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

Diagnosis of AB-PA

The pathology of “parental alienation” can be reliably identified by a set of three definitive diagnostic indicators:

1.) Attachment System Suppression:

The complete suppression of the child’s attachment bonding motivations toward a normal-range and affectionately available parent in which the child seeks to entirely sever the attachment bond with this parent.

Therapist Note: This symptom originates in the disorganized attachment networks of the allied narcissistic/(borderline) parent in which breaches to the relationship with the attachment figure result in a complete severing of the relationship (Bowen: relationship cutoffs) rather than effective repair of the relationship.

Under the distorting pathogenic influence of the narcissistic/borderline parent, the child is induced into adopting a similar “cutoff” of relationships as a means of coping with the divorce.

2.) Personality Disorder Traits

The child displays a characteristic set of five specific narcissistic/(borderline) personality traits in the child’s symptom display toward the targeted rejected parent:

Grandiosity: The child sits in a grandiose position of judgment of the targeted parent as both a parent and as a person.

Absence of Empathy: The child displays a complete absence of empathy and compassion for the targeted parent.

Entitlement: The child expresses an entitled belief that the child’s every desire should be met by the targeted-rejected parent to the child’s satisfaction, and if these entitled expectations are not met to the child’s satisfaction then the child feels entitled to exact a retaliatory revenge on the targeted parent

Haughty and Arrogant Attitude: The child displays an arrogant attitude of haughty contempt and disdain for the targeted parent.

Splitting: The child’s symptoms evidence the pathology of splitting in which the child displays a polarized perception of his or her parents, with the supposedly favored parent characterized as the ideal all-wonderful parent whereas the targeted parent is characterized as the entirely bad and worthless parent

Therapist Note: This set of narcissistic/(borderline) personality traits in the child’s symptom display are the result of psychological influence by the allied narcissistic/(borderline) parent on the child’s beliefs toward the targeted parent. Diagnostic Indicator 2 represents the “psychological fingerprints” in the child’s symptom display of the psychological influence and control of the child by the allied narcissistic/(borderline) parent who is the actual source for these narcissistic beliefs and attitudes.

3.) Delusional Belief

The child evidences an intransigently held, fixed-and-false belief (i.e., a delusion) regarding the supposedly “abusive” parental inadequacy of the targeted-rejected parent. The child shares this delusional belief (an encapsulated persecutory delusion) with the narcissistic/(borderline) parent, who is the actual original source of this delusional belief (ICD-10 diagnosis code F24: Shared Psychotic Disorder).

The child uses this delusional belief regarding the supposedly “abusive” inadequacy of the targeted parent to justify the child’s rejection of the targeted parent as deserving to be rejected and punished for this parent’s supposedly “abusive” inadequacy.

Therapist Note: This symptom is a product of the child’s induced role in the trauma reenactment narrative of the narcissistic/(borderline) parent as the “victimized child.” The trauma reenactment narrative is a false drama created from the decompensating delusional pathology of the narcissistic/(borderline) parent (Millon, 2011; see below).

The child is induced by distorted and manipulative communication exchanges with the narcissistic/borderline parent into adopting the “victimized child” role in the narcissistic/(borderline) parent’s attachment trauma reenactment narrative (Childress, 2015; Foundations). Since the attachment trauma reenactment narrative is a false drama (a delusion), the child’s role as the “victimized child” in this false drama is also a delusional belief.

The child’s rejection of the targeted parent is induced through a series of distorted communication and relationship exchanges between the child and the narcissistic/(borderline) parent in which the child is led into believing that the child is being “victimized” by the supposedly “abusive” parenting of the targeted parent. This allows the allied narcissistic/(borderline) parent to then self-adopt and conspicuously display to others, and to the child, the role as the supposedly ideal and “protective” parent.

The trauma reenactment narrative is in the pattern of “abusive parent”/”victimized child”/”protective parent.” However, this is a false drama. The targeted parent is not abusive, the child is not victimized, and the narcissistic/borderline parent is not a protective parent. It is a false drama created by the pathology of the narcissistic/(borderline) parent.

Abusive Parent: The internal working model of the “abusive parent” which is contained within the attachment trauma networks of the narcissistic/(borderline) parent is assigned to the current targeted parent (i.e., the supposedly “abusive” spousal attachment figure who is rejecting/abandoning the narcissistic/borderline spouse)

Victimized Child: The internal working model of the “victimized child” which is contained in the attachment trauma networks of the narcissistic/(borderline) parent is assigned to the current child through a series of distorted communication exchanges with the child in which a criticism of the targeted parent is first elicited from the child through motivated and directive questioning by the narcissistic/(borderline) parent, followed by the inflammation and distortion of this elicited criticism by the response it receives from the narcissistic/(borderline) parent, who leads the child into believing that the child is being “victimized” by the supposedly abusive parental inadequacy of the other parent. It is the child’s belief in this false trauma reenactment role as the supposedly “victimized child” that represents Diagnostic Indicator 3 of the delusional belief.

Protective Parent: The internal working model of the all-wonderful and ideally nurturing and “protective parent” is self-adopted and conspicuously displayed by the narcissistic/(borderline) parent for the “bystander” therapists, attorneys, social workers, teachers, and judges. The role of the “bystander” therapists, attorneys, social workers and judges in the trauma reenactment narrative is to validate the authenticity of the false narrative created by the pathology of the narcissistic/(borderline) parent of “abusive parent”/”victimized child”/”protective parent.”

Anxiety Variant

In some cases, the child’s symptoms may display an extreme and excessive anxiety supposedly triggered by the presence or anticipated presence of the targeted parent. In the Anxiety Variant, the child’s anxiety symptoms will meet DSM-5 diagnostic criteria for a Specific Phobia, with the type of phobia being a bizarre and unrealistic “mother phobia” or “father phobia.”

Persistent Unwarranted Fear: The child will display a persistent and unwarranted fear of the targeted-rejected parent that is cued by either by the presence of the targeted parent or in anticipation of being in the presence of the targeted parent (DSM-5 Phobia criterion A).

Severe Anxiety Response: The presence of the targeted parent almost invariably provokes an anxiety response which can reach the levels of a situationally provoked panic attack (DSM-5 Phobia criterion B).

Avoidance of Parent: The child seeks to avoid exposure to the targeted parent due to the situationally provoked anxiety or else endures the presence of the targeted parent with great distress (DSM-5 Phobia criterion C).

Associated Clinical Signs (ACS)

While not diagnostic of the pathology of “parental alienation,” a set of prominent associated clinical signs are often present in the surrounding symptom display:

ACS 1: Use of the Word “Forced”

The child’s time spent with the targeted parent is characterized as being “forced” to be with this parent.

Narcissistic/Borderline Parent: “What can I do, I can’t force the child to go on visitations with the other parent.”

N/B Parent: “What can I do, I can’t force the child to accept phone calls from the other parent.”

N/B Parent: “I won’t force the child to be with the other parent.”

Child: “I don’t want to be forced to be with the other parent.”

A more appropriate and accurate characterization would be that the child is being given the “opportunity” to form positive and affectionate relationships with both parents.

Sometimes this characterization of being “forced” to be with the targeted parent is combined with an offer of possible reconciliation at some point in the future if the targeted parent simply allows the current rejection to occur.

Child: “If the targeted parent allows me to spend all my time with the favored parent, then maybe someday I might want to spend time with the targeted-rejected parent.”

ACS 2: Child Empowerment to Reject

The allied narcissistic/(borderline) parent actively supports and seeks to empower the child’s ability to reject the targeted parent.

Child Decide: The child should be “allowed to decide” whether to go on visitations with the other parent.

Listen to the Child: We should “listen to the child” (because the child is under the manipulative control of the narcissistic/(borderline) parent).

Speak to the Judge: The child should be allowed to testify in court or speak to the judge in order to tell the judge that the child wants to reject the targeted parent.

An effort by an allied and supposedly favored parent to have the child testify in court or speak to the judge in order for the child to overtly reject the targeted parent is almost always indicative of attachment-based “parental alienation.” The only reason this is not among the principle diagnostic indicators is that it is not consistently present in all cases of attachment-based “parental alienation.” However, when it is present and an allied and supposedly favored parent seeks to have the child testify in court in order to overtly reject the other parent, this is almost always indicative of attachment-based “parental alienation.”

ACS 3: The Exclusion Demand

The child seeks to exclude the targeted parent from attending the child’s activities and ceremonies (dance recitals, baseball games, school performances), supposedly because the child becomes too anxious and stressed by the mere presence of the targeted parent at these activities.

Therapist Note: The actual source of the child’s stress is the psychological distress of the allied narcissistic/borderline parent which is created by the presence of the targeted parent at these child events.

The child is in a role-reversal relationship with the narcissistic/(borderline) parent in which the child is being used as an external “regulatory object” by the narcissistic/(borderline) parent to stabilize this parent’s psychopathology. When the targeted parent shows up for the child’s events and activities this destabilizes the emotional and psychological state of the narcissistic/(borderline) parent. The child’s role as the regulatory object for the narcissistic/(borderline) parent’s emotional and psychological state is to keep this parent in an organized and regulated psychological state, which can be accomplished by the child banishing the targeted parent from attending the child’s activities and events.

The presence of the Exclusion Demand is almost 100% indicative of attachment-based “parental alienation.” No normal-range child EVER banishes a parent from attending the child’s events or activities. Normal-range children seek and enjoy their parents’ attendance at the child’s activities and ceremonies.

The only reason the Exclusion Demand is not one of the principle diagnostic indicators is because it is not consistently present in all cases of attachment-based “parental alienation.” However when the Exclusion Demand is present, it is almost 100% indicative of attachment-based “parental alienation.”

ACS 4: Parental Replacement

The child replaces the child’s authentic parent with the step-parent spouse of the allied narcissistic/(borderline) parent.

De-Ownership: The child stops calling his or her authentic parent “mom” or “dad” and instead begins calling the authentic parent by his or her first name.

Replacement: The child begins calling the step-parent spouse of the allied narcissistic/(borderline) parent with the parental appellation of “mom” or “dad”

This replacement of the authentic parent with the step-parent spouse of the allied narcissistic/(borderline) parent is tacitly condoned by the narcissistic/(borderline) parent, typically with the role-reversal theme of “It’s not me, it’s the child who decided to call the step-parent mom/dad.”

