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, perpetratorrescuer-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 Foundations11/21/14: 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, perpetratorrescuer-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 Foundations11/21/14: 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 totalEITHER 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 hostileabusive 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.

Diagnostic Checklist for Pathogenic Parenting

I have just posted to my website a Diagnostic Checklist for the three Primary Diagnostic Indicators and Secondary Clinical Features for the pathogenic parenting associated with an attachment-based model of “parental alienation.”

This diagnostic checklist is available at the link below:

Diagnostic Checklist for Pathogenic Parenting, and directly through my website

I am not sure if this checklist will be helpful to targeted parents, but I am trying to provide you with something simple that you can give to therapists and child custody evaluators.

Unfortunately, as the saying goes, we can lead a horse to water but we can’t make him drink.

We can’t force mental health professionals to be knowledgeable.  If you have cancer and you’re in the position of educating your physician regarding the diagnosis and treatment of cancer… you’re in trouble.  The treating physician should know more than you about the disorder.  Would that this were the case with mental health professionals and “parental alienation.”

This Diagnostic Checklist for Pathogenic Parenting may, or may not, be helpful in educating therapists and child custody evaluators.

If the three Primary Diagnostic Indicators are present then a diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation” is warranted, because no other possible explanation can account for this specific set of child’s symptoms.  It is simple.  It is clear.  It is definitive.

In addition, there are a set of secondary clinical features that can be used as confirmatory support for the diagnosis, or as initial signs triggering additional focused assessment for the three Primary Diagnostic Indicators.

The diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation” is made solely on the presence or absence of the three Primary Diagnostic Indicators.

If one or more of the three Primary Diagnostic Indicators is sub-threshold, then a 6-month Response to Intervention (RTI) trial of therapy would be warranted to assist in clarifying the diagnosis. If the parent-child conflict with the targeted parent is NOT due to the pathogenic influence of the child’s cross-generational coalition with a narcissistic/(borderline) parent (i.e., “parental alienation”), then 6 months of appropriate therapy should produce a significant resolution to the parent-child conflict.  Perhaps not a complete resolution in 6 months, but significant gains should be achieved from 6 months of therapy.

If, however, the parent-child conflict IS the result of the pathogenic influence of the child’s cross-generational coalition with a narcissistic/(borderline) parent (i.e., “parental alienation”), then 6 months of therapy will have had no effect, the Primary Diagnostic Indicators would have become more clearly evident, and the presence of secondary clinical features could confirm the diagnosis.

If you want to remain focused in educating a therapist or child custody evaluator, I structured the checklist so you can simply present the first two pages.  At the end of the first page are resources of my website, blog, and online seminar if the mental health professional wants more information.  At the end of the second page is the appropriate DSM-5 diagnosis (including V995.51 Child Psychological Abuse, Confirmed) with a reference in the footnote to the article on my website where I provide an analysis of the DSM-5 diagnosis for an attachment-based model of “parental alienation.”

The third page is a single-page checklist for all of the associated secondary clinical features, followed by bullet-point descriptions of each secondary clinical feature.  I’m planning to address each one in turn in future blog posts, describing each feature and explaining why it occurs.

Again, this may, or may not, be helpful.  We can lead a horse…

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

 

Nothing New – No Excuse

There is nothing NEW in an attachment-based model of “parental alienation.”

All of the component elements for an attachment-based model of “parental alienation” are established and accepted psychological principles and constructs. I am not proposing something new. I am simply connecting the dots between several constructs that EVERY mental health professional already knows as part of their professional competence.

Narcissistic and Borderline Personality Disorder

Personality disorders are defined within the DSM diagnostic system, and ALL mental health professionals are expected to be professionally familiar with ALL of the diagnoses within the DSM.  Narcissistic and borderline personality processes are not new or exotic constructs.

The theoretical foundations for narcissistic and borderline personality disorder processes have been extensively described and elaborated in the professional literature (e.g., Beck, et al., 2004; Kernberg, 1975; Linehan, 1993; Millon 2011) and if a mental health professional is not familiar with this literature at a professional-level of competence, then that mental health professional is not professionally competent in the domain of personality disorders and so should refer cases involving narcissistic and borderline personality disorder dynamics to professionals with the appropriate background and expertise

(not only SHOULD the mental health professional refer cases outside of the professional’s “boundaries of competence” to more expert and competent professionals, the mental health professional is actually REQUIRED to refer cases that are outside of the professional’s “boundaries of competence”
under established standards of professional practice.)

Mental health professionals are only allowed to practice within their “boundaries of professional competence.”

American Psychological Association Ethical Principles of Psychologists and Code of Conduct Standard 2.02:

“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.”

American Counseling Association Code of Ethics; Standard C.2.a

“Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.”

If a mental health professional is not knowledgeable and experienced regarding the diagnosis and treatment of narcissistic and borderline personality disorder dynamics, then the mental health professional is professionally required to refer the client to someone who is professionally competent.  Plastic surgeons should not diagnose and treat cancer.

Cross-Generational Parent-Child Coalition

Professionally competent treatment of families requires understanding principles of family dynamics. This should be patently obvious.  Therefore, mental health professionals working with families should be professionally familiar with basic family systems constructs. 

