Two Diagnostic Models: Your Choice

You need to be an informed consumer of mental health services. These are your children and it is your family.  Which diagnostic model is used with your children and with your family is your choice.

So let’s compare.

There are currently two diagnostic models for determining the cause of a child’s rejection toward a parent surrounding divorce, the 8-symptom Gardnerian PAS diagnostic model, and the three-symptom AB-PA diagnostic model. They are assessed in different ways, and they lead to different outcomes.

The 8-symptom Gardnerian PAS diagnostic model has been applied for the past 35 years. It is the current diagnostic model being used. It is responsible for the current situation. If you want to see what the Gardnerian 8-symptom diagnostic model leads to, just look around… we’ve been using the 8-symptom Gardnerian PAS diagnostic model for 35 years, and it is currently the most prevalent diagnostic model being used to assess the pathology of “parental alienation” (attachment-related family pathology surrounding divorce).

AB-PA: The AB-PA diagnostic model was first described by Childress in Foundations (2015). It is mostly unknown in professional psychology, but it is rapidly gaining awareness in professional psychology.

As evidence of this increasing awareness, Dr. Childress has already conducted a six-session treatment focused assessment by court order (conducted across three consecutive days of clinical assessment sessions with the family; and a turn-around time for the treatment focused assessment report to the court in less than two weeks). An AB-PA pilot program for the family courts is also currently available in Houston, Texas; with 15 AB-PA knowledgeable mental health professionals trained to administer the six-session treatment focused assessment protocol, trained to manage the Strategic family systems intervention of a Contingent Visitation Schedule, and knowledgeable in solution-focused family therapy (Minuchin, Bowen, Berg) for stabilizing the post-divorce separated-family structure, along with 10 AB-PA knowledgeable amicus attorneys to coordinate family treatment with court orders and court support.

The three-symptom AB-PA diagnostic model represents change.

The AB-PA diagnostic model represents the application of the highest caliber of professional knowledge (Bowlby, Minuchin, Beck) and standards of practice to the assessment, diagnosis, and treatment of attachment-related family pathology surrounding divorce.

The 8-symptom Gardnerian PAS diagnostic model is based on the proposals of one man, a psychiatrist in the 1980s, that there exists a “new form of pathology” unique in all of metal health, so unique that this “new form of pathology” needs its own unique new set of symptoms unlike any other symptoms for any other pathology in all of mental health, eight symptoms made up 35 years ago, in the 1980s, by this one psychiatrist .

The three diagnostic indicators of AB-PA are based in the standard and established constructs and principles of professional psychology; Bowlby, Minuchin, Beck; the attachment system, personality disorder pathology, family systems therapy.

The 8-symptom Gardnerian diagnostic model is assessed using a six to nine month child custody evaluation costing $20,000 to $40,000.

The three diagnostic indicators of AB-PA (an attachment-based model for the pathology) are assessed in six sessions for around $2,500.  All three symptoms of AB-PA are standard symptoms fully within the existing scope of practice for all mental health professionals to identify.

When the three diagnostic indicators of AB-PA are present in the child’ symptom display, the DSM-5 diagnosis is V995.51 Child PsychologicaL Abuse, Confirmed.

When the 8-symptom Gardnerian PAS diagnostic model is used, this does NOT lead to a DSM-5 diagnosis of Child Psychological Abuse. The 8-symptom Gardnerian PAS diagnostic model does NOT result in a DSM-5 diagnosis of Child Psychological Abuse.

The 8-symptom Gardnerian PAS diagnostic model requires that targeted parents prove “parental alienation” through a court trial. It is in the two year run-up period to the trial that the child custody evaluation is typically ordered.

Since child custody evaluations take six to nine months to complete, this typically extends the time needed to obtain the court trial that’s needed to prove “parental alienation” using the 8-symptom Gardnerian PAS diagnostic model to about two years, or longer, from the start of the pathology (six months to get the court order for the custody evaluation, nine months for the custody evaluation to be completed, and three to six months to schedule the trial).  Assuming there aren’t court scheduling delays or delay tactics used by the allied narcissistic-borderline parent, the minimum anticipated time before trial is two years, and it often takes closer to three to five years before trial due when court delays and delay tactics by the allied narcissistic-borderline parent are factored in.

With the three diagnostic indicators of AB-PA, the pathology can be assessed by a mental health professional in six sessions.  This means that the time frame for an assessment and report to the court can be as short as two weeks, and typically not longer than 8 weeks.  Because the AB-PA diagnostic model returns a confirmed DSM-5 diagnosis of V995.51 Child Psychological Abuse, the start of treatment, including a possible protective separation of the child from the pathogenic parenting of the allied narcissistic-borderline parent, can begin within months of the start of the pathology.

With the 8-symptom Gardnerian PAS model (the one currently being used throughout psychology), it typically takes at least two years and over $100,000 in legal costs before even reaching the point where a decision is made by the court… and who knows what the custody evaluator will decide and then what the court will decide.

Typically the initial custody report returns a vague “both parents are contributing” analysis and conclusion (it’s a safe middle-of-the road position), with a recommendation for no change in the current de facto sole custody to the allied parent that is created by the child’s rejection of the targeted parent, and a recommendation for “reunification therapy” between the child and targeted parent to rehabilitate their relationship (that’s being damaged by the allied parent).

