Category: Diagnosis

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

Trauma Reenactment in Parental Alienation

At its foundational core, the family processes of attachment-based “parental alienation” represent the manifestation of a trauma reenactment narrative of a narcissistic/(borderline) parent that is embedded in the distorted “internal working models,” or “schemas,” of the narcissistic/(borderline) parent’s attachment networks.

The narcissistic/(borderline) parent is psychologically decompensating into persecutory delusional beliefs due to the activation of excessive anxiety surrounding the perceived interpersonal rejection and perceived abandonment associated with the divorce (sometimes the triggering of this perceived rejection and abandonment is delayed until the spouse remarries).

One of the foremost experts in personality disorders, Theodore Millon, describes the propensity for the narcissistic personality structure to decompensate into persecutory delusional beliefs under stress,

“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.”

The reenactment of attachment trauma is also documented in the clinical treatment literature,

“Reenactments of the traumatic past are common in the treatment of this population and frequently represent either explicit or coded repetitions of the unprocessed trauma in an attempt at mastery. Reenactments can be expressed psychologically, relationally, and somatically and may occur with conscious intent or with little awareness. One primary transference-countertransference dynamic involves reenactment of familiar roles of victim, perpetrator–rescuer-bystander in the therapy relationship. Therapist and client play out these roles, often in complementary fashion with one another, as they relive various aspects of the client’s early attachment relationships. (Perlman & Courtois, 2005, p. 455)

In response to three separate but interrelated psychological stresses associated with the divorce, 1) the threatened collapse of the narcissistic defenses against the experience of primal inadequacy that is triggered by the perceived interpersonal rejection inherent to the divorce (i.e., narcissistic personality processes), 2) the activation of immense anxiety from severe abandonment fears triggered by the divorce (i.e., borderline personality processes), and 3) the reactivation of attachment trauma networks when the attachment system becomes active to mediate the loss experience associated with the divorce (trauma processes), the narcissistic/(borderline) personality decompensates into persecutory delusional beliefs centering on the other parent’s “abuse” potential relative to the child.

This decompensation into persecutory delusional beliefs is centered around the pattern contained in the internal working models (schemas) of the narcissistic/(borderline) parent’s traumatized attachment networks of 1) victimized child, 2) abusive parent, 3) protective parent. The split representation for the parent role in the attachment trauma networks is the product of the “splitting” dynamic that originated in the relationship trauma involving a parent (i.e, the parent of the narcissistic/(borderline) parent as a child) who simultaneously triggers attachment bonding and avoidance motivations.

“Various studies have found that patients with BPD [borderline personality disorder] are characterized by disorganized attachment representations (Fonagy et al., 1996; Patrick et al, 1994). Such attachment representations appear to be typical for persons with unresolved childhood traumas, especially when parental figures were involved, with direct, frightening behavior by the parent. Disorganized attachment is considered to result from an unresolvable situation for the child when “the parent is at the same time the source of fright as well as the potential haven of safety” (van IJzendoorn, Schuengel, & Bakermans-Kranburg, 1999, p. 226).” (Beck et al., 2004, p. 191)

The family processes of attachment-based “parental alienation” are the product of the narcissistic/(borderline) parent creating a reenactment in the current family relationships of the narcissistic/(borderline) parent’s own attachment trauma patterns, or “schemas,” by inducing the child into adopting the “victimized child” role within the trauma reenactment narrative. The moment the child is induced into adopting the “victimized child” role, then this automatically IMPOSES upon, and DEFINES, the targeted parent into the role as the “abusive parent” in the trauma reenactment narrative. The definitions of these two trauma reenactment roles (which are created the moment the child adopts the “victimized child” role) then allows the narcissistic/(borderline) parent to adopt the coveted role in the trauma reenactment narrative as the wonderful and nurturing “protective parent,” in direct contrast to the role being imposed on the other parent as the all-bad “abusive parent.”

This artificially created reenactment of “various aspects” of the narcissistic/(borderline) parent’s own “early attachment relationships” (Perlman & Courtois, 2005, p. 455) represents a false drama in which the present is distorted into a re-creation of the past.

This is psychotic. The narcissistic/(borderline) parent is no longer in touch with actual reality, but is reliving and recreating early attachment relationships that do not reflect actual events in the current world.

The very term “borderline” to describe this type of personality process reflects the recognition of the psychotic core to this type of personality structure,

“The diagnosis of “borderline” was introduced in the 1930s to label patients with problems that seemed to fall somewhere in between neurosis and psychosis. (Beck et al, 2004, p. 189)

Narcissistic and borderline personality structures are simply variants of the same core processes.

“One subgroup of borderline patients, namely, the narcissistic personalities… seem to have a defensive organization similar to borderline conditions, and yet many of them function on a much better psychosocial level.” (Kernberg, 1975, p. xiii)

Delusions and Psychotic Processes

Many people in the general public, and many mental health professionals, have the mistaken belief that psychotic and delusional processes will manifest as overtly “crazy” and bizarre.  That’s not true.

Prior to obtaining my doctorate degree I first obtained a Master’s degree in Community/Clinical psychology and I worked for 15 years on a clinical research project at UCLA on schizophreria.  During my time with this project I was trained to clinical competence on a symptom rating scale called the Brief Psychiatric Rating Scale (BPRS) on which a variety of patient symptoms are rated, including psychotic symptoms, along a 7-point scale from mild to severe.

Psychotic symptoms can manifest along a continuum of severity, and are not always overtly bizarre.  This is especially true for a diagnosis of Delusional Disorder in which the only manifestation of the psychotic process is the presence of an intransigently held, fixed and false belief that is maintained despite contrary evidence.

The diagnostic criteria for the DSM-5 diagnosis of a Delusional Disorder specifically requires that that person’s general functioning is “not markedly impaired” or “obviously odd or bizarre.”

DSM-5 Delusional Disorder

Criterion C: “Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.“

The delusional belief of the narcissistic/(borderline) parent in attachment-based “parental alienation” would be considered a nonbizarre “encapsulated” delusion.

Nonbizarre delusions express content that is within the realm of possibility, such as a fixed and false belief that the person’s spouse is having an extramarital affair. It’s possible that the person’s spouse is having an affair, extramarital affairs are not a bizarre occurrence, but it’s simply not true that the person’s spouse is having an extramarital affair.  Yet no amount of contrary evidence will convince the person that his or her belief in the spouse’s infidelity is wrong. The false belief is maintained despite contrary evidence.

An encapsulated delusion is limited and contained in its scope.  The jealousy delusion noted above would be an encapsulated delusion.  It’s presence and impact would not generally be evident.  Unless you asked the person specifically about the martial relationship you might never know of the existence of this delusional belief.

A bizarre delusion on the other hand, might be that people were inserting thoughts into the person’s mind (called “a delusion of control”). This false belief is outside the realm of plausibility.  This would also not be an encapsulated delusion since it affects a broad spectrum of the person’s perceptions and functioning.

The narcissistic/(borderline) parent’s delusional belief in attachment-based “parental alienation” stems from the trauma reenactment narrative and is the false belief that the other parent represents an abusive threat to the child.  It is delusional because this belief in the threat potential of the targeted parent is false and yet is maintained despite contrary evidence, it is a nonbizarre delusional belief because it is within the domain of possibility that a parent is abusive of a child, and it is an encapsulated delusion because this fixed and false belief is limited to only a narrow and contained domain of distortion, the perception of the other parent, and is not a false belief that affects a broad spectrum of the person’s perception.

At a deeper level, the delusional belief of the narcissistic/(borderline) parent in the abusive parenting threat posed to the child by the targeted parent represents a component of a trauma reenactment in which the narcissistic/(borderline) parent distorts current reality into creating and reliving a reenactment of the narcissistic/(borderline) parent’s own childhood attachment trauma patterns.

Remember what Millon said about the decompensation of the narcissistic personality under stress,

“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.

The rumination and weaving of the narcissistic/(borderline) parent in which they “reconstruct reality” is guided by the attachment patterns embedded in the internal working models, or schemas, of the narcissistic/(borderline) parent’s attachment system.  The distorted beliefs take on the pattern of the attachment trauma, abusive parent – victimized child – protective parent.  It is the trauma reenactment narrative that is the fundamental psychotic process, of which the narcissistic/(borderline) parent’s delusional belief in the abusive threat posed by the other parent is a surface manifestation.

The psychological processes associated with attachment-based “parental alienation” represent the interwoven expression within the family relationships of 1) personality disorder processes, 2) trauma-related processes, and 3) psychotic processes (i.e., the decompensation of narcissistic/(borderline) personality structures into delusional belief systems).

The presence of a delusional belief DOES NOT mean the person will act in an overtly abnormal way, and in the case of a narcissistic/(borderline) personality the person’s nonbizarre persecutory delusional belief may go entirely unrecognized by other people, including mental health professionals, who may mistakenly accept the plausible assertions of the narcissistic/(borderline) parent as valid. 

After all, the story offered by the narcissistic/(borderline) parent is not abnormal or bizarre, it’s not uncommon for a parent to be a bad parent who presents a risk of emotional abuse for a child, especially when the child is backing up this storyline, the narrative of the trauma reenactment, by adopting the role as the “victimized child,”  And the narcissistic/(borderline) parent presents so well, as articulate and self-assured, and as being so protective and caring for the child’s well-being.  Who suspects a delusional reenactment of childhood trauma when presented with this storyline.

A nonbizarre delusional belief is not always evident.

Professional Competence

The presence of psychotic processes is an extremely serious expression of psychopathology. That many mental health professionals are simply not recognizing and diagnosing the extreme psychopathology involved represents a highly disturbing reflection of the inadequate professional competence of these mental health professionals.