Oftentimes, the allied narcissistic/(borderline) parent will present this parental replacement to the “bystander” therapists and attorneys as being a good thing since it evidences that the child no longer needs the other parent now that the other parent has been effectively replaced in the child’s affections by the new step-parent spouse of the narcissistic/(borderline) parent.

When present, Parental Replacement is almost 100% indicative of attachment-based “parental alienation.” The only reason Parental Replacement is not included as one of the principle diagnostic indicators is that it is not always present in all cases of attachment-based “parental alienation.” But when Parental Replacement is present, it is almost 100% indicative that attachment-based “parental alienation” is present.

ACS 5: The Unforgiveable Event

The child reports on one or two events from the past as representing supposedly “unforgiveable events” that justify all current and future rejection of the targeted parent. The child typically uses these supposedly unforgivable events from the past as justification that the targeted parent supposedly “deserves” to be rejected for the supposed prior failures of the targeted parent as a parent.

The associated clinical sign of the Unforgiveable Event is often associated with the child’s demand for an apology from the targeted parent for the supposed wrongs inflicted on the child in the past. The targeted parent will often dispute the accuracy of the child’s characterizations of these events.

If the targeted parent does not apologize for the supposed wrongs done to the child in the past, then the child will allege that the targeted parent “doesn’t take responsibility” for past parental failures. However, even if the targeted parent apologizes for these alleged parental misdeeds the child will nevertheless remain hostile and rejecting of the targeted parent over these supposedly unforgiveable past events.

Therapist Note: In normal-range families, parents judge children’s behavior as appropriate or inappropriate, and parents then deliver consequences (punishments and rewards) based on these parental judgements of the child’s behavior.

In an “inverted hierarchy” of a cross-generational coalition of the child with the allied parent against the other parent (what Haley refers to as the “perverse triangle”), the child is empowered by the coalition with the supposedly favored and allied parent to sit in judgement of the other parent and to punish this parent for child judgements of parental failures and misdeeds.

ACS 6: Liar – Fake

The child accuses the targeted parent of being “fake” and a “liar” whenever the targeted parent displays positive feelings of affection for the child or hurt at the child’s rejection.

Therapist Note: The child is unable to acknowledge authentic displays of affection by the targeted parent because of the child’s guilt and grief at betraying the affectional bond with the beloved-but-now-rejected targeted parent. The child copes with the immense guilt and grief by discounting the authenticity of the targeted parent’s displays of affection and by maintaining that the targeted parent “deserves” to be rejected (because of supposed past parental failures and misdeeds).

ACS 7: Themes for Rejection

The characteristic themes offered by the child for rejecting the targeted parents are:

Too Controlling: The targeted parent is too “controlling” – “Things always have to be his way (or her way).”

Anger Management: The targeted parent gets excessively angry over supposedly minor incidents (incidents often provoked by the child’s disrespectful and hostile attitude).

Neglectful: The targeted parent didn’t or doesn’t spend enough time with the child, or provides inadequate care for the child. The neglectful theme often centers around time given to the new romantic partner or spouse of the targeted parent, and is sometimes given as a past “unforgiveable event” (e.g., “my father never spent enough time with me before the divorce, so now I don’t want to spend time with him”). In some cases the neglectful theme centers around food and feeding issues (e.g., the targeted parent does not provide adequate or acceptable food in the home).

ACS 8: Use of the Word “Abuse”

The word “abuse” is used extensively in attachment-based “parental alienation” to characterize normal-range and non-abusive parenting practices of the targeted parent (for example, taking away the child’s cell phone as a discipline measure is not “abusive” parenting but will be characterized with the term “abusive” by the child and allied narcissistic/borderline parent).

The elevated threat perception of the allied narcissistic/(borderline) parent in which the parenting practices of the other parent are vaguely perceived as threatening for the child is typically accompanied by an expressed need by the allied narcissistic/borderline parent to “protect the child” whenever the child is with the targeted parent, so the frequent use of the word “protection” when the child is actually in no threat or danger is also associated with the pathology of attachment-based “parental alienation.” The supposed need to “protect the child” is often used to justify the frequent and incessant texting of the narcissistic/borderline parent with the child while the child is in the care of the targeted parent.

Therapist Note: This symptom set of unwarranted and excessive characterizations of “abuse” and “protection” concerns emerges from the elevated anxiety of the narcissistic/(borderline) parent activated from this parent’s own developmental trauma history and patterns in the attachment system, which are then triggered by being separated from the child.

ACS 9: Excessive Texting

The narcissistic/(borderline) parent seeks to maintain almost continual contact with the child (through texting, phone calls, and emails) while the child is in the care of the targeted parent.

Therapist Note: The two inter-related goals of this excessive contact are:

Anxiety Reduction: To lessen the narcissistic/(borderline) parent’s own anxiety at separations from the child.

Interfere with Relationship: To intrude into the relationship of the targeted parent with the child in order to disrupt and prevent the targeted parent and child from forming an affectionally bonded relationship.

The narcissistic/(borderline) parent will often frame this excessive texting (emails, phone calls, etc.) as a need to monitor and “protect the child” while the child is in the care of the targeted parent. The incessant texting and contact with the child will sometimes be framed in a role-reversal theme as the child needing to be in continual contact with the narcissistic/borderline parent

N/B Parent: “It’s not me, it’s the child who is texting me because the child loves me so much and can’t bear to be separated from me. But it’s not me, it’s the child.”

When present, the associated clinical sign of continual and incessant texting will often provoke the targeted parent to take away the child’s phone while on visitations, which will create an incident of conflict in which the child claims that the removal of the child’s phone was unjustified and that the targeted parent “had no right to take my phone.”

In some cases, the child will lock himself or herself in the bathroom with a computer or phone for long periods of time in order to excessively text or email the narcissistic/(borderline) parent while on visitations with the targeted parent. This may provoke the targeted parent to remove the locks on the bathroom doors, which will then create an incident of conflict in which the child and the allied narcissistic/(borderline) parent will express privacy concerns for the child with no lock on the bathroom door. In some cases, this may become the “unforgivable event” used to justify the rejection of the targeted parent.

ACS 10: Role-Reversal Use of the Child

(“It’s not me, it’s the child who…”)

The allied narcissistic/(borderline) parent triangulates the child into the spousal conflict by placing the child into the leadership position of having to reject the targeted parent. The characteristic pattern of this role-reversal manipulation and exploitation of the child is: “It’s not me, it’s the child who…”

N/B Parent: “It’s not me, it’s the child who doesn’t want to be with the targeted parent. I tell the child to go on visitations, but the child doesn’t want to. But it’s not me, it’s the child.

N/B Parent: “It’s not me, it’s the child who doesn’t want to play baseball anymore. I asked the child if he/she wanted to play baseball and the child said no. It’s not me, it’s the child.”

N/B Parent: “It’s not me, it’s the child who doesn’t want the other parent to attend the child’s music recital (school play, soccer game, graduation, etc.)” (the Exclusion Demand)

N/B Parent: “It’s not me, it’s the child who…”

Therapist Note: This role-reversal use of the child by the narcissistic/(borderline) parent represents the manipulation and exploitation of the child to meet the needs of the narcissistic/(borderline) parent.

ACS 11: Deserves to be Rejected

A highly characteristic theme expressed by both the child and by the allied narcissistic/(borderline) parent is that the targeted parent deserves to be rejected by the child because of past parental failures. This theme frames the child as an almost retaliatory angel of justice whose mission is to inflict suffering and rejection onto the targeted parent who deserves to suffer for this parent’s alleged misdeeds as a parent.

Normal-range children never express this attitude toward a parent. It is, however, a very prominent and highly characteristic theme expressed in attachment-based “parental alienation.”

Therapist Note: This theme emanates from the retaliatory pathology of the narcissistic/(borderline) parent which is being transmitted to the child’s attitudes and beliefs. It is the narcissistic/(borderline) parent who believes that the other spouse deserves to suffer for his or her failures as a spouse.

Since the child is being used as a retaliatory weapon against the other spouse, the retaliatory theme that the other spouse “deserves to suffer” and “deserves to be rejected” is transferred to the child and to the child’s role with the other parent. So that this “spousal” theme of the narcissistic/(borderline) personality parent becomes translated into the child’s “parental” theme with the targeted parent; that the targeted parent “deserves to suffer” and “deserves to be rejected” for this parent’s supposed failures as a parent. This theme is initially a spousal theme which is now being enacted by the “retaliatory weapon” of the child as a parent-child theme.

This theme of “deserving to be rejected” also links into the childhood developmental trauma history of the narcissistic/(borderline) parent as both an unexpressed anger toward his or her own parent (who “deserves to be rejected” in the mind of the narcissistic/(borderline) parent), as well as a projected self-loathing and primal fear of the narcissistic/(borderline) parent that he or she “deserves to be rejected” because of the inherent personality inadequacies of the narcissistic/(borderline) parent. This theme of “deserves to be rejected” is a complex knot of interwoven pathology within the narcissistic/(borderline) parent.

ACS 12: Disregards of Court Orders

A narcissistic/(borderline) parent personality does not recognize the court’s authority over his or her impulses and desires. The narcissistic/(borderline) style personality believes that he or she is exempt from the rules and standards that govern other people. As a result of this belief of inherent superiority, the narcissistic/(borderline) parent will frequently and unilaterally disregard court orders regarding custody and visitation that this parent finds inconvenient.

The narcissistic/(borderline) parent transmits this disregard of court orders and court authority to the child, so that the child feels similarly entitled to disregard court orders for custody and visitation. This child’s empowerment to disregard court authority is reflected in the child’s refusal to go on court ordered visitations with the targeted parent, and reaches its zenith when the child selects to run away from the care of the targeted parent, in direct contravention to the court orders for custody and visitation.

According to Aaron Beck, a leading authority on personality disorders, narcissistic personalities “consider themselves superior and entitled to special favors and favorable treatment; they are above the rules that govern other people… [and] the core narcissistic beliefs are as follows: “Since I am special, I deserve special dispensations, privileges, and prerogatives” (Beck et al., p. 43). This core narcissistic belief leads the narcissistic/(borderline) parent to simply disregard court orders that this parent finds inconvenient.

