I just posted a YouTube video series for mental health professionals in which I discuss the assessment and diagnosis of attachment-related pathology surrounding divorce.
The discussion content is at a professional-level.
Opening: In this opening segment I describe the series as a conversation with my colleagues in professional psychology, and then I do a little professional housekeeping in returning our professional-level discussion to standard and established constructs and principles of professional psychology.
1 – Intake Assessment: This segment describes the importance of the intake assessment and begins to walk through the collection of information from the initial intake assessment, identifying the presenting problem of a “child rejecting a parent surrounding divorce” as fundamentally an attachment-related pathology, and then identifying the three sets of symptoms; hostile-conflict symptoms, excessive anxiety symptoms, attachment-related symptoms.
2 – Conflict Symptoms: This segment walks through the conflict symptoms, identifying the narcissistic personality traits being displayed by the child in the parent-child conflict, leading to a discussion surrounding the inauthenticity of this symptom feature and its cause in the cross-generational coalition with an allied narcissistic/(borderline) parent.
3 – Anxiety Symptoms: This segment walks through the excessive anxiety symptoms sometimes displayed by the child in attachment-related pathology surrounding divorce. Child anxiety symptoms surrounding attachment-related pathology require assessment for “dangerousness” from the targeted parent. If the dangerousness of the targeted parent is ruled out as a causal factor by the assessment, then the inauthentic features of this excessive anxiety display are described and the role of the allied parent in creating the child’s excessive anxiety is identified.
4 – Attachment Symptoms: This segment provides information on the inauthenticity of attachment symptoms that involve a child rejecting a parent. This segment describes how the attachment system (a neurologically embedded primary motivational system of the brain) functions, and how it characteristically dysfunctions, explaining why and how these child symptoms of attachment pathology are inauthentic to how the brain and the attachment system actually works.
5 – DSM-5 Diagnosis: This segment takes the information from the prior segments and discusses the appropriate DSM-5 (and ICD-10) diagnosis for the pathogenic parenting pathology. This segment identifies the DSM-5 diagnosis of V995.51 Child Psychological Abuse as the appropriate categorical diagnosis for the pathogenic parenting evidenced in this type of attachment-related family pathology.
6 – Splitting: This segment discusses the origins of the splitting pathology in disorganized attachment (polarization of perception: all-good/all-bad), resulting in a neurologically imposed imperative for functional consistency in the brain networks of the narcissistic/(borderline) parent, in which the ex-spouse must also become an ex-parent; the ex-husband must become an ex-father, the ex-wife must become an ex-mother in order to maintain the neurologically imposed consistency of the “splitting” pathology embedded in the neurological networks of the brain.
7 – A Request: This segment concludes the conversation with a personal request from Dr. Childress to clinical mental health professionals to begin conducting an appropriate and adequate assessment of attachment-related pathology surrounding divorce, and to begin documenting their adequate assessments as a standard of professional practice.
In the final segment of this professional-to-professional conversation, I also urge my clinical psychology colleagues (clinical psychologists and family therapists) to begin fulfilling their standard of practice child protection obligations by making the DSM-5 diagnosis of V995.51 Child Psychological Abuse for this type of attachment-related family pathology. Pathogenic parenting that is creating significant psychopathology in the child is a DSM-5 diagnosis of Child Psychological Abuse, and all mental health professionals have an established professional obligation – called a “duty to protect” – that mandates our role in the protection of children from child abuse.
We are going to bring standards of professional practice to the clinical assessment of attachment-related family pathology surrounding divorce. (notice I did not say “parental alienation”).
I don’t know how long this will take, but established standards of professional practice in the assessment of attachment-related pathology surrounding divorce are on their way.
Establishing professional standards of practice begins with establishing a semi-structured and flexibly standardized protocol for the assessment of attachment-related pathology surrounding divorce (notice I did not say “parental alienation”).
We are also going to establish standards of professional practice for the professional knowledge-base needed by mental health professionals for professional competence in the assessment, diagnosis, and treatment of attachment-related pathology surrounding divorce (notice I did not say “parental alienation”).
