The Diagnosis of Unicorns

To all mental health professionals:


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

In proposing a new form of pathology – a “new syndrome” – which was supposedly unique in all of mental health, so unique in fact, that it required an equally new and unique set of symptom identifiers created just for this form of pathology, Richard Gardner skipped the crucial step of diagnosis.

While he correctly identified the existence of a pathology, he too quickly abandoned the application of established psychological constructs and principles to the symptoms of the pathology by proposing that the symptoms he was recognizing represented an entirely new form of pathology – a “new syndrome” – which was unique in all of mental health – so unique that this new form of pathology required its own unique new name for this unique new form of pathology – “parental alienation.”

But in proposing a unique new form of pathology, Gardner was wrong.  He was a poor diagnostician.  He too quickly abandoned the professional rigor necessary to understand the origins of the pathology using standard and established psychological principles and constructs.  Instead, Gardner’s approach of proposing a unique “new form of pathology” was – to put it bluntly – conceptually lazy and diagnostically unsound.

Professional diagnosis involves the application of standard and established constructs and principles to a set of symptoms.  Richard Gardner violated this professional tenet, this standard of professional practice regarding professional diagnosis. That’s a problem. 

In skipping the step of diagnosis by proposing a “new syndrome” – a unique new form of pathology unlike any other pathology in all of mental health – Gardner put everyone on the wrong path.  Bad things happen when professional standards of practice are not followed.  Professional diagnosis involves the application of standard and established constructs and principles from professional psychology to a set of symptoms.  Gardner skipped this step of diagnosis, and the result has been 30 years of controversy and a still unsolved pathology.

Current mental health professionals who, like Gardner, are still proposing the existence of an entirely “new form of pathology” called “parental alienation” are as conceptually indolent in their professional diagnostic obligations as Gardner was in not applying the professional rigor necessary for a professional diagnosis of the pathology.  My statement to these mental health professionals who are continuing to propose a unique new form of pathology called “parental alienation” is:

Do the work required of professional diagnosis.  Apply standard and established constructs and principles from professional psychology to the symptom set.  No “new syndrome” or new forms of pathology short-cuts.  Make the diagnosis using standard and established constructs from professional psychology.  Do the work.  Your clients need you to do the work, targeted parents and their children need you to do the work.

AB-PA, as described in Foundations, represents what a professional diagnosis of psychopathology looks like; a detailed and exhaustive application of standard and established constructs and principles to a set of symptoms.  A visual representation for the pathology of AB-PA is available on my website: Diagram of AB-PA Pathology.

The diagnostic construct of “parental alienation” doesn’t exist in clinical psychology.  It is a unicorn.  A mythical pathology.  There is no such thing as “parental alienation” in clinical psychology.

The pathology that Richard Gardner identified does exist, but it’s just not a “new form of pathology,” a “new syndrome,” that’s unique in all of mental health.  It is a manifestation of standard and fully established forms of existing pathology.

An Attachment-Related Pathology

The pathology that’s traditionally called “parental alienation” in the general-culture represents an attachment-related pathology.

The attachment system is the neurologically embedded brain system that governs all aspects of love and bonding throughout the lifespan, including grief and loss.  The pathology called “parental alienation” in the general-culture represents a disruption to the love-and-bonding system of the brain; the attachment system.  It is an attachment-related pathology.

The form of attachment-related pathology is called “disordered mourning” (Bowlby), involving the pathological processing of sadness, grief, and loss.  The allied parent, who is the primary case of pathological mourning, is transferring this parent’s own disordered mourning surrounding the divorce to the child through aberrant and distorted parenting practices.  Under the distorting influence of the allied parent, the child’s sadness, grief, and feelings of loss surrounding the divorce are being translated into “anger and resentment, loaded with revengeful wishes” (Kernberg) that are identical to how the allied parent (the primary case of disordered mourning) is processing this parent’s own experience of sadness, grief, and loss surrounding the divorce.

The distorting parental influence of the allied parent is being imposed on the child through the formation of a cross-generational coalition (Haley, Minuchin) of the allied parent with the child. This cross-generational coalition is created through the psychological control (Barber) and manipulation of the child that acts to triangulate the child (Bowen) into the spousal conflict by creating a loyalty conflict for the child surrounding the divorce and break-up of the intact family structure.