DSM-5 Diagnosis

When the three diagnostic indicators of attachment-based “parental alienation” are present in the child’s symptom display, the appropriate DSM-5 diagnosis is:

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

Child Psychological Abuse

The DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed is warranted by the induced psychopathology evidenced in the child’s symptom display which is created by the severely pathogenic parenting practices of a narcissistic/borderline parent as a means to stabilize the pathology of the parent.

The pathogenic parenting practices of the narcissistic/(borderline) parent are creating the following child pathology:

Developmental Pathology:

Diagnostic Indicator 1: Induced suppression of the child’s attachment bonding motivations toward a normal-range and affectionally available parent.

Personality Disorder Pathology

Diagnostic Indicator 2: The presence in the child’s symptom display of five a-priori predicted narcissistic/(borderline) personality traits directed toward the targeted parent

Psychiatric Pathology

Diagnostic Indicator 3: The presence in the child’s symptom display of severe psychiatric psychopathology involving an induced delusional belief and possibly induced phobic anxiety.

Pathogenic parenting that is creating severe developmental pathology, personality disorder pathology, and psychiatric pathology in a child as a means to stabilize the parent’s own psychopathology, and which is resulting in the 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 – which then activates the mental health professional’s “duty to protect” and professional obligation to take affirmative actions to protect the child.

The pathology of “parental alienation” is not a child custody issue, it is a child protection issue.

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

From: Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley. (emphasis added)

“Axis I Co-Morbidities

“Delusional Syndromes (DEL). Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders. Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs. Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking. Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions. Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence. They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up. Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast.” (pp. 407-408; emphasis added)

References

Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.

Childress, C.A. (2015). An attachment-based model of parental alienation: Foundations. Claremont, CA: Oaksong Press.

Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.), The interactional

Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley. view (pp. 31-48). New York: Norton.

Puzzles

I received the following question from a targeted parent and I thought my response may be of broader interest:

Dr. Childress, can you give an example of a question that you would put to a child that would indicate any of the narcissistic processes and the splitting dynamic from your 2nd set of diagnostic indicators in a child’s symptom display.

Response:

There isn’t a specific question, per se. Typically the display of the child will evidence narcissistic symptoms in response to my general question:

Dr. C: “So, tell me. Why do you hate your mom (your dad) so much?”

and my follow-up questions asking for specific incidents to support the child’s general assertions.

As the child responds, the child will display an attitude of judgement of the parent from an elevated position above that of the parent. As I ask about specifics, a sense of entitlement will become evident.

As I probe for empathy (“How do you think it makes your mom feel that you don’t want to be with her?”), the child will evidence a complete absence of caring and empathy for the targeted parent’s experience of love and emotional suffering. Oftentimes the child will display a characteristic attitude that the targeted parent “deserves” to be rejected, or that the display of love and suffering by the targeted parent is “fake” or a lie.

When I inquire about the favored parent, on the other hand, the child provides a uniformly positive critique of the allied and supposedly favored parent, free from parent-child troubles.

The Puzzle

Think of it this way, clinical psychology is like putting together a puzzle. The parent tells you what they think the puzzle is, which may or may not be accurate. Sometimes the parent has no idea what the ultimate picture is, and the origins of the child’s behavior and angry outbursts are a total mystery to the parent.

I’ll then open the box and begin putting the puzzle pieces together to see what the picture is. Is this the trains in the mountain puzzle, or is it boats on the lake? I’ll start with the borders because they have straight edges (i.e., the general family context and general complaints). As I’m putting together the general structure, I’ll look for similar color patterns (i.e., emerging themes).

Gradually I’ll begin to recognize shapes in the picture that can help in locating specific pieces to complete a particular pattern. Eventually the picture emerges (typically even before all the pieces are in place). There may be some pieces missing here and there, but it’s clearly a picture of cats in the garden. It’s definitely not a locomotive. Nor is it a picture of boats on the lake.

There are three cats in the picture, one’s black with short hair, one’s grey and white stripes, and one’s black and white. I’m missing the pieces for this one’s ear, and I don’t have the pieces for the black cat’s left paw. They’re in a garden with red and yellow flowers, this portion of the garden is missing, as is this part of the fence. But it’s clearly cats in the garden, and it’s definitely not a locomotive or boats on the lake.

So when I conduct an initial clinical interview, the parent typically tells me what the puzzle is (i.e., they present me with the picture on the box top). The parent will say to me,

“Dr. Childress, can you help me with this problem? I have a puzzle of a train in the mountains.”

I then open the box and start putting together the pieces to see if that’s true, if it’s really a train in the mountains, and also to determine which train in the mountains puzzle it is. Is it the one with the steam locomotive going across the canyon bridge, or is it the one with the modern locomotive coming out of the tunnel?

Dr. C: “So what does the child do? Can you give me an example? How do you respond when your child does that? How does the child respond to what you do? What’s going on in the surrounding family? How do you and the other parent get along?”

Gradually, I put the puzzle picture together. If it’s actually a train, I can begin asking questions that help me understand if it’s a steam engine or a modern locomotive. Is it traveling through farmlands or across mountains? Is there a bridge over the river, or is this the train with red and yellow boxcars?

The “Alienation” Puzzle

In attachment-based “parental alienation” the allied parent says to me,

Parent: “Dr. Childress, I have a puzzle of a train in the mountains. See, look here, here’s some pieces from the puzzle. Here’s a piece with the train’s engine and smokestack. Here’s one of the engine’s wheels. This one is a puzzle piece showing one of the boxcars. And look at this picture on the box top. See, it’s of a train going through the mountains.

Sure enough, the picture on the box top is of a train in the mountains. And the puzzle pieces I’m shown are clearly from a locomotive.

So, let’s open the box and start putting the puzzle together. I never just accept the picture on the box top. I always put the puzzle together myself, just to make sure.

So, let’s put this picture together… hmmm that’s odd. The actual puzzle pieces in the box are much smaller than the locomotive pieces I was shown. You know what… those locomotive pieces don’t belong to this puzzle (i.e., the symptom display by the child is inauthentic).

So, let’s start with the edges… and… wait, this isn’t a locomotive puzzle. You know what… This looks like cats in the garden. Well if it’s cats in the garden, then there should be a red and yellow piece that goes right in this spot. Yep. There it is. And there should be another black and red piece that goes right here. Yep. There it is. And then there should be a kitten’s nose that goes right here. Yep. There it is. This isn’t train in the mountains, this is cats in the garden.

Well, I’ve still got some time left, let’s put together more of the puzzle just to make sure. This area should be red and yellow flowers, with this piece here and another one over here. Yep. This is the grey cat’s eye. Yep, it goes right here and fits with this. There’s the bee over here on the flower. Yep. We’re definitely looking at cats in the garden.

I see the picture made by the puzzle pieces, clear as day. We’re looking at three cats in the garden.

As I try to put together the puzzle train in the mountains, I realize that’s not the picture which is being revealed by the actual puzzle pieces,

The initial “presentation” is one of parent-child conflict caused by the targeted-rejected parent. However, as I collect the clinical data, the parent-child conflict is not being initiated by the parent’s problematic behavior, but is being initiated by, dare I say provoked by, the child.

Furthermore, the child’s attachment system display is not authentic. Child protest behavior is an “attachment behavior” designed to increase parental involvement (commonly referred to as seeking “negative attention”). In this situation, the child is showing “detachment behavior,” a motivated desire to sever the parent child bond. An authentic attachment system never shows “detachment behavior” except under an extremely limited set of severely abusive parenting (e.g., incest or chronic and severe parental violence), or in response to a cross-generational coalition with a narcissistic/(borderline) parent (i.e., attachment-based “parental alienation” – cats in the garden).

As I’m putting together the actual puzzle pieces, they form into the picture features of the cats in the garden puzzle. Once I begin to recognize the cats in the garden puzzle (typically because the puzzle piece of “detachment behavior” is so distinctive of cats in the garden), I then begin to look for three specific puzzle pieces in each of three different locations (i.e., the three diagnostic indicators of attachment-based “parental alienation”) because no other puzzle has all three of these pieces except cats in the garden.

Cats in the garden has a black and red piece here, a yellow and red piece that goes right here, and a piece with a kitten’s nose that goes right here (i.e., the three diagnostic indicators of attachment-based “parental alienation”).

Train in the mountains has a black and red piece here, just like cats in the garden, but train in the mountains doesn’t have the red and yellow piece here. Instead, train in the mountains has a green piece in that location. And train in the mountains definitely doesn’t have a kitten’s nose. So if there is a kitten’s nose in the puzzle, it definitely can’t be train in the mountains.

Boats on a lake has the same black and red piece and the same red and yellow piece (although the shapes of these pieces are different from the shapes of these pieces in cats in the garden), but boats on a lake doesn’t have a kitten’s nose either.

Dogs at play has a kitten’s nose over here, but not in the same location. And dogs at play does not have the black and red piece. And instead of the red and yellow piece, dogs at play has a red and green piece in that location.

Only cats in the garden has all three pieces. And even when there is overlap in the pieces shared by the different puzzles, the actual pieces are slightly different shapes, and in slightly different locations across the different puzzles.

So if you know what the different puzzles are, it’s actually pretty easy to spot train in the mountains, or boats on the lake, or cats in the garden. You just have to know what the pictures are and know what you’re looking for in each picture. That’s called “knowing what you’re doing.”

But even more importantly, I’m not making the diagnosis of cats in the garden based just on the three specific puzzle pieces alone, although I could because they’re so distinctive and definitive of cats in the garden. Instead, I go ahead and put together some more of the puzzle, and sure enough, the actual picture that emerges is of three cats sitting and playing in the garden.

It’s not the three puzzle pieces that make it cats in the garden. It’s the actual picture itself that makes it cats in the garden. The three puzzle pieces (the three diagnostic indicators of attachment-based “parental alienation”) are just easily identifiable definitive markers for cats in the garden. It’s the actual picture of three cats sitting among flowers that makes the puzzle cats in the garden.

The Original Question

So then, to answer the question about what specific questions I ask to elicit the child’s narcissistic symptoms, the primary question is to ask the child about the child’s reasons for rejecting the targeted parent. I ask the child to explain it to me.

Puzzle Analogy

If the puzzle picture is of the train in the mountains, then the child’s explanation for the parent-child conflict is going to be some variant of xyz.