By defining the pathology entirely within standard and established constructs and principles of professional psychology, AB-PA established defined domains of knowledge required for professional competence:
The Attachment System
Personality Disorder Pathology
Family Systems Therapy
Failure to possess a professional-level knowledge in these four domains of scientifically and professionally grounded knowledge when assessing, diagnosing, and treating attachment-related family pathology that involves the psychological collapse, and subsequent dysfunctional stabilization, of a narcissistic/(borderline) parent surrounding divorce would likely represent practice by the mental health professional that is beyond their boundaries of professional competence.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857
An Example of Professional Competence in an Initial Assessment of Pathology:
As an example of what a professional standard of practice looks like for an initial intake assessment and documentation protocol, I have provided an example from the field of early childhood mental health:
The assessment of attachment-related pathology surrounding divorce will not require anything as involved and detailed as this example of an intake form from the field of early childhood mental health, and the content of information collected during the initial intake assessment would be different in many ways from the information collected by an early childhood initial intake assessment, but I am providing this initial intake assessment form from early childhood mental health as an example of what standard of practice for an initial intake assessment looks like in other fields of professional psychology.
In Chapter 11 of Foundations, I provide my recommended reading list for establishing a ground of professional competence:
From Foundations: “Recommendations for professional literature of vital importance for the development of professional expertise in this area would include:
Bowlby, J. (1969). Attachment and Loss: Vol. 1. Attachment. NY: Basic Books.
Bowlby, J. (1973). Attachment and Loss: Vol. 2. Separation: Anxiety and Anger. NY: Basic Books.
Bowlby, J. (1980). Attachment and Loss: Vol. 3. Loss: Sadness and Depression. NY: Basic Books.
Fonagy, P., Target, M., Gergely, G., Allen, J.G., and Bateman, A. W. (2003). The developmental roots of Borderline Personality Disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23, 412-459.
Fonagy P. and Target M. (2005). Bridging the transmission gap: An end to an important mystery in attachment research? Attachment and Human Development, 7, 333-343.
Fonagy, P., Luyten, P., and Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47-69.
Lyons-Ruth, K., Bronfman, E. and Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. In J. Vondra & D. Barnett (Eds.) Atypical patterns of infant attachment: Theory, research, and current directions. Monographs of the Society for Research in Child Development, 64, (3, Serial No. 258).
Main, M. and Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M.T. Greenberg, D. Cicchetti, & E.M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). Chicago: University of Chicago Press.
van IJzendoorn, M.H., Schuengel, C., and Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249.
Kerig, P.K. (2005). Revisiting the construct of boundary dissolution: A multidimensional perspective. Journal of Emotional Abuse, 5, 5-42.
Macfie, J. Fitzpatrick, K.L., Rivas, E.M. and Cox, M.J. (2008). Independent influences upon mother-toddler role-reversal: Infant-mother attachment disorganization and role reversal in mother’s childhood. Attachment and Human Development, 10, 29-39
Macfie, J., McElwain, N.L., Houts, R.M., and Cox, M.J. (2005) Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment & Human Development, 7, 51-65.
Pearlman, C.A. and Courtois, C.A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18, 449-459.
Prager, J. (2003). Lost childhood, lost generations: the intergenerational transmission of trauma. Journal of Human Rights, 2, 173-181.
Shaffer, A., and Sroufe, L. A. (2005). The developmental and adaptational implications of generational boundary dissolution: Findings from a prospective, longitudinal study. Journal of Emotional Abuse. 5(2/3), 67-84.
Sroufe, L. A. (2005). Attachment and development: A prospective, longitudinal study from birth to adulthood, Attachment and Human Development, 7, 349-367.
Bacciagaluppi, M. (1985). Inversion of parent-child relationships: A contribution to attachment theory. British Journal of Medical Psychology, 58, 369-373.
Benoit, D. and Parker, K.C.H. (1994). Stability and transmission of attachment across three generations. Child Development, 65, 1444-1456
Brennan, K.A. and Shaver, P.R. (1998). Attachment styles and personality disorders: Their connections to each other and to parental divorce, parental death, and perceptions of parental caregiving. Journal of Personality 66, 835-878.
Bretherton, I. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11, 237-252.
Sable, P. (1997). Attachment, detachment and borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training, 34(2), 171-181.
Cassidy, J., and Berlin, L. J. (1994). The insecure/ambivalent pattern of attachment: Theory and research. Child Development, 65, 971−991.
Mikulincer, M., Gillath, O., and Shaver, P.R. (2002). Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality and Social Psychology, 83, 881-895.