The mild-moderate-severe dimension of the parent-child conflict noted by Gardner’s proposed range of “parental alienation” pathology represents the mild-moderate-severe range typical of the cross-generational coalition pathology, in which the allied parent is diverting spousal anger (Minuchin) directed toward the targeted parent through the child by creating and supporting the child’s conflict with the other parent.

The distinctive symptom feature evidenced in the pathology of the child’s active rejection of a relationship with a normal-range and affectionally available parent emerges from the addition of parental narcissistic/(borderline) personality pathology to the cross-generational coalition.  The addition of the splitting pathology (an extreme polarization of perception and the inability to tolerate ambiguity) of the narcissistic/borderline parent to the cross-generational coalition with the child transmutes an already pathological “perverse triangle” (Haley) into a particularly virulent and malignant form in which the child seeks to entirely terminate the relationship with the targeted-rejected parent.

The pathology of splitting (an extreme polarization of perception and inability to tolerate ambiguity) is characteristic of both the narcissistic and borderline personality pathology.  The addition of parental splitting pathology to the cross-generational coalition with the child creates the distinctive feature of this attachment-related pathology involving the child’s complete, polarized, extreme, and non-ambiguous rejection of a parent. Gardner identified these symptoms, he just didn’t diagnose these symptoms (apply standard and established constructs from professional psychology – in this case the pathology of splitting associated with both narcissistic and borderline personality pathology – to the symptoms he identified).

With the addition of the splitting pathology of the narcissistic/(borderline) parent (polarization and the inability to tolerate ambiguity), the ex-wife must also then become an ex-mother; the ex-husband must also become an ex-father.  This complete absence of ambiguity in the relative role-relationships within the family represents a neurologically imposed imperative required by the splitting pathology of the allied narcissistic/(borderline) parent, which is being transferred to the motivational agenda of the child through the child’s cross-generational coalition with the narcissistic/(borderline) parent.

This is called diagnosis; the application of standard and established constructs and principles from professional psychology to a set of symptoms.

Gardner skipped the step of diagnosis.  Instead, he opted for a conceptually lazy approach of proposing an entirely “new form” of pathology, which he proposed was so unique in all of mental health that it required its own category of diagnosis and it’s own unique name, “parental alienation,” and, according to Gardner, its own unique new set of diagnostic identifiers that Gardner simply made up to be specific for this “new form” of pathology.

Gardner was wrong.  It is not a new form of pathology.  Gardner was simply a poor diagnostician.  As are all mental health professionals who are proposing a Gardnerian-based model for the pathology.  Professional diagnosis involves the application of standard and established psychological principles and constructs to a set of symptoms. Do the work.

Proposing a “new form of pathology” that is unique in all of mental health is beneath the acceptable professional standards of practice for a professionally responsible diagnosis of pathology.  I hope that’s clear. 

Professionally responsible diagnosis of pathology involves the application of standard and established constructs and principles from professional psychology to a set of symptoms.  I hope that too is clear.

For thirty years now, establishment psychology has been providing the Gardnerians with this constructive professional feedback.  But for thirty years the Gardnerians have steadfastly refused to listen to and accept this constructive professional feedback from establishment psychology.  For thirty years the Gardnerians have been trying to force establishment psychology to accept a “new form” of pathology rather than apply the professional rigor necessary to appropriately diagnose the pathology using standard and established psychological constructs and principles of professional psychology applied to the set of symptoms.  Diagnosis.  Professional diagnosis of pathology.

The pathology we are diagnosing is NOT a unique new form of pathology.  It is an attachment-related pathology called pathological mourning (Bowlby).  It involves the child’s triangulation into the spousal conflict (Bowen) through the formation of a cross-generational coalition of the child with an allied parent against the other parent (Haley; Minuchin).  The application of standard and established psychological constructs and principles to a set of symptoms: Diagnosis.