Personality disorders, the attachment system, trauma disorders, and delusional disorders are ALL established DSM constructs. There is absolutely no reason whatsoever for mental health professionals to be missing the level of severe psychopathology involved. 

It doesn’t matter what their opinions are about the construct of “parental alienation,” they are required by professional practice standards to be knowledgeable about DSM disorders, particularly if they are treating that type of DSM disorder.

If a mental health professional is diagnosing and treating the family sequelae of trauma-related reenactments of a narcissistic/(borderline) parent’s psychological decompensation into delusional belief systems, in which the child is enacting the “victimized child” role within the reenactment narrative of the narcissistic/(borderline) parent’s traumatized attachment networks, then the diagnosing and treating mental health professional better know about trauma reenactments,  narcissistic and borderline personality presentations and processes, and the nature of “internal working models” of the attachment system.

If a plastic surgeon decides to diagnose and treat cancer without possessing the requisite knowledge, training, and background necessary for professional competence, and the patient dies because of the lack of professional knowledge and competence of the plastic surgeon in diagnosing and treating cancer, this would likely be considered malpractice.

If a podiatrist suddenly decided to do brain surgery on a patient’s brain tumor, and the patient dies as a result of the podiatrist’s lack of professional knowledge and competence regarding brain surgery, this would likely be considered malpractice.

Why is it considered malpractice in the medical profession for a doctor to practice beyond the boundaries of his or her professional knowledge and competence but it’s not considered malpractice in mental health?  Oh wait, it is considered malpractice in mental health too.

Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association (2002)

Standard 2.02 Boundaries of Competence

“Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.”

It doesn’t matter what they may think about the Gardnerian construct of “Parental Alienation Syndrome” or if they are familiar with the attachment-based model of “parental alienation” described in my writings and in my Master Lecture Series seminars.  Because all of the constructs I describe in an attachment-based model of “parental alienation” are established and accepted psychological constructs within the DSM diagnostic system, AND all of the constructs have a solid and established foundation in the research base of professional psychology.

It doesn’t matter if the plastic surgeon says that he doesn’t believe in this so-callled cancer disease (or never heard of cancer).  If a physician is going to diagnose and treat cancer then it is incumbent upon the physician to ensure that he or she has the necessary professional knowledge and expertise to diagnose and treat cancer. 

“Whoops, my mistake. Didn’t know what I was doing. Sorry.” is NOT an acceptable answer if the patient dies as a result of the professional’s lack of appropriate knowledge and professional competence.

It doesn’t matter if the podiatrist THINKS she can do brain surgery because she went to medical school.  To do brain surgery requires specialized professional knowledge and expertise.  Just because a physician went to medical school does not necessarily mean the physician is competent to do brain surgery without first taking steps to acquire the specialized professional knowledge and training necessary for brain surgery.

There is nothing “NEW” regarding an attachment-based model of “parental alienation” except that these established psychological constructs are being applied to the family processes traditionally called “parental alienation.” ALL of the psychological principles and constructs discussed in an attachment-based model of “parental alienation” are firmly established and accepted psychological principles and constructs that should be part of the professional competence for ALL mental health professionals generally, and particularly for mental health professionals who are diagnosing and treating this set of psychological issues.

If you don’t know what you’re diagnosing and treating, you should probably stay away from diagnosing and treating it.

Notice that in all of my writings, I put the term “parental alienation” in quotes. That’s because the term “parental alienation” represents a popularized lay term for the psychopathology involved.

The correct clinical term is pathogenic parenting (i.e., patho=pathological; genic=genesis, creation). The term pathogenic parenting refers to the creation of psychopathology in a child through aberrant and distorted parenting practices, and the actual clinical psychopathology involved is the psychological decompensation of a narcissistic/(borderline) parent into delusional belief systems that are manifesting through a reenactment of attachment trauma patterns into current family relationships.

When I first entered private practice from my position as the Clinical Director for a children’s assessment and treatment center I knew nothing about the construct of “parental alienation.”  My areas of specialty are ADHD, parent-child conflict, and marital and family therapy, and I have a secondary expertise in early childhood mental health and the neuro-development of the brain during childhood. 

When I ran across my first case of “parental alienation,” however, I was able to recognize the personality disorder processes, the delusional belief systems, and the trauma reenactment.  In my early writings on “parental alienation” I was discussing this clinical phenomenon as warranting the DSM-IV TR diagnosis of a Shared Psychotic Disorder and I was noting the descriptions contained within the DSM-IV TR regarding a Shared Psychotic Disorder diagnosis and the family processes traditionally described as “parental alienation,”

DSM-IV TR – Shared Psychotic Disorder:

“The essential features of Shared Psychotic Disorder (Folie a Deux) is a delusion that develops in an individual who is involved in a close relationship with another person (sometimes termed the “inducer” or “the primary case”) who already has a Psychotic Disorder with prominent delusions (Criteria A).” (American Psychiatric Association, DSM-IV TR, 2000,p. 332)

“Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person. Individuals who come to share delusional beliefs are often related by blood or marriage and have lived together for a long time, sometimes in relative isolation. If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear. Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur in larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.” (American Psychiatric Association, DSM-IV TR, 2000,p. 333)

“Aside from the delusional beliefs, behavior is usually not otherwise odd or unusual in Shared Psychotic Disorder.” (American Psychiatric Association, DSM-IV TR, 2000, p. 333)

With regard to the course of Shared Psychotic Disorder, the DSM-IV TR notes,

“Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change. With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.” (American Psychiatric Association, DSM-IV TR, 2000, p. 333)

When the diagnosis of Shared Psychotic Disorder was discontinued in the DSM-5 I wrote a paper currently up on my website in which I analyzed the clinical psychopathology of an attachment-based model for the construct of “parental alienation” relative to the newly revised DSM-5 diagnostic system, and I concluded that the clinical psychopathology represents a DSM-5 diagnosis of,

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

Of note, is that the diagnosis of Adjustment Disorder in the DSM-5 is in the category of “Trauma– & Stressor-Related Disorders.”

The clinical psychopathology involved is all comprised of standard psychological principles and constructs.  It is beyond me why this pathology hasn’t been identified and resolved earlier, other than the possibility that the field was so distracted by the debate over the Gardnerian model of PAS that no one bothered to define the pathology from within standard and established psychological principles and constructs.

The pathology is there, and it is clearly evident to anyone with a knowledge of the relevant domains of pathology, and ALL mental health professionals should have at least a basic knowledge of these relevant domains (i.e., personality disorders, delusions, trauma, the attachment system) as part of their foundational understanding of the DSM diagnostic system, since all of these constructs are in the DSM diagnostic system . 

I want to make sure I am entirely clear on this, ALL of the psychological constructs associated with an attachment-based model for the construct of “parental alienation” are established and accepted principles and constructs currently within professional psychology and the DSM diagnostic system.  There is absolutely NO REASON why mental health professionals have not, and are not currently, making the appropriate clinical and DSM-5 diagnosis of the pathology.

  • Narcissistic and borderline personality disorders are established and recognized constructs within the DSM diagnostic system.
  • Delusional beliefs are established and recognized constructs within the DSM diagnostic system.
  • The attachment system is a recognized construct within the DSM diagnostic system, and the attachment system has a substantial research base establishing it as a primary professional construct.
  • Trauma is a recognized construct within the DSM diagnostic system, and the construct of trauma has a substantial research base establishing it as a primary professional construct, including trauma reenactment.

Trauma Reenactment

Regarding the reenactment of trauma, van der Kolk describes the impact of childhood exposure to “developmental trauma,”

“After a child is traumatized multiple times, the imprint of the trauma becomes lodged in many aspects of his or her makeup… Unless this tendency to repeat the trauma is recognized, the response of the environment is likely to replay the original traumatizing, abusive, but familiar, relationships.” (van der Kolk 2005)

The recognition of trauma reenactment also includes the association of borderline personality symptoms to trauma reenactment processes:

Trippany, R. L., Helm, H. M., & Simpson, L. (2006). Trauma reenactment: Rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counseling, 28(2), 95-110.

As is the role of attachment trauma reenactments in the treatment of trauma-related disorders:

Pearlman, C.A., Courtois, C.A. (2005). Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma. Journal of Traumatic Stress, 18, 449-459

According to van der Kolk,

“When the trauma fails to be integrated into the totality of a person’s life experiences, the victim remains fixated on the trauma. Despite avoidance of emotional involvement, traumatic memories cannot be avoided: even when pushed out of waking consciousness, they come back in the form of reenactments, nightmares, or feelings related to the trauma… Recurrences may continue throughout life during periods of stress.” (van der Kolk, 1987, p. 5)

There is absolutely NO REASON that the pathology associated with an attachment-based model for the construct of “parental alienation” is not currently recognized and addressed within mental health OTHER than professional ignorance and incompetence.

It is NOT an issue of “parental alienation,” the pathology being expressed in the family processes involves standard, established, and accepted constructs of psychopathology.

If ANY targeted parent is in a position of educating a mental health professional regarding the nature or degree of the psychopathology involved with the construct of attachment-based “parental alienation” then this is clear evidence that a podiatrist is doing brain surgery, i.e., that the mental health professional is practicing beyond the boundaries of professional competence in likely violation of professional practice standards. 

ALL diagnosing and treating mental health professionals should be sufficiently knowledgeable so that it is the mental health professional who is educating the targeted parent regarding the personality disorder dynamics, the delusional processes, the reenactment narrative structure, and the attachment system distortions involved in attachment-based “parental alienation,” NOT the other way around.

I have two invited Master Lecture Series seminars available online through California Southern University in which I discuss at a professional level the nature and severity of the pathology.  Mental health professionals can watch these seminars to become educated and aware of the pathology involved. 