If, on the other hand, the puzzle picture is of boats on the lake, then child’s explanation for the parent-child conflict is going to be a variant of abc.

If the puzzle is of cats in the garden, then the child’s explanation for the parent-child conflict is going to be qrs.

I always start with what I’m told the puzzle is. So if I’m told the puzzle is dogs at play, that’s what I start with and I begin to put together the puzzle picture of dogs at play. Sometimes the puzzle turns out to be one of the other dog puzzles, such as dog on the fire engine or hunting dog with duck. But which dog puzzle becomes evident as I put the puzzle pieces together.

Once you know the various puzzles, it’s pretty straightforward determining which exact puzzle it is (i.e., whether it’s an ADHD spectrum issue, or a parenting problem issue, or an autism-spectrum issue, or sensory-motor sensitivities, etc.). Each puzzle has distinctive features.

If the puzzle pieces don’t actually fit the initial presentation of the picture by the parent (this isn’t a dogs puzzle, this is one of the boat series) I then readjust to unravel the actual puzzle picture from of the actual puzzle pieces. As a clinical psychologist, I really don’t care if its dogs at play or boats on the lake, or train in the mountains. I just want to know which puzzle we’re dealing with so that we know how to fix things.

That’s what clinical child and family therapy does. It fixes things. But first we need to know if the puzzle is dogs at play or boats on the lake. If we try to fix dogs at play but the actual puzzle is train in the mountains, our efforts are going to be entirely ineffective. Determining which puzzle were working with is called “diagnosis.”

So, in putting together the puzzle I’ll start by asking the child,

Dr. C: “So tell me, why don’t you want to be with your mom?” (or dad)?

Child responses to boats on the lake puzzles have one set of characteristics. Child responses from the train in the mountains puzzle have a different set of characteristics. Cats in the garden… holy cow, the child’s responses in cats in the garden are highly distinctive. It’s incredibly easy to spot cats in the garden (i.e., attachment-based “parental alienation”).

Q: So why do so many mental health professions not diagnose cats in the garden?

A: Because they don’t even know this puzzle exists. They think everything is train in the mountains. So when the allied parent and child show them the box top of the train in the mountains picture, and the child displays the three over-sized puzzle pieces of the locomotive, the ignorance of these mental health professionals just accepts that it’s the train in the mountains puzzle.

Q: But don’t they see that it’s not a train, it’s cats?

A: No. Because they don’t put the actual puzzle together. They just accept that the picture on the box top is the actual puzzle. Kinda lazy if you ask me. And it results in a wrong diagnosis, which then results in incorrect and ineffective treatment. They’re treating train in the mountains, when the actual puzzle is cats in the garden. Pointless and ineffective treatment.

Plus, these mental health professionals don’t even know there is such a thing as the cats in the garden puzzle. That’s why I wrote Foundations. This book explains the cats in the garden puzzle. Once mental health professionals read Foundations, they will go “Hey, this isn’t train in the mountains. This is cats in the garden.” Until they read Foundations, however, they’ll just go on diagnosing and treating train in the mountains no matter what the actual puzzle is.

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

Foundations is Available

An Attachment-Based Model of Parental Alienation: Foundations

is now available on Amazon.com

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

Identifying Pathology

I recently heard (secondhand) a critique by a mental health professional about an attachment-based model of “parental alienation.” This mental health professional was apparently concerned about “labeling” the alienating parent’s pathology as being related to personality disorder processes (“Why do we need to “label” the parent as having a personality disorder?”)

I wish to take this opportunity to address this concern for “labeling” the pathology of the allied and supposedly favored parent.

Identifying pathology is the central and primary function of mental health professionals.

To say that we shouldn’t identify the nature and severity of psychological pathology is like saying the legal system shouldn’t identify the nature and severity of the violations of the law.

Judge: “I really feel uncomfortable labeling someone as a murderer. Can’t we just say they’re a doer of bad things?”

Psychologist: “I know the person has prominent hallucinations, delusions, and conceptual disorganization, but why do we need to label the person as having schizophrenia? Is that really necessary? Can’t we just say they have different thoughts and experiences?”

Social Worker: “Just because someone sexually molests a child, do we really need to label that person as a pedophile? Can’t we just say the person has unusual sexual desires?”

Our job in mental health is to understand the nature and variety of psychopathology, to assess persons and situations, and then to apply this knowledge of psychopathology to the person and situation based on standard principles of professional psychology, including the DSM diagnostic system of the American Psychiatric Association.

Personality disorders, and in this context I am speaking specifically about narcissistic and borderline personalities, are acknowledged and fully described forms of psychological pathology by preeminent figures in mental health, including Otto Kernberg (1975), Theodore Millon (2011), Arron Beck (2004), and Marsha Linehan (1994).

Narcissistic and borderline personality disorders are also recognized mental health pathology in the DSM-5 diagnostic system of the American Psychiatric Association with established diagnostic criteria.

In addition, the pathology of personality disorders is recognized as presenting along a “dimensional” continuum of severity (Widiger & Trull, 2007), meaning that a person can present some traits or features of a personality disorder without necessarily meeting the full diagnostic criteria for a personality disorder.

Furthermore, blends of personality disorder traits are acknowledged as more the norm than the exception. For example, the renowned psychiatrist, Arron Beck, describes that,

“Patients with BPD [borderline personality disorder] consistently meet criteria of one to five other personality disorders.” (Beck et al., 2004, p. 196)

And the preeminent expert in personality disorders, Theodore Millon (author of the Millon Clinical Multiaxial Inventory, which is considered the gold-standard for the assessment of personality disorders), describes the overlap of personality disorder traits for the narcissistic personality;

“Several personality disorders often covary with the narcissistic spectrum. Most notable among these are the antisocial and histrionic spectrum variants. Also listed are covariations seen with the sadistic, paranoid, negativistic personality spectra, as well as borderlines.” (Millon, 2011, p. 406)

The renowned expert in personality disorders, Otto Kernberg, identified the core structure of the narcissistic personality as representing a “subgroup of borderline patients,”

“One subgroup of borderline patients, namely, the narcissistic personalities…” (Kernberg, 1975, p. xiii)

In addition, both narcissistic and borderline personalities have been prominently associated with the collapse of thinking into delusional belief systems when under stress. The label of “borderline” personality was given to this personality style in the 1930s because this personality structure was considered to be on the “borderline” between neurotic and psychotic, and Theodore Millon has specifically described the collapse of the narcissistic personality disorders into delusional beliefs:

“Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders. Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs. Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking. Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions. Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence. They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up. Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast. Rarely physically abusive, anger among narcissists usually takes the form of oral vituperation and argumentativeness. This may be seen in a flow of irrational and caustic comments in which others are upbraided and denounced as stupid and beneath contempt. These onslaughts usually have little objective justification, are often colored by delusions, and may be directed in a wild, hit-or-miss fashion in which the narcissist lashes out at those who have failed to acknowledge the exalted status in which he or she demands to be seen.” (Millon, 2011, pp. 407-408; emphasis added)

A delusion is an intransigently held, fixed and false belief that is maintained despite contrary evidence. The shared belief by the allied and supposedly favored narcissistic/(borderline) parent and child that the targeted-rejected parent is an emotionally or psychologically “abusive parent,” whose parenting practices present a risk to the child, represents an intransigently held, fixed and false belief which is held despite contrary evidence that the parenting practices of the targeted parent are entirely normal-range. The belief that the targeted parent is an “abusive parent” who presents a danger to the child is delusional. It is not true.

This intransigently held, fixed and false belief (i.e., a delusion) is created by the collapse of the organized cognitive structures of the narcissistic/borderline personality into delusional beliefs, as specifically described by Millon (2011), in response to the psychological stresses triggered by the “unrelieved adversity and failure” surrounding the divorce experience (i.e., the public rejection and abandonment of the narcissistic/(borderline) parent by the attachment figure of the other spouse).

The pathology of attachment-based “parental alienation” is extraordinarily severe. To miss making the diagnosis of this extremely severe psychopathology is, to me, stunningly incompetent. I can only attribute this level of professional incompetence to professional ignorance regarding the nature of personality disorder pathology, which would then likely represent practice beyond the boundaries of professional competence if the mental health professional is then diagnosing and treating personality disorder pathology.

If a patient has the characteristic symptoms of cancer, the physician diagnoses cancer.

If a patient has the characteristic symptoms of heart disease, the physician diagnoses heart disease.

The physician does not say, “Cancer is such a serious disorder, why do we need to label the patient as having cancer? Can’t we just say the patient has some “uncomfortable pains”?

According to the DSM-5, if the patient has hallucinations and delusions, then the patient is diagnosed with schizophrenia. If the patient has mania and depression, the patient is diagnosed with bipolar disorder. Personality disorder pathology exists within the DSM diagnostic structure. Delusional disorders exist within the DSM diagnostic structure.

The purpose of identifying the nature of the parental personality pathology in attachment-based “parental alienation” is NOT to diagnose the parent. The diagnosis of attachment-based “parental alienation” is made SOLELY on the CHILD’s symptom display, not the parent’s.

The purpose of identifying the nature of the parental psychopathology is to gain an accurate conceptual understanding for the nature of the pathology being displayed by the child in attachment-based “parental alienation.” The key feature of this conceptual understanding is that the pathology of the parent is being TRANSFERRED TO THE CHILD through the distorting influence on the child’s belief systems of the narcissistic/(borderline) parent’s pathology. As a result of this transfer of pathology from the parent to the child, we will see evidence in the child’s symptom display of the distorted parental influence from the narcissistic/(borderline) parent’s psychopathology.

The pathology of the parent is creating the child’s pathology, and as a result, features of the parental pathology will be evident in the child’s symptom display (I refer to these symptom features as “psychological fingerprints” of parental influence by a narcissistic/(borderline) parent).

This “psychological fingerprint” evidence in the child’s symptom display represents Diagnostic Indicator 2 for an attachment-based model of “parental alienation,” i.e., the presence of five specific a-priori predicted narcissistic/(borderline) personality traits in THE CHILD’S symptom display (I’ll defer discussion of the anxiety variant).

Q: How does a child acquire this specific set of narcissistic/(borderline) personality characteristics that are being expressed selectively just toward the targeted-rejected parent?

A: Through the psychological influence on the child’s symptom formation from the pathology of a narcissistic/(borderline) parent.