The variant factor in this particular form of attachment-related pathology is simply the addition of parental personality disorder pathology from the allied parent in a cross-generational coalition with the child.  When the allied parent has prominent narcissistic and/or borderline personality pathology, the addition of the parent’s splitting pathology to the cross-generational coalition transmutes the already pathological “perverse triangle” (Haley) of the cross-generational coalition into a particularly virulent and malignant form in which the child seeks to terminate the child’s relationship with the targeted-rejected parent.

Notice that nowhere in this diagnostic statement did I need to resort to creating some “new form” of psychopathology. Diagnosis involves the application of standard and established psychological constructs and principles from professional psychology to a set of symptoms.

Gardner skipped the step of diagnosis by too quickly proposing that the set of symptoms he was noticing in his patients represented an entirely “new and unique” form of pathology – a “new syndrome” – that required a unique new category of pathology and a unique new name for the pathology – “parental alienation.”

Gardner was wrong.  The pathology he identified as a unique new form of pathology – which he called “parental alienation” – is NOT a new form of pathology. It is a manifestation of standard and fully established, existing and fully accepted, forms of pathology in mental health. It is an attachment-related pathology (a severe disruption to the love-and-bonding system of the brain) called “pathological mourning” (Bowlby), that involves the child’s triangulation into the spousal conflict (Bowen) through the formation of a cross-generational coalition of the child with the allied parent against the other parent (Haley, Minuchin), that includes the addition of parental personality pathology (Beck, Kernberg, Millon, Linehan) to the cross-generational coalition.  Gardner was simply a poor diagnostician.

What does this mean, that Gardner was a poor diagnostician?  It means that Gardner’s proposal of a “new form” of pathology called “parental alienation” is incorrect.  There is no new form of pathology called “parental alienation.” The pathology identified by Gardner represents a symptom manifestation of standard and established forms of pathology; pathological mourning, cross-generational coalition, parental personality disorder pathology.

There is no “new form” of pathology.  The pathology of “parental alienation” doesn’t exist.  Gardner was wrong.  He was a poor diagnostician, that’s all.

I want that to sink in for a bit…

In professional clinical psychology, there is no such thing as “parental alienation.”  It doesn’t exist.  It is a diagnostic unicorn.  A mythical pathology.

I know that Gardner said that this was a new form of pathology.  But he was wrong.  It’s not a new form of pathology, it is a manifestation of well-established and existing forms of pathology.

What’s required from us as mental health professionals is an accurate diagnosis of the pathology – and we achieve this accurate diagnosis of pathology by applying the standard and established psychological constructs and principles of professional psychology to the set of symptoms.

A child’s rejection of a normal-range and affectionally available parent represents a dysfunction to the love-and-bonding systems of the brain; the attachment system.  This is fundamentally an attachment-related pathology.  Then we begin to work out the diagnosis from there; cross-generational coalition, narcissistic symptoms displayed by the child, a fixed and false belief regarding the child’s supposed “victimization” by the normal-range parenting practices of the targeted parent (an encapsulated persecutory delusion) … diagnosis.

The term “parental alienation” is a popular-culture term that has developed from Gardner’s incorrect and inaccurate diagnosis of the pathology as being a unique “new form of pathology” – a “new syndrome” – that required a new term to describe it.  This term – “parental alienation” – is being used in the general-culture to describe an attachment-related pathology in which a child rejects a normal-range and affectionally available parent as a result of the distorting parental influence applied to the child by an allied parent in a cross-generational coalition with the child against the other parent.

But just because Richard Gardner said that a new form of pathology exists, doesn’t mean that a new form of pathology actually exists.  A pathology exists most definitely.  No question about that.  It’s just not a “new form” of pathology that requires a “new name.”  It is a manifestation of well-established and existing forms of pathology that already have existing names with strong research and theoretical support surrounding these existing pathologies with existing names, such as:

  • Pathogenic parenting
  • Cross-generational coalition
  • Disordered mourning
  • Narcissistic and borderline pathology (and the Dark Triad personality)

Most recently, I’ve added AB-PA to the set of possible diagnostic descriptors for the pathology.  The construct of AB-PA represents a comprehensive description of the attachment-related pathology across multiple levels of analysis using standard and established constructs and principles from professional psychology.  While AB-PA incorporates the term “parental alienation” it does so in order to avoid disorienting people who have become accustomed to the term “parental alienation” as a descriptive label for this type of attachment-related pathology.  However, the definition of AB-PA is based entirely on standard and established psychological constructs and principles of professional psychology (Childress: Foundations).