It is NOT about “parental alienation.”  All of the involved principles and constructs are established and accepted principles and constructs within the DSM diagnostic system and the established professional research base.

If you don’t know what you are diagnosing and treating, then you probably shouldn’t be diagnosing and treating it.

Podiatrists are not allowed to perform brain surgery, plastic surgeons are not allowed to treat cancer.

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

References

Personality Disorder

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

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

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

Trauma Reenactment

Pearlman, C.A., Courtois, C.A. (2005). Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma. Journal of Traumatic Stress, 18, 449-459

van der Kolk, B.A. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.

van der Kolk, B.A. (1987). The psychological consequences of overwhelming life experiences. In B.A. van der Kolk (Ed.) Psychological Trauma (1-30). Washington, D.C.: American Psychiatric Press, Inc.

Trippany, R. L., Helm, H. M., & Simpson, L. (2006). Trauma reenactment: Rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counseling, 28(2), 95-110.

Professional Standards

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

False Allegations of Parental Alienation

 Not everything is “parental alienation.”

Sometimes a child’s desire to avoid a relationship with one parent is justified by the parenting practice of that parent.

In about 25% of the cases that come to me because of my expertise in “parental alienation” the narcissistic parent turns out to be the targeted parent who is seeking my help in fostering the child’s relationship with this narcissistic parent because this parent feels entitled to possess the narcissistic object of the child.

This parent’s absence of empathic resonance for the child’s inner experience becomes clearly evident in the first few sessions with this narcissistic parent.  The child’s experience isn’t relevant to this parent, only the experience of the narcissistic parent is relevant in this parent’s perception.

Since the narcissistic parent has a fixed belief in his or her own perfection and wonderfulness, in their view there can be no other reason for the child’s reluctance to provide them with the narcissistic supply of adoration other than “parental alienation.”

In these cases, the child does NOT display the three diagnostic indicators of attachment-based “parental alienation” (Diagnostic Indicators and Associated Clinical Signs), and when I meet with the favored parent, this favored parent is entirely normal-range and does not display any narcissistic or borderline traits. 

Only the targeted parent displays narcissistic/(borderline) traits, and the child’s complaints about the absence of empathy of this parent makes total sense to me as a psychologist.  I see this narcissistic parent’s absence of empathy displayed in our sessions.  I know exactly what the child is saying.

Not everything is “parental alienation.”  Sometimes it is the targeted parent who is narcissistic.

Living with a Narcissistic Parent

In these false “parental alienation” cases, the profound absence of parental empathy of the narcissistic parent is experienced by the child as emotionally and psychologically painful.

There is interesting research by Moor and Silvern (2006) on the association of child abuse to parental empathic failure which found that parental empathic failure actually represents a form of psychological trauma for the child.

“The indication that posttraumatic symptoms were no longer associated with child abuse, across all categories, after statistically controlling for the effect of perceived parental empathy might appear surprising at first, as trauma symptoms are commonly conceived of as connected to specifically terrorizing aspects of maltreatment (e.g., Wind & Silvern, 1994).

However, this finding is, in fact, entirely consistent with both Kohut’s (1977) and Winnicott’s (1988) conception of the traumatic nature of parental empathic failure. In this view, parental failure of empathy is predicted to amount to a traumatic experience in itself over time, and subsequently to result in trauma-related stress. Interestingly, even though this theoretical conceptualization of trauma differs in substantial ways from the modern use of the term, it was still nonetheless captured by the present measures.” (Moor & Silvern, 2006, p. 197)

Moor, A. and Silvern, L. (2006). Identifying pathways linking child abuse to psychological outcome: The mediating role of perceived parental failure of empathy. Journal of Emotional Abuse, 6, 91-112.

The absence of parental empathy is painful, and severe failures of parental empathy, such as those associated with a narcissistic parent, are traumatic for the child.

When a child is exposed to chronic and severe failures of parental empathy, such as from a narcissistic parent, the child will seek to avoid the psychologically painful relationship with this parent. The child’s efforts to avoid a relationship with a narcissistic parent represent a normal-range and healthy protective response to the chronic and severe failure of parental empathy associated with narcissistic parenting practices.

A child seeking to avoid a relationship with a narcissistic parent represents an authentic response of the child to severe and chronic failures of parental empathy.

A narcissistic parent is incapable of empathy. For the narcissistic parent, the child is an object; a possession. The narcissistic parent cannot resonate with the child’s inner needs and experiences. For the narcissistic parent only the narcissistic supply that the child offers the narcissistic parent is important.

In their relationship, only one person exists, the narcissistic parent. The child’s authenticity is not acknowledged, the child’s authenticity is nullified and obliterated so that the child can serve as a narcissistic reflection of the parent’s own self-experience.

In these cases of false allegations of “parental alienation,” the child experiences a relationship with the narcissistic parent as being painful and tries to communicate this to the narcissistic parent. However, the narcissistic parent is unable to self-reflect and deflects the authentic criticism of the child as being invalid. The narcissistic parent is entirely unable to comprehend why the child wouldn’t want to adore and become the narcissistic possession of the magnificent wonderfulness of the narcissistic parent.

Over time, the child becomes discouraged that the narcissistic parent will ever be able to show empathic care and responsiveness for the child’s authenticity, so that the child begins to withdraw from a relationship with the narcissistic parent because the relationship is too painful, the relationship with the narcissistic parent is experienced as being psychologically traumatic for the child.

The narcissistic parent, however, cannot abide criticism –

“I’m not at fault. I’m perfect. You’re the problem, not me. I’m wonderful.”

So then why is the child critical of the “wonderful” narcissistic parent? Why does the child seek to avoid a relationship with the “perfect” narcissistic parent? The only answer the narcissistic parent can come up with is that it must be “parental alienation” by the other parent. What else could account for the child’s criticisms and rejection of the perfection and wonderfulness of the narcissistic parent?

Not everything is “parental alienation.”

Sometimes the narcissistic parent is the targeted parent and the child’s avoidance of a relationship with this parent is an authentic child response to the profound failure of parental empathy associated with a narcissistic parent. So that in these cases, the allegation of “parental alienation” made by one parent toward the other is actually a false allegation.

Differentiating True “Parental Alienation” from False Allegations of “Parental Alienation”

How can we differentiate true “parental alienation” from false allegations of “parental alienation?”

The answer is that the full set of the three diagnostic indicators for an attachment-based model of “parental alienation” will NOT be evident in false allegations of “parental alienation,” and the full set of three diagnostic indicators will always be present in true allegations of “parental alienation.”

Attachment System Suppression

The differentiation of the attachment system differences in authentic parent-child conflict from cases of “parental alienation” is subtle but distinctive.

False Allegations of “Parental Alienation” – In authentic parent-child conflict, the child’s “protest behavior” (e.g, angry-oppositional behavior) remains an “attachment-behavior” designed to elicit GREATER parental involvement.

In authentic parent-child conflict, the child still WANTS to form a relationship with the targeted parent but is frustrated and discouraged by some element of the targeted parent’s behavior, such as the chronic failure of parental empathy associated with narcissistic parenting practices. In authentic parent-child conflict the child’s withdrawal from a relationship with the targeted parent reflects the child’s discouragement in achieving an affectionally bonded relationship rather than a rejection of a relationship with the targeted parent.

In cases of authentic parent-child conflict, since the child’s protest behavior and withdrawal from the targeted parent reflect the child’s discouragement in achieving a positive relationship rather than rejection of a relationship, if the behavior of the targeted parent is changed to allow for child bonding then the child’s motivation toward bonding with the parent will achieve completion and the parent-child conflict will resolve.

In authentic parent-child conflict the child’s protest behavior reflects an “attachment behavior” designed to elicit GREATER parental involvement, and the child’s withdrawal from a relationship with the parent reflects DISCOURAGEMENT in forming an affectional bond to the parent, so that if the parenting behaviors are changed to allow an affectional bond to be established, the parent-child conflict will resolve.

True Allegations of “Parental Alienation” – Whereas when the parent-child conflict with the targeted parent is the product of attachment-based “parental alienation,” the child’s protest behavior will represent an inauthentic display as a “detachment behavior” designed to sever the child’s relationship with the parent. The authentic functioning of the attachment system DOES NOT ALLOW child detachment behaviors.

From an evolutionary perspective, children who detached in their bonding to parents fell prey to predators and other environmental dangers, so that genes allowing child detachment behaviors were selectively removed from the collective gene pool. Whereas children who bonded MORE strongly to problematic parents were more likely to acquire parental protection from predators, so that genes motivating INCREASED CHILD BONDING motivation to problematic parents were selectively increased in the gene pool because of the survival advantage that increased child bonding to the problematic parent provided..

This is important to understand about the authentic functioning of the attachment system, children are MORE STRONGLY motivated to bond to problematic parents. Children do NOT reject parents. Children who rejected parents were eaten by predators.

Authentic parent-child conflict is a product of the child’s desire TO FORM an affectional bond to the parent that is being frustrated in some way. When the barrier to the parent-child bonding is removed, the child completes his or her desire to form an affectional bond to the parent and the parent-child conflict is resolved.

In attachment-based “parental alienation,” on the other hand, the child is SEEKING TO SEVER the parent-child bond, so that the child’s protest behavior represents a “detachment behavior.” Child “detachment behaviors” represent an inauthentic display of the attachment system.

There are only a limited number of highly pathogenic circumstances that can override the survival advantage conferred by the parent-child bond so that a termination of the parent-child bond is sought.

