“When someone seeks,” said Siddhartha, “then it easily happens that his eyes see only the thing that he seeks, and he is able to find nothing, to take in nothing because he always thinks only about the thing he is seeking, because he has one goal, because he is obsessed with his goal. Seeking means: having a goal. But finding means: being free, being open, having no goal.” — Hermann Hesse, Siddhartha
Diagnosis is not seeking, diagnosis is following, diagnosis is discovering.
The goal of clinical assessment is to follow the symptom pattern to discover the cause. In court-involved mental health, the findings of the assessment should be carefully documented in the patient record.
The goal of clinical assessment is not to “find” something, like ADHD or autism or bipolar disorder. The goal of clinical assessment is to follow the symptoms into the pattern that discloses the cause, discloses the ADHD diagnosis or the bipolar diagnosis. As a clinical psychologist, I don’t care what pathology is identified through the assessment. We will fix whatever it is.
We simply need an accurate diagnosis in order to develop an effective treatment plan. In clinical psychology, we follow the symptoms into the pattern that discloses the diagnosis.
The application of standard and established constructs and principles to a set of symptoms is called diagnosis. A description of pathology using the standard and established constructs and principles of professional psychology is called a diagnostic model; it explains why we see a particular symptom pattern.
The diagnostic model of attachment-based “parental alienation” (AB-PA) makes a prediction about the child’s symptom pattern. AB-PA predicts the presence of three disparate, extremely rare, and seemingly unconnected child symptoms:
1.) Attachment system suppression toward a normal-range parent,
2.) Specific personality pathology in the child’s symptom display,
3.) An encapsulated persecutory delusion.
If these symptoms are not present in the child’s symptoms, then the assessment and diagnosis follows the symptoms wherever they lead to discover the cause.
However, if these three a-priori predicted symptoms of AB-PA are present in the child’s symptom display, they need explanation.
How does a child acquire this specific set of three highly unusual and disparate symptoms?
How does a child develop an attachment bonding rejection pathology toward a normal-range and affectionally available parent?
AND… How does the same child develop five specific narcissistic personality traits expressed specifically toward a parent? AND…
AND… How does the same child develop an encapsulated persecutory delusion about the normal-range parenting of a normal-range parent? This symptom is impossible to explain other than AB-PA.
If these three symptoms are present, they require an explanation. An attachment-based model for the pathology of “parental alienation” surrounding divorce not only explains these symptoms, it predicts these specific symptoms.
The presence of these three symptoms in the child’s symptom display confirms the diagnostic model that makes this prediction.
Each of these symptoms is exceedingly rare generally, and exceptionally rare in children. Attachment bonding rejection from a child toward a normal-range parent is essentially unheard of beyond the age of 18 months, except in severe cases of child abuse such as incest or severe physical abuse. Personality disorder pathology is also extremely unusual in a child. An encapsulated persecutory delusion toward a normal-range parent is not only rare, it is impossible to explain outside of the pathology of AB-PA. There is no method by which a child acquires an encapsulated persecutory delusion regarding a normal-range parent except through the pathology of AB-PA (a cross-generational coalition with an allied parent against the targeted parent).
Not only does a Bowlby-Minuchin-Beck model of attachment-based “parental alienation” explain the presence of these three disparate and unusual symptoms in the child’s symptom display, a Bowlby-Minuchin-Beck diagnostic model predicts these symptoms.
The presence of these three symptoms in the child’s symptom display is confirmatory evidence for the diagnostic model that predicts these symptoms.
Assessment leads to diagnosis, and diagnosis guides treatment.
It begins with assessment. Three symptoms.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857