The Battle to Reclaim Mental Health

The mental health system has failed you and your children.

It is the mental health system, not the legal system, that should identify the degree of psychopathology being expressed in your family.  Because the mental health system has completely failed you, the legal system does not receive clear direction from mental health as to what needs to be done to resolve the pathology and restore normal-range family relationships.

The current response of the mental health system to the pathology of “parental alienation” (as defined by an attachment-based model: Foundations) is replete with rampant ignorance, incompetence, and the general arrogance of mental health providers in diagnosing and treating the pathology. As a result, it falls upon you, the client, to know more than the mental health provider about the pathology and its diagnosis, and to educate the mental health provider in what should be their area of expertise.

This is analogous to knowing more about the law than your attorney so you can tell your attorney how to argue your case, or knowing more about medicine than your physician so you can instruct your physician in diagnosing and treating your illness.  Stupid.  But that’s what we’re looking at with mental health providers and the pathology of “parental alienation.”

That the mental health system is requiring clients to know more than the mental health providers in order to obtain professionally competent assessments and diagnoses of the family’s pathology is a professional disgrace. The American Psychological Association and other professional organizations should be ashamed that the professional response to the pathology of “parental alienation” is so incredibly inadequate that it is requiring clients to be more knowledgeable than providers in order to educate providers in the both nature of the pathology and its diagnosis in an effort to receive a competent professional response.

As professionally disgraceful as this may be, this is nevertheless the current state of affairs in the mental health system’s response to the pathology of “parental alienation” (as defined by an attachment-based model). It is what it is. So we might as well roll up our sleeves and set about changing the response of the mental health system to the pathology of “parental alienation.”

The Strategy for Change

The strategy to reclaim the mental health system as your ally involves two separate but interrelated assaults by contingents of targeted parents.

The first contingent of targeted parents represents our boots-on-the-ground infantry. These are the targeted parents with currently active cases of alienation which place them in direct contact with mental health providers and child custody evaluators. It is up to these targeted parents to educate the individual mental health providers one-by-one about the professionally competent assessment, diagnosis, and treatment of the pathology being expressed in your families. 

Be kind, but be relentless.  In seeking professional competence, you have as your weapon Standards 2.01, 9.01, and 3.04 of the ethics code of the American Psychological Association (but only if you use an attachment-based definition of the pathology, NOT if you use a Gardnerian PAS description)

These mental health professionals are likely to be ignorant and resistant to being educated. They are likely to be rudely dismissive and arrogant in their ignorance. Overcoming their ignorance, incompetence, and arrogance is your challenge. I never said that this fight would be easy.

Be kind. Be relentless, but be kind. When we argue with someone they feel threatened and their brain drops into lower brain systems of threat-based functioning involving the fight, flight, or freeze response to threat. There is a wonderful little YouTube clip on the art of winning an argument that would be useful to watch:

Why internet arguments are useless and how to start winning arguments

The second contingent of targeted parents are our cavalry who are flanking the mental health providers and are instead assaulting the citadel of establishment mental health directly. This contingent of targeted parents is seeking a change to the Position Statement of the American Psychological Association regarding the family pathology of “parental alienation” as the focal target of this assault. The cavalry might include targeted parents who have grown children now or who no longer have active contact with individual mental health providers but who want to bring an end to this pathology for all children and all families everywhere.  Your friends and family could participate in this effort as well. Actively alienated parents (our infantry) may also want to do something additional in their spare time to solve “parental alienation” for all children and all families.

The role of our infantry is to engage the battle one individual mental health provider at a time, educating them one-by-one in the professionally competent assessment, diagnosis, and treatment of the pathology. The role of the cavalry is to flank the individual treatment providers by engaging the citadel of establishment mental health directly, by demanding a change to the Position Statement of the American Psychological Association on the family pathology of “parental alienation” to:

1. Formally acknowledge that the pathology exists (i.e., a role-reversal relationship with a narcissistic/(borderline) parent in which the child is used as a “regulatory object” to stabilize the pathology of the parent etc. – you’ll need to know the correct professional terminology – the phase “parental alienation” carries no power).

2. Formally recognize that the complexity of the pathology warrants the designation of your children and families as a “special population” who require specialized professional knowledge and expertise to competently assess, diagnose, and treat.

So let me describe the battle plans for each of these contingents of targeted parents.

The Infantry: Protect the Child

We cannot ask the child to reveal their authentic love for you until we are able to first protect the child from the brutal psychological retaliation and guilt-inducing manipulation of the narcissistic/(borderline) parent that is sure to follow any display by the child of affectionate bonding with you, or even for not rejecting you with a sufficient enough display of hostility and contempt.

Any effort to restore the normal-range authenticity of the child will simply turn the child into a psychological battleground between our efforts to restore the child’s normal-range authenticity and the continual efforts of the pathological narcissistic/(borderline) parent to maintain the child’s symptomatic rejection of you, and turning the child into a “psychological battleground” will be destructive of the child’s healthy emotional and psychological development.

We must first protect the child.

This is critical to understand. The pathology of attachment-based “parental alienation” is NOT a child custody and visitation issue, it is a child protection issue. The correct clinical term for the pathology of attachment-based “parental alienation” is “pathogenic parenting.”

patho = pathology
genic = genesis; creation

Pathogenic parenting refers to creating severe psychopathology in the child through highly aberrant and distorted parenting practices.

When the three diagnostic indicators of attachment-based “parental alienation” are present in the child’s symptom display, the pathogenic parent is the allied and supposedly favored parent. There is no question about it. The ONLY way this specific set of three disparate symptom displays can be evidenced by a child is through the pathology of attachment-based “parental alienation” as described in Foundations.  That’s the only way.  No other type of pathology will produce this specific set of three diagnostic indicators.

The presence of the three diagnostic indicators in the child’s symptom display will accurately identify the pathology of “parental alienation” 100% of the time and will also accurately differentiate the pathology of “parental alienation” from all other types of parent-child conflict (such as pathogenic parenting by the targeted parent).

Child Psychological Abuse

Pathogenic parenting by a narcissistic/(borderline) parent that is inducing severe:

Developmental pathology (Diagnostic Indicator 1)

Personality pathology (Diagnostic Indicator 2)

Psychiatric pathology (Diagnostic Indicator 3)

in the child as a means to stabilize the emotional and psychological functioning of the narcissistic/(borderline) parent, and which causes the developmental loss for the child of an affectionally bonded relationship with a normal-range and affectionally available parent, reasonably represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

The DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed activates the mental health professional’s “duty to protect” which must then be discharged by taking an affirmative action to protect the child and documenting this action in the patient’s record.

On this, there is no compromise. The pathology of attachment-based “parental alienation” is psychological child abuse.

To say that it is not child abuse is to argue that it is acceptable parenting to induce severe developmental, personality disorder, and psychiatric pathology in a child in order to stabilize the emotional and psychological state of the parent.

Inducing severe developmental pathology (Diagnostic Indicator 1), personality pathology (Diagnostic Indicator 2), and psychiatric pathology (Diagnostic Indicator 3) in a child in order to stabilize the emotional and psychological functioning of a narcissistic/(borderline) parent represents psychologically abusive parenting, especially when the child’s induced pathology results in the loss for the child of an affectionally bonded relationship with a normal-range and affectionally available parent.

Our first obligation with all forms of child abuse is to protect the child. Our response to the psychological abuse of “parental alienation” should be commensurate with our response to any other form of child abuse.

Protective Separation:

In all forms of child abuse, physical, sexual, and psychological, our first response to the abuse of the child is to protectively separate the child from the abusive parent and place the child in kinship care of an affectionally available and protective caregiver. We do this for a child exposed to a physically abusive parent, we do this for a child exposed to a sexually abusive parent, we do this for a child exposed to a psychologically abusive parent.

In the case of “parental alienation” pathology, the kinship care is with the normal-range and affectionally available targeted parent.

In all cases of child abuse, once we have protectively separated the child from the abuse of the parent, we then provide the child with appropriate trauma-focused therapy to resolve the consequences of the child’s exposure to an abusive parent. We do this for a child exposed to a physically abusive parent, we do this for a child exposed to a sexually abusive parent, we do this for a child exposed to a psychologically abusive parent.

In attachment-based “parental alienation,” this involves helping the child process the grief surrounding the divorce and the previously lost relationship with the targeted parent which occurred as a result of the psychologically abusive parenting of the narcissistic/(borderline) parent. The child’s grief is processed and resolved by helping the child re-bond to the formerly targeted-rejected parent.

We do not re-expose a child to an abusive parent until we are confident that the formerly abusive parent will not continue to abuse the child. We do this for a child exposed to a physically abusive parent, we do this for a child exposed to a sexually abusive parent, we do this for a child exposed to a psychologically abusive parent.

In all forms of child abuse, prior to re-exposing the child to the abusive parent we require that the abusive parent receives adequate therapy that specifically addresses and resolves the psychological issues that led to their prior abusive parenting practices. We do this for a child exposed to a physically abusive parent, we do this for a child exposed to a sexually abusive parent, we do this for a child exposed to a psychologically abusive parent.

If the previously abusive parent fails to obtain treatment and continues to pose a risk of ongoing child abuse, then we actively restrict, monitor, and supervise this parent’s contact with the child. We do this for a child exposed to a physically abusive parent, we do this for a child exposed to a sexually abusive parent, we do this for a child exposed to a psychologically abusive parent.

Paradigm Shift

Richard Gardner took us down the wrong road when he proposed a “new syndrome” in mental health that was unique in all of professional psychology, which included an equally unique set of eight vaguely defined symptom identifiers which had no underlying conceptual foundation for the pathology.

The pathology of “parental alienation” is NOT a new and unique syndrome in all of mental health. It is a manifestation of well-established and fully accepted forms of psychopathology (personality disorder pathology, family systems pathology, attachment trauma pathology).

An attachment-based reformulation of the pathology of “parental alienation” corrects the error of Richard Gardner and places us back onto the proper path of defining the pathology entirely from within standard and fully accepted forms psychopathology. And when we do this, the pathology of “parental alienation” becomes defined as severely “pathogenic parenting” which warrants the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

An argument used against the Gardnerian PAS model of the pathology is that this supposedly unique new syndrome of “parental alienation” is not a recognized DSM-5 diagnosis. Once we shift to an attachment-based model for defining the pathology of “parental alienation,” the pathology is immediately in the DSM-5… it’s a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed. There. Right there. See, on page 719,,, the pathology of “parental alienation” is already in the DSM-5: V995.51 Child Psychological Abuse, Confirmed

To achieve this DSM-5 diagnosis we MUST give up the Gardnerian PAS model and switch to an attachment-based definition of the pathology that is based entirely within standard and well-established forms of existing psychopathology. Which model is being used will be evidenced by the diagnostic indicators being applied to the pathology:

Gardnerian PAS: Eight diagnostic indicators (campaign of denigration, weak and frivolous reasons, borrowed scenarios, etc.)

Attachment-Based Model: Three diagnostic indicators evidenced in the child’s symptom display:

1. Attachment Suppression

2. Personality Disorder Traits

3. Delusional Belief

Any mental health professional who is continuing to advocate for a Gardnerian PAS model and its eight diagnostic indicators rather than a switch to an attachment-based model and its three diagnostic indicators is delaying the necessary paradigm shift to defining the pathology as a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

The Gardnerian PAS model does NOT provide the DSM-5 diagnosis of Child Psychological Abuse, Confirmed because the Gardnerian PAS model defines the pathology as a “new syndrome” which is unique in all of mental health, with no association to any other form of established and existing psychopathology within mental health. In order for this “new syndrome” model to provide a solution, it must first be accepted by establishment mental health as a “new syndrome” or else the pathology it describes doesn’t formally exist.

An attachment-based model corrects this error. By defining the pathology of “parental alienation” from entirely within standard and well-established forms of accepted psychopathology within mental health, an attachment-based model activates the construct of “pathogenic parenting” which then activates the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

An attachment-based model of “parental alienation” gives you the DSM-5 diagnosis of Child Psychological Abuse, Confirmed; a Gardnerian PAS model doesn’t.

The pathology of “parental alienation” is NOT a child custody and visitation issue, it is a child protection issue. This is the unrelenting message that our infantry will carry to each and every mental health provider involved with their children and families. Initially, this will be discounted and scoffed at by mental health professionals. But the truth is the truth. Try out that Socratic questioning method described in the YouTube video on arguments. Ask the mental health provider to educate you as to why inducing severe developmental pathology, personality pathology, and psychiatric pathology (a delusional belief) is NOT abusive parenting.  So inducing severe pathology in your child is acceptable parenting?  Really?

The correct clinical term for “parental alienation” is “pathogenic parenting” (i.e., parenting practices that are so aberrant and deviant that they are creating severe psychopathology in the child).

The pathology of attachment-based “parental alienation” is a DSM-5 diagnosis of Child Psychological Abuse and warrants the same child protection response from mental health that we provide to all forms of child abuse; i.e., a protective separation of the child from the pathology of the abusive parent and placement of the child in protective kinship care, which in the case of “parental alienation” pathology is with the affectionally available and normal-range targeted parent.

The moment the paradigm shifts for defining the pathology of “parental alienation” is the exact moment that this solution becomes available. Until the paradigm shifts, no solution is available.

Standard 9.01: Assessment

I want ALL targeted parents to go to the online version of the APA’s ethics code and read for yourself Standard 9.01a of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association. Go and read it, just to let it fully sink in. This code of practice is the defined standard of practice for ALL psychologists, and Standard 9.01 defines the standard of practice regarding the assessment of pathology.

It reads:

9.01 Bases for Assessments
(a) Psychologists base the opinions contained in their recommendations, reports and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings.

“…base their opinions contained in their… diagnostic… statements… on information and techniques sufficient to substantiate their findings.”

So psychologists are REQUIRED to conduct assessments that are sufficient to substantiate their diagnostic findings.

When assessing the pathology of “parental alienation” (i.e., a role-reversal relationship of the child with a narcissistic/(borderline) parent… etc.), psychologists are REQUIRED to conduct an assessment sufficient to substantiate their diagnostic findings.

What is an assessment “sufficient to substantiate their findings” regarding the pathology of “parental alienation”?  Glad you asked.

Up on my website is a Diagnostic Checklist for Pathogenic Parenting (either the three diagnostic indicator short form or the Extended Version that includes the Associated Clinical Signs).

Also up on my website is a pdf of my blog post on Diagnosing Parental Alienation. My blog post on Diagnosing Parental Alienation can be used as a companion piece for the Extended Checklist that includes Associated Clinical Signs.

Using the Diagnostic Checklist for Pathogenic Parenting to identify the presence or absence of established and accepted forms of symptom displays (the child’s attachment system display, standard DSM defined personality disorder traits, standard DSM defined phobic anxiety symptoms, and standard DSM defined delusional beliefs – all representing standard and established forms of mental health pathology) would represent an assessment “sufficient to substantiate” their diagnostic findings in assessing the pathology of attachment-based “parental alienation” (i.e., the cross-generational coalition of the child with a narcissistic/(borderline) parent in which the child is being used in a role-reversal relationship as an external “regulatory object” to stabilize the pathology of the narcissistic/(borderline) parent, etc.)

If the psychologist or mental health professional DOES NOT assess for these specific symptom features (as identified on the Checklist; i.e., the child’s attachment system display, personality disorder traits, phobic anxiety, and delusional beliefs), then this would NOT be an assessment “sufficient to substantiate” their diagnostic findings, in possible violation of Standard 9.01a of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

We are not allowing them be incompetent.

The APA ethics code is the anvil and the Diagnostic Checklist for Pathogenic Parenting is our hammer.  Using these two together, we will forge an accurate diagnosis of the pathology.

If the mental health professional does not conduct an assessment sufficient to substantiate their diagnostic findings, then they are in violation of Standard 9.01a. If they don’t use the Diagnostic Checklist for Pathogenic Parenting – which is simply a set of three established forms of pathology; attachment pathology, personality pathology, psychiatric pathology – then they will need to explain why they refused to assess for these established forms of psychopathology.

They are really going to have to fight to remain professionally incompetent.  On the other hand, it is incredibly easy to be competent in the assessment of the pathology.  Just complete the Checklist. If the symptom indicators are present in the child’s symptom display, then make the appropriate DSM-5 diagnosis:.

DSM-5 Diagnosis

309.4 Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

The first diagnosis of Adjustment Disorder is the primary diagnosis. The three V-code diagnoses are modifiers that describe why the child is having an adjustment problem. Notice the third V-code diagnosis.

Pathogenic parenting that is inducing significant developmental pathology (Diagnostic Indicator 1), personality disorder pathology (Diagnostic Indicator 2), and psychiatric pathology (Diagnostic Indicator 3) in the child in order to stabilize the psychopathology of a narcissistic/(borderline) personality parent, and which is causing the developmental and potentially permanent loss for the child of a healthy and affectionally bonded relationship with a normal-range and affectionally available parent, represents Child Psychological Abuse. That these three symptoms are evident in the child’s symptom display Confirms the psychological child abuse.

I’m not giving mental health professionals the option to be incompetent. I know they are incompetent. I know they’re arrogant and aren’t listening to you. But if they do not conduct an assessment “sufficient to substantiate” their diagnostic findings, then they are in violation of Standard 9.01a of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Psychologists are NOT ALLOWED to be incompetent. You have a right to expect – and to demand – professional competence. Be kind. But be relentless. You have a right to expect that the mental health professionals who are diagnosing and treating your children and families conduct an assessment “sufficient to substantiate” their diagnostic findings (Standard 9.01a).

Are you starting to understand the strategy?  Is it starting to make sense? Are you beginning to see the solution? Be kind. Don’t be angry and demanding. Be kind, and oh so relentless.  Think Gandhi.  Think Martin Luther King.  Kind.  Reasonable.  And relentless.

Even if the mental health professional doesn’t agree with an attachment-based model of the pathology, or doesn’t want to learn about it, ask them to fill out the Diagnostic Checklist for Pathogenic Parenting just as a personal favor to you, just to get their perceptions documented. Their answers on the Checklist could then serve as a starting point for their more complete understanding of the child’s symptoms, and the mental health professional may become open to learning more about an attachment-based model of the pathology.

The Cavalry – Demand Competence

But educating mental health professionals one-by-one is going to take too long.  Every day that you are separated from your child is one day too long.  Isn’t there something we can do to speed up the process?

Yes.

Lay siege to the citadel of establishment mental health, the American Psychological Association.  The focal goal is the official Position Statement of the APA on the family pathology of “parental alienation.”

You will be talking to establishment mental health so you have to use the professional words of power I’ve given you in Foundations.  The term “parental alienation” has no power.

The pathology is:

The influence on family relationships of the pathology of a narcissistic/borderline personality parent following a divorce – this pathology exists.  The divorce represents a narcissistic injury and activates the narcissist’s retaliatory anger.  The divorce activates the borderline personality’s fears of abandonment and perception of being abused by the abandoning attachment figure of the spouse.

The pathology of the narcissistic/borderline personality engages the child in a “role-reversal” relationship with a narcissistic/borderline parent in which the child serves as an external “regulatory object” (also called a “regulatory other”) in order to stabilize the decompensating psychological and emotional state of the narcissistic/borderline parent surrounding the divorce and their rejection by the other spouse.

The narcissistic/borderline parent is “manipulating” the child into rejecting the targeted parent (manipulation is a key feature of borderline pathology) and is exploiting the child’s rejection of the targeted parent (exploitation is a key feature of narcissistic pathology) to define the targeted parent as the rejected and inadequate parent/(spouse)/(person), thereby restoring the narcissistic defense which was challenged by the divorce experience.

“Oh God, Dr. Childress, these are such complicated descriptions.”

I know. The pathology is very complicated. But it is always the same, so it becomes increasingly familiar with repeated explanation. The more you hear the explanation of the pathology, the more it will make sense.  But you’re right, it’s very complicated.  Which is exactly why you and your children warrant the professional designation as a “special population” who require specialized professional knowledge and expertise to competently assess, diagnose, and treat.

Not any old average mental health professional is capable of recognizing and understanding the complex nature of this pathology.  It requires specialized expertise. That’s point two of your demand from the APA. You shouldn’t have to know more than your therapist about the pathology.  They should explain it to you, you shouldn’t have to explain it to them.

The Position Statement

I want you to notice several things about the official Position Statement of the APA on the family pathology of “parental alienation.” 

1.) The Title

The title of the Position Statement is about “Parental Alienation Syndrome.”  So right away it is out of date.  We’re not talking about PAS.  We’re talking about an attachment-based description of the pathology that defines the pathology from entirely within well-established and fully accepted forms of mental health pathology (personality disorder pathology, family systems pathology, attachment trauma pathology). 

No one is talking about PAS.  So this Position Statement needs to be updated to reflect the current models of the pathology.

2.)  The Length

Two sentences.  That’s all the APA deems worthy to give the family pathology and family tragedy of “parental alienation.”  Two measly sentences.  And the first sentence is about domestic violence. So actually, the position statement is only one sentence long.  Wow. This severe form of family pathology and child psychological abuse, that destroys the lives of targeted parents and their children, merits only a single measly sentence. That’s insulting

3.  Out of Date Citation

Notice that this position statement references a Task Force from 1996.  From 20 years ago.  That is incredibly out of date, especially considering the emergence of a new attachment-based reformulation for the pathology that defines the pathology of “parental alienation” from entirely within standard and well-established forms of mental health pathology.

4. Lack of Support

The single sentence position statement also states that this 20 year old Task Force noted “the lack of data to support the so called “Parental Alienation Syndrome.”

Okay.  But that’s irrelevant.  Because no one is talking about Parental Alienation Syndrome.  We’re talking about the influence on family relationships of a narcissistic/(borderline) personality parent following divorce. 

We’re not talking about Parental Alienation Syndrome.  We’re talking about the pathogenic parenting of a narcissistic/(borderline) parent and the creation of severe developmental pathology, personality disorder pathology, and psychiatric pathology in the child as a means to stabilize the emotional and psychological state of the narcissistic/(borderline) parent.

We’re not talking about Parental Alienation Syndrome.  We’re talking about the trans-generational transmission of attachment trauma from the childhood of the narcissistic/(borderline) parent to the current family relationships, mediated through a false attachment trauma reenactment narrative in the pattern of “abusive parent”/”victimized child”/”protective parent” which is contained in the internal working models of the attachment trauma networks of the narcissistic/(borderline) parent.

We’re not talking about Parental Alienation Syndrome.  We’re talking about the addition of the splitting pathology of a narcissistic/(borderline) parent to a cross-generational coalition of the child with this narcissistic/(borderline) parent in which the polarization of the splitting pathology requires that the ex-spouse also become an ex-parent; the ex-husband must become an ex-father, the ex-wife an ex-mother, consistent with the polarization of the splitting pathology.

This pathology exists. It is NOT a “so called” pathology.  It exists within the standard and established pathology accepted by professional mental health. 

And this pathology is so complex that it warrants the designation of these children and families as a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

We’re not talking about Parental Alienation Syndrome.  We’re talking about a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

So can you, the APA, please address what we’re talking about, because your current position statement is irrelevant and out of date.

5.  Disputed Terminology

The position statement expresses concern about the use of the term “parental alienation.”  Okay.  We can call the pathology something different if you’d like. What would you like to call it?  As long as you formally acknowledge that the pathology exists, by whatever terminology you choose to label it.

Shall we call it pathogenic parenting?  That seems the most straightforward. 

Or we could call it an attachment-trauma reenactment pathology.  That’s the most accurate label.

But whatever you want.  We just want you, the APA, to acknowledge that the pathology exists, and to designate these children and families as a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

That is an entirely reasonable request.

6.  Stay Focused APA

We’re not addressing the issue of domestic violence.  We’re talking about the pathology of a narcissistic/(borderline) parent who is using the child in a role-reversal relationship as an external regulatory object to stabilize the pathology of the narcissistic/(borderline) parent.  The position statement needs to stay focused on the relevant issues.