  1. Sexual abuse/incest
  2. Prolonged and severe physical abuse of the child (years)
  3. Prolonged and severe domestic violence (years)
  4. Sometimes: chronic prolonged parental alcoholism or severe substance abuse (decades). More often, however, parental alcoholism and substance abuse produces a “parentified child” who adopts a caretaking role toward the parent

In the absence of these specific circumstances in the parent-child relationship, problematic parenting produces an INCREASED child motivation toward bonding with the problematic parent. Authentic child withdrawal from a relationship with a parent represents discouragement, NOT rejection.

Stimulus Control

The clearest way to differentiate authentic from inauthentic parent-child conflict is through the construct of “stimulus control.”

All behavior is elicited by stimuli, or cues. Our driving behavior, for example, is under the “stimulus control” of traffic lights. If the traffic light is red, we stop. If it is green, we go. Yellow is a transitional warning. In addition, our driving behavior is under the stimulus control of painted lines on the road, traffic signs, and our internalized rules for driving. All of these various stimuli control our driving behavior.

Children’s behavior in authentic parent-child conflict is under the “stimulus control” of the parent’s behavior, so that changes in the parent’s behavior will produce corresponding changes in the child’s behavior.

If, however, changes to the parent’s behavior do not produce corresponding changes to the child’s behavior, then the child’s behavior is NOT under the “stimulus control” of the parent’s behavior, meaning that the parent-child conflict is inauthentic.

In attachment-based “parental alienation,” the child’s behavior toward the targeted parent is not under the “stimulus control” of the targeted parent’s behavior.  It doesn’t matter what the targeted parent does or doesn’t do, the child rejects a relationship with this parent. 

In attachment-based “parental alienation,” the locus of “stimulus control” for the child’s behavior toward the targeted-rejected parent is to be found in the cross-generational coalition of the child with the narcissistic/(borderline) parent, and is contained in internalized “rules” the child has acquired through the distorted parenting practices of the narcissistic/(borderline) parent regarding the child’s relationship with the targeted parent, much in the same way that our internalized rules regarding driving act to control our driving behavior.

Differentiating Authentic Versus Inauthentic Conflict

One means of differentiating authentic versus inauthentic parent-child conflict is whether the child’s protest behavior represents an “attachment behavior” designed to increase parental involvement in response to barriers to the child’s ability to form an affectionally bonded relationship with the parent, or whether the child’s protest behavior represents an inauthentic display of “detachment behavior” designed to sever the parent-child relationship.

A second means of differentiating authentic versus inauthentic parent-child conflict is through the construct of “stimulus control.” The child’s behavior in authentic parent-child conflict is under the stimulus control of the parent’s behavior, so that changes in the parent’s behavior produce corresponding changes in the child’s behavior. Whereas in inauthentic parent-child conflict the child’s behavior toward the targeted parent is NOT under the stimulus control of the targeted parent, so that changes to the behavior of the targeted parent DO NOT produce corresponding changes to the child’s behavior.

Personality Disorder Symptoms

This is the clearest set of symptoms for differentiating true allegations of attachment-based “parental alienation” from false allegations of “parental alienation.”

In attachment-based “parental alienation,” the child’s symptomatic rejection of a relationship with the targeted parent is the product of pathogenic parental influence on the child by the narcissistic/(borderline) parent. In influencing the child to reject a relationship with the other parent, the narcissistic/(borderline) parent leaves telltale evidence of his or her pathogenic influence on the child through the narcissistic/borderline features of the child’s attitude toward the targeted-rejected parent.

Children to not spontaneously develop narcissistic and borderline personality traits. The development of narcissistic and borderline personality traits in children can ONLY be produced by the pathogenic parenting practices of a narcissistic or borderline parent. The psychological influence on a child by a narcissistic/(borderline) parent will leave “psychological fingerprint” evidence of this pathogenic influence in the child’s symptom display toward the targeted parent.

The “psychological fingerprint” evidence of distorting pathogenic influence on the child by a narcissistic/(borderline) parent is the presence in the child’s symptom display of five specific narcissistic and borderline features.

In authentic parent-child conflict in which a false allegation of “parental alienation” is made, the child’s symptom display toward the targeted parent WILL NOT display narcissistic and borderline personality features. In particular, the child will not evidence a sense of entitlement relative to the targeted-rejected parent, nor will the child evidence an attitude of haughty and arrogant contempt for the targeted-rejected parent.

In authentic parent-child conflict the child will also typically continue to evidence normal-range empathy for the emotional experience of the targeted parent, although this capacity for empathy may periodically disappear during periods of open anger toward the targeted parent. In authentic parent-child conflict, the child’s capacity for normal-range empathy for the targeted parent will typically be evident during inter-episode periods that occur between openly angry exchanges the child has with the targeted parent.

Also, in authentic parent-child conflicts the psychological dynamic of splitting will not be evident in the child’s symptom display. Spitting is the characteristic tendency for polarized black-and-white thinking in which people and relationships are seen as entirely good and wonderful, or as entirely bad and evil. In authentic parent-child conflict the child will express anger and frustration with the targeted parent, but will not characterize the targeted parent as a polarized extreme of all bad. Instead, during periods when the parent and child are not openly fighting, the child will be able to maintain a nuanced, shades-of-gray, perception of both positive and negative qualities possessed by the targeted parent, even though the child may find some parental qualities frustrating and provoking.

In order for attachment-based “parental alienation” to be diagnosed as being present, ALL FIVE narcissistic and borderline traits MUST be present in the child’s symptom display. The presence of all five narcissistic and borderline traits in the child’s symptom display represents the “psychological fingerprint” evidence for the distorting pathogenic influence on the child by a narcissistic/(borderline) parent.

Since the child is rejecting a relationship with the targeted parent, the psychological influence on the child that is evidenced in the child’s display of narcissistic and borderline personality traits CANNOT be emanating from the targeted parent, since the child is rejecting the influence of this parent. Since narcissistic and borderline personality traits can ONLY emerge as a result of distorting pathogenic parenting practices by a narcissistic/borderline parent, the only possible source for the child’s symptom display of narcissistic and borderline personality traits is the distorted pathogenic parenting practices of the allied and supposedly favored parent.

Sub-Threshold Display

If the child’s symptoms display some but not all of the five narcissistic and borderline personality traits predicted by an attachment-based model of “parental alienation,” then the diagnosis of attachment-based “parental alienation” cannot be made.

In sub-threshold cases in which some but not all of the diagnostic indicators of attachment-based “parental alienation” are present, a 6-month “Response-to-Intervention” (RTI) trial can be initiated, treating the parent-child conflict as if it was authentic. This 6-month RTI trial can clarify diagnostic features in one or the other direction.

If the parent-child conflict is authentic, then six months of treatment should produce substantial improvements in the relationship. If the parent-child conflict is the result of attachment-based “parental alienation,” then six months of treatment will produce no gains, and during the six month RTI trial the additional confirmatory diagnostic indicators should become evident during the course of treatment.

The presence of additional clinical signs (Diagnostic Indicators and Associated Clinical Signs) indicative of attachment-based “parental alienation” may also help confirm diagnostic impressions.

Delusional Beliefs

The third diagnostic indicator of attachment-based “parental alienation,” an intransigently held, fixed and false belief (i.e., a delusion) regarding the supposedly abusive parental inadequacy of the targeted rejected parent, will not be present in authentic parent-child conflicts.

The foundational source of this delusional belief is the reenactment narrative involving attachment trauma networks in the “internal working models,” or “schemas,” of the alienating parent’s attachment system. This process is explained more fully in my online Master Lecture Series seminars on theory and treatment (7/18/14: Theoretical Foundations – 11/21/14: Diagnosis and Treatment) through California Southern University. The child’s delusional belief represents the child’s adopting the “victimized child” role within the trauma reenactment narrative.

This type of trauma reenactment is familiar within the treatment literature related to trauma,

“Reenactments of the traumatic past are common in the treatment of this population and frequently represent either explicit or coded repetitions of the unprocessed trauma in an attempt at mastery. Reenactments can be expressed psychologically, relationally, and somatically and may occur with conscious intent or with little awareness.” (Perlman & Courtois, 2005, p. 455)

“One primary transference-countertransference dynamic involves reenactment of familiar roles of victim, perpetrator–rescuer-bystander in the therapy relationship. Therapist and client play out these roles, often in complementary fashion with one another, as they relive various aspects of the client’s early attachment relationships. (Perlman & Courtois, 2005, p. 455)

Pearlman, C.A., Courtois, C.A. (2005). Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma. Journal of Traumatic Stress, 18, 449-459.

In the case of attachment-based “parental alienation” it is the family members who are enacting the various roles of the narcissistic/(borderline) parent’s attachment trauma history, in which the child is enacting the role as the “victimized child,” the targeted parent is enacting the role as the “abusive parent,” and the narcissistic/(borderline) parent is adopting and enacting the coveted role as the “rescuing/protective parent.”

But none of this trauma reenactment narrative is true. The child is not a victim, the targeted parent is not abusive, and the narcissistic/(borderline) parent is not protective. It is a false drama created in the trauma contained in the narcissistic/(borderline) parent’s attachment system.

The child’s delusional belief represented by Diagnostic Indicator 3 is a manifestation of the child having been induced through the distorted pathogenic parenting practices of the narcissistic/(borderline) parent into adopting the “victimized child” role within the false trauma reenactment narrative of the narcissistic/(borderline) parent’s attachment trauma.

So that expert clinical diagnosticians, which should be a requirement for all mental health professionals working with this “special population” of children and families, should look beyond the mere surface features of the child’s delusional beliefs into the surrounding context for signs of the trauma reenactment narrative of which the child’s false belief in the “victimization role” is but one feature.