There is No Santa

So I hate to be the one to break it to the Gardnerians, but… here goes… there is no such thing as “parental alienation.”  It is a diagnostic unicorn, a mythical form of pathology.  It doesn’t exist.

I can hear the howls of outrage…

I’m sorry, but someone needs to tell them that “parental alienation” is a mythical pathology.  What they are calling “parental alienation” based on Gardner’s diagnostic failure is actually an attachment-related pathology involving a cross-generational coalition of the child with a narcissistic/(borderline) parent.  I know that children can become upset when they first learn that there is no Santa Claus and no Easter Bunny.  Sorry.  But it’s time to grow up into professional psychology, using standard and established constructs of professional psychology to diagnose pathology.  No unicorns, no pixies, no demon possession, no mythical forms of pathology.

A child’s rejection of a normal-range and affectionally available parent is a disorder of the love-and-bonding system of the brain, the attachment system; it’s an attachment-related pathology.  Start from there.  Stand on that solid ground of professional psychology.  It’s an attachment-related pathology.

If you want to work it out on your own, that’s fine.  But just no mythical “new forms” of pathology.  Your diagnosis has to be entirely based on standard and established psychological principles and constructs.  That’s an absolute and steadfast requirement of professional diagnosis.  So stop using the term “parental alienation” in your professional discourse.  Pathogenic parenting is fine, cross-generational coalition is fine, disordered mourning is fine, and if you want to just bundle everything up into a nice tidy little conceptual package, AB-PA is fine.  But just NO “parental alienation” – no mythical forms of pathology.

If you want, you can take my hand and I’ll help you find your way.  Look to family systems theory; triangulation, cross-generational coalitions, and emotional cutoffs.  Look to attachment theory; disorganized attachment, the trans-generational transmission of attachment trauma, schemas and internal working models, role-reversal relationships and regulatory objects, trauma reenactments, the grief response and pathological mourning.  Look to personality pathology; narcissistic and borderline personalities, splitting pathology, the invalidating environment.  Look to research on the Dark Triad personality; the absence of empathy and their propensity for revenge and the creation of conflict.  Look to research on psychological control, such as the work of Barber.  Look to psychological boundary violations, such as the work of Kerig.

Don’t worry.  The pathology is all there.  It’s all described.  We won’t leave you without a pathology… it just won’t be called “parental alienation.”

I’d suggest we use the standard and established construct of pathogenic parenting (patho=pathology; genic=genesis, creation) to label this standard and established form of attachment-related pathology.  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 frequently used in association with attachment-related pathology since the attachment system never spontaneously dysfunctions but only dysfunctions in response to pathogenic parenting, and in fact the construct of “pathogenic caregiving” was referenced in the DSM-IV TR regarding an attachment-related pathology.  It is a standard and accepted construct in professional psychology.

Plus, I suspect that there’s not a targeted parent out there who doesn’t fully recognize the creation of pathology in their beloved child by the aberrant and distorted parenting practices of their ex-spouse, the child’s other parent.  All targeted parents clearly recognize that the distorted parenting practices of the allied parent, who is in a cross-generational coalition with their child, are absolutely creating significant love-and-bonding pathology in their beloved child.  The standard and professionally established construct of pathogenic parenting completely captures this pathology-creating feature of this form of attachment-related pathology; i.e., pathogenic parenting: the allied parent’s creation of significant attachment-related pathology in the child through aberrant and distorted parenting practices.

Or, if you prefer, the established professional construct of a cross-generational coalition fits equally as well.  In fact, the correspondence of the cross-generational coalition construct is so close to the construct of “parental alienation” that there’s hardly a hair’s breadth of difference between the two.  And once we add the personality disorder pathology of a narcissistic/(borderline) parent to the cross-generational coalition construct, the correspondence of pathology to the construct of “parental alienation” is nearly identical.  So maybe you’ll feel more comfortable with the construct of a cross-generational coalition.  The nice thing about shifting into family systems constructs is that you’ll also get two additional constructs, triangulation (i.e., a professional term for the “loyalty conflict”) and emotional cutoffs (which leads into the multi-generational transmission of trauma through Bowen’s work).

