I recently completed a professional-to-professional Skype Consultation with a psychologist, and I wrote the psychologist a follow-up email providing assessment-protocol resources. I thought this email follow-up with resources might be more broadly helpful, so I am making it available here on my blog as well.
The psychologist with whom I consulted appeared to absolutely get it. She indicated that she will be making the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed and will be filing a suspected child abuse report with CPS. She also indicated that she is likely to be terminating therapy under Standard of 10.10 of the APA ethics code which requires that therapy be terminated if it is likely to be harmful to the child (making the child a “psychological battleground” between the goals of therapy to restore the child’s normal-range development, and the countervailing goals and pressure placed on the child by the allied narcissistic/(borderline) parent to create and maintain the child’s symptomatology), or terminating therapy if the therapy is not likely to be effective.
This psychologist indicated that she intends to write a discharge summary with this DSM-5 diagnosis and the decision to terminate therapy under Standard 10.10 of the APA ethics code until a protective separation of the child from the psychologically abusive allied parent is enacted that will allow therapy to proceed without harming the child because of the countervailing pressures placed on the child by the allied narcissistic/(borderline) parent for the child to remain symptomatic.
Is CPS likely to do anything? Probably not. Will the Court issue an order for a protective separation period from the psychologically abusive parent that will allow therapy to restore the child’s normal-range development while not simultaneously turning the child into a “psychological battleground” between the goals of therapy and the countervailing goals of the narcissistic/(borderline) parent to create and maintain the child’s symptomatic rejection of the other parent? Who knows.
But this is absolutely the correct professional course of action in cases of AB-PA. The pathology of AB-PA is a child protection issue, not a child custody issue. Assessment leads to diagnosis, and diagnosis guides treatment.
All mental health professionals have an ethical obligation under Standard 10.10 of the APA ethics code to terminate therapy that is either harmful to the client (the “psychological battleground” issue), or when therapy is not likely to be effective (therapy that does not seek change but that simply colludes with the continuation of the pathology).
If all mental health professionals follow their professional standards of practice and decline to treat without the necessary protective separation of the child from the psychologically abusive parent, this will clearly communicate to the legal system what is needed. Declining to treat AB-PA without first obtaining the necessary protective separation of the child from the psychologically abusive parent (a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed) is the ethical obligation of all psychologists under Standard 10.10 of the APA ethics code.
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.
The following is my email follow-up after a professional-to-professional consultation. In this follow-up email I provide the psychologist with my recommended resources for a standard-of-practice assessment in all cases of attachment-related pathology surrounding divorce:
Hello Dr. <name>
It was a pleasure to speak with you the other day. I am attaching some assessment resources that you may find helpful.
The first is a Diagnostic Checklist for Pathogenic Parenting (this is also available on my website) that identifies the symptoms we discussed. I typically recommend that therapists complete this brief checklist and place it in the patient record as documentation of the child’s symptoms of concern. Once the symptoms are documented, mental health professionals can then rely on the support provided through my book An Attachment-Based Model of Parental Alienation: Foundations for the diagnosis of the pathology.
I am also including a companion piece for the Diagnostic Checklist for Pathogenic Parenting, Chapter 4 from my book Essays that describes the three diagnostic indicators and the 12 Associated Clinical Signs.
I am also attaching a related measure that I recommend as part of a standard assessment protocol for attachment-related pathology surrounding divorce, the Parenting Practices Rating Scale. This is a brief rating scale of therapist determinations regarding the parenting practices of the targeted-rejected parent (although it can also be applied to the parenting of the allied parent if there is sufficient information on which to make these ratings).
The role of the Parenting Practices Rating Scale is to document the broadly normal-range parenting of the targeted parent (Levels 3 and 4; a Permissive to Authoritarian Dimension Rating of 25-75). It can also be used as a treatment-related tool for discussion with the targeted parent to identify areas of parenting concern.
A third potential instrument in the treatment of attachment-related pathology surrounding divorce is the Parent-Child Relationship Rating Scale used by the targeted parent to document daily relationship quality with the child. Collaboratively completing the Parent-Child Relationship Rating Scale during joint parent-child sessions can also be used as a treatment-related tool in these parent-child sessions as a discussion prompt regarding their relationship by seeking to reach consensus on relationship quality over the intervening period between sessions.
I have modified the Parent-Child Relationship Rating Scale (attached) to include a 5th item on the rating scale of Texting & Phone Call Cooperation (Parent-Child Relationship Rating Scale – Texting Modification) based on what we discussed regarding the child’s excessive texting and phone contact with the allied parent when the child is with the targeted parent.
Craig Childress, Psy.D.
Psychologist, PSY 18857