In authentic parent-child conflict involving false allegations of “parental alienation,” the child’s beliefs regarding the parenting practices of the targeted parent are not delusional. If, for example, the child asserts that the parent is physically abusive, the evidence presented by the child for this belief will be consistent with the child’s expressed belief. So that a child who asserts that the targeted parent is physically abusive should report that this belief is based on repeated incidents of being hit with a belt, or with a fist, or with an electrical cord.

Whether or not these child reports can be substantiated is another matter, but the reports of the child regarding the parenting practices of the parent should be consistent with the child’s beliefs that the parent is physically abusive (in the case of allegations of physically abusive parenting).

This is in contrast to a child who alleges the targeted parent is “emotionally abusive” because the parent took the child’s iphone away as punishment for the child’s hostile and negative attitude and display of disrespect. This is not considered “abusive” parenting, this is considered “discipline” and is entirely within normal-range parenting practices.

In this case, if the child maintains the position that the parent taking the child’s iphone away for a period of time as discipline for inappropriate child behavior represents “emotional abuse” rather than normal-range parenting practice (i.e., “discipline”), then this would suggest the presence of an intransigently held, fixed and false belief in the supposedly abusive parenting practices of a normal range and affectionally available parent, which would be consistent with the child adopting a “victimized child” role.

In authentic parent-child conflicts, such as when the targeted parent is the parent with the narcissistic personality, or in cases of authentically abusive parenting, the child’s beliefs regarding the parenting practices of the targeted parent are not delusional, they are accurate.

Furthermore, in cases where it is the targeted parent who has the narcissistic personality and is making a false allegation of “parental alienation” from an inability to self-reflect and from a charcterological propensity to externalize blame and responsibility, professional clinical interviews with the targeted parent should reveal the presence of narcissistic personality traits.

Prominent among the distinctive clinical indicators of narcissistic personality is the absence of empathy. So in cases of authentic parent-child conflict in which the narcissistic parent is the targeted parent, clinical interviews with the narcissistic targeted parent should be able to reveal this parent’s profound absence of empathy, which then supports the beliefs of the child regarding the problematic parenting practices of the narcissistic targeted parent, so the child’s beliefs again are not delusional but are supported by direct clinical observation.

Diagnosis of Attachment-Based “Parental Alienation”

Not everything is “parental alienation.”

Sometimes the targeted parent is the narcissistic parent and the child’s withdrawal from a relationship with this narcissistic parent is an understandable and reasonable response to the profound absence of parental empathy emanating from the narcissistic parent. Sometimes the allegation of “parental alienation” by a narcissistic parent represents the inability of the narcissistic parent to self-reflect and the narcissistic tendency to externalize blame and responsibility.

Sometimes the child’s withdrawal from a relationship with a parent is the product of actual physical or sexual abuse of the child, or is the product of prolonged and severe domestic violence. In these cases the child’s belief in the abusive parenting practices of the physically or sexually abusive parent are not delusional, they’re true.

However, in these circumstances the child will not display narcissistic personality traits toward the abusive parent. In particular, the child will not display an attitude of haughty and arrogant disrespect and contemptuous disdain toward the physically or sexually abusive parent, nor will the child display a sense of entitlement relative to the abusive parent, in which the child feels entitled to have every desire immediately met by the physically or sexually abusive parent.

Instead, physically and sexually abused children tend to present as timid and submissive in their relationship with the abusive parent, and they may display as angry and aggressive in other settings, such as in peer relationships at school.

Sometimes, however, a narcissistic/(borderline) parent has formed a cross-generational coalition with the child against the other parent, in which the child has been induced into adopting the “victimized child” role in the trauma reenactment narrative of the narcissistic/(borderline) parent, so that the child is induced through the distorted pathogenic parenting practices of the narcissistic/(borderline) parent into rejecting a relationship with a normal-range and affectionally available parent so that the child can be used by the narcissistic/(borderline) parent as a “regulatory object” for this parent’s own emotional and psychological needs.

This process is explained more fully in my online Master Lecture Series seminars on theory and treatment (7/18/14: Theoretical Foundations – 11/21/14: Diagnosis and Treatment) through California Southern University.

So that sometimes the child’s rejection of a relationship with a parent is the product of attachment-based “parental alienation.”

When ALL THREE diagnostic indicators of attachment-based “parental alienation” are present in the child’s symptom display, then a clinical diagnosis of attachment-based “parental alienation” is warranted since NO OTHER PROCESS can produce THIS SPECIFIC SET of child symptoms other than an attachment-based model of “parental alienation.”

Authentic parent-child conflict will not produce this specific symptom set. Authentic child abuse will not produce this specific symptom set. ONLY the processes of an attachment-based model for the construct of “parental alienation” will produce this specific symptom set of three diagnostic indicators (Diagnostic Indicators and Associated Clinical Signs)

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

References

Moor, A. and Silvern, L. (2006). Identifying pathways linking child abuse to psychological outcome: The mediating role of perceived parental failure of empathy. Journal of Emotional Abuse, 6, 91-112.

Pearlman, C.A., Courtois, C.A. (2005). Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma. Journal of Traumatic Stress, 18, 449-459.

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

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

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

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

I believe this seminar is significant in several primary areas:

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

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

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

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

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

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

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

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

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

Powerpoint Slides from Master Lecture Series Presentation

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

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

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

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

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

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

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

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

Online Seminar on Diagnosis and Treatment

On November 21, 2014 from 10:00-12:00 Pacific Standard Time I will be presenting an online seminar through the Masters Lecture Series of California Southern University regarding the Diagnosis and Treatment of an attachment-based model for “parental alienation.”  

This seminar is offered free to the general public and the seminar will be recorded and made available online through California Southern University’s Master Lecture Series for later viewing.

Registration for this online seminar regarding the Diagnosis and Treatment of attachment-based “parental alienation” is at:

http://www.calsouthern.edu/content/events/treatment-of-attachment-based-parental-alienation/

This Diagnosis and Treatment seminar is a follow-up to my earlier online seminar regarding the Theoretical Foundations for an attachment-based model of “parental alienation” that I delivered on July 18 through the Masters Lecture Series of California Southern University, and which is currently available at:

http://www.calsouthern.edu/content/events/parental-alienation-an-attachment-based-model/

My hope is that these two companion seminars will provide foundational information for mental health professionals in understanding, diagnosing, and treating the family dynamics associated with “parental alienation,” so that these seminars can serve as a resource to which targeted parents can refer diagnosing and treating mental health professionals to improve their understanding for the issues involved.

An attachment-based model for the construct of “parental alienation” is based entirely within standard and established psychological principles and constructs.  Within the field of mental health, all of these constructs are fully recognized and fully accepted psychological principles and constructs.

The family systems constructs of the child’s triangulation into the spousal conflict through the formation of a cross-generational coalition of the child with one parent against the other parent is an established psychological principle within family systems therapy (Haley, 1977; Munichin, 1974).  Minuchin refers to this cross-generational coalition as a “rigid triangle,” Haley refers to it as a “perverse triangle.”

“The rigid triangle can also take the form of a stable coalition. One of the parents joins the child in a rigidly bounded cross-generational coalition against the other parent.” (Minuchin, 1974, p. 102)

“The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two… In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer. By ‘coalition’ is meant a process of joint action which is against the third person… The coalition between the two persons is denied. That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition… In essence, the perverse triangle is one in which the separation of generations is breached in a covert way. When this occurs as a repetitive pattern, the system will be pathological. (Haley, 1977, p. 37)

Narcissistic and borderline personality disorder processes are recognized forms of pathology within the DSM diagnostic system (American Psychiatric Association, 2013) and are fully elaborated and described by preeminent theorists in professional psychology (e.g., Beck, et. al. 2004; Kernberg, 1977; Linehan, 1993; Millon, 2011).

The attachment system is a well-established and accepted psychological construct within professional psychology, with substantial theoretical foundation and research support (Ainsworth, 1989; Bowlby, 1969; 1973; 1980; Bretherton, 1992).

There is nothing new or controversial in any of these psychological principles or constructs.  They are all established and accepted psychological principles and constructs with which all mental health professionals should be familiar as a matter of professional competence, particularly if they are diagnosing and treating issues involving a child’s triangulation into the spousal conflict through a cross-generational coalition of the child with a narcissistic/(borderline) parent that results in the induced suppression of the normal-range functioning of the child’s attachment system.

While targeted parents do not possess the professional background, training, and expertise in professional psychology to explain to the mental health professionals involved with their families the application of these established psychological principles and constructs , I do. 

In these two online seminars I explain to other mental health professionals the application of these accepted psychological principles and constructs to the family processes traditionally described as “parental alienation.”  Hopefully this professional-level dialogue can begin to shift the mental health community into greater professional expertise and responsiveness to the needs of targeted parents and their children that will be necessary if we are to resolve the family tragedy of “parental alienation” for all families in all cases.

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

References

Family Systems:

Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.), The interactional view (pp. 31-48). New York: Norton.

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.

Personality Disorders:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

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.  

Attachment System:

Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.

Bowlby, J. (1969). Attachment and loss. Attachment, Vol. 1. NY: Basic Books.

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. NY: Basic Books.

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. NY: Basic Books.

Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 1992, 28, 759-775.

False Allegations of Abuse: Technical Issues

False Allegations of Incest

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

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

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

And… on occasion,

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

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

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

Assertion 1: Child Sexual Abuse Allegations are Not Developmentally Normal

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

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

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

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

1)   Authentic child abuse incest by the parent

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

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

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

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

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

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

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

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

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

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

Personal Estimates of Prevalence

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

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

1. Authentic child abuse

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

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

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

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

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

Individual Assessments

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

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

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

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

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

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

Decisional Errors

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

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

“Null Hypothesis” – no sexual abuse occurred

“Clinical Hypothesis” – sexual abuse did occur

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

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

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

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

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

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

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

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

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

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

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

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

Prosecution and Child Protection

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

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

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

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

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

And…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Low Base-Rate Phenomenon

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

Say we are assessing for TRAIT X in the population.

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

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

Great. So far, so good.

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

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

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

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

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

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

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

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

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

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

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

Conclusion to Part I

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

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

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

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

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

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

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

 References

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

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

Key Concept: Splitting

Understanding Splitting

This post builds some bricks in the structure for understanding the construct of “parental alienation” which I will then be able to reference in future discussions. 

In this post I’m going to discuss a key construct, the nature of the splitting dynamic that is characteristic of both narcissistic and borderline personality organizations.  As part of this discussion, I will also elaborate on the equivalence of narcissistic and borderline personality organizations at the attachment level, and the key role of splitting in the symptom manifestation of “parental alienation” within an attachment-based framework of the construct (i.e., as the child’s cross-generational coalition with a narcissistic/(borderline) parent).

Splitting

Central to the psychological processes of narcissistic and borderline personalities is the characteristic of “splitting,” which is a polarized perception of events and people into extremes of all-good, ideal, and wonderful or all-bad, entirely devalued, and demonized.  In splitting, thinking and perception are black-or-white. Modulated shades of grey, of mixed positive and negative qualities, are not possible. People are EITHER idealized as the all-wonderful source of nurture and narcissistic supply, OR they are entirely demonized as being “abusive” and as “deserving” to be punished for their inadequacy.  Splitting involves black-or-white extremes of polarized thinking and perception.

The American Psychiatric Association (2000) defines splitting as,

“Splitting. The individual deals with emotional conflict or internal or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images. Because ambivalent affects cannot be experienced simultaneously, more balanced views and expectations of self or others are excluded from emotional awareness. Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nurturant, and kind — or exclusively bad, hateful, angry, destructive, rejecting, or worthless.” (p. 813)

One of the leading figures in personality disorder dynamics, Otto Kernberg (1977), links the characteristic of splitting to the capacity for denial as a defense mechanism,

“Denial here is typically exemplified by “mutual denial” of two independent areas of consciousness (in this case, we might say, denial simply reinforces splitting). The patient is aware of the fact that at this time his perceptions, thoughts, and feelings about himself or other people are completely opposite to those he has had at other times; but this memory has no emotional relevance, it cannot influence the way he feels now. At a later time, he may revert to his previous ego state and then deny the present one, again with persisting memory, but with a complete incapacity for emotional linkage of these two ego states.” (p. 31-32)

One of the leading authorities on borderline personality disorder processes, Masha Linehan, captures the characteristic inflexibility of the splitting mindset,

“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.” (p. 35)

Both the narcissistic and borderline personality display spitting as a characteristic feature of their personalities. This is because both the narcissist and borderline personality share an underlying personality organization with differing surface manifestations.

Both the narcissistic and borderline personalities have an experience of tremendous core-self inadequacy and both believe that this core-self inadequacy will result in their being rejected and abandoned by others, principally by attachment figures. These personality disorder dynamics are the product of underlying patterns in their attachment system that serve as the formative core for the development of the personality structure. Bowlby (1969; 1973; 1980), who initially described the formation and nature of the attachment system, called these underlying patterns “internal working models” of attachment. Beck et al., (2004) refer to them as organizing “schemas” that guide our perceptions of events and relationships.

The underlying internal working models of attachment, or organizing schemas, for both the borderline personality and the narcissist are the same, a fundamental experience of core-self inadequacy (belief about self-in-relationship) and a belief that he or she will be rejected and abandoned by the attachment figure because of this fundamental core-self inadequacy (belief about other-in-relationship). The difference between the borderline and narcissistic personality is the differing manner in which each personality style copes with and defends against this identical underlying core belief system.

Equivalence of Narcissistic and Borderline Organizational Structure

Kernberg (1975), one of the leading figures in understanding narcissistic and borderline personality dynamics, equates the two types of personalities as essentially representing differing external manifestations of an underlying borderline personality organization,

“One subgroup of borderline patients, namely, the narcissistic personalities… seem to have a defensive organization similar to borderline conditions, and yet many of them function on a much better psychosocial level.” (Kernberg, p. xiii)

“Most of these patients [i.e., narcissists] present an underlying borderline personality organization.” (p. 16)

For mental health professionals reading this post, let me extend Kernberg’s discussion a little deeper,

“Underneath the feelings of insecurity, self-criticism, and inferiority that patients with borderline personality organization present, one can frequently find grandiose and omnipotent trends. These very often take the form of a strong unconscious conviction that they have the right to expect gratification and homage from others, to be treated as privileged, special persons. If an external object can provide no further gratification or protection, it is dropped and dismissed because there was no real capacity for love of this object in the first place.” (p. 33)

Childress Comment: it is interesting to note that when the targeted parent supposedly “provides no further gratification” for the child (according to the child’s report), the relationship with this parent is “dropped and dismissed” as if “there was no real capacity for love” in the child in the first place.  This child presentation is classically characteristic of narcissistic/borderline personality processes, and it is entirely inconsistent with the authentic functioning of the attachment system.

“In attachments, as in other affectional bonds, there is a need to maintain proximity, distress upon inexplicable separation, pleasure and joy upon reunion, and grief at loss.” (Ainsworth, 1989, p. 711)

“The difference between narcissistic personality structure and borderline personality organization is that in the narcissistic personality there is an integrated, although highly pathological grandiose self… The integration of this pathological, grandiose self compensates for the lack of integration of the normal self-concept which is part of the underlying borderline personality organization: it explains the paradox of relatively good ego functioning and surface adaptation in the presence of a predominance of splitting mechanisms, a related constellation of primitive defenses, and the lack of integration of object representations in these patients.” (p. 265-266)

“The pathological grandiose self compensates for the general “ego-weakening” effects of the primitive defensive organization, a common characteristic of narcissistic personalities and patients with borderline personality organization, and explains the fact that narcissistic personalities may present an overt functioning that ranges from the borderline level to that of better integrated types of character pathology.” (p. 269)

Both the narcissistic and borderline personalities experience a primal core-self inadequacy that, at the attachment system level, represents the internal working models in the attachment system for self-in-relationship.

Both the narcissistic and borderline personalities also have a corresponding belief that they will be rejected and abandoned by the primary attachment figure, which represents at the attachment system level their internal working model for other-in-relationship.

Bowlby refers to these basic internalized belief systems that comprise the attachment system as “internal working models,” while Beck et al., (2004) refer to them as “schemas,”

Bowlby: Internal Working Models

“No variables, it is held, have more far-reaching effects on personality development than have a child’s experiences within his family: for, starting during the first months of his relations with his mother figure, and extending through the years of childhood and adolescence in his relations with both parents, he builds up working models of how attachment figures are likely to behave towards him in any of a variety of situations; and on those models are based all his expectations, and therefore all his plans for the rest of his life.” (Bowlby, 1973, p. 369).

“Every situation we meet within life is construed in terms of the representational models we have of the world about us and of ourselves. Information reaching our sense organs is selected and interpreted in terms of those models, its significance for us and for those we care for is evaluated in terms of them, and plans of action conceived and executed with those models in mind.” (Bowlby, 1980, p. 229)

Beck: Schemas

“How a situation is evaluated depends in part, at least, on the relevant underlying beliefs. These beliefs are embedded in more or less stable structures, labeled “schemas,” that select and synthesize incoming data.” (Beck et al., 2004, p. 17)

“The content of the schemas may deal with personal relationships, such as attitudes toward the self or others, or impersonal categories… When schemas are latent, they are not participating in information processing; when activated they channel cognitive processing from the earliest to the final stages.” (Beck et al., 2004, p. 27)

“In personality disorders, the schemas are part of normal, everyday processing of information… When hypervalent, these idiosyncratic schemas displace and probably inhibit other schemas that may be more adaptive or more appropriate for a given situation. They consequently introduce a systematic bias into information processing.” (Beck et al., 2004, p. 27)

”Some subsystems composed of cognitive schemas are concerned with self-evaluation, others are concerned with evaluation of other people.” (Beck et al., 2004, p. 28)

These distorted internal working models of attachment (or organizing schemas) guide and direct the interpretation of relationships and the responses made to these distorted interpretations of reality by the narcissistic/(borderline) parent. Some “alienating” parents will present with stronger narcissistic personality styles while other “alienating” parents will present with stronger borderline personality styles. Note in this regard, Kernberg’s analysis of the narcissistic personality that,

“…narcissistic personalities may present an overt functioning that ranges from the borderline level to that of better integrated types of character pathology.” (Kernberg, 1977, p. 269)

It is this wide variability in the overt presentation of the narcissistic/(borderline) parent in “parental alienation,” combined with the absence of personality disorder expertise in the mental health professionals who are diagnosing and treating general child and family problems, that may have contributed to the seeming non-recognition of the narcissistic/(borderline) pathology associated with “parental alienation.”

It is IMPERATIVE that ALL mental health professionals, all child custody evaluators and all therapists, who are involved in diagnosing and treating this “special population” of children and families have a professional level of expertise regarding the nature, dynamics, and presentation of personality disorder processes, particularly narcissistic and borderline personality development and characteristics.

I would strongly urge and strongly recommend that ALL mental health professionals involved in diagnosing and treating this special population of children and families, which means all child custody evaluators and treating therapists, read the following set of literature to establish professional competence in the requisite domain of personality disorder components for this special population:

Core Texts:

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.