Failure to acknowledge the nature of the pathology will lead to a MISDIAGNOSIS of the personality disorder pathology displayed in the child’s symptoms as falsely representing diagnostic indicators of either oppositional-defiant behavior by the child, or problematic parenting by the targeted-rejected parent.

No. This is the wrong diagnosis.

Let me be abundantly clear… this would be the WRONG diagnosis.

The child’s symptom display is NOT oppositional-defiant behavior and is NOT the result of problematic parenting from the targeted-rejected parent. The child’s symptom display directed toward the targeted parent represents a set of specific narcissistic and borderline personality traits that are being acquired by the child through the distorted pathogenic parenting practices of the allied and supposedly favored parent. The source for this child symptom set is the narcissistic/(borderline) personality pathology of the parent that is creating the pathology of attachment-based “parental alienation” as expressed by the child.

If a mental health professional makes the WRONG diagnosis as a consequence of the personal discomfort of this mental health professional with the correct diagnosis, it would be analogous to a medical doctor making an incorrect diagnosis of cancer as instead representing high blood pressure because the physician was personally uncomfortable with the seriousness of the cancer diagnosis. The physician would then treat the patient for high blood pressure, and the patient would die from cancer.

When mental health professionals make the WRONG diagnosis concerning the pathology of attachment-based “parental alienation” as incorrectly being the product of the child’s oppositional-defiant behavior or as being caused by the problematic parenting of the targeted-rejected parent, this leads to incorrect and entirely ineffective treatment, and the patient (i.e., the child’s healthy development and the child’s healthy loving relationship with a normal-range and affectionally available parent) dies as a direct consequence of the misdiagnosis by the mental health professional.

If a physician were to ignore the symptom indicators of cancer and instead misdiagnose a patient’s cancer as being high blood pressure because of a motivated desire by the physician to avoid the correct diagnosis of cancer, and as a result of this motivated misdiagnosis the patient dies from untreated cancer, this would seemingly represent professional malpractice.

So why doesn’t the same apply to mental health? Actually, it does.

The central defining role for the mental health professional is to correctly identify psychological psychopathology.

The central defining role for the medical professional is to correctly identify the nature of physical pathology.

The central defining role for the legal professional is to correctly identify violations of the law.

Failure in any of these areas represents a fundamental failure in the primary professional obligation of the mental health, medical, or legal professional.

Personality disorder pathology exists. Delusional pathology exists, particularly in association with specific types of personality disorder pathology. It is the central professional obligation of mental health professionals to CORRECTLY identify the nature of the pathology in every single case.

Failure to do so would represent a foundational failure in the professional’s “duty of care” for the patient.

To then also assert a professional reluctance to correctly diagnose the nature of the psychopathology because of an unwillingness to apply a professionally established and defined professional label regarding the nature of the pathology runs perilously close to a motivated misdiagnosis of the psychopathology, which may then represent professionally negligent practice rather than simple incompetence.

The issue is NOT diagnosing the parent. An attachment-based model for the construct of “parental alienation” DOES NOT diagnose the parent.

The diagnosis of the pathology associated with an attachment-based model of “parental alienation” remains solely and completely focused on the symptom indicators in the child’s symptom display.

The correct clinical term for “parental alienation” is “pathogenic parenting” (patho=pathology; genic=genesis, creation). Pathogenic parenting is the creation of significant pathology in the child through highly aberrant and distorted parenting practices.

The issue is NOT the parent’s pathology. It is the transfer of this parental psychopathology to the child through highly aberrant and distorted pathogenic parenting practices, as evidenced in the specific features of the child’s symptom display.

The reason for identifying the nature of the parental psychopathology is to ground the diagnosis in an underlying theoretical understanding regarding the nature of the psychopathology, which then allows us to identify specific diagnostic indicators in THE CHILD’s symptom display that represent definitive diagnostic evidence of the psychopathology.

At its fundamental core, attachment-based “parental alienation” represents the trans-generational transmission of attachment trauma from the childhood of the allied and supposedly favored narcissistic/(borderline) parent to the current family relationships. This trans-generational transmission of attachment trauma is mediated by the distorted personality pathology of the parent. The personality pathology of the parent is, in turn, the consequent product of the attachment trauma (i.e., of disorganized attachment patterns) from the childhood of the allied and supposedly favored narcissistic/(borderline) parent.

The professional issue is NOT labeling the parent, the issue is correctly identifying the nature of the psychopathology being expressed in the child’s symptom display.

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

References:

Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.

Kernberg, O.F. (1975). Borderline conditions and pathological narcissism. New York: Aronson.

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

Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley.

Widiger, T.A. and Trull, T.J. (2007). Plate tectonics in the classification of personality disorder: Shifting to a dimensional model. American Psychologist, 62, 71-83.

Remedy: Single-Case ABA Design

“Remedy: The manner in which a right is enforced or satisfied by a court when some harm or injury, recognized by society as a wrongful act, is inflicted upon an individual.”

I am a psychologist, not an attorney. For legal advice consult an attorney and follow the advice of your attorney.

When the three diagnostic indicators of attachment-based “parental alienation” are present, treatment requires the protective separation of the child from the pathogenic parenting of the narcissistic/(borderline) parent during the treatment and recovery stabilization period.

We cannot ask the child to expose his or her authenticity until we can first protect the child.

“Parental alienation” is not a child custody issue, it is a child protection issue. The first and only consideration should be the child’s welfare.

When the three diagnostic indicators of attachment-based “parental alienation” are present, the child’s welfare requires the protective separation of the child from the psychopathology and pathogenic parenting of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery stabilization.

Achieving the required protective separation requires the cooperation of the Courts.

Courts, however, are not psychologists. Superficially, the child appears bonded to the narcissistic/(borderline) parent. The psychologically destructive impact of the role-reversal is not overly evident. Courts may be reluctant to do what’s necessary, and may desire a more moderate response.

Until Courts recognize the severity of the pathology involved, we must work with the legal system as it is. Under the current conditions, providing judges with an alternative that is both balanced and temperate may help achieve a resolution.

Toward that end, I have developed a possible remedy that may be acceptable to the Court. It involves a scientifically grounded and evidenced-based approach to resolving “parental alienation.” This potential remedy employs a standard scientific research methodology called a single-case ABA design (actually a single-case ABAB reversal design).

(In addition to teaching graduate-level courses in psychopathology, treatment planning, and child development, I also teach courses in research methodology.)

I have posted a description of this approach to my website, just below the Therapy article, and a direct link to the single-case ABA design article is at:

Single-Case ABA Design

If a Court wishes to employ this approach, I would be happy to consult with a psychologist in supervising the implementation of the single-case design.

Craig Childress, Psy.D.
Clinical 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

Court Consideration of Adolescent Wishes

I was recently asked a question by a targeted parent about the practice in some Courts of considering the wishes of an adolescent in custody placement decisions, and I’d like to share my response.

While I will explain my response in a lengthy post, it’s actually quite simple:

At no time should the Court ever consider the wishes expressed by the child whenever there is spousal-parental conflict.

Pretty simple. Now let me explain why. There are two primary reasons.

First, the authenticity of the child’s expressed wishes may likely have been compromised by a “role-reversal” relationship with the allied and supposedly favored parent (who is likely seeking the admission of the child’s wishes for Court consideration).

Second, whenever there is spousal conflict, seeking the child’s input essentially triangulates the child into the spousal-parental conflict. This is EXACTLY the WRONG thing to do. Bad. Bad. Bad. Extremely destructive. It not only supports the pathology in the family, it actually fosters and creates pathology in the family and it will have extremely harmful effects on the child’s underneath psychology. We DO NOT ever want to triangulate the child into the spousal conflict. No. No. No. Never. I don’t care what the age of the child is. Never. No.

1. The Role-Reversal Relationship

One of the central concepts in understanding “parental alienation” is the role-reversal relationship.

In healthy child development, the child uses the parent as a “regulatory other” for the child’s emotional and psychological state. When the child faces a developmental challenge that the child cannot independently master, the child emits “protest behaviors” that elicit the involvement of the parent who helps the child regain an emotionally and psychologically organized and regulated state.

The parent acts as an external “regulatory other” (also called a “regulatory object”) for the child. In doing so, the parent “scaffolds” the building of the child’s own internal networks for self-regulation. With the brain, we build what we use. Every time we use a brain system it gets a little stronger, more sensitive, and more efficient through use-dependent changes.

In healthy child development, every time the parent acts as a “regulatory other” for the child by scaffolding the child’s state transition from a disorganized and dysregulated brain state (as manifested in disorganized and dysregulated behavior) back into an organized and well-regulated brain state (as manifested by calm and cooperative behavior) all of the brain networks and brain systems that were used in this transition process become stronger, more sensitive, and more efficient. We build what we use.

Over multiple repetitions of these state transitions, the child’s own brain networks for making these transitions become stronger, more sensitive, and more efficient so that the child develops the internalized capacity for “self-regulation” without the need for the scaffolding support of the “regulatory other” of the parent. Overall, this development of internalized self-regulatory capacity is called the child’s development of “self-structure.”

This is a very important construct… the development of the child’s own self-structure through the repeated scaffolding support provided to the child by the “regulatory other” role of the parent.

The parent’s role as a “regulatory other” for the child is extremely important for the healthy development of the child. In fact, it is THE central role of parenting beyond providing basic food and safety. By acting as a “regulatory other” for the child, the parent “scaffolds” the child’s internal development of healthy “self-structures” for the child’s independent self-organization and self-regulation.

One of the leading figures in attachment research, Alan Sroufe, describes this process.

“At first, they [caregivers] are almost solely responsible for maintaining smooth regulation. They attend to the infant’s changes in alertness or discomfort and signs of need, imbuing primitive infant behaviors with meaning In the typical course of events, caregivers quickly learn to “read” the infant and to provide care that keeps distress and arousal within reasonable limits. And they do more. By effectively engaging the infant and leading him or her to ever longer bouts of emotionally charged, but organized behavior, they provide the infant with critical training in regulation.”