However, the really rich domain of constructs comes from attachment theory.  The constructs of attachment theory open a whole range of doors to understanding, including disorganized attachment, role-reversal relationships, regulatory objects, trans-generational transmission of attachment trauma, and internalized schema patterns.  Attachment theory provides such deeply rich conceptual material for understanding the core roots of this attachment-related pathology

Or you can choose to adopt the comprehensive description I’ve uncovered in AB-PA.  It’s spot-on accurate.  AB-PA provides a thorough and in-depth analysis of the pathology from within three separate and distinct levels of analysis (the family systems level, the personality disorder level, and the attachment system level) as well as an integrated analysis across all three levels, in which the attachment system level is responsible for creating the personality disorder level, which then creates the pathology found at the family systems level.  No model of pathology could provide such an integrated description of the pathology both within and across three separate and distinct levels of analysis unless the model was accurate and correct.  AB-PA is absolutely an accurate model for the pathology.

AB-PA gives us three definitive diagnostic indicators that lead directly to a confirmed DSM-5 diagnosis of V995.51 Child Psychological Abuse through the construct of pathogenic parenting.  In addition, because AB-PA is based entirely on standard and established professional constructs and principles, it allows targeted parents to hold ALL mental health professionals accountable for the accurate assessment and diagnosis of the pathology.  And AB-PA leads directly to treatment models.  Assessment leads to diagnosis, and diagnosis guides treatment.

But it’s up to you which path you take.  You can take any path to professional diagnosis that you want.  You can find your own way, or you can take some of the paths I’ve suggested.  But what you cannot do anymore is diagnose unicorns.  The diagnosis of unicorns doesn’t exist anymore.  Unicorns is a made-up mythical pathology – “parental alienation” is a mythical form of pathology.  It doesn’t exist.  Sorry, but true is true.  Pathogenic parenting exists.  Cross-generational coalitions exist.  The trans-generational transmission of attachment trauma exists.  But “parental alienation” does not exist as a professional construct.  There is no “new form of pathology” unique in all of mental health.  We are going to cease compounding Gardner’s initial diagnostic failure by continuing down the road of mythical constructs.

Professional diagnosis is the appliction of standard and established constructs and principles from professonal psychology to a set of symptoms.  No “new forms” of pathology proposals.  That’s NOT diagnosis.  That’s just nonsense.  No unicorns.

So from here on out, I’m going to expect professional competence from ALL mental health professionals.  So realize this, whenever I hear a mental health professional use the term “parental alienation” as if that construct actually had meaning, I’m going to be mentally substituting the word “unicorns” in its place.  I can’t stop you from diagnosing “unicorns” if you’re dead-set on diagnosing “unicorns.”  But I’m going to be encouraging the rest of us to be diagnosing real pathology using the standard and established constructs and principles of professional psychology.

It is long-past overdue that professional psychology surrounding this attachment-related pathology returns to using standard and established constructs and principles for assessment, diagnosis, and treatment.

Assessment leads to diagnosis, and diagnosis guides treatment.

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

Assessment:

The Diagnostic Checklist for Pathogenic Parenting

Diagnosis:

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.

Treatment:

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 which requires the protective separation of the child from the abusive parent.  We 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.  Once the child’s normal-range and healthy development has been restored, the child’s relationship with the formerly abusive parent is reintroduced 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.

All mental health professionals must decide if they are going to base their professional diagnoses of pathology on the standard and established constructs of professional psychology, or whether they are going to diagnose unicorns.  For my part, I will always base my professional diagnosis on the standard and established constructs of professional psychology in order to diagnose real pathologies that actually exist.  My clients deserve no less.  Targeted parents and their children deserve no less.

It is time we returned to the solid Foundations of professional practice, and stop diagnosing unicorns and pixies.

Assessment leads to diagnosis, and diagnosis guides treatment.

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

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

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