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

Readings of Special Note:

Moor, A. and Silvern, L. (2006). Identifying pathways linking child abuse to psychological outcome: The mediating role of perceived parental failure of empathy. Journal of Emotional Abuse, 6, 91-112.

Childress Comment: Highly recommended regarding parental empathic failure as a form of psychological child abuse and developmental trauma. Failure of parental empathy is a characterological feature of both narcissistic and borderline personalities.

Kerig, P.K. (2005). Revisiting the construct of boundary dissolution: A multidimensional perspective. Journal of Emotional Abuse, 5, 5-42.

Childress Comment: Highly recommended regarding the nature of role-reversal parent-child relationships.  Role-reversal relationships are an extremely common feature of narcissistic and borderline parenting.

Dutton, D. G., Denny-Keys, M. K., & Sells, J. R. (2011). Parental personality disorder and Its effects on children: A review of current literature. Journal Of Child Custody, 8, 268-283.

Childress Comment: Recommended review of the impact of narcissistic parenting

Rappoport, A. (2005). Co-narcissism: How we accommodate to narcissistic parents. The Therapist.

Childress Comment: Recommended discussion of children’s presentation when living with a narcissistic parent.

There is no excuse or justification for professional ignorance.  If a mental health professional is going to be involved in the diagnosis and/or treatment of families that involve narcissistic and/or borderline personality dynamics, then the mental health professional MUST be professionally knowledgeable and competent in personality disorder dynamics.

There is NO EXCUSE for professional ignorance.

The Neurological Origins of Splitting

Spitting is not an actual physical splitting of areas in the brain. It involves the excessive “cross-inhibition” of two brain areas, so if one area is active (the area containing positive representations, for example) then this active area of the brain triggers inhibitory connections that entirely suppress the activity of another area of the brain (the area containing negative representations), so that only one or the other area of the brain can be active at any one time.

So, as noted earlier by Kernberg regarding denial and splitting, the person will continue to have a memory that he or she previously didn’t feel this way, “but this memory has no emotional relevance” for the person because that area of the brain that was previously active is now entirely turned off (entirely inhibited by the activity of the other brain area).

For the rest of us, living in a normal-range brain, we can have both brain areas on simultaneously. Our brain area containing positive representations can be on AT THE SAME TIME as our brain area containing negative representations, so that we can have a complex blend of both positive and negative features about an event or person. Yet even in our normal-range brains we still have a little bit of cross-inhibition occurring. If we like someone, we tend to see more positive things about that person, and we’ll tend to overlook their negative qualities (this is called a “positive halo” effect), whereas if we don’t like someone we will tend to interpret what they do in a more negative and critical way (this is called a “negative halo” effect).

But our cross-inhibition is relatively mild (hopefully), which allows us a more balanced perception of events and people. For the narcissistic and borderline personalities, however, the cross-inhibition of the two brain areas is complete and total.  EITHER the positive representation area is active, in which case the negative representation area is entirely turned off (i.e., creating the all-good, perfectly nurturing, and idealized extreme), OR the negative representation area is active, in which case the positive representation area is entirely turned off (i.e., creating the all-bad, entirely devalued, and demonized extreme).

No balanced blend of perception is possible in the brain circuitry of the narcissistic borderline parent. Black-or-white extremes. This is called “splitting.”

How does a situation like this develop?

Spitting occurs in the attachment system, and it is a response to a parent who is simultaneously a source of fear and a source of nurture.

“Various studies have found that patients with BPD are characterized by disorganized attachment representations… Disorganized attachment is considered to result from an unresolvable situation for the child when “the parent is at the same time the source of fright as well as the potential haven of safety” (van IJzendoorn, Schuengel, & Bakermans-Kranburg, 1999, p. 226).” (Beck et al., 2004, p. 191)

The positive representation area of the brain is the area containing attachment bonding motivations, and the negative representation area of the brain is the area containing avoidance motivations. The parent, as a source of nurture for the child, naturally triggers the child’s attachment bonding motivations. However, when this parent is simultaneously a source of threat who provokes an intense fear in the child, the child’s avoidance motivations also become active, and the child becomes strongly motivated to flee from the source of threat and danger (the hostile-abusive parent) and seek nurture and protection from… the parent… who is… the source of threat and danger and who is triggering the child’s avoidance motivation.

This creates a state of intolerable inner conflict, where both the attachment bonding and avoidance motivation systems are simultaneously active at high intensities. If this becomes a chronic experience, the brain begins to resolve this conflict by excessively cross-inhibiting these networks, so that if one network is active, say the attachment bonding network, then the other network, the avoidance network, is entirely inhibited and becomes completely inactive. Or, if the avoidance motivation system is active, then this entirely inhibits the attachment bonding motivation system. So that ONLY one or the other motivating system is on at any given time.

So unlike our normal-range brains that can simultaneously experience both attachment bonding and avoidance motivations, with only minimal cross-inhibition (i.e., the halo effect), the brain of the narcissistic/borderline personality experiences EITHER one OR the other motivation (an intense bonding motivation or an intense avoidance motivation), but never both simultaneously (i.e., never a complex blend of good and bad).

This is what “splitting” is. It is a distinctive and characteristic feature of both narcissistic and borderline psychopathology. It is easily recognized by a competent mental health professional.

Splitting and “Parental Alienation”

The narcissistic/(borderline) parent is neurologically unable to simultaneously experience both positive and negative perceptions of a person. Either the other person is seen as an idealized source of nurture and narcissistic supply, or the other person becomes a devalued object of complete contempt and scorn. No middle ground is possible. Ambiguity is neurologically impossible for the narcissistic/(borderline) personality.

When the divorce occurs, the targeted parent becomes an ex-husband or an ex-wife.

In the black-and-white polarized brain pathways of the narcissistic/(borderline) parent, the “bad husband” MUST also become the “bad father” and the “bad wife” MUST also become the “bad mother.”  There is no other possibility.  This is an imperative imposed by the neurological networks of the narcissistic/(borderline) brain, i.e., by the splitting dynamic characteristic of both narcissistic and borderline personalities.

What’s more, since the narcissistic/(borderline) brain cannot experience (fundamentally cannot experience) ambiguity, the ex-husband must also become an ex-father; the ex-wife must become an ex-mother. To the mind of the narcissistic/(borderline) parent this seems self-evident and obvious. Remember Kernberg’s discussion of denial,

“The patient is aware of the fact that at this time his perceptions, thoughts, and feelings about himself or other people are completely opposite to those he has had at other times; but this memory has no emotional relevance, it cannot influence the way he feels now… [There is] a complete incapacity for emotional linkage of these two ego states.” (p. 31-32)

All memories held by the narcissistic/(borderline) parent of the positive relationship the targeted parent may have had with the children are lost to relevance. The bad spouse has now become a bad parent, and the ex-husband must become an ex-father, the ex-wife must become the ex-mother, and there is a “complete incapacity for emotional linkage” to any prior experiences of the targeted parent as a good spouse or good parent. These memories have “no emotional relevance.”

And, since the child is in a shared psychological state with the narcissistic/(borderline) parent (variously called an “intersubjective” state (Stern, 2004; Trevarthan, 2001), a “dyadic state of consciousness” (Tronick, 2003), or “enmeshment” (Minuchin, 1974), the child is acquiring the orientation and belief systems of the narcissistic/(borderline) parent, hence the presence of narcissistic and borderline traits in the child’s symptom display (i.e., diagnostic indicator 2).

So the child will exhibit the SAME splitting process (diagnostic indicator 2.5). The child’s memories of formerly positive experiences with the targeted parent will also lose relevance for the child. The child may remain “aware of the fact that at this time his perceptions, thoughts, and feelings about [the targeted parent] are completely opposite to those he has had at other times; but this memory has no emotional relevance, it cannot influence the way he feels now… [There is] a complete incapacity for emotional linkage of these two ego states.”

This explains what otherwise is a very puzzling feature of “parental alienation.”

Why doesn’t the child remember all the good times with the targeted parent? Their love and affection, their laughter and warmth? What happened to all those positive memories?

“In this case, we might say, denial simply reinforces splitting” (Kernberg, 1977, p. 31)

Now Kernberg wasn’t talking about “parental alienation.” Kernberg was describing the narcissistic/borderline personality. Which highlights an important point, the moment we ground our definition of “parental alienation” in established psychological constructs and principles, a wealth of relevant information immediately becomes available to us, and explanations are revealed.

Understanding the role of splitting in “parental alienation” is just one more brick in a comprehensive and accurate explanation of what “parental alienation” is from within standard and established psychological principles and constructs.

Parallel Process

Whenever multiple mental health professionals work with borderline personality processes (and narcissistic processes have an underlying borderline organization), there always exists the potential that the splitting dynamic of the borderline process will be transferred and expressed among the involved mental health professionals, variously called “parallel process” and “staff splitting.”

Linehan, one of the premiere experts in borderline personality processes, describes this potential for the transfer of splitting into the professional team working with borderline personality dynamics in patients,

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

This very much sounds to me like the professional discussion surrounding “parental alienation” that has occurred over the past 30 years, in which each side (pole in the dialectic) is advocating for their position without finding synthesis with the other side (the other pole in the dialectic).  Establishment mental health (symbolized by the DSM committees) have discounted Gardnerian PAS as “junk science” and have withheld granting legitimacy to the construct of PAS, and a separate partisan divide has swirled around the construct of false allegations of child abuse, with each side taking staunchly polarized positions. 

For their part, the Gardnerian PAS advocates have failed to grasp and appreciate the legitimate criticism of PAS as being founded on a set of loose anecdotal indicators that have no connection to established psychological constructs or principles. Rather than take this criticism to heart and employ the professional rigor necessary to define “parental alienation” within standard and established psychological constructs and principles, the Gardnerian PAS supporters have simply tried to storm the gates of the DSM with the same continual argument of “it exists.”