“The movement toward self-regulation continues throughout the childhood years, as does a vital, though changing, role for caregivers. During the toddler period, the child acquires beginning capacities for self-control, tolerance of moderate frustration, and a widening range of emotional reactions, including shame and, ultimately, pride and guilt. Practicing self-regulation in a supportive context is crucial. Emerging capacities are easily overwhelmed. The caregiver must both allow the child to master those circumstances within their capacity and yet anticipate circumstances beyond the child’s ability, and help to restore equilibrium when the child is over-taxed. Such “guided self-regulation” is the foundation for the genuine regulation that will follow.” (Sroufe, 2000, p. 71)

However, in a role-reversal relationship the normal roles for the parent and child are reversed, so that it is the parent who uses the child as a “regulatory object” for the parent’s emotional and psychological state. This is extremely destructive to the child’s emotional and psychological development. The parent is essentially robbing the child’s self-structure development to support the parent’s own inadequate self-structure.

In healthy child development, the parent empathizes with the child and responds in ways that keep the child in a regulated state, i.e., acts as a “regulatory other” for the child. This scaffolds the healthy development of the underlying neurological networks in the child’s brain that are central to healthy self-structure development.

In a role-reversal relationship, this is reversed so that it is the child who empathizes with the parent and responds in ways that keep the parent in a regulated state. The roles are reversed. The parent becomes the child and the child fulfills the psychological parent-role for the psychologically infantile parent. This is extremely destructive to the child’s healthy development of self-structure.

And this unhealthy role-reversal relationship will be passed on to future generations. The child in a role-reversal relationship will have his or her self-structure development robbed by the parent to feed the parent’s own inadequate self-structure. When this child grow up, this child-now-adult will have inadequate self-structure organization because it was robbed in it’s healthy development in order to feed the parent’s inadequate self-structure.

So this child, now an adult, will repeat the role-reversal use of the child with his or her own children. The child-now-adult will use his or her own children in a role-reversal relationship to feed the inadequate self-structure of the parent which had been robbed from the parent’s development during the parent’s childhood.

The role-reversal relationship is a pathology that is passed on trans-generationally from one generation to the next.

And so it goes, from generation to generation. Parents using their children to meet the emotional and psychological needs of the parent, rather than healthy child development in which the parent meets the emotional and psychological needs of the child. Instead, in the pathology of the role-reversal relationship each generation of parents rob their children of their healthy childhood development to meet the inadequate childhood development of the parent who had been robbed of self-structure development in his or her own childhood with his or her own parent.

Key Construct:

In a healthy parent-child relationship, the child uses the parent as a “regulatory other” for the child’s emotional and psychological state.

In a pathological role-reversal relationship, the parent uses the child as a “regulatory other” for the parent’s emotional and psychological state.

So, to turn now to the question of adolescents’ “independent” judgment;

For any child no matter the age who is engaged in a role-reversal relationship with a parent, the child’s capacity for “independent” judgment has been significantly compromised by both the severity and the specific nature of the pathology of the role-reversal relationship.

Instead of a normal and healthy childhood development that would result in normal-range and healthy self-structure, the child’s psychological development has been severely compromised by the use of the child in the parent’s psychopathology to serve as a “regulatory object” for the parent’s own emotional and psychological needs.

If a child has experienced normal-range development then we may be willing to provide some consideration to the expressed wishes of an adolescent. However, the development of a child in a role-reversal relationship with a parent has been severely distorted by the role-reversal relationship so that their judgment is significantly compromised. The child’s expressed wishes no longer reflect the authenticity of the child, but are instead being used in the service of meeting the needs of the pathological parent.

When the child is in a role-reversal relationship with the pathology of the parent in which the child is meeting the needs of the psychologically infantile parent, the child’s expressed wishes are no longer authentic to the child.

The analogy would be to a hostage situation. In the case of a role-reversal relationship the child is a “psychological hostage” as a “regulatory object” to the needs of the pathological, inadequate, and psychologically infantile parent.

Would we consider the statements made by a hostage as being authentic while the hostage is still in the custody of the hostage taker? Absolutely not.

The child is acting under psychological duress (whether the child realizes it or not).

Would it be sufficient to ask the hostage, “Are you being influenced by anyone in making these statements?” while the hostage was still in the custody of the hostage taker? Absolutely not. Of course the hostage will say, “No, I’m not being influenced” to our question.

Imagine an American hostage held by Islamic terrorists. The American makes a televised statement critical of American policies. Would we believe that these statements made by the hostage while the hostage was still being held by the terrorists represented the authentic beliefs of the hostage, and weren’t being coerced and influenced by his captors? Of course not.

What if the Islamic terrorists allowed a newspaper reporter to ask the hostage, “Are you making these statements of your own free will, or are you being told what to say by your captors?” and the hostage said, “I am making these statements of my own free will. No one is telling me what to say.” Would we then say, “Well, I guess that settles it, these are the hostage’s authentic beliefs.” That would be just plain stupid beyond imagination.

The statements made by the hostage are under duress as long as the hostage is in the custody of the captors, even if it is under psychological duress.

In a role-reversal relationship, the child is a “psychological hostage” to the pathology of the parent. The child is being “psychologically held” in a role-reversal relationship by the pathology of the parent to act as a “regulatory object” for the parent so that the pathology of the parent can feed off of the child’s self-structure development, robbing the child of self-structure to support the inadequate self-structure formation of the parent.

But to all external appearances, the child will appear to be in a hyper-bonded relationship with the allied and supposedly favored – but actually severely pathological – parent.

Role-reversal relationships are extremely pathological. The inadequate self-structure of the parent is feeding off of the healthy self-structure of the child to the extreme detriment of the child’s healthy development.

The child is being robbed of a normal and healthy childhood in the service of meeting the emotional and psychological needs of a pathological parent, who was robbed in his or her own childhood of healthy development.

Parents feeding off of their children’s self-structure to support the parent’s own inadequate self-structure development is extremely pathological.

So when evaluating the statements made by a child of any age, a prominent “moderator variable” in our consideration needs to be the possible presence of a role-reversal relationship in which the child is being used by a pathological parent as a “regulatory other” to meet the emotional and psychological needs of the parent.

Before considering the statements of any child, the question is whether the child is being held as a psychological hostage through the child’s use as a “regulatory other” to the pathology of the parent.

To all external appearances, the child will look like he or she is in a bonded relationship with the pathological parent. But to a trained and expert eye, the role-reversal relationship is clearly evident in a variety of features. Only an incompetent and ignorant psychologist will miss a role-reversal relationship and believe the superficial presentation of a bonded relationship.

Unfortunately, many mental health professionals who work with children are incompetent and ignorant.

If a role-reversal relationship exists, this is extremely destructive to the child’s healthy emotional and psychological development, and if left untreated and unresolved the role-reversal relationship represents a continuing risk not only to the current child but to the development of future generations of his or her children as well, so that treatment and resolution of the pathology becomes imperative and child protection considerations become prominent concerns.

2. Triangulation of the Child

Whenever there is spousal conflict there arises a significant risk that the child will be “triangulated” into the spousal conflict.

Triangulating the child into the spousal conflict is extremely destructive for the child’s healthy emotional and psychological development. We NEVER want to triangulate the child into the spousal conflict. Never, never, never. Under any circumstances. Never.

The spousal conflict is a two-person event. When the child is brought into the middle of it, either the child will be torn apart by allegiances to both parents, or the child will need to take sides in the spousal conflict. Either way, it is extremely destructive to the child to be triangulated into the spousal conflict. We want to keep children out of the middle of their parents’ conflict.

When the child does become triangulated into the spousal conflict, the direct goal of therapy is to un–triangulate the child from the spousal conflict.

Whenever there is spousal conflict, the risk of pathologically triangulating the child into the spousal conflict is extreme.

If we ask the child or adolescent what they want, WE ARE TRIANGULATING THE CHILD INTO THE SPOUSAL CONFLICT!!!!!!

No. No. No. This is exactly what we DON’T want to do.

Furthermore, any hopes for therapy will be smashed. Abandon all hope of successful therapy for the child’s well-being. The Court has essentially inflicted the pathology onto the child.

Under NO circumstances do we ever want to ask the child what the child wants when there is spousal conflict. We are essentially asking the child to choose sides in the spousal conflict, and we are opening the door directly to the role-reversal use of the child by the parent to meet the parent’s emotional and psychological needs. Pathology, pathology, pathology.

If the Court is concerned about the child’s well-being, then the Court should appoint a psychologist to serve as the voice of the child’s healthy development. But under no circumstances should we ask the child to choose sides in the spousal conflict.

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

References:

Sroufe, L.A. (2000). Early relationships and the development of children. Infant Mental Health Journal, 21(1-2), 67-74.

The Exclusion Demand as Independence

I received a Comment from a targeted parent to my Exclusion Demand post in which the targeted parent indicated that a prior therapist had justified the child’s “exclusion demand” rejection of the targeted parent as representing the child’s desire for independence.

I want to address this (and any other therapist-offered justifications for the “exclusion demand”) as a separate blog post because I believe professional competence to be so incredibly important as a required expectation for all therapists working with children.

The suggestion by ANY therapist that the child’s “exclusion demand” represents even a remotely normal-range expression of emerging child independence is incredibly ignorant, and just plain stupid. Let me describe why:

Preparatory Foundation

First, there are a number of cultural factors that are involved in a consideration of this therapist suggestion that the “exclusion demand” represents the child’s seeking independence. The construct of independence is culturally defined and tends to be a more prominent construct in Northern European cultural values than in more collectivist cultures, such as Hispanics and Asian cultures. Furthermore, the construct of “independence” reflects a male-dominated value system rather than a more female-oriented value system that emphasizes mutual interdependence.

But let’s put all this entirely relevant information aside so we can get right the heart of the immense stupidity of suggesting that the “exclusion demand” represents the child’s normal-range (or even abnormal-range) seeking of independence.

1. Frequency

All children – 100% – must deal with issues of separation and independence (interdependence) from parents and the family of origin. If the “exclusion demand” was a normal-range expression of the child’s seeking independence, then we would expect to see this symptom in a vast number of normal-range children, since ALL children must deal with this issue. So we would expect to see millions of children expressing the “exclusion demand.”

Go to any park on a Saturday afternoon. How many children are demanding that their parents not attend their soccer or baseball games? None. Not a single child. Go to any school music performance by children, how many children are demanding that their parents not attend their school concert performance. None. Not a single child. Go to any high school football or basketball game, how many of the adolescent players are demanding that their parents not attend their game. None. Not a single adolescent.