For example, the Model Standards of Practice for Child Custody Evaluation proposed by the Association of Family and Conciliation Courts (2006) identifies a set of “areas of expected training for all child custody evaluators” that includes “(2) family dynamics, including, but not limited to, parent-child relationships, blended families, and extended family relationships” (p. 8).

A central construct of family systems theory is the child’s triangulation into the spousal conflict, and among the standard triangulation patterns is a cross-generational coalition of the child with one parent against the other parent.

Salvador Minuchin (1974), considered by many to be THE preeminent family systems theorist, identified this cross-generational coalition of the child with one parent against the other parent as a form of “rigid 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.” (p. 102)

Another preeminent family systems theorist, Jay Haley (1977) defined a cross-generational parent-child coalition as a “perverse triangle”,

“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.” (p. 37)

The construct of “parental alienation” is simply a manifestation of a cross-generational parent-child coalition of the child with a narcissistic/(borderline) personality disordered parent. Nothing new. I am simply linking two established constructs that ALL mental health professionals working with children and families are responsible to know and understand within standards of professional practice.

It is the addition of narcissistic/(borderline) personality disorder traits of the allied and supposedly “favored” parent that transforms the family dynamics into a particularly malignant and virulent form of the cross-generational parent-child coalition.

Narcissistic and borderline personality dynamics occur.  Cross-generational parent-child coalitions against the other parent occur.  When the two occur together, the addition of the narcissistic and borderline personality disorder traits of the allied and supposedly “favored” parent transforms the family dynamics into a particularly malignant and virulent form of the cross-generational parent-child coalition.  It is this malignant and particularly virulent form of cross-generational parent-child coalition that has traditionally been described as “parental alienation.” 

Nothing new, nothing exotic.  Personality disorders and cross-generational parent-child coalitions are simply standard psychological constructs with which all mental health professionals working with families should already be familiar as part of their existing professional competence.

No Excuse

Since the constructs of narcissistic and borderline personality disorders and cross-generational coalitions of the child with one parent against the other parent are established psychological constructs about which ALL mental health professionals working with children and families should be familiar, for ANY mental health therapist or child custody evaluator to miss making the diagnosis of the child’s cross-generational coalition involving a narcissistic/(borderline) parent that is targeted against a normal-range and affectionally available parent is simply unacceptable and represents professional incompetence.

The clinical evidence for the child’s cross-generational coalition with a narcissistic/(borderline) parent is clearly evident in the child’s symptom display (see Diagnostic Indicators and Associated Clinical Signs post) and the diagnostic clinical indicators are available to ANY professional who is competent in personality disorders and family systems constructs. If a mental health professional is NOT competent in personality disorders and family systems constructs, then that professional should not be diagnosing or treating family dynamics involving the presence of personality disorder dynamics, and should instead refer the client to a professionally competent child custody evaluator or therapist.

These are NOT new or exotic constructs. There is NO EXCUSE.

To the extent that professional incompetence in diagnosing narcissistic and borderline personality processes involved in a cross-generational parent-child coalition causes developmental, emotional, and psychological harm to the child client through the loss of an affectionally bonded attachment relationship with a normal-range and affectionally available parent (i.e., the parent who is rejected by the child as a result of the undiagnosed and so untreated psychopathology and pathogenic parenting of the narcissistic/(borderline) allied and supposedly “favored” parent within the parent-child coalition), this may represent negligent professional practice that is directly responsible for causing harm to the client.

To the extent that professional incompetence in diagnosing evident narcissistic and borderline personality processes involved in a cross-generational parent-child coalition causes harm to the targeted-rejected parent through the loss of an affectionally bonded attachment relationship with their child as a result of the undiagnosed and untreated psychopathology and pathogenic parenting of the narcissistic/(borderline) allied and supposedly “favored” parent within the parent-child coalition, this may represent negligent professional practice that is directly responsible for causing harm to the client.

Nothing New

No component of an attachment-based model of “parental alienation” is new or exotic.

Personality disorders are NOT new constructs. There is extensive literature regarding the dynamics of narcissistic and borderline personality disorder processes.

The triangulation of the child into the spousal conflict through a cross-generational coalition of the child with one parent that is against the other parent is not a new construct. It is a professionally established construct of family dynamics with extensive support in the family systems literature.

The attachment system and its characteristic functioning and dysfunctioning is not a new construct. There exists extensive professional research and literature regarding the nature, functioning, and dysfunctioning of the attachment system. There is also extensive literature linking narcissistic and borderline personality disorders to patterns of dysfunction in the attachment system, and regarding the transmission of dysfunctional attachment patterns from parents to children.

The psychological decompensation of narcissistic and borderline personality disorder processes into persecutory delusional belief systems is not new. One of the preeminent researchers and theorists in personality disorders, Theodore Millon (2011), explicitly links the decompensation of narcissistic personality processes under stress into persecutory delusional beliefs.

“Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders. Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs.

Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking. Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions.

Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence. They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up.

Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast.” (p. 407)

Delusional beliefs are a well defined construct in the DSM diