop using the term “parental alienation” (or are forced to substitute the word “unicorns”), I think we will begin to make substantial professional progress in understanding the attachment-related pathology commonly referred to as “parental alienation” (the attachment-related pathology is analogous to a computer virus in the attachment system – the pathogen creating the symptom manifestation represents a patterned constellation of broken and damaged information structures in the attachment system – this patterned set of broken and damaged information structures is created by developmental trauma; i.e., by the profound absence of parental empathy – the pathogen has specific “meme-structures” or “information structures” that attack identity and memory information structures in the attachment system – there are characteristic meme-structure fragments in the pathogen that suggest that the original trauma experience a generation or two earlier was sexual abuse incest. Once we move beyond the construct of “parental alienation” things are going to become very intriguing. I’m 62 years old. My shelf-life is limited. It is to the next generation of researchers – it’s to you and your colleagues – to grab ahold of this attachment-related pathology and explore it’s implications and meaning relative to the brain systems of attachment and trauma across generations).

      Try this experiment, remove the construct of “parental alienation” from your personal draft for your upcoming paper. Do a search-and-replace. Every time you use the term “parental alienation” substitute the word unicorn. Then read your paper. Then do a search and replace and substitute pathogenic parenting and see how this alters meaning. Then do a search and replace and substitute trans-generational attachment trauma. Then do a search and replace and substitute cross-generational coalition. There is absolutely no need for a “new form of pathology.” When Gardner skipped diagnosis he took everyone down the wrong road. It’s time to get back on the proper road of standard and established psychological principles and constructs.

      There is no such thing as “parental alienation.” That’s why I always put the term in quotes. It doesn’t exist as a clinical psychopathology.

      So while you may think you’re not basing your work on a Gardnerian framework, I would disagree as long as you are using the construct of “parental alienation” as if it actually had existence. It doesn’t. It’s a unicorn (actually, a horse with a stick taped to its head).

      There have been some critiques of AB-PA that it only deals with severe “alienation.” This fails to comprehend what AB-PA is saying. The pathology commonly called “parental alienation” is a cross-generational coalition. We can do a direct one-to-one search and replace on these two constructs and lose absolutely nothing and gain a whole lot of family systems material. Minuchin and Haley identified cross-generational coalitions a full decade before Gardner proposed a construct of “parental alienation.” Cross-generational coalitions are mild-moderate-severe. However, when the splitting pathology of a narcissistic/(borderline) parent is added to the pathology of a cross-generational coalition it transmutes the already pathological “perverse triangle” of the cross-generational coalition into a particularly virulent and malignant form that seeks to entirely terminate the child’s relationship with the targeted parent (cross-generational coalition + splitting = “parental alienation”/AB-PA). Mild-moderate-severe is a feature of the cross-generational coalition. AB-PA is the addition of the splitting pathology of the narcissistic/(borderline) parent to the cross-generational coalition.

      There’s no such thing as parental alienation or unicorns. Mythical things. Drop the term from your professional usage, use cross-generational coalition, or pathogenic parenting, or pathological mourning, or trans-generational transmission of attachment trauma, or trauma reenactment narrative and watch what happens. As long as you use the construct of “parental alienation” as if it exists, you are basing your work on Gardner’s proposal that there is a new form of pathology unique in all of mental health.

      You’re doing great work, your lit review methodology was great. But you are doing a lit review on types of unicorns. Studies have reported sighting of blue unicorns and red unicorns, and one study reported on the magical rainbow unicorn. Unicorns don’t exist. The studies you reviewed are like the bestiaries of the middle ages. There is no such thing as “parental alienation.” Mental health professionals, ALL mental health professionals, need to return to using standard and established constructs and principles in our description of psychopathology. Know that when I read an article about “parental alienation” I mentally substitute the word unicorn. Try it and see what happens.

      You’re doing great work. The pathology is real – very real. But it is an attachment-related pathology. ALL mental health professionals need to stop using the mythical construct of a unique “new form” of pathology – “parental alienation” – as if it exists. It doesn’t. It’s an attachment-related pathology – the trans-generational transmission of attachment trauma and disordered mourning surrounding the divorce.

      If your work continues to use the Gardnerian-based construct of “parental alienation” as if it actually exists, then your work will be built on the insubstantial foundations of a mythical non-existent pathology. It’s an attachment-related pathology. The attachment system is the set of brain networks that govern all aspects of love and bonding throughout the lifespan, including grief and loss. The pathology everyone describes as “parental alienation” is a disruption to the love-and-bonding system in the brain. That’s the attachment system. It’s an attachment-related pathology. The defining feature of the pathology is a disrupted attachment bond to a normal-range and affectionally available parent.

      The phrase “disruption to the attachment-bonding motivations” anchors the pathology in established constucts, and the addition of the phrase “to a normal-range and affectionally available parent” will get rid of the problems surrounding the alternate phrase “without reasonable justification.” Instead of trying to demonstrate that the child’s rejection is not “reasonable” we instead demonstrate that the parenting practices of the targeted parent are “normal-range and affectionally available.” The encapsulated persecutory delusion construct also deals with this “without reasonable justification” issue.

      The encapsulated persecutory delusion is the symptom feature of the trauma reenactment narrative – specifically the imposed false “victimized child” role. A fixed and false belief that’s maintained despite contrary evidence. A persecutory belief, a belief that the child is being “victimized” by the normal-range parenting of the targeted parent.

      However, if you continue to use the construct of “parental alienation” as if such a thing exists – it doesn’t, there is no such pathology – I’ll continue to require that you define the pathology, and then ultimately that you justify why we need a new form of pathology rather than standard and established constructs such as triangulation, cross-generational coalition, pathogenic parenting, pathological mourning, etc. If you propose that there is such a thing as “parental alienation” – which you did in the best practice article – then it will be incumbent upon you to justify why the new form of pathology you’re proposing isn’t other forms of pathology.

      But if you return to the fold of ONLY using established psychological principles and constructs, then you’ll be off to the races.

      Best wishes,
      Craig Childress, Psy.D.

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