And many of these families have significant pathology. Yet we NEVER see the “exclusion demand.” Never. Yet if the “exclusion demand” was an expression of the child’s independence and 100% of children need to address this issue, then we would expect to see millions of children expressing the “exclusion demand” but instead the rate of the “exclusion demand” in the normal (and abnormal) range population is 0%.

Furthermore, the developmental challenge of independence occurs in adolescence (Erikson), so we should NEVER see the “exclusion demand” prior to the age of 12. And developmentally, adolescents do not express their emerging independence by excluding parents from public events. The most common way of establishing adolescent independence is through the increased frequency and intensity of angry exchanges between the adolescent and parent that psychologically highlights boundaries of self-autonomy. Go to any high school football or basketball game. How many players have demanded that their parents NOT attend the game. None. Not a single one. Yet all of the players are adolescents, and many of the families have significant pathology.

To suggest that the “exclusion demand” is an expression of the child’s seeking “independence” is just plain stupid.

2. Healthy Child Development

Healthy children love their parents. “Independence” – whatever that concept may mean – with regard to children and families is weird. Children and families are inter-dependent. Children are separate and independent, and they are involved and integrated into the family. Healthy child development NEVER means the child’s rejecting a parent.

Normal adolescents express independence by causing conflicts that highlight psychological boundaries. Normal adolescents express independence by withholding information about friends and activities from parents. Normal adolescents express independence by socially different clothing or grooming choices, or by holding and expressing different values from their parents.

Children, even adolescent children, do not express independence by not loving a parent. Not loving a parent is a symptom of extreme clinical concern

3. Separation-Individuation

Furthermore, the primary model of “individuation” is Margaret Mahler’s from her direct research with children. Mahler describes three component phases of separation-individuation, 1) the separation phase, 2) the depressive phase, and 3) the rapprochement phase. In the separation phase the child seeks greater psychological independence by increasing angry exchanges with the parent. This is followed by the depressive phase in which the child’s emotional expansiveness created by separation collapses in the child’s psychological isolation, which is then followed by the child’s return to the parent to repair the relationship with the parent (the rapprochement phase).

So if the “exclusion demand” represents the child’s seeking of independence, we would also expect to see the rapprochement phase in which the child seeks to repair the bond to the rejected parent. But we NEVER see the child seeking to restore the parent-child bond following the “exclusion demand” symptom. Never.

4. Independence from Whom?

If the “exclusion demand” is an expression of the child’s desire for independence, then the child should be expressing the symptom toward BOTH parents, since the child needs to separate and become independent from both parents (assuming the irrational belief in independence rather than the actual construct of healthy inter-dependence).

But wait. The child is already rejecting the targeted parent. So the child has a whole bunch of independence from the targeted parent. If the child is seeking independence then the child should be displaying the “exclusion demand” symptom toward the bonded-parent not toward the parent the child is ALREADY separated from.

Why would the child need to separate from the parent the child is already separate from, but NOT from the parent the child isn’t separated from?

Why would telling a parent not to come to a music recital attended by every other child’s parent, represent “independence?” Why would a parent sitting in the bleachers with all the other parents watching the child play sports at a public event reflect the child’s “independence?”

Stupid, stupid, stupid.

Stupid Reasons

Just because a therapist offers a “reason” doesn’t make the reason rational.

“Your child is excluding you from attending his baseball games because his horoscope has Jupiter in the house of Sagittarius.”

Is that a reason? Yep. Is it a stupid reason? Yep.

“Your child is excluding you from attending her school Christmas play because she’s seeking independence.

Is that a reason? No doubt. Is it a stupid reason. Absolutely.

The “exclusion demand” is nowhere near normal. It’s not even close to abnormal. The “exclusion demand” is a symptom of extreme pathology. When I hear this symptom my clinical concern immediately becomes a 10 on a 10-point scale.

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

The Exclusion Demand Symptom

It is beyond my comprehension how so many mental health professionals can entirely miss the extreme psychopathology involved in attachment-based “parental alienation.” I am truly stunned.

Let me describe just one example, the “exclusion demand” symptom made by children, in which the child demands that the targeted parent no long attends the child’s events.

The Exclusion Demand:

Child: “I don’t want you to come to my baseball games (school open house, dance recital, school awards ceremony, etc.). I get too anxious.”

This “exclusion demand” by the child is often followed with a statement that the child wants the targeted parent to show “respect” for the child’s feelings and “boundaries.”

The “exclusion demand” is among the more common symptoms of pathology displayed by the child in attachment-based “parental alienation.”

Extremely Severe Psychopathology

The “exclusion demand” is a symptom of extreme psychopathology. It floors me how mental health professionals can act like this child symptom is anywhere near normal-range. So let me explain the psychopathology inherent to this symptom.

Normal-Range Children

A parent attending a child’s activity is entirely normal range and healthy. I recommend all parents everywhere attend their children’s school activities, sporting events, musical recitals, awards ceremonies, etc.

There is nothing, absolutely nothing, wrong or problematic about a parent attending a child’s event. Normal-range children are happy and excited when their parent attends an event of the child’s.

A child who becomes hyper-anxious and seeks to exclude a parent’s attendance at an event is demonstrating extremely pathological behavior of GREAT CLINICAL CONCERN.

There is no – NO – normal-range reason for this symptom display by a child. No normal-range child EVER displays this symptom. Never happens. Never.

The only thing that can produce this symptom is extreme psychopathology, either from the targeted-rejected parent or from the allied and supposedly favored parent. But under NO circumstances is this symptom EVER displayed by anything near normal-range children.

In evaluating this symptom, every mental health professional should consider a normal-range child’s response to a parent attending an event; excitement, joy, a feeling of being loved by the parent, a feeling of being special to the parent. This is normal.

So if this is normal, then when the child exhibits the “exclusion demand” symptom, this means that the child’s normal-range capacity for excitement and joy have been twisted into something unrecognizable as even remotely resembling excitement and joy. What type of pathology needs to be involved to twist a child’s normal-range capacity for excitement and joy into such a perversely distorted form?

So, if a child’s normal-range response to a parent attending the child’s event is to feel loved and wonderfully special by the parent, this means that the child’s normal-range capacity for feeling loved and special has also been twisted into a distorted and unrecognizable shape that rejects love that rejects feeling special. Let that sink in.

All children want their parents love. That’s normal. That’s healthy.

Unhealthy child development occurs when children DON’T feel that they are special and loved by their parents.

Unhealthy child development NEVER occurs because a child feels special and loved. Never.

So then how completely unhealthy is it for a child to display a symptom of REJECTING feeling special and loved? The child is displaying a symptom that, in itself, is the actual SOURCE-ORIGIN of childhood pathology. That is really twisted.

The source-origin of childhood pathology causes childhood psychopathology. But here, the child’s symptom is not an outcome of the source-origin of childhood pathology, the symptom itself IS the source-origin of childhood pathology. It’s as if the symptom is its own cause. The symptom is caused by the absence of parental love, that is the symptom itself, the child’s rejection of parental love. That is so weird and twisted.

The “exclusion demand” symptom is 180 degrees opposite of normal. It is so far away from normal-range that it is stunning to me that ANY mental health therapist can act like this symptom is even remotely understandable and acceptable.

It would be like a physician doing a medical exam and finding the child had no internal organs and responding, “Oh. Okay. So I guess this kid just doesn’t’ need internal organs.”

What? Are you kidding me? What human body doesn’t need internal organs? That is so totally weird that the child doesn’t have internal organs. How is that even possible? How is it possible to be alive and not have any internal organs? That’s just extremely weird.

ALL normal-range children want their parents’ love. All normal-range children want to feel special to their parents. All of them. Every single normal-range child on the planet. All.

Pathological child development occurs because of the ABSENCE of parental love.

So how is it that the child is presenting as if this one child, among all the children on the planet, this one child does not want a parent’s love? How is it that this one child doesn’t want to feel special to a parent? Explain it to me.

The very fundamental core of children thrives on parental love. Children’s psychological development starves in the absence of parental love. Parental love is the very essence of healthy child development. And here we have a child REJECTING parental love. That is extraordinarily pathological and simply weird.

Yet many, many mental health professionals simply accept this extremely pathological symptom display by children as if it’s somehow understandable. It is bizarre.

No even remotely normal-range child rejects parental love. Ever. The child’s rejection of parental love is extremely weird and requires explanation. A therapist response of, “Okay, well I guess that’s just the way it is for this child” is not an explanation. A therapist response of “What? Are you kidding me? You don’t want your mom to watch you play baseball. Wow, that’s really weird.” is a healthy therapist response reflecting an accurate understanding for child psychology and child development.

If child and family therapists are not completely stunned by this symptom then they need to re-set their understanding for what represents normal and what is abnormal child behavior.

Grumpy-angry kids, relatively normal.

Very active and annoying kids, relatively normal.

Shy and quiet kids, relatively normal.

Irresponsible kids who resist doing homework, relatively normal.

Kids who reject parental love, extremely weird.

Kids who are made hyper-anxious by their parents, extremely weird.

How can child and family therapists be so ignorant regarding normal and abnormal child development to accept as reasonable child symptoms of such extreme pathology? I am aghast at the level of professional ignorance.

Let me be clear on this to all mental health professionals, it is NOWHERE NEAR normal-range child behavior to reject a parent’s love. Not even close. It is extremely abnormal and pathological and requires an explanation.

Targeted Parent Pathology

A child symptom of such extreme pathology requires an explanation.

Maybe it’s a history of profound domestic violence by the targeted-rejected parent. Maybe the targeted-rejected parent sexually abused the child. Maybe the targeted rejected parent physically beats the child, screaming curses and insults at the child.

Okay, this is an explanation. This level of parental psychopathology by the targeted-rejected parent could account for the degree of pathology displayed by a child who makes an “exclusion demand” of a parent, “I don’t want you to attend my games (my awards ceremony, my play, my music recital, etc.).

So immediately these possibilities all become relevant domains for diagnostic consideration.

So the moment the therapist hears an “exclusion demand” the immediate thought of the therapist should be, “Uh-oh, this is very serious. We may be looking at severe child abuse here” not, “Hmm, okay, I guess that’s just the way this child is.”