APA Divisions

The American Psychological Association has different Divisions.  Contacting the leadership of the relevant Divisions of the APA may be one means of obtaining responsiveness to your needs to have the pathology of attachment-based “parental alienation” acknowledged and your status as a “special population” of children and families recognized.

Among the relevant Divisions I might recommend starting with would be:

Division 12 Society of Clinical Psychology

Division 37 Society for Child and Family Policy and Practice

Division 41 American Psychology-Law Society

Dorcy Pruter and I have a submission pending to this Division for a proposed presentation at the 2016 APA Convention in Denver regarding the assessment and remedy of “parental alienation” pathology in a legal setting.  Hopefully this proposal gets accepted.  I guarantee it will be an amazing presentation.

Division 43 Society for Couple and Family Psychology

Division 53 Society of Clinical Child and Adolescent Psychology

Division 56 Trauma Psychology

The targeted parent mothers out there may also wish to contact:

Division 35 Society for the Psychology of Women

There is a variant of “parental alienation” involving a narcissistic husband who psychologically abuses the wife during their marriage consistent with the domestic violence themes of power, control, and domination.  When the wife eventually divorces this psychologically abusive narcissistic husband she creates a narcissistic injury by rejecting his self-perceived magnificence. 

This abusive narcissistic husband then seeks to retaliate against the now ex-wife but can no longer abuse the wife directly, because she’s no longer living with him.  So he instead uses the children as his weapons to inflict retaliatory suffering on his now ex-wife.  This abusive ex-husband enlists the children as his proxy abusers.  Instead of using his fists to beat his ex-wife, he uses the children’s hostile contempt and rejection of her to inflict his retaliatory revenge.

This variant of the “parental alienation” pathology essentially represents a variant of the domestic violence themes of power, control, and domination.  It essentially represents domestic violence by proxy – using the children as his weapons.

I believe this variant very much relates to the psychology of women as relevant to Division 35 of the APA.  For those targeted parent mothers out there, you may wish to get ahold of the leadership of Division 35 to seek their help in the recognition of this severe form of unrecognized complex domestic violence.

The Goal

My goal is to have the solution to “parental alienation” in place and available by Christmas of 2016.  There is nothing standing in the way of the solution except professional ignorance that an attachment-based model of the pathology even exists.  The moment the paradigm shifts is the moment we have a solution.

The Diagnostic Checklist of Pathogenic Parenting will identify the three diagnostic indicators of the pathology of attachment-based “parental alienation.”

When the three diagnostic indicators are present in the child’s symptom display, the accurate DSM-5 diagnosis is V995.51 Child Psychological Abuse, Confirmed which then activates the mental health professional’s “duty to protect” which requires that the mental health professional take affirmative action to protect the child and then document this affirmative action in the patient’s record.

Our response to the Child Psychological Abuse of “parental alienation” should be commensurate with our response to all forms of child abuse.  We first protectively separate the child from the abusive parent and place the child in kinship care, which in the case of “parental alienation” pathology is with the normal-range and affectionally available targeted parent.

The solution is sitting right there.  Right in front of us.  It’s available tomorrow.  The only thing standing in the way of this solution is professional ignorance.  The paradigm needs to shift from a rejected Gardnerian PAS model for defining the pathology to a theoretically grounded attachment-based formulation of the pathology.  The moment the paradigm shifts is the moment we have the solution.

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

Synthesis

I recieved a Comment to my blog that I would like to respond to as a full post.

“Dr Childress, thank you for your generic letters to therapists and the child’s attorney. Have you written a generic correspondence to the judges in these cases?” – Jeff

There’s a problem in writing a generic letter to the Court that I think will be helpful to explain.

My professional background is not as an expert in “parental alienation.” My professional expertise is actually in Attention Deficit Hyperactivity Disorder, with a secondary specialty in early childhood mental health (ages 0-5) which necessarily includes an expertise in the neuro-development of the brain during childhood.

Before entering private practice I served as the Clinical Director for a children’s assessment and treatment center that primarily served children in the foster care system.  My expertise in the attachment system comes from both my background in early childhood mental health, which is the period of active formative processes in the attachment system (although we use the patterns of the attachment system throughout our lives), and from also applying this attachment-related information directly with children in the foster care system who were the victims of parental abuse and neglect that created a variety of severe distortions with their attachment system.

My foundational expertise in ADHD and angry-defiant children focuses on older age children (school-age) and adolescents, although it also has applicability to preschool age children as well. This overlap was particularly prominent in my work at Children’s Hospital of Orange County where I served as the lead clinical psychologist on a collaborative project with the University of California, Irvine’s Child Development Center on the identification and treatment of ADHD in preschool-age children.

I know the impact of child abuse up close and personal. I’ve seen the results of child physical and sexual abuse and severe neglect. I’m not a “parental alienation” expert. I’m a clinical child and family psychologist.

I only ran across “parental alienation” when I entered private practice to begin writing my book solving ADHD and all aspects of parenting generally

And I’m being honest on that, I’ve got the non-medication solution to ADHD (most forms) and to nearly all.. no, I’d say all… parenting issues. These solutions represent the synthesis of my years of work with ADHD and the neuro-development of brain systems during childhood – look what I’ve done with “parental alienation” in a couple of years of focused effort, imagine what I’ve done with ADHD and parenting from a lifetime of effort. Solved it.

But I just can’t get to writing about it because I’m busy solving “parental alienation” first. But the reason I’ve been able to solve “parental alienation” is because I’ve first solved parenting generally, and oppositional-defiant children, and ADHD children, and healthy child development, and all the stuff related to parenting and childhood. I simply applied this knowledge to “parental alienation.”

I’m currently waiting for “parental alienation” to catch up to an attachment-based model and then I’m going to drop down one level deeper for mental health professionals into an understanding of “parental alienation” at some basic neurological levels, and in particular with a brain system called “intersubjectivity.”

For any mental health professionals who are interested in where this is going, read these two articles by Fonagy,

Fonagy, P., Luyten, P., and Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47-69.

Fonagy P. & Target M. (2005). Bridging the transmission gap: An end to an important mystery in attachment research? Attachment and Human Development, 7, 333-343.

Fonagy is one of the leading figures in the field of attachment and intersubjectivity.  His work is brilliant.

The problem in writing a generic letter to the judge is, what happens if it is actually the targeted parent who is the narcissistic parent, who may be inflicting emotional, physical, or psychological abuse on the child, or on the other parent through a history of severe domestic violence?

What if the favored parent is authentically trying to protect the child from an emotionally or physically or sexually abusing narcissistic parent, and the narcissistic targeted parent is manipulatively using the allegation of “parental alienation” against the favored parent to nullify the favored parent’s authentic efforts to protect the child from abuse?

What if the narcissistic targeted parent feels “entitled” to possession of the “narcissistic object” of the child and cannot understand why the child wouldn’t want to be with the magnificence of the ideal and perfect narcissistic parent, so that the narcissistic targeted parent is externalizing blame onto the favored normal-range and healthy parent for the child’s reluctance to be with the chronic empathic failures and nullification of the child’s self-authenticity experienced from the narcissistic targeted parent?

I know child abuse up close and personal. I will NOT participate in or collude with the ability of a narcissistic parent to emotionally, psychologically, physically, or sexually abuse the child and then avoid responsibility and nullify the protective efforts of the normal-range and healthy parent by alleging that the child’s allegations are simply a case of “parental alienation.”

The valid concern is that the narcissistic targeted parent will externalize responsibility by alleging “parental alienation,” thereby continuing the child’s exposure to emotional and psychological abuse from profound parental empathic failure and nullification of the child’s self-authenticity, physical and psychological control and intimidation of the child, or active sexual exploitation of the child, and if the child reports the abuse the narcissistic predator simply alleges that it’s a “false allegation” because of “parental alienation.”

In about 20% of the cases that come to me because of my expertise in “parental alienation” it turns out that the targeted parent who is alleging “parental alienation” actually turns out to be the narcissistic parent who is externalizing blame and responsibility for the child’s reluctance to be with the narcissistic parent onto the other parent by alleging “parental alienation” because the narcissistic targeted parent feels “entitled” to possess the child.

The Critics

This is the argument of the critics of “parental alienation.” They are deeply and rightly concerned that the construct of “parental alienation” defined by Gardner is so poorly formed that it will allow narcissistic predatory parents to continue their abuse, including the incestuous sexual abuse of the child and the psychological domination of the child (and spouse) through threats of violence directed toward the child and spouse.

I know child abuse up close and personal. The concerns expressed by the critics of “parental alienation” are entirely valid. The critics aren’t our enemy. And we should not be theirs.

They are absolutely correct in their heartfelt and authentic concerns for the well-being of children and families. As are we.

We should be joined together in a collaborative effort to accurately identify narcissistic parenting (i.e., psychological and other forms of child abuse) in 100% of the cases. We’re not adversaries, the critics and supporters of “parental alienation,” we are fundamental allies.

So why are we divided? Why do we see them as the enemy to be “overcome” and they see us as radicals that presents a “threat” to children and families?

Staff-splitting.

There is a well-established construct in working with borderline personalities referred to as “staff-splitting.”

It’s called a “parallel process” in which arguments and divisions appear in the treatment team as a parallel process of manifesting the splitting dynamic (see Key Concept: Splitting post) inherent to borderline (and narcissistic) personality dynamics.

Remember, narcissistic and borderline personality organizations are simply external variants of an underlying borderline core. They are not two different types of personalities, they are two different expressions of the same type of underlying process.

Staff-splitting is described by one of the foremost experts on borderline personality processes, Marsha Linehan,

“Staff splitting,” as mentioned earlier, is a much-discussed phenomenon in which professionals treating borderline patients begin arguing and fighting about a patient, the treatment plan, or the behavior of the other professionals with the patient… arguments among staff members and differences in points of view, traditionally associated with staff splitting, are seen as failures in synthesis and interpersonal process among the staff rather than as a patient’s problem… Therapist disagreements over a patient are treated as potentially equally valid poles of a dialectic. Thus, the starting point for dialogue is the recognition that a polarity has arisen, together with an implicit (if not explicit) assumption that resolution will require working toward synthesis.” (p. 432)

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford

Notice the date… 1993. This is not a new concept. It is familiar to everyone who works with borderline personality dynamics.

It is not a coincidence that both sides in the “parental alienation” debate adopt an idealized self-attitude that “we” are the wonderful protectors of children, and that “the other side” is comprised of callous and insensitive people who are unconcerned about child abuse.

Splitting, pure and simple. Polarized extremes of perception in which “we” are idealized and “they” are demonized.

There are no sides. We all want exactly the same thing.

The critics of “parental alienation” aren’t our enemies, and we are not theirs.

All the critics want is to ensure that we protect children from child abuse. That’s entirely reasonable. The concerns expressed by the critics are that the Gardnerian PAS model is too poorly defined so that it allows narcissistic targeted parents to continue their abuse of children by evading protection efforts through alleging “parental alienation.”

That’s an entirely reasonable concern.

So let’s look at the diagnostic criteria for Gardnerian PAS, are they specific enough to ensure that narcissistic targeted parents cannot use the construct of “parental alienation” as a manipulative means to evade our child protection efforts?

Uhhhh, no, actually they’re not. The Gardnerian PAS diagnostic criteria, while possibly accurate for identifying cases of “parental alienation” in which the narcissistic parent is the allied and supposedly favored parent, do not sufficiently differentiate cases when the targeted parent is the narcissistic parent.

Diagnostic criteria must meet standards for “sensitivity” (correctly identifying the presence of something) and “specificity” (not misidentifying other things as being the thing we’re looking for).

The Gardnerian criteria may have sufficient “sensitivity” (and I’m conceding some on the “may” here), but they lack sufficient “specificity.” There is too great a risk that the Gardnerian criteria will be used by narcissistic targeted parents to evade our child protection efforts.

I am not a “parental alienation” expert. I am a clinical psychologist. I know child abuse up close and personal. I will not participate in or collude with the pathology of a narcissistic parent, whether that parent is the allied and supposedly favored parent or whether that parent is the targeted parent.

Over the past several years, I have actually withdrawn from cases of “reunification” because I was unwilling to participate in the restoration of the child’s relationship with a narcissistic targeted parent. So far, I’ve withdrawn from three cases for exactly this reason.  In other cases where this has occurred, I’ve continued my work with an understanding that the reason for the child’s “protest behavior” was not “parental alienation” but instead represented valid child concerns.

If you’re a normal-range parent being falsely accused of “parental alienation” your best chance is probably to come see me. I know what “parental alienation” is, so I also know what it’s not.

And not everything is “parental alienation.” Sometimes the narcissistic parent is the targeted parent.

So I will not write a generic letter to a judge, because the risk is too high that a narcissistic targeted parent might use the letter to evade child protection efforts. I will ask therapists to consider the issues. I will ask minor’s counsels to consider the issues.  Judges decide.

If it is helpful, I will offer my professional expertise to the Court when desired.  I respect the Court.  If I can help the Court produce a decision that will be in the child’s best interests in achieving healthy emotional and psychological development, I would be privileged to do so. But only if my expertise can help the Court make a proper decision in the specific case before it.

Diagnosis

Achieving synthesis in this unnecessary professional debate surrounding “parental alienation” requires listening to the constructive criticism of the other position.  

The critics cited that the Gardnerian PAS model was insufficiently grounded in established psychological principles and constructs. So when I set about developing an actualizable solution to “parental alienation” I went back to the very foundations of the construct.

I first had to work out what the psychological structure of the pathology was.  From this foundational understanding for the psychological structure of “parental alienation,” I then identified key diagnostic features of this structure that would,

1.) Identify “parental alienation” in ALL cases (sensitivity)

2,) Not identify anything else that wasn’t “parental alienation” as being “parental alienation” (specificity)

The three diagnostic indicators for an attachment-based model of “parental alienation” meet this standard.

That’s why ALL THREE of the diagnostic indicators must be present to make the diagnosis of attachment-based “parental alienation.” Any of the three individual diagnostic indicators may be present from other causes, but not ALL THREE. When all three diagnostic indicators are present, the only possible cause is an attachment-based model for the construct of “parental alienation.”

In my post, Diagnostic Indicators and Associated Clinical Signs, notice how many features didn’t make the cut, i.e., all of the associated clinical signs.  All of these features are characteristic of “parental alienation” but they lack sufficient sensitivity or specificity to make the cut into being a formal diagnostic indicator.

That’s the process, the professional rigor, that Gardner should have adopted,

A) Identify the structure of the pathogenic process

B) Determine diagnostic indicators of sufficient sensitivity and specificity based on a foundational understanding for the pathogenic process

Instead, Gardner adopted what I consider to be an intellectually lazy approach of proposing a “new syndrome” without sufficient analysis, and then a proposed set of anecdotal diagnostic features that are inadequate to the task.

Synthesis

We are mental health professionals. You guys, you mental health professionals on both sides who have been engaged in this unnecessary “parental alienation” debate for 30 years, should be really embarrassed that you fell prey to the parallel process of staff-splitting… for 30 years. Oh my gosh. Thirty years.

When I first looked at the debate, it took me about 30 seconds to recognize the splitting.

“We are the wonderful protectors of children”

Whether this statement is made by the Gardnerians or by the critics.

“They are callous and uncaring about the suffering of children”

Whether this statement is made by the Gardnerians or by the critics.

“We are the righteous and noble. They are the enemy to be defeated.”

Again, whether this statement is made by the Gardnerians or by the critics.

Stop it.  Splitting.  Splitting.  Splitting.

“We” are idealized and “they” are demonized. Stop it.

All of you should be really embarrassed. How can you have succumbed to the parallel process of staff-splitting for so long? The only answer I can come up with is ignorance about working with borderline personality processes. Linehan’s identification of staff-splitting is from 1993. Twenty years ago.

If you don’t know about borderline personality processes, I would gently suggest that you may be practicing beyond the boundaries of professional competence if you are working with borderline personality processes.

But enough with my chastisement. The important thing now is to stop it. We are not idealized and they are not the enemy. On both sides of this unnecessary debate. The critics must also stop it. We are not your enemy. We all have the same goal. Protection of children 100% of the time.

Protection of children 100% of the time when the targeted parent is the narcissistic parent.

Protection of children 100% of the time when the supposedly favored parent is the narcissistic parent.

ALL children need to be protected from all forms of child abuse 100% of the time.  There is absolutely no disagreement.  There are no sides.

We need to start listening to a recognized expert in dealing with borderline personality processes, Marsha Linehan:

1.) “The starting point for dialogue is the recognition that a polarity has arisen”

2.) The disagreement represents a “failure of synthesis”

3.) The disagreement is treated as “equally valid poles” in the dialogue

4.) “Resolution will require working toward synthesis.

The critics are rightly concerned that Gardner’s PAS model is too sloppily put together and will expose some child abuse victims to re-victimization.  I’ve seen child abuse up close and personal  That’s a valid concern.

Our concern is that professional incompetence and ignorance results in the acceptance of superficial appearances that leads to a misdiagnosis of the severely pathogenic parenting involved in the child’s role-reversal relationship with a narcissistic/(borderline) parent as representing an authentic display of the child’s rejection of the targeted parent, and that the pathology involved in attachment-based “parental alienation” rises to the level of a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

From our position advocating for the construct of “parental alienation,” achieving synthesis involves expending the necessary effort to define the construct of “parental alienation” from entirely within standard and established professional constructs, so that we can develop strong diagnostic indicators that are both sensitive AND specific, and that can be used in 100% of the cases to accurately differentiate when the narcissistic parent is the targeted parent and when the narcissistic parent is the supposedly favored parent, so that we can protect 100% of the children 100% of the time.

From the other side, movement toward synthesis represents the acknowledgement that an attachment-based model for the construct of parental alienation represents an accurate description of the clinical phenomenon and warrants a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed when the three diagnostic indicators of attachment-based “parental alienation” are present.  Synthesis.  Solution.

There are no sides. We are all on the same side. I invite the Gardnerians to join us in synthesis. I invite the critics to join us in synthesis. You are not our enemy, and we are not yours. We all want exactly the same thing. To protect children from the abuse inflicted on them by a narcissistic parent.

When mental health speaks with a single voice, we can achieve a solution to “parental alienation.” It is time for a solution.

Craig Childress, Psy.D.
Psychologist, PSY 18857

Dominoes Falling: The Sequence

This is the second post of a two-part series.  The initial post in the series is “Dominoes Part 1: Paradigm Shift


We cannot solve “parental alienation” for any individual family until we solve it for all families.  And solving parental alienation” for all families will require a paradigm shift away from a Gardnerian PAS model to an attachment-based model that has its foundations in established scientific principles and constructs of professional psychology (see Dominoes Part 1: Paradigm Shift post).

Once that first domino of the paradigm shift occurs, a series of dominoes will follow, beginning with diagnosis, followed by protective separation, and leading to the final domino of treatment and restoring the child’s healthy development. 

But we cannot achieve the final domino of the restoration of the child’s healthy and normal-range development until the first set of dominoes have fallen.

The Second Domino: Diagnosis & Defined Standards of Professional Competence

Once the first domino of the paradigm shift falls, the second domino will immediately fall.  Immediately with the paradigm shift the three definitive Diagnostic Indicators for attachment-based “parental alienation” become operative (see Diagnostic Indicators and Associated Clinical Signs).

We will then have a clear and definitive set of diagnostic criteria for identifying attachment-based “parental alienation” in all cases, and to which ALL mental health professionals can be held accountable

Professional accountability is key to achieving professional competence.  Since the Gardnerian PAS model is not defined through established psychological principles and constructs, and instead proposes a “new syndrome” within psychology, the PAS model does not allow us to establish defined domains of knowledge or professional practice to which ALL mental health professional can be held accountable

Under the PAS proposal of a “new syndrome,” resting as it does on poorly defined theoretical foundations, mental health professionals are allowed to say, “I don’t believe in parental alienation” and this is acceptable.  Mental health professionals are free to accept or not accept this proposed “new syndrome” of PAS, so that “I don’t believe in parental alienation” and “parental alienation doesn’t exist” are acceptable statements.  Ignorant perhaps, but acceptable.

An attachment-based model solves this. Because it is defined entirely from within standard and scientifically established professional constructs and principles, adherence to an attachment-based paradigm is not a matter of belief, it becomes an expectation.

Furthermore, the Diagnostic Indicators for attachment-based “parental alienation” are dichotomous, meaning that “parental alienation” is either present or absent. No grey areas.  Which means that mental health professionals can no longer avoid identifying the pathology by assigning “shared responsibility” to “both parents.”  The diagnostic presence of attachment-based “parental alienation” is the SOLE result of the distorted parenting practices of the narcissistic/(borderline) parent.

When the three Diagnostic Indicators of attachment-based “parental alienation” are evident, the targeted parent is NOT responsible for producing any aspect of the child’s symptoms.

The three Diagnostic Indicators of attachment-based “parental alienation” focus solely on the child’s symptom display,

We do not need to evaluate the narcissistic/(borderline) parent.  The child’s symptom characteristics provide all the definitive proof necessary for identifying the source of the child’s symptoms as being the distorted pathogenic parenting practices by the narcissistic/(borderline) parent.

This is important, we are not proving “parental alienation” through the Diagnostic Indicators, we are proving pathogenic parenting” (patho=pathology; genic=genesis, creation).  Pathogenic parenting is the creation of significant psychopathology in the child through aberrant and distorted parenting practices. 

Our sole diagnostic focus is on the child’s symptom display for indicators of the characteristic pathology that can ONLY be the product of severely pathogenic parenting by an allied and supposedly favored narcissistic/(borderline) parent, i.e., the three Diagnostic Indicators of attachment-based “parental alienation.”

When all three of the definitive Diagnostic Indicators of attachment-based “parental alienation” are present, ALL mental health professionals will make exactly the same diagnosis regarding the presence of “parental alienation” given the same clinical information. It’s no longer a matter of belief or opinion. It becomes an expectation of competent professional practice

If a mental health professional does not make the accurate diagnosis in response to the displayed presence of the three definitive Diagnostic Indicators, then the mental health professional can be held accountable for the misdiagnosis.

By establishing clear domains of knowledge and professional expertise required to work with this “special population” of children and families, we can eliminate the involvement of incompetent and fundamentally ignorant mental health professionals. Only mental health professionals who possess the necessary professional knowledge and expertise needed to competently diagnose and treat this special population of children and families will be allowed to work with this group of children and families.

If you are going to work with attachment-based “parental alienation” you MUST know what you are doing.  That is not a suggestion.  It is a requirement.

The moment we have a professionally established diagnosis for the construct of “parental alienation,” mental health can begin to speak with a single voice. The division in mental health created by the controversy surrounding the Gardnerian PAS construct will be ended.

Both sides in the debate were right.

Gardner was correct, there is a valid clinical phenomenon involving a child’s induced rejection of a relationship with a normal-range and affectionally available parent,

AND…

The critics were right, Gardner’s PAS definition of this clinical phenomenon lacked the necessary scientific foundation in established psychological principles and constructs.

Once the first domino falls and the paradigm shifts to an attachment-based model for the construct of “parental alienation,” the second domino of diagnosis immediately falls, and mental health becomes united into a single voice that establishes clearly defined domains of knowledge and professional practice for identifying professional competence in diagnosing and treating this “special population” of children and families, to which ALL mental health professionals can be held accountable.

The Third Domino: Protective Separation

Once the second domino of diagnosis falls, the third domino falls. In every case of diagnosed attachment-based “parental alienation” professionally responsible treatment REQUIRES the child’s protective separation from the pathogenic parenting of the allied and supposedly favored narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery stabilization period.

This is a treatment-related requirement in every case of identified attachment-based “parental alienation” (i.e., the presence in the child’s symptom display of the three Diagnostic Indicators of attachment-based “parental alienation”).

Since all therapists treating attachment-based “parental alienation” will have established professional competence and expertise, no therapist, anywhere, will treat attachment-based “parental alienation” without first acquiring the child’s protective separation from the pathogenic parenting of the allied and supposedly favored narcissistic/(borderline) parent.

When mental health speaks with a single voice, the Court will be able to act with the decisive clarity needed to solve the pathology of “parental alienation.”

Once the paradigm shifts, so that established standards of professional practice allow us to eliminate professional incompetence from diagnosing and treating this “special population” of children and families, then the knowledge and expertise in mental health will require that no therapist anywhere will treat a case of attachment-based “parental alienation” without first obtaining the child’s protective separation from the pathogenic parenting of the narcissistic/(borderline) parent.

The Court will then have two choices, either order the child’s protective separation from the allied and supposedly favored parent during the active phase of the child’s treatment and recovery stabilization period, or abandon the child to psychopathology.

But there’s more. When the three Diagnostic Indicators of attachment-based “parental alienation” are present, standards of professional practice will require that the clinical diagnosis of attachment-based “parental alienation” must be made by the mental health professional.  This is where the quote marks around “parental alienation” become relevant.  The clinical diagnosis of “parental alienation” is not the DSM diagnosis.  The DSM-5 diagnosis will be an Adjustment Disorder, AND the additional DSM-5 diagnosis of,

V995.51 Child Psychological Abuse, Confirmed.

Here’s the linkages:

The presence of the three diagnostic indicators requires a clinical diagnosis of attachment-based “parental alienation”

A clinical diagnosis of attachment based “parental alienation” triggers the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed

The DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed requires a child protection response from the mental health professional. 

This duty to protect can be discharged by the mental health professional filing a child abuse report with an appropriate child protection agency

Initially, the child protective service agency receiving these reports won’t know what to do with these reports of child abuse. They will have three choices:

1.  Ignore the report. It is unlikely that they will choose this option.

2.  They can accept the diagnosis made by the mental health professional and take the appropriate child protection response of removing the child from the care of the allied and supposedly favored narcissistic/(borderline) parent and placing the child in the protective care of the targeted parent, thereby enacting the protective separation required for treatment of attachment-based “parental alienation” without having the targeted parent spend years of expensive litigation trying to prove “parental alienation” in Court.

3.  They can conduct their own independent investigation.

If they choose option 3, then all of their investigators who respond to these reports will need to learn the attachment-based model of “parental alienation,” thereby further eliminating professional ignorance and incompetence in working with this “special population” of children and families.

And once they learn an attachment-based model of “parental alienation” they will apply the same diagnostic standard of the three definitive Diagnostic Indicators for attachment-based “parental alienation. When the three Diagnostic Indicators are present, the investigator will confirm the diagnosis of Child Psychological Abuse made by the reporting mental health professional, and the child protective services agency will then remove the child from the care of the allied and supposedly favored narcissistic/(borderline) parent and place the child in the protective care of the healthy and normal-range targeted parent.

The necessary child protection response of the child’s protective separation  from the pathogenic parenting of the narcissistic/(borderline) will be achieved without needing extensive litigation within the Court system.

If the Court reviews the placement decision made by the child protection agency, then the Court will be presented with two independent DSM-5 diagnoses of Child Psychological Abuse, Confirmed, one made by an expert in this specialty area of professional practice, and one made independently by the child protection agency.

Two independently established DSM-5 diagnoses of Child Psychological Abuse, Confirmed are sufficient to warrant the removal of the child from the pathogenic parenting of the narcissistic/(borderline) parent, so that the child can be placed in the protective care of the normal-range parent during the period of the child’s active treatment and recovery stabilization.

Once the child’s symptoms have been resolved and stabilized, the pathogenic parenting of the narcissistic/(borderline) parent can be reintroduced with treatment monitoring to ensure that the child’s symptoms do not reemerge.

If the child’s symptoms reemerge upon reintroducing the pathogenic parenting of the narcissistic/(borderline) parent, then another period of protective separation and supervised visitation would be warranted.

When mental health speaks with a single voice, the legal system will be able to act with the decisive clarity needed to solve “parental alienation.”

The Fourth Domino: Treatment

Once the third domino of the child’s protective separation is achieved, the fourth domino will fall.

My first book on the theoretical foundations of an attachment-based model is due out shortly. The first domino of the paradigm shift is falling. I’m anticipating my second book on diagnosis to appear this summer. The second domino will begin to fall. I’m anticipating my third book on treatment for around this time next year. The last domino will begin to fall.

The treatment domino is the most exciting. There are some things about treatment I haven’t yet shared. 

I am optimistic, I am convinced, that when we reach this phase of the solution we will be able to resolve the child’s symptoms (with a protective separation in place) within a matter of days.  Days.

We will still need a period of protective separation from the pathogenic parenting of the narcissistic/(borderline) parent in order to stabilize the child’s recovery.  But I am convinced that we can achieve an initial resolution of the child’s symptoms within a matter of days.

This last domino is in the works.

Imagine resolving the child’s symptoms of “parental alienation” within a matter of days. This is my goal, our goal, and I am convinced it is achievable.

The Solution

We must achieve the solution for all families, or we can achieve the solution for no families.

The solution requires a series of dominoes to fall, and the first domino is the paradigm shift from the Gardnerian paradigm of PAS to an attachment-based model of parental alienation which is based entirely within standard and established psychological principles and constructs.

Whether this first domino takes one year or ten is up to you, the community of targeted parents. I’m doing what I can, but I can only do so much on my own.

The reason mental health professionals can say “I don’t believe in parental alienation” is because the Gardnerian PAS model allows them to say this.

An attachment-based model will not allow them to say that they “don’t believe in parental alienation,” because the principles on which an attachment-based model are constructed are not a matter of opinion or belief, they are established and scientifically validated facts.

The solution to “parental alienation” awaits the falling of the first domino, the change in paradigm. Once the first domino falls the remaining dominoes will begin to fall in succession.

In order to achieve a solution for any individual family we must achieve a solution for all families.

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

Online Seminar: The Diagnosis & Treatment of Attachment-Based Parental Alienation

My 11/21/14 online seminar regarding the Diagnosis and Treatment of Attachment-Based “Parental Alienation” through the Master Lecture Series of California Southern University is now available online for the general public at:

https://vimeo.com/calsouthern/review/113572265/8d0b48de77

A handout of the Powerpoint slides for this seminar is available on my website: www.drcachildress.org

I believe this seminar is significant in several primary areas:

Standards of Practice: This seminar describes clearly defined standards for professional competence in the diagnosis and treatment of this “special population” of children and families experiencing attachment-based “parental alienation.”

Psychological Child Abuse: It establishes the theoretical foundations and support for identifying attachment-based “parental alienation” as psychological child abuse that warrants the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Diagnostic Criteria: It defines a set of clear diagnostic criteria based in established and accepted psychological principles and constructs that can reliably identify attachment-based “parental alienation” in every case, and that can reliably differentiate attachment-based “parental alienation” from other forms of parent-child conflict, including false allegations of “parental alienation.”

Protective Separation: It defines the structure necessary for treatment that begins with a protective separation of the child from the pathogenic parenting practices of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery.

This online seminar is now available for review by therapists, child custody evaluators, attorneys, judges, and the general media, and so can serve as a referral resource for targeted parents trying to increase general public awareness and the understanding of legal and mental health professionals regarding the issues surrounding an attachment-based model of “parental alienation” and the mental health needs of children and families experiencing this type of tragic family process.

With the proper professional understanding that leads to an appropriate legal and mental health response, the solution to attachment-based “parental alienation” in any individual family circumstance is likely to be achievable within a relatively short period of active treatment intervention.

The family tragedy of “parental alienation” needs to end.  Today.

Every day that passes that we do not enact the required solution is another day that we tolerate the profoundly destructive psychological abuse of the child.

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

Powerpoint Slides from Master Lecture Series Presentation

This morning I provided an online seminar through the Master Lecture Series of California Southern University regarding the Diagnosis and Treatment of an attachment-based model of “parental alienation.”  The seminar seems to have been well-received.

This online seminar was recorded and will become available online in about one week through the Master Lecture Series of California Southern University.  Both this seminar on Diagnosis and Treatment, and the earlier companion seminar I delivered in July of 2014 through the Master Lecture Series regarding the Theoretical Foundations of an attachment-based model of “parental alienation” will then be available online to mental health professionals, and as importantly, as a resource for targeted parents to refer treating mental health professionals for further information about an attachment-based model of “parental alienation.”

I have posted a handout of my Powerpoint slides for today’s seminar to my website.  Of particular note is my discussion beginning on page 15 of the handout regarding children and families evidencing the diagnostic indicators of attachment-based “parental alienation” as representing a “special population” requiring specialized professional knowledge, training, and expertise to appropriately and competently diagnose and treat. 

Failure to possess the specialized professional knowledge, training, and expertise necessary for professional competence in diagnosing and treating this “special population” of children and family issues likely represents practice beyond the boundaries of professional competence in violation of professional practice standards (Standard 2.02 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association (2002).

It is long past overdue to expect and demand professional competence from mental health professionals with regard to diagnosing and treating the severe psychopathology associated with an attachment-based model of “parental alienation.”

Also of note from this seminar is my discussion of the pathogenic parenting associated with an attachment-based model of “parental alienation” as representing a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.  The presence in the child’s symptom display of the three definitive Diagnostic Indicators of an attachment-based model of “parental alienation” shifts the issue from one of child custody and visitation to one of child protection.

Attachment-based “parental alienation” is not a child custody issue; it is a child protection issue.

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

The Solution

Any solution to “parental alienation” that requires that we prove “parental alienation” in Court is a failure.

1.  Financially Prohibitive: Proving “parental alienation” in Court is simply too expensive for the vast majority of targeted-rejected parents. The financial costs associated with proving “parental alienation” in Court places it beyond the means of 95% of targeted-rejected parents.

 Any solution that requires proving “parental alienation” in Court is only a solution for 5% of targeted-rejected parents. This is no solution.

2.  Requires Egregious Displays of Alienation: Proving “parental alienation” in Court is only possible in the most egregious cases of alienation. The more subtle cases of insidious alienation are nearly impossible to prove in Court.

Any solution that requires proving “parental alienation” in Court is only a solution for the limited number of targeted-parents who have sufficient financial resources and only in the most egregious cases. So now we’re down to 1-2% of the cases of “parental alienation.”

While proving “parental alienation” in Court may seem like a solution to professionals who work within the Court system. For those of us who work in the daily lives of people who cannot financially afford attorneys and child custody evaluations, it is no solution at all.

3.  Robbing the Child: The high financial costs of fighting “parental alienation” in Court robs the child of what should be his or her college education fund. Every dollar paid to an attorney or child custody evaluator harms the child by taking money from the child that should be going to his or her college education.

Any solution that requires proving “parental alienation” in Court harms the child by draining financial resources from the family that should be going toward the child.

4.  Too Slow: Proving “parental alienation” in Court can often take years of protracted legal battles.  During this time, important child developmental phases come and go, and are lost forever.  Lost childhood can never be reclaimed.  A mother only has 365 days of her child being 8 years old, that’s it.  And not a single lost day can ever be reclaimed.  A father only has a brief time with daddy’s little girl, with his princess. Once lost, this time never returns.

Years to enact a solution is simply too long.  Months are too long a timeframe.  Any solution to “parental alienation” should be able to be enacted within weeks in the life of the child. If we require months, so be it, but definitely not years.

Any solution that requires proving “parental alienation” in Court irrevocably harms the child by robbing the child of important and irretrievable developmental phases and experiences with a loving and affectionally available parent. It simply takes too long.

Of note is that I recently had the opportunity for a conversation with Ms. Dorcy Pruter (http://www.consciouscoparentinginstitute.com).  During our conversation she said she can enact the child’s restoration with the targeted-rejected parent in a matter of days, once the Court orders a protective separation of the child from the alienating parent, and based on my initial review of her approach during our conversation I suspect her treatment model can accomplish what she claims for it.  Just to be generous, I’ll give her some leeway and say weeks rather than days (yet days makes sense to me based on her description of the model), but the point is, in a very short time frame. Her approach seemingly has the proper components to accomplish what she claims for it.

Once we achieve a protective separation of the child from the ongoing pathogenic parenting of the narcissistic/(borderline) parent, restoration of a normal-range and affectionally bonded relationship with the targeted-rejected parent is relatively straightforward because we are working WITH the normal-range functioning of the child’s own attachment system.  The child’s authentic brain WANTS to bond to the targeted-rejected parent.  We just need to provide the setting, structure, and guidance to allow the child’s natural attachment bonding motivations to achieve completion. 

Once the child’s attachment bonding motivations are able to achieve completion, the child’s (misinterpreted) grief response resolves, and the impact on the child of the narcissistic/(borderline) parent’s distorted and pathogenic parenting practices is eliminated.  We have recovered the authentic child.  We then take steps to build the child’s “psychological immune system” relative to the pathogenic parenting of the narcissistic/(borderline) parent and then we can begin to restore the child’s relationship with the narcissistic/(borderline) parent.

If the narcissistic/(borderline) parent cooperates with the treatment process, that would be wonderful.  If not, then we need to take steps to ensure the child’s ongoing stability and balance in response to the narcissistic/(borderline) parent’s continuing pathogenic parenting.

The Solution

Any solution to “parental alienation” that requires that we prove “parental alienation” in Court is no solution at all because of the immense financial barriers, legal hurdles, and inherent harm to the child’s normal-range developmental trajectory associated with the long and arduous task of trying to prove “parental alienation” in Court.

An attachment-based model of “parental alienation” provides a solution. Once the paradigm shifts away from a Gardnerian PAS model to an attachment-based model, the solution becomes available immediately.

Phase 1

An attachment-based model of “parental alienation” immediately identifies a set of standards of practice for professional competence involving an advanced level of professional understanding for the attachment system (and intersubjective system), and a professionally advanced level of understanding for narcissistic/borderline personality dynamics, their characteristic displays, their underlying dynamics, and processes of their manifestation in family relationships.

Once the paradigm shifts to an attachment-based model of “parental alienation” these children and families become immediately identified as a “special population” requiring specialized professional knowledge, training, and expertise to diagnose and treat.

Phase 2

Once professional practice in this specialty field is limited to a qualified set of highly trained and knowledgeable experts, the diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation” is established in a clearly defined set of three Diagnostic Indicators (see Diagnostic Indicators and Associated Clinical Signs post), supported by an additional set of confirming clinical signs.

This set of three clearly defined and dichotomous (i.e., present or absent) Diagnostic Indicators has a corresponding DSM-5 diagnosis of:

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

(for an analysis of the DSM-5 diagnosis of an attachment-based model of “parental alienation” see “Childress, 2013: DSM-5 Diagnosis of ‘Parental Alienation’ Processes” on my website)

Phase 3

All specialized experts in High-Conflict Family Divorce (HCFD specialty practice) will make the same DSM-5 diagnosis in response to the identifiable set of three clearly defined and dichotomous (present-absent) Diagnostic Indicators of attachment-based “parental alienation” (i.e., pathogenic parenting). 

This means that all HCFD specialty psychologists will make a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Phase 4

In making the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, these HCFD specialty psychologists then engage a professional responsibility to take protective action for the child.  Chief among these protective steps, and an option that I strongly urge them to enact, is to make a child abuse report to Child Protective Services (CPS) regarding their diagnosis of Child Psychological Abuse, Confirmed.

Phase 5

CPS workers will initially not know how to deal with the influx of child abuse reports by this group of specialist psychologists who are providing a DSM-5 diagnosis of v995.51 Child Psychological Abuse, Confirmed along with their report.  CPS agencies will have one of three possible options,

1.  Ignore the reports (which is an unlikely response, especially as these reports continue to come in)

2.  Accept the DSM-5 diagnosis of the HCFD specialist and remove the child from the custody of the alienating (pathogenic) parent and place the child in the custody of the targeted, normal range and healthy parent (i;e;, engage a protective separation of the child from the psychopathology and pathogenic parenting practices of the narcissistic/(borderline) parent).

3.  Conduct their own investigation of possible child psychological abuse.

I suspect that CPS agencies will choose option 3. 

In the context of having a clinical psychologist who is expert in High-Conflict Family Divorce provide a confirmed DSM-5 diagnosis of Child Psychological Abuse, if the CPS system wants to conduct their own investigation then they will need to obtain similar training in the assessment of an attachment-based model of “parental alienation” upon which the psychologist’s diagnosis is based (i.e., CPS case workers will need to develop professional competence in the specialty practice area of identifying child psychological abuse that occurs within high-conflict family divorce settings) since this knowledge base serves as the foundation for the diagnosis of V995.51 Child Psychological Abuse, Confirmed made by the HCFD specialist psychologist.

So ALL CPS workers everywhere will receive training in an attachment-based model of “parental alienation” and the three definitive diagnostic indicators of pathogenic parenting associated with the child’s cross-generational coalition with a narcissistic/(borderline) parent against the other parent that is inducing significant developmental (Diagnostic Indicator 1), personality (Diagnostic Indicator 2), and psychiatric (Diagnostic Indicator 3) pathology in the child.

Phase 6

The Diagnostic Indicators for attachment-based “parental alienation” are clearly defined and dichotomous, either attachment-based “parental alienation” is present or absent.  Once CPS has a set of clearly defined dichotomous criteria by which to identify pathogenic parenting associated with an attachment-based model of “parental alienation,” they will become empowered and confident in removing the child from the care of pathogenic narcissistic/(borderline) parent in every case where the three Diagnostic Indicators are present.

The Solution

Once a case of pathogenic parenting associated with an attachment-based model of “parental alienation” enters the specialty practice of an HCFD specialist psychologist, a child abuse report will be filed with CPS that includes the psychologist’s diagnosis of V995.51 Child Psychological Abuse, Confirmed.  Once the report enters the CPS system, the CPS case worker will confirm the presence of the three Diagnostic Indicators of pathogenic parenting and will confirm the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, so that the diagnosis has now been confirmed by two independent assessments of mental health professionals expert in the family processes associated with high-conflict divorce.

CPS will then immediately remove the child from the custody of the alienating narcissistic/(borderline) parent (i.e., a protective separation of the child from the psychopathology of the pathogenic parent) and place the child with the normal-range and healthy targeted parent to allow for the treatment and resolution of the child’s symptoms.

This establishes the necessary protective separation conditions for a Pruter-style model of treatment that resolves the child’s symptoms within days or weeks.  Once the child’s symptoms have been resolved under the treatment guidance of an HCFD specialist psychologist, the child’s own “psychological immune system” can be strengthened to resist “reinfection” by the distorting pathology of the narcissistic/(borderline) parent, and the child’s relationship with the narcissistic/(borderline) parent can be reestablished.

Of note is that Ms. Pruter also indicated that she has a treatment protocol component for the alienating parent to complete as a requirement for their “reunification therapy” with the child.

This solution never enters the Court system.

It provides an immediate protective separation of the child from the psychopathology of the narcissistic/(borderline) parent.

It solves the family conflict in a matter of weeks and so restores the child to a normal-range developmental trajectory quickly.

It is relatively cost free to the parent so that it does not require an extensive parental financial investment of funds that should be allocated to the child’s future college education.

This is the solution.

If the case does enter the Court system, the judge can order a Treatment Needs Assessment report, which would be a targeted assessment by an HCFD specialist for the presence or absence of the three Diagnostic Indicators of pathogenic parenting associated with an attachment-based model of “parental alienation.”  The targeted Treatment Needs Assessment would be focused and so less extensive than a full child custody evaluation.  Since all child custody evaluators would have become HCFD specialists, this could be a secondary professional service available from them.

My estimate of a Treatment Needs Assessment is that it could be completed in four to six weeks and could provide a clear directive to the Court regarding the treatment needs of the child. If the three Diagnostic Indicators of pathogenic parenting associated with an attachment-based model of “parental alienation” are present, then the HCFD specialist psychologist conducting the assessment would make the appropriate DSM-5 diagnosis of the child (relative to the issue of pathogenic parenting) which would include the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Upon receiving the report from the HCFD psychologist that contains the DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed, the judge could order removal of the child from the custody of the narcissistic/(borderline) parent and placement of the child with the targeted, normal-range and healthy parent during the active phase of the child’s treatment and recovery.  Under the guidance of an HCFD specialty psychologist, the child and targeted parent could receive a Pruter-style treatment protocol that would restore their relationship within weeks, followed by building the child’s “psychological immune system” response to the distorted pathogenic parenting practices of the narcissistic/(borderline) parenting, culminating in “reunification therapy” between the child and the narcissistic/(borderline) parent.

This is the solution.

Enacting the Solution

I have created the solution.  All the dominoes are in line, and through my writings on my website and blog I have tipped the first domino.  In my view, it is just a matter of time now.

My estimate is the change in paradigm will take about 10 years.  The solution I have enacted has no natural allies.  Establishment mental health has little to no interest in “parental alienation.”  Their interest tends toward Attention Deficit Hyperactivity Disorder and the typical types of parent-child conflict.  “Parental alienation” isn’t really on their radar.  They are likely to simply equate an attachment-based model of “parental alienation” with the Gardnerian PAS model as being “controversial” (when actually an attachment-based model is not at all controversial – all of the constructs are standard and accepted psychological principles and constructs).

The Gardnerian PAS experts are likely to be reluctant to see the end of their favored paradigm for conceptualizing “parental alienation” because they have fought for it for so long and hard.  To see it simply disappear and be replaced by a new paradigm about which they are entirely unfamiliar will likely be hard for them. The Gardnerian PAS experts are likely to simply ignore an attachment-based model and to continue their efforts to seek Court-based solutions for the PAS model.

So an attachment-based paradigm for “parental alienation” will probably languish in obscurity for a while.  Eventually it will get picked up (for a variety of reasons, one of the primary reasons will be its promise for guiding future research efforts).  It will likely become established through the efforts of a new generation of psychologists and mental health professionals who will see the value in a paradigm shift because they have no prior attachment to the PAS model.  They will have an easier time letting go of the PAS model and adopting a new paradigm for describing and understanding “parental alienation” processes.

Eventually the paradigm will shift.  The moment it does the other dominoes will begin to fall.  There is actually a line of dominoes that will also begin to fall that will solve the issue of false allegations of child abuse that are such a troubling part of “parental alienation,” but I’ll leave a description of that line of dominoes for another post.

It’s just a matter of time.

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

False Allegations of Abuse: Technical Issues

False Allegations of Incest

Let me approach this discussion with the basic premise that all mental health professionals have the child’s best interests as their primary consideration. All mental health professionals wish to protect children from sexual abuse. No mental health professional seeks to expose a child to sexual abuse victimization.

If there are differing viewpoints on how to accomplish this goal, they are good-faith expressions of “equally valid poles of a dialectic” (Linehan, 1993), and the goal should be to move toward synthesis of differing perspectives rather than adopting adversarial positions.

Authentic sexual abuse occurs far too frequently. We must act to protect children from sexual abuse victimization.

And… on occasion,

A narcissistic/(borderline) parent will induce or elicit false allegations from the child of sexual abuse victimization by the other parent as a means to exploit these child allegations to achieve power over the situation and the other parent. When this occurs, not only does the child lose a loving and affectionally bonded relationship with a normal-range targeted parent, the child also loses the potential protective influence that the normal-range psychological organization of the targeted-rejected parent can have in lessening the distorting pathogenic influence of the narcissistic/(borderline) parent on the child’s development.

Furthermore, for a narcissistic/(borderline) parent to induce or elicit from a child false allegations of sexual abuse against the other parent represents extremely distorted parenting that rises to the level of severe psychological abuse of the child. Failure to respond to this type of psychological child abuse when it is present is to abandon the child to the severely distorting effects of the psychological child abuse of the narcissistic/(borderline) parent that will have a long-term destructive impact on the child’s psychological development, likely influencing future generations of the family as well through the transmission of the effects of the child abuse to the next generation through the future pathogenic parenting of the current child with his or her own children.