From the perspective of “staff splitting,” Marsha Linehan provides us the way out of this unproductive professional squabbling.  First, we must recognize that a polarity has arisen, and that both sides represent equally valid poles of a dialectic.  Second, we must come together to work toward synthesis.

The criticism of Gardner’s model of PAS as not being sufficiently grounded in scientifically established psychological principles and constructs is a valid criticism.  An attachment-based reconceptualization of the construct of “parental alienation” addresses this criticism levied by establishment mental health against Gardner’s model of PAS.  And, in applying the professional rigor necessary to describe the construct of “parental alienation” entirely from within standard and established psychological constructs and principles, a wealth of explanatory information is made available to guide both diagnosis and treatment.

Equally, establishment mental health needs to similarly work toward synthesis by recognizing the legitimacy of a clinical phenomenon associated with what has traditionally been called “parental alienation.”  It doesn’t matter what it’s called, but it represents severe distortions to family processes as a result of a cross-generational coalition of the child with a narcissistic/(borderline) parent that is creating serious developmental (diagnostic indicator 1), personality (diagnostic indicator 2), and psychiatric (diagnostic indicator 3) pathology in the child, which defines it as “pathogenic parenting.”

Because the construct has a history of being labeled as “parental alienation,” I would recommend we keep this descriptive label, but I have added the prefix “attachment-based” to the label to differentiate this scientifically grounded model for the clinical phenomenon from the earlier Gardnerian PAS model.

Fundamentally, however, within mental health we must show enlightened professionalism and bring this parallel process of “staff splitting” to an end for the benefit of our client children and families.  Both sides are right, both sides represent equally valid poles in a dialectic.  It is time we engage in professional dialogue that recognizes this truth so that we can maintain our professional focus on serving the needs of our client families by coming together to work toward synthesis. 

This is ALSO true surrounding the divisive issue of false allegations of abuse.  We need to protect children from child abuse and a healthy trust for children’s reporting of abuse is warranted.  One of the absolutely worst things we can do in a case of authentic child abuse is allow the child to report the abuse, and then not believe the child and not do anything to stop the abuse.  That is psychologically devastating to the child.  The skeptics of false allegations of child abuse, who are advocating for providing greater credibility to child reporting of abuse have an extremely legitimate and important point.  They are right.

And…

In some cases, particularly when there is parental narcissistic and borderline processes and a cross-generational role-reversal relationship in which the child has been induced/seduced into meeting the emotional and psychological needs of the narcissistic/borderline parent, there are occurrences of the narcissistic/borderline parent inducing/seducing false and distorted allegations of abuse from the allied child directed toward the other parent in order that the narcissistic/borderline parent can exploit the allegations to achieve power over the situation and the targeted parent.  Furthermore, borderline personality parents may have been abused themselves and so have a pre-potentiated schema of fearfulness in which they see abuse where none exists (the term “borderline” refers to being on the “border” of neurosis and psychosis).

“Young’s schema model… patients with BPD were characterized by higher self-reports of beliefs, emotions, and behaviors related to the four pathogenic BPD modes (detached protector, abandoned/abused child, angry child, and punitive parent model.” (Beck et al., 2004, p. 193)

“Patients with BPD are characterized by hypervigilance (being vulnerable in a dangerous world where nobody can be trusted) and dichotomous thinking.” (Beck et al., 2004, p. 193)

“The conceptualization of the core pathology of BPD as stemming from a highly frightened, abused child who is left alone in a malevolent world, longing for safety and help but distrustful because of fear of further abuse and abandonment, is highly related to the model developed by Young (McGinn & Young, 1996)… Young elaborated on an idea, in the 1980s introduced by Aaron Beck in clinical workshops (D.M. Clark, personal communication), that some pathological states of patients with BPD are a sort of regression into intense emotional states experienced as a child. Young conceptualized such states as schema modes…” (p. 199)

Young hypothesized that four schema modes are central to BPD: the abandoned child mode (the present author suggests to label it the abused and abandoned child); the angry/impulsive child mode; the punitive parent mode, and the detached protector mode… The abused and abandoned child mode denotes the desperate state the patient may be in related to (threatened) abandonment and abuse the patient has experienced as a child. Typical core beliefs are that other people are malevolent, cannot be trusted, and will abandon or punish you, especially when you become intimate with them. (p. 199)

Narcissistic personalities can also decompensate into paranoid and persecutory delusional beliefs (Millon, 2011). 

“Owing to their excessive use of fantasy mechanisms, they [narcissists] are disposed to misinterpret events and to construct delusional beliefs… Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence… Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions…” (Millon, 2011, p. 407)

The presence of parental narcissistic and borderline personality dynamics realistically elevates the risk of false allegations of abuse directed toward a normal-range targeted parent as a consequence of the psychopathology of the narcissistic/(borderline) parent, especially when the child has been induced/seduced into a cross-generational coalition with the narcissistic/(borderline) parent against the other parent that involves a role-reversal relationship in which the child is being used to meet the emotional and psychological needs of the narcissistic/(borderline) parent.

We need to protect children from ALL forms of child abuse.

Both sides represent “equally valid poles in a dialectic.”  For the well-being of our clients, professional psychology must demonstrate sufficient self-reflective insight to avoid the parallel process dynamic of staff splitting associated with treating borderline personality processes (i.e., “parental alienation”) and must work together, NOT as adversaries, toward a synthesis of understanding that recognizes the legitimacy of both poles in the dialectic.

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

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.

Attachment

Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.

Bowlby, J. (1969). Attachment and loss. Attachment, Vol. 1. NY: Basic Books.

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. NY: Basic.

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. NY: Basic.

Personality Disorders

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

Moor, A. and Silvern, L. (2006). Identifying pathways linking child abuse to psychological outcome: The mediating role of perceived parental failure of empathy. Journal of Emotional Abuse, 6, 91-112.

“The indication that posttraumatic symptoms were no longer associated with child abuse, across all categories, after statistically controlling for the effect of perceived parental empathy might appear surprising at first, as trauma symptoms are commonly conceived of as connected to specifically terrorizing aspects of maltreatment (e.g., Wind & Silvern, 1994). However, this finding is, in fact, entirely consistent with both Kohut’s (1977) and Winnicott’s (1988) conception of the traumatic nature of parental empathic failure. In this view, parental failure of empathy is predicted to amount to a traumatic experience in itself over time, and subsequently to result in trauma-related stress. Interestingly, even though this theoretical conceptualization of trauma differs in substantial ways from the modern use of the term, it was still nonetheless captured by the present measures.” (Moor & Silvern, 2006, p. 197)

Kerig, P.K. (2005). Revisiting the construct of boundary dissolution: A multidimensional perspective. Journal of Emotional Abuse, 5, 5-42.

“The breakdown of appropriate generational boundaries between parents and children significantly increases the risk for emotional abuse. (Kerig, 2005, p. 6)

Rather than telling the child directly what to do or think, as does the behaviorally controlling parent, the psychologically controlling parent uses indirect hints and responds with guilt induction or withdrawal of love if the child refuses to comply. In short, an intrusive parent strives to manipulate the child’s thoughts and feelings in such a way that the child’s psyche will conform to the parent’s wishes. (p. 12)

Dutton, D. G., Denny-Keys, M. K., & Sells, J. R. (2011). Parental personality disorder and Its effects on children: A review of current literature. Journal Of Child Custody, 8, 268-283.

“One of the most impactful consequences brought about as a result of growing up with parental PD is the way in which a child is raised with emotionally unavailable, unpredictable, or hostile–abusive parenting and the consequences of this upbringing on attachment issues.” (p. 271)

“The results [of Horne’s study] indicated mothers’ narcissism rates correlated significantly and positively with their sons’ narcissism and negatively with their sons’ expressions of empathy.”

Rappoport, A. (2005). Co-narcissism: How we accommodate to narcissistic parents. The Therapist.

“To the extent that parents are narcissistic, they are controlling, blaming, self-absorbed, intolerant of others’ views, unaware of their children’s needs and of the effects of their behavior on their children, and require that the children see them as the parents wish to be seen. They may also demand certain behavior from their children because they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents’ emotional needs. (Rappoport, 2005, p. 2)

In a narcissistic encounter, there is, psychologically, only one person present. The co-narcissist disappears for both people, and only the narcissistic person’s experience is important. Children raised by narcissistic parents come to believe that all other people are narcissistic to some extent. As a result, they orient themselves around the other person in their relationships, lose a clear sense of themselves, and cannot express themselves easily nor participate fully in their lives. (Rappoport, 2005, p. 3)

“Often, the same person displays both narcissistic and co-narcissistic behaviors, depending on circumstances. A person who was raised by a narcissistic or a co-narcissistic parent tends to assume that, in any interpersonal interaction, one person is narcissistic and the other co-narcissistic, and often can play either part. Commonly, one parent was primarily narcissistic and the other parent primarily co-narcissistic, and so both orientations have been modeled for the child. (Rappoport, 2005, p. 2)

 Intersubjectivity & Enmeshment

Stern, D. (2004). The Present Moment in Psychotherapy and Everyday Life. New York:

Trevarthen, C. (2001). The neurobiology of early communication: Intersubjective regulations in human brain development. In Kalverboer, A.F. and Gramsbergen, A. (Eds) Handbook of Brain and Behaviour in Human Development. London: Kluwer Academic Publishers

Tronick, E.Z. (2003). Of course all relationships are unique: How co-creative processes generate unique mother-infant and patient-therapist relationships and change other relationships. Psychoanalytic Inquiry, 23, 473-491.

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.