If I hear this symptom from a child my seriousness alert response immediately maxes out at a 10 on a 10-point scale. There is no symptom I could hear that would give me more concern. An “exclusion demand” symptom is consistent with severe domestic violence exposure, incestuous sexual abuse of the child, or severe physical and emotional abuse of the child.

But wait… if the child is actually afraid of the parent’s violence then the child would likely be very reluctant to displease the parent because then the child would face retaliation from the hostile-aggressive parent. But with the “exclusion demand” the child is assertively demanding that the hostile-aggressive parent not attend events, thereby overtly displeasing the extremely hostile-aggressive parent. Yet if the targeted-rejected parent is actually extremely hostile and aggressive (the domestic violence and physical violence categories) then the child’s behavior would INCREASE the child’s exposure to possible hostile-aggressive retaliation by the targeted-rejected parent.

Making an “exclusion demand” toward a parent instead suggests that the child feels safe enough to be willing to displease the rejected parent without fearing retaliation. So an “exclusion demand” suggests that the targeted-rejected parent does not make the child anxious. But wait, the child is saying the reason for the “exclusion demand” is that the parent makes the child feel anxious. This is a very odd symptom that doesn’t make any sense whatsoever. This symptom keeps getting curiouser and curiouser the more I look at it.

What if the child actually feels excited by the presence of the targeted parent at the child’s events, consistent with the normal response of every normal-range child on the planet, but the child is then misinterpreting the feeling of “excitement” as “anxiety.” That would make sense.

The child actually isn’t afraid of the targeted parent, so the child feels safe enough to displease the targeted parent without fear of retaliation. But the child is misinterpreting excitement as anxiety. This explanation makes sense of what otherwise is a very odd constellation of features.

In any event, the child’s “exclusion demand” symptom is NOT fully consistent with exposure to severe domestic violence or physical abuse. It’s possible, but not likely. I would need to look for corroborating signs of exposure to domestic violence or physical child abuse. These could be a wide array of signs, among which might be:

* A documented history of domestic violence or child abuse (not merely allegations by the allied and supposedly favored parent, although I wouldn’t dismiss these allegations outright, I’d just need ADDITIONAL evidence besides the allegations of the allied and supposedly favored parent)

* A child display of over-anxiousness generally, such as toward me in our discussions, or with teachers, or in public generally.

* Or perhaps the child may be evidencing an increased anger response to the child’s exposure to parental violence. Is the child getting in trouble at school for aggressive acts? Does the child assault siblings?

* The age of the child. Younger children are more vulnerable, so child anxiety in response to the child’s exposure to domestic violence and physical child abuse would be more consistent with a 6-10 year old child than with a 12-16 year old adolescent. Not impossible, but less likely.

* Especially for older children, I’d want to explore what the child fears the parent would do at the event. Assault the child? Really? The child fears that the targeted parent is going to assault the child at the child’s music recital or school awards ceremony? Normal-range children NEVER fear parental violence at a school awards ceremony or dance recital. That would be a really odd belief system. How did the child acquire such a peculiar belief system? Has the targeted parent ever become violent at a child’s activity before? Perhaps assaulting opposing coaches at the child’s soccer game? Perhaps the targeted parent is a chronic alcoholic, and the child is afraid the parent will be overtly drunk at the event (but then the child’s reason will be expressed as “embarrassment” not “anxiety”).

Anything like that? Or is the child asserting that the child’s anxiety is a PTSD response to the child’s prior exposure to violence. Okay, what violence? Tell me what you’ve seen from this parent in the past? Beating and kicking the mother in drunken rages? Hitting and kicking the child? What’s the trauma the child has been exposed to that is producing a very serious PTSD response? It must be pretty severe if it has produced a PTSD response, so my seriousness alert response remains maxed out at a 10.

I’ll keep an ear open for other indicators of severe domestic violence and physical child abuse, but these two possibilities of domestic violence exposure and physical child abuse will fall slightly lower in my differential diagnosis considerations.

On the other hand, an “exclusion demand” would be consistent with incestuous sexual abuse of the child by the targeted-rejected parent. That’s a possibility. I am extremely concerned by this child symptom.

The incestuous sexual abuse of the child would account for the extreme level of distortion and pathology displayed by this extremely weird child symptom. Sexual abuse would also account for the absence of the child’s fear of retaliation because the parent is disgusting, NOT hostile-aggressive, and sexual abuse of the child would account for the strange combination of the child being anxious about being in the presence of the parent and yet also not fearful of retaliation from the parent for the child’s making an “exclusion demand.”

Sexual abuse of the child by the targeted rejected parent would account for the level and pattern of the extreme pathology.

Or…

The parental pathology that is creating the child’s extremely strange and highly concerning symptom is to be found in the parenting practices of the allied and supposedly favored parent.

In this case, the parental psychopathology would be a role-reversal relationship with the child in which the child is being used as a “regulatory other” by the pathology of the parent to regulate the parent’s own emotional and psychological state.

Uh-oh. This too is an extremely damaging psychopathology to the child’s healthy development. My seriousness alert response to a role-reversal relationship is in the 8-10 range.

In normal and healthy child development, the child uses the parent as a “regulatory other” to regulate the child’s emotional and psychological state. This is healthy and this is entirely normal. At a neuro-biological level, this is what’s suppose to happen to wire up the child’s brain systems.

In a role-reversal relationship the parent uses the child as a “regulatory other” for the parent’s emotional and psychological state. This type of role-reversal is extremely pathological and will have a variety of extremely destructive impacts on the emotional and psychological development of the child.

If the “exclusion demand” symptom is the product of a role-reversal relationship with the allied and supposedly favored parent, then I am very concerned.

In the case of a role-reversal relationship, the child is emitting the “exclusion demand” in the child’s role as a “regulatory other” for the allied and supposedly favored parent, so that the origin of the child’s “exclusion demand” is the desire of the allied and supposedly favored parent for the child to reject the other parent, and the child is simply emitting the parentally desired child behavior as a means to keep the pathology of the parent in an organized and regulated state.

And if the child is emitting this highly pathological symptom involving a highly twisted distortion to the child’s expression of joy, and excitement, and feelings of being loved and special, then the child is likely emitting other rejection-type symptoms toward the targeted parent as a product of the child’s role of being used by the allied and supposedly favored parent as a “regulatory other” for the parent’s own emotional and psychological state.

Role-reversal relationships and parental use of the child as an external “regulatory object” for the emotional and psychological state of the parent are associated with a disorganized attachment classification. Yikes. This is getting very serious. Is there other evidence for the presence of a disorganized attachment within the family, such as a high degree of chaos and disorganization in family relationships following a divorce?

Disorganized attachment is associated with the development of narcissistic and borderline personality traits, so if the allied and supposedly favored parent has a disorganized attachment pattern, then they might also have borderline and narcissistic personality traits. Are there any signs of borderline or narcissistic traits with the allied and supposedly favored parent?

How is the targeted parent describing the marital history with the other parent, the parent who is supposedly favored by the child. Are these descriptions consistent with possible narcissistic or borderline traits with the allied and supposedly favored parent? The descriptions by the targeted parent are not definitive, but they might help to disconfirm the hypothesis if there is no reported description consistent with narcissistic or borderline traits in the allied and supposedly favored parent, and yet if there are descriptions by the targeted parent regarding the marital history with the other parent that are consistent with the other parent possibly having narcissistic or borderline personality traits then these parental descriptions by the targeted parent might contribute to an overall preponderance of clinical evidence supporting the role-reversal hypothesis.

Splitting. Splitting is a highly characteristic symptom of disorganized attachment and for narcissistic or borderline personality. Is there evidence of splitting? Does the child evidence polarized thinking of all-good and all-bad? Does the child believe that once a person is defined as being all-bad, as being fundamentally flawed, then that person will stay that way forever?

According to Marsha Linehan in describing the splitting dynamic evidenced by borderline personalities:

“They tend to see reality in polarized categories of “either-or,” rather than “all,” and within a very fixed frame of reference. For example, it is not uncommon for such individuals to believe that the smallest fault makes it impossible for the person to be “good” inside. Their rigid cognitive style further limits their abilities to entertain ideas of future change and transition, resulting in feelings of being in an interminable painful situation. Things once defined do not change. Once a person is “flawed,” for instance, that person will remain flawed forever.” (Linehan, 1993, p. 35)

Does the child or allied and supposedly favored parent see the targeted parent as “abusive” without substantiating evidence for the allegation? The use of the term “abusive” is characteristic of a borderline personality organization. The term “abusive” is rarely used by normal-range people (sometimes it is, typically in cases of authentic abuse). Normal range people use words like mean, or insensitive, or rude. Rarely “abusive.” But borderline personalities often use the term “abusive” to describe other people. It’s not definitive, but it’s suggestive.

How does the allied and supposedly favored parent describe the targeted parent? Are there indications of splitting into the all-bad characterization of the targeted parent in the descriptions of the targeted parent by the allied and supposedly favored parent?

If there is a narcissistic or borderline parent, then my seriousness alert response maxes out at a 10. Only sexual abuse of the child would cause me more clinical concern for the child’s emotional and psychological development than would parental narcissistic or borderline pathology.

Very Serious Pathology

One way or the other, the child’s symptom display of an “exclusion demand” is of extraordinarily serious clinical concern.

It may be evidence of the child’s sexual abuse victimization, of the child’s traumatic exposure to severe parental domestic violence, to prior severely traumatic physical and emotional abuse of the child, or of a highly pathological role-reversal relationship with a narcissistic/borderline parent that is producing severe psychopathology in the child.

My two primary differential diagnoses would be sexual abuse of the child by the targeted parent OR a role-reversal relationship with the allied and supposedly favored parent in which the child is being used by a narcissistic/borderline parent as an external “regulatory other” for the emotional and psychological state of the parent.

An “exclusion demand” symptom is NOWHERE NEAR normal range. It is highly pathological and REQUIRES an explanation.

That child and family therapists would act like this child symptom is anywhere near to being an understandable or reasonable child symptom is stunning to me.

When I hear the “exclusion demand” symptom, my level of clinical concern is immediately at a 10. An “exclusion demand” is among the most concerning symptoms I could possibly hear. If you are a child and family therapist and you are not equally as concerned by a child’s presentation of an “exclusion demand” symptom as I am, then I would question your competence to be working with children.

Craig Childress, Psy.D.
Psychologist, PSY 18857

References:

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