Our goal should be to protect the child from ALL forms of child abuse, particularly the severe forms being considered in this discussion. It is NEVER acceptable to abandon a child to any form of child abuse.

Assertion 1: Child Sexual Abuse Allegations are Not Developmentally Normal

Under no circumstances does a child ever spontaneously develop a false belief that a parent sexually abused the child. It doesn’t happen. Ever.

Children may develop on their own symptoms of hyperactivity or inattention, or anger control problems, or cognitive delays, or social problems, or phobic anxieties. All of these types of symptoms can sometimes arise endogenously to the child’s own developmental course.

Children NEVER spontaneously develop, on their own, a false belief that a parent sexually abused the child.

When a child asserts that a parent sexually abused the child, there are only three differential diagnostic possibilities:

1)   Authentic child abuse incest by the parent

2)   Extremely distorted pathogenic parenting by a narcissistic/borderline parent in which this parent induces or elicits the child’s false belief of sexual abuse,

A)  In order to exploit the child’s symptoms to achieve power over the situation or other parent, or

B)  As a result of semi-psychotic decompensation of the narcissistic/borderline parent into a delusional belief in the (false) threat represented by the other parent, with the parental delusional belief then being transferred to the child through severely distorted parenting practices of the narcissistic/borderline parent.

“When particular schemas are hypervalent, the threshold for activation of the constituent schemas is low: they are readily triggered by a remote or trivial stimulus. They are also “prepotent”; that is, they readily supersede more appropriate schemas or configurations in processing information. (Beck et al., 2004, p. 28)

“The conceptualization of the core pathology of BPD as stemming from a highly frightened, abused child who is left alone in a malevolent world, longing for safety and help but distrustful because of fear of further abuse and abandonment, is highly related to the model developed by Young… that some pathological states of patients with BPD are a sort of regression into intense emotional states experienced as a child. Young conceptualized such states as schema modes…” (Beck et al., 2004, p. 199)

3)    The child, typically an adolescent, lacks a moral conscience, typically as a result of extraordinarily poor parenting, and is consciously, intentionally, and independently using a false allegation of sexual abuse against a parent as an intentional manipulation to achieve a desired goal or outcome.

This is not a spontaneous development of a false belief, this is simply a conscious lie perpetrated by the adolescent for manipulative gain.

Exclusionary caveat: The adolescent’s actions are not the product of influence from an allied and supposedly “favored” parent to allow the parent (or parent-child alliance) to then exploit the child’s allegations for manipulative gain (i.e., Causal Origin 2).

In my clinical practice I have known adolescents who admitted to me that they colluded with peers on how to create marks on their body to substantiate false allegations they made about physical abuse from a parent. In one of these cases the motivation of the adolescent was to obtain a custody change from the current parent to the desired parent. However, it wasn’t so much that the desired parent was in a cross-generational coalition with the child as much as the desired parent was exceedingly lax and permissive as a parent, which was a parenting style preferred by this adolescent over the current parent’s more structured expectations.  Other adolescents in my clinical practice have threatened their parents with filing false child abuse allegations against the parent if the parent did not capitulate to the child’s demands in some area. These families had a history of highly dysfunctional relationships.

In all three causal origins for sexual abuse allegations made by a child against a parent, there is extremely bad parenting somewhere within the family. Sexual abuse allegations made by a child against a parent are ALWAYS evidence of extremely bad parenting occurring somewhere within the family. The only question is where.

Personal Estimates of Prevalence

Note: There is no existing reliable data to support these estimates. These are personal estimates based solely on my clinical judgment.

From the domain consisting of all sexual abuse allegations made by a child of incest by a parent, my estimates of the prevalence for the three different origins for the child’s sexual abuse allegations against a parent are:

1. Authentic child abuse

Estimate of the likely prevalence of this causal origin for the child’s allegations: I would estimate that authentic sexual abuse of the child is the causal origin of the child’s allegations in approximately 95% of the cases of children’s alleged sexual abuse by a parent.

2.  Extremely distorted pathogenic parenting by a narcissistic/borderline parent that induces or elicits from the child a false allegation of sexual abuse against the other parent

Estimate of the likely prevalence of this causal origin for the child’s allegations:  I would estimate that pathogenic parenting by a narcissistic/borderline parent that induces or elicits from the child a false allegation of sexual abuse against the other parent is the causal origin of the child’s allegations in approximately 1% – 2% of the cases of children’s alleged sexual abuse by a parent.

3. An intentional adolescent lie as a manipulative or retaliatory action against the parent

Estimate of the likely prevalence of this causal origin for the child’s allegations:  I would estimate that an independent intentional lie created by an adolescent as a manipulative or retaliatory action against the parent is the causal origin of the child’s allegations in approximately 3% to 5% of the cases of children’s alleged sexual abuse by a parent

Individual Assessments

In any individual case, the estimated population prevalence is not a relevant consideration.

For example, in the 1% or 2% of the cases in which the child’s allegation of sexual abuse incest against a parent is induced and elicited by the pathogenic parenting practices of a narcissistic/borderline parent, in those 1% – 2% of cases the likelihood that the child’s symptoms were induced or elicited by the pathogenic parenting practices of a narcissistic/borderline parent is 100% – in those cases.

Is the specific case under consideration one of these rare cases? Perhaps. And if this specific individual case is one of those rare cases, then the probability that the child’s allegations are the induced or elicited product of pathogenic parenting practices by a narcissistic/borderline parent is 100% (i.e., if this specific case is one of those 1% – 2% of cases).

So population prevalence is not a consideration in evaluating any specific case. Each case is individual.

This is a foundational construct in psychological testing.  Just because the population prevalence of any specific issue, such as learning disabilities, ADHD, or mental retardation, is an infrequent occurrence in the general population doesn’t mean that this specific child doesn’t have the issue in question.

General population prevalence is not relevant to the assessment of any individual case. The assessment of each specific case is individualized to the specific data of that individual case.

Decisional Errors

There are technical considerations in establishing the criteria by which we make decisions.  In some cases the data allows us to make decisions based on 100% certainty, but this is extremely rare in decisions about psychological issues. When 100% certainty is not available, there are two possible types of errors we can make in our decisions based on the data

When a child makes sexual abuse allegations against a parent, there are two possible hypotheses that can be supported or disconfirmed by the data,

“Null Hypothesis” – no sexual abuse occurred

“Clinical Hypothesis” – sexual abuse did occur

Type I Error: A Type I error is when we erroneously accept the Clinical Hypothesis that sexual abuse occurred when, in truth, there was NO sexual abuse of the child. This is called a “false positive” decisional error, when we erroneously say something took place when it actually didn’t occur.

Type II Error: A Type II error is when we erroneously accept the Null Hypothesis that NO sexual abuse occurred, when in actuality the child was sexually abused by the parent. This is called a “false negative” decisional error, when we say nothing took place when it actually did occur.

These two types of decisional errors are interrelated. The lower the probability of making one type of decisional error, the higher the probability of making the other type of decisional error.

In establishing the criteria for making a decision from data that does not allow 100% certainty, the question is which type of error is worse in the context of the issue under consideration. So if we are making a decision about whether a child has been sexually abused by a parent, is it worse to,

A)  Erroneously conclude that the child was sexually abused when in actuality no sexual abuse took place (a Type 1 Error).

The consequences of this decisional error would be that we would needlessly and erroneously terminate the child’s relationship with a normal-range and affectionally available parent, and we would abandon the child to the custody of a narcissistic/borderline parent who is engaging in extremely distorted parenting practices that will severely distort the child’s emotional and psychological development (Causal Origin 2), or

We will terminate the child’s relationship with a parent in collusion with the child’s manipulative intent of attaining a desired goal or outcome (Causal Origin 3)

B) Erroneously conclude that the child was NOT sexually abused when in actuality the child was sexually abused by the parent (a Type II Error)

The consequence of this decisional error would be that we DO NOT terminate the child’s relationship with a sexually abusive incestuous parent, thereby abandoning the child to continued sexual abuse victimization.

One of the particularly devastating consequences of this decisional error with regard to child sexual abuse allegations against a parent is that we communicate to the child that we do not believe the child’s report is accurate when the child is, in actuality, telling us the truth. This is psychologically devastating to the sexually abused child. For the child to overcome the personal shame and family secrecy surrounding sexual abuse victimization and to come forward in disclosing the abuse, and then not to be believed and to be abandoned to their continued victimization, is psychologically devastating to the child, compounding the severity of the trauma for the child.

The decision as to which is worse, the impact of Type I errors or the impact of Type II errors, with regard to any particular issue is a value judgment regarding the comparative impacts. Based on this value judgment we then set decisional criteria that minimize either the likelihood of making a Type I decisional error (thereby increasing the likelihood of making a Type II decisional error), or we establish decisional criteria that minimize the likelihood of making a Type II error (thereby increasing the likelihood of making a Type I decisional error), or we seek decisional criteria that provide some sort of balance between the risks of making Type I and Type II errors in our decision making about the data.

But the criteria we establish for making our decisions is based on value judgements regarding the relative dangers of making a Type I decisional error (called a “false positive”) compared to the dangers associated with making a Type II decisional error (called a “false negative”).

Prosecution and Child Protection

The legal system in the United States has traditionally made a value judgment to minimize the potential for Type I errors (“false positive” decisions of convicting an innocent person). The decisional criteria in the legal system would prefer to set free numerous criminals (i.e., Type II errors of “false negatives”; saying the person is innocent when the person is actually guilty) in order to avoid (to the extent possible) convicting an innocent person (i.e., to minimize the risk of making a Type I error of a “false positive”).

This approach to establishing decisional criteria is based on our value judgments concerning our desired system of justice.

The impact of this approach within mental health and social service systems dealing with child allegations of parental sexual abuse, however, is troubling to many. The value judgment of the legal system to minimize Type I errors (“false positives” of saying there was child abuse when in actuality there was no child abuse) will correspondingly increase the probability of making Type II decisional errors (“false negatives” of saying there was no child sexual abuse when in truth there actually was child sexual abuse), meaning that many instances of actual child sexual abuse by a parent will not result in a proper child protection response as a result of our Type II decisional error.

Advocates for child protection rightly become extremely concerned about the rate and frequency of Type II decisional errors that leave children unprotected, even when, and especially when, the child discloses the sexual abuse. Parental sexual abuse of the child is surrounded by tremendous personal shame for the child, and is masked beneath the cover of family secrecy. For the child to break free from this family secrecy and personal shame associated with parental incest is a significant achievement for the child. But then for the child not to be believed and to be cast back into the abusive relationship with an incestuous parent compounds trauma upon trauma.

The psychological injury caused to the child by a Type II decisional error of saying there was no sexual abuse of the child when in truth there was, and when the child actually takes the momentous step of disclosing the sexual abuse to others, is extremely severe and devastating to the child. That child advocates within the mental health and family service fields are highly concerned about the frequency of Type II decisional errors is understandable and justified.

And…

There are a certain percentage of cases of false child allegations of parental sexual abuse (i.e., Causal Origins 2 and 3).

Within the legal system, the wrongful conviction of a parent as a pedophile (i.e., a Type I decisional error of a “false positive” attribution), so that this parent is wrongly identified with the lifelong stigma as being a “sex offender” can have an extremely devastating impact on this parent. Given the heavy consequences for an innocent person of a wrongful conviction as being an incestous sexual pedophile, the legal system is justifiably reluctant to make Type I errors, and would prefer to allow some guilty people to go free rather than convict an innocent person. So the decisional criteria within the legal system are adjusted toward limiting the probability of making Type I decisional errors (i.e., a “false positive” attribution that convicts an innocent person).

Most people support this general legal philosophy of limiting to the extent feasible the probability of convicting innocent people for crimes they did not commit (i.e., of making Type I decisional errors of saying something happened when in truth it didn’t), and we are willing to adjust to the negative consequences associated with sometimes allowing the guilty to go free in order to minimize to the extent feasible the risk of convicting an innocent person.

Despite our best efforts, we nevertheless sometimes convict innocent people (i.e., make a Type I decisional error), and this is extremely distressing for both the legal system and the general public, and yet it is also unavoidable. The only way we can ensure with 100% certainty that we will NOT make a Type I decisional error of convicting an innocent person is to set our decisional criteria so far in favor of not making a Type I error that we make far too many Type II errors of allowing all, or nearly all, criminals go free rather than run even the barest of infinitesimal risks of possibly convicting an innocent person.

In our decisions we must balance the risks of making a Type I error (a “false positive”) against the risks of making a Type II error (a “false negative”). As we lessen the risk of one type of decisional error we increase the risk of making the other type of decisional error. That’s just the way it works.

While in general, we can appreciate the reluctance of the legal system to convict an innocent person, so that we accept and tolerate the release of burglars and thieves, and even murderers, when it comes to the sexual abuse of children we become disturbed by the possibility of exposing children to continued sexual abuse victimization in order to limit the risk of making a Type I decisional error of a “false positive” attribution that the parent is an incestuous pedophile when in truth no sexual abuse of the child occurred, especially when the likely population prevalence of “false positives” is so incredibly low (for example, my estimate of between 4% to 7% of all sexual abuse allegations made by children against a parent; Causal Origins 2 and 3).

While we are willing to tolerate the consequences of a “false negative” decision that results in the release of a thief or even a murderer, we are much more reluctant to tolerate the consequences of a “false negative” decision that results in the release of a parental pedophile, in which we will be re-exposing the child to continued sexual abuse predation by the parent.

Given the very low estimated population prevalence of “false positives” (i.e., parents who are accused of sexual child abuse when NO abuse occurred), if we wanted to eliminate the risks of making a Type II error (a “false negative” of saying there was no sexual abuse of the child when in fact the child had been sexually abused by the parent) because of the devastating effect of a Type II decisional error on the emotional and psychological well-being of the child, we could simply accept all child allegations of sexual abuse as valid. This would mean that we would likely make between 4% and 7% Type I errors of making a “false positive” attribution (i.e., saying there was sexual abuse of the child by the parent when, in truth, the parent did not actually sexually abuse the child). In accepting the consequences of making an estimated 5% to 10% (rounding off) wrongful convictions of innocent parents as being incestuous sexual predators when they are not, we can ensure that we do not re-expose ANY child to authentic sexual abuse victimization.

This would represent a value decision regarding the comparative negative consequences associated with making a Type I decisional error as compared to making a Type II decisional error.  The decisional criteria we decide on regarding the acceptable probability of making Type I versus Type II decisional errors is based on our value judgments regarding the comparative damage of making each type of decisional error. The more we reduce the chances of making one type of decisional error, the more we increase the chances of making the other type of decisional error.  

Since the estimated population prevalence of “”false positives” (i.e., false child allegations of parental sexual abuse) is so small relative to all child allegations of parental sexual abuse, it is conceivable that a reasonable discussion would consider the relative benefit of accepting all child allegations of parental sexual abuse as valid in order to eliminate the possibility of making Type II decisional errors of “false negative” decisions that continue a child’s exposure to an incestuous pedophiliac parent even after the child has disclosed the predatory sexual abuse victimization.

However, if this decision is made we should also recognize that we are accepting that there will be a certain, not insubstantial number of “false positive” Type I decisional errors in which we wrongly say that an actually innocent parent sexually abused his or her own child. Recognizing that we will be making such errors in a relatively substantial number of cases (my personal estimates are between 5% to 10% of all cases of child sexual abuse allegations), we would likely want to limit the damage to these wrongly convicted parents.

One approach to limiting the damage to innocent parents who are wrongly accused of sexual abuse that they did not actually commit is to separate the legal from the social service responses, so that the social service response to child allegations of parental sexual abuse would be to accept ALL child allegations of parental sexual abuse as valid, recognizing that approximately 5% to 10% of these allegations are not true, in order to eliminate the damage to children re-exposed to authentic sexual abuse incest because of an erroneous Type II “false negative” decision and response from us. Whereas the legal response of convicting the parent as a “sex offender” would be disconnected from the social service response, so that the legal criteria for conviction would maintain higher standards against making a Type I “false positive” decisional error of convicting an innocent person.

This approach would result in ALL child accusations of parental sexual abuse being accepted as valid by social service agencies, so that ALL child accusations of parental sexual abuse result in termination of parental contact with the child, but only a limited number of these cases would actually result in a legal conviction of the parent as a “sexual offender.”

While separating our social service response to child allegations of parental sexual abuse (limiting our risk of making Type II decisional errors) from our legal response to child allegations of parental sexual abuse (limiting our risk of making Type I decisional errors) would provide for interesting and lively discussion, such an approach to separating decisional criteria would be unlikely to withstand legal challenge in the Courts. But I believe this possibility at least merits considered discussion as we strive for synthesis of equally valid poles of the dialectic.

Low Base-Rate Phenomenon

When a condition is rare in the general population this can substantially affect the rate of “false positive” decisions (Type I errors) we make from our assessments. For example,

Say we are assessing for TRAIT X in the population.

The population prevalence of TRAIT X is 5% (i.e., a “low base-rate”) and our instrument for identifying TRAIT X is 95% accurate. No approach to identifying a psychological trait in a population will be 100% accurate and in most cases a sensitivity of 80% is generally considered excellent. But for the purposes of our example, let’s say we have an amazingly good assessment instrument that can accurately identify 95% of the cases of TRAIT X.

So out of 1000 people assessed for TRAIT X, the prevalence of TRAIT X will be 50 people (i.e., 5%). Our 95% accurate instrument will then correctly identify roughly 48 people with TRAIT X, and will miss only 2 people who actually have TRAIT X but who we said didn’t have the trait (i.e., “false negatives,” a Type II error). Correctly identifying 48 of the 50 people with TRAIT X (i.e., “true positives”) while only missing 2 people with TRAIT X (i.e., “false negatives”) is pretty good.

Great. So far, so good.

However, there are 950 people in our population of 1000 without TRAIT X, and our instrument has a 5% error rate, so our 95% accurate instrument will identify 5% of the 950 people without TRAIT X as incorrectly having the trait (i.e. “false positives”), so that our instrument will incorrectly say that 48 people have TRAIT X when they don’t (5% of 950).

This means that out of 1000 people, our 95% accurate instrument will correctly identify 48 people as having the trait (“true positives”) and will miss only 2 who have the trait (“false negatives”), and will also incorrectly identify 48 people as having the trait when they don’t (“false positives”). So essentially, our identification of TRAIT X is only 50% accurate, we correctly identify as many people as having the trait (“true positives”) as we incorrectly identify people as having the trait when in actuality they don’t (“false positives”).

This is the result of what’s called “the low base-rate phenomenon” – no matter how accurate our assessment instrument (even an insanely accurate 95%) we will nevertheless produce and inordinately high number of “false positives” because of the low-base rate of the characteristic in the population.

Out of all the cases of child allegations of parental sexual abuse, the base rate of false child allegations is going to be low (my estimate is around 1% to 2%, others may assert other prevalence estimates).

If our value system says that we should avoid “false positive” identifications (i.e., avoid Type I decisional errors), then any approach that identifies as many “false positives” as “true positives” is going to present a problem. If we are trying to identify cases of “false child allegations of sexual abuse” and out of 1000 cases of alleged sexual abuse we identify 50 cases of false allegations, but in order to do this we also incorrectly identify 50 children who were ACTUALLY sexually abused by the parent as NOT being sexually abused by the parent, that’s a lot of kids who were authentically abused who we are not protecting simply because of the low base-rate phenomenon.  We protect as many children from child abuse as we expose to child abuse.

AND… if our assessment method is less that 95% accurate, then the number of decisional errors increases substantially. So in actual practice, in order to identify the 50 cases of false allegations of sexual abuse we may wind up erroneously identifying 200 or 300 children who were actually sexual abused as NOT being sexually abused by the parent.  This may mean that for every one parent-and-child we protect from the pathology of an actual false allegation of sexual abuse, we expose as many as four or five other, authentically abused children to continued sexual abuse victimization.

At what point does the damage caused to the 200 or 300 children who were authentically abused outweigh the damage to the 50 children who were not abused and whose false allegations were the product of severely distorted parenting by a narcissistic/borderline parent?

And yet do we simply abandon these “false allegation” children to the severe psychological abuse inflicted on them by the psychopathology of the narcissistic/borderline parent in order for us to reduce the harm to other children who were authentically sexually abused?  Is it moral to knowingly sacrifice one to save many?

Or do we still try to identify these “false allegation” children anyway, even though we know that this will lead to more Type II errors in identifying children who were authentically abused, so that we will be abandoning some authentically abused children to the psychopathology of their pedophile parent?

It would be wonderful if we could achieve 100% accuracy in our diagnosis of both “true positives” (children we identify as being sexually abused who were actually sexually abused by the parent) and “true negatives” (children who make false allegations of sexual abuse and who we identify as false allegations), but be we can’t. There will always be some error in our decisional criteria. Do we wish to limit Type I errors and increase Type II errors, or do we wish to limit Type II errors and increase Type I errors. This is a value judgment based on the relative damage we judge to result from each type of decisional error.

Another consideration in this discussion is that the legal system itself will bias decisional criteria to limit Type I errors (i.e., to limit the probability of incorrectly identifying children as being sexually abused by a parent when there was no sexual abuse), so that the rates of not identifying authentic sexual abuse will already be inordinately high.  Since this is already the case, should we then try to identify actual cases of false allegations of child sexual abuse in order to rescue and protect as many of these children as we can, since trying to identify actual cases of false allegations of child abuse is not likely to affect rates of identifying authentic child sexual abuse cases since the Court is already not identifying these cases anyway by its decisional criteria to limit Type I errors.

Conclusion to Part I

The issues are complex. My assumption is that ALL mental health professionals want what is best for children, and that ALL mental health professionals want to protect all children from all forms of child abuse.

Differing views on how to achieve this represent “equally valid poles of a dialectic” (Linehan, 1993). We should work for synthesis of these poles in which we achieve consensus on a reasonable approach to very difficult and challenging issues, rather than engaging in continual unproductive adversarial conflict in which each side falsely “demonizes” the other as being callously unconcerned about protecting children from child abuse.

We all want to protect children from child abuse. The issues are difficult and challenging.

Moving forward, I hope to engage in productive dialogue regarding these complex and challenging issues in which reasonable people can disagree about approaches while still maintaining a fundamental agreement about the underlying desire to protect ALL children from ALL forms of child abuse.

In a future blog post (Part II) I will discuss my personal views regarding potential resolutions of the complex and difficult issues surrounding child allegations of parental sexual abuse. In this next blog post on the subject of false child allegations of parental sexual abuse, I will offer my thoughts on whether there are specific distinctive identifying features in the 1% to 2% of cases reflecting false child allegations of sexual abuse as a result of the pathogenic influence on the child of a cross-generational coalition with a narcissistic/(borderline) parent (Causal Origin 2).   If there are distinctive and reliable identifying features for false child allegations of parental sexual abuse originating from the pathogenic influence on the child of a narcissistic/(borderline) parent, then we may be able to protect some of these children without inordinately affecting our ability to ALSO protect children whose allegations of parental sexual abuse are true.

I recognize ahead of time that no matter what position I take in this second blog post there will be those who disagree, and that the views of these people are reasonable and well founded. Down the road, they may convince me of the greater correctness of their views, or I may convince them of my views. At this point I believe the primary issue is engaging in reasoned and productive dialogue that recognizes that both poles in the dialectic represent reasonable and understandable positions that merit careful consideration and dialogue.

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

 References

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford

“Staff splitting,” as mentioned earlier, is a much-discussed phenomenon in which professionals treating borderline patients begin arguing and fighting about a patient, the treatment plan, or the behavior of the other professionals with the patient… arguments among staff members and differences in points of view, traditionally associated with staff splitting, are seen as failures in synthesis and interpersonal process among the staff rather than as a patient’s problem… Therapist disagreements over a patient are treated as potentially equally valid poles of a dialectic. Thus, the starting point for dialogue is the recognition that a polarity has arisen, together with an implicit (if not explicit) assumption that resolution will require working toward synthesis.” (p. 432)