Tronick, E.Z. (2003). Of course all relationships are unique: How co-creative processes generate unique mother-infant and patient-therapist relationships and change other relationships. Psychoanalytic Inquiry, 23, 473-491.
van der Kolk, B.A. (1987). The separation cry and the trauma response: Developmental issues in the psychobiology of attachment and separation. In B.A. van der Kolk (Ed.) Psychological Trauma (31-62). Washington, D.C.: American Psychiatric Press, Inc.
van der Kolk, B.A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411
van Ijzendoorn, M.H. (1992) Intergenerational transmission of parenting: A review of studies in nonclinical populations. Developmental Review, 12, 76-99
Holmes, J. (2004). Disorganized attachment and borderline personality disorder: a clinical perspective. Attachment & Human Development, 6(2), 181-190.
Lopez, F. G., Fuendeling, J., Thomas, K., and Sagula, D. (1997). An attachment-theoretical perspective on the use of splitting defenses. Counseling Psychology Quarterly, 10, 461-472.
Raineki, C., Moriceau, S., and Sullivan, R.M. (2010). Developing a neurobehavioral animal model of infant attachment to an abusive caregiver. Biological Psychiatry, 67, 1137-1145.
Cozolino, L. (2006): The neuroscience of human relationships: Attachment and the developing social brain. WW Norton & Company, New York.
Siegel, D. (1999). The developing mind: Toward a neurobiology of interpersonal experience (New York: Guilford Press, 1999)
Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J., and Rizzolatti, G. (2005). Grasping the intentions of others with one’s own mirror neuron system. Plos Biology, 3(3), e79.
Kaplan, J. T., and Iacoboni, M. (2006). Getting a grip on other minds: Mirror neurons, intention understanding, and cognitive empathy. Social Neuroscience, 1(3/4), 175-183.
Fraiberg, S., Adelson, E., and Shapiro, V. (1975). Ghosts in the nursery. Journal of the American Academy of Child and Adolescent Psychiatry, 14, 387–421.
Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley.
Beck, A.T., Freeman, A., Davis, D.D., and Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.
Kernberg, O.F. (1975). Borderline conditions and pathological narcissism. New York: Aronson.
Moor, A. and Silvern, L. (2006). Identifying pathways linking child abuse to psychological outcome: The mediating role of perceived parental failure of empathy. Journal of Emotional Abuse, 6, 91-112.
Trippany, R.L., Helm, H.M. and Simpson, L. (2006). Trauma reenactment: Rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counseling, 28, 95-110.
Rappoport, A. (2005). Co-narcissism: How we accommodate to narcissistic parents. The Therapist.
Carlson, E.A., Edgeland, B., and Sroufe, L.A. (2009). A prospective investigation of the development of borderline personality symptoms. Development and Psychopathology, 21, 1311-1334.
Juni, S. (1995). Triangulation as splitting in the service of ambivalence. Current Psychology: Research and Reviews, 14, 91-111.
Barnow, S. Aldinger, M., Arens, E.A., Ulrich, I., Spitzer, C., Grabe, H., Stopsack, M. (2013). Maternal transmission of borderline personality disorder symptoms in the community-based Griefswald Family Study. Journal of Personality Disorders, 27, 806-819,
Dutton, D. G., Denny-Keys, M. K., and Sells, J. R. (2011). Parental personality disorder and its effects on children: A review of current literature. Journal of Child Custody, 8, 268-283.
Fruzzetti, A.E., Shenk, C. and Hoffman, P. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17, 1007-1030.
Garety, P. A. and Freeman D. (1999) Cognitive approaches to delusions: A critical review of theories and evidence. The British Journal of Clinical Psychology; 38, 113-154.
Hodges, S. (2003). Borderline personality disorder and posttraumatic stress disorder: Time for integration? Journal of Counseling and Development, 81, 409-417.
Levy, K.N. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, p. 959-986
Stepp, S. D., Whalen, D. J., Pilkonis, P. A., Hipwell, A. E., and Levine, M. D. (2011). Children of mothers with Borderline Personality Disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders: Theory, Research, and Treatment. 1-16.
Svrakic, D.M. (1990). Functional dynamics of the narcissistic personality. American Journal of Psychiatry. 44, 189-203.
Widiger, T.A. and Trull, T.J. (2007). Plate tectonics in the classification of personality disorder: Shifting to a dimensional model. American Psychologist, 62, 71-83.
Minuchin, S. (1974). Families and family therapy. Harvard University Press.”
(Foundations: Childress, 2015, p. 344-351)
Alternatively, Foundations brings all of this information together into a coherent and comprehensive explanatory model for attachment-related pathology surrounding divorce.