After a year of utterly failed “reunification therapy” in which the severity of the child’s rejection of the targeted parent has become more severe and more fully entrenched, a second “follow-up” custody report is usually ordered, typically with the same evaluator because it’s assumed the prior knowledge of the evaluator with this family will be useful. However, this assumption is usually not warranted. If the mental health professional doesn’t have the knowledge needed to correctly identify the pathology the first time, then the second time is probably not going to be all that different.

The time frame using the 8-symptom Gardnerian PAS diagnostic model becomes:

• Initial order for a custody evaluation: six months to a year from the start of the pathology (cost: $20,000 to $40,000 per evaluation).
• Completed custody evaluation: Six to nine months to complete the custody evaluation, typically recommending no-change in the de facto sole custody to the allied parent, and usually recommending “reunification therapy.”
• “Reunification Therapy”: One year of failed “reunification therapy.”
• Update custody evaluation: Six months to complete the follow-up custody evaluation, and three months to schedule the court date.

So by the time the trial arrives, it has typically been at least three years since the start of the pathology.

No matter what the outcome at trial, three entire years of the parent-child relationship is lost with the targeted parent. That time can never be recovered no matter what decision is ultimately reached at trial.

In addition, if an ultimate decision is made at trial of “parental alienation,” this means that the child has been abandoned to the pathological parenting of a narcissistic-borderline parent for three entire years of development without the compensating healthy influence of the normal-range targeted parent.  Using the 8-symptom diagnostic model of Gardnerian PAS, the damage and pathology is allowed to continue for three to five years before it is addressed.  The damage is done, and three years of parent-child time with the normal-range, loving and beloved parent, is lost, and can never be recovered.

Because the 8-symptom Gardnerian PAS diagnostic model is assessed using a child custody evaluation and proving “parental alienation” in a court trial, legal costs can often run in excess of $100,000, and often closer to $150,000 through three years of litigation and trial before action is taken to solve the pathology (typically three to five years of litigation is needed before reaching trial).

Dr. Childress: In my view as a clinical psychologist, every cent of this money should go to the child’s college education fund, not to attorneys and child custody evaluators.  In my view as a clinical psychologist, it is both unethical and immoral practice for any psychologist to actively collude with and participate in a process that is known to abandon a child for up to three years with a pathological parent, and that will knowingly drain the family’s money needed for the college education of the child, to pay for the legal and therapy costs imposed by the diagnostic model of the pathology.  When there is a more efficient, successful, and better way, it is the ethical obligation of all psychologists to take this route.

The three diagnostic indicators of AB-PA are made by a mental health professional within six to eight weeks of the initial identification of the pathology, and it is the DSM-5 diagnosis of V995.51 Child Psychological Abuse from this assessment by a mental health professional that is provided to the court to support the targeted parent’s requests for orders from the court.

With the AB-PA diagnostic model, a confirmed DSM-5 diagnosis for the pathology can be made in six-sessions ($2,500) and the targeted parent, whether represented by an attorney or self-representing pro se, begins the litigation process with a confirmed DSM-5 diagnosis of Child Psychological Abuse for the parenting practices of the allied narcissistic-borderline parent.

Dr. Childress: In my professional view as a clinical psychologist, this is a lock-down reason for selecting the AB-PA diagnostic model. The AB-PA diagnostic model provides (in six assessment sessions) a confirmed DSM-5 diagnosis of Child Psychological Abuse for the pathology.

The 8-symptom Gardnerian PAS diagnostic model does not result in a DSM-5 diagnosis of Child Psychological Abuse (in six to nine months of assessment; $20,000 to $40,000 for just the assessment).

If you use the 8-symptom Gardnerian PAS diagnostic model, the differential diagnosis in the assessment process is a pathology that’s been made up in forensic psychology to coincide with their construct of “parental alienation,” called “justified estrangement.” If targeted use the 8-symptom Gardnerian PAS diagnostic model, they will need to defend themselves against the allegation that the pathology is “justified estrangement,” meaning that the targeted parent “deserves” to be rejected for past parental failures.  When the 8-symptom Gardnerian PAS diagnostic model is used, targeted parents must defend their prior parenting, that they do not “deserve” to be rejected because of their prior problematic parenting (“justified estrangement”)

Since there are no criteria for “justified estrangement,” the mental health professionals assessing for the 8-symptom Gardnerian PAS diagnostic model can find a blend (a “hybrid”) of both “parental alienation” and “justified estrangement” – typically leading to no treatment for the “parental alienation” because the targeted parent is deemed to be partially contributing to their “justified estrangement.”

In the AB-PA diagnostic model, the presence of the three diagnostic indicators of AB-PA is a confirmed DSM-5 diagnosis of V995.51 Child Psychological Abuse. Period, end of story.  In AB-PA, there is no such thing as “justified estrangement.”

In AB-PA, the construct of “justified estrangement” is called physical and sexual abuse of the child by the targeted parent, and the rule-out diagnosis for the targeted parent is that there is no physical or sexual abuse of the child by the targeted parent, that the parenting practices of the targeted parent are broadly normal-range.

These are not differences of opinion regarding the two diagnostic models, these are the facts surrounding the use of each diagnostic model. You are the parent.  These are your children, and this is your family.  You should be an informed consumer of mental health services.

You are the parent.  The choice as to which diagnostic model you want to ask be applied with your children and with your family is up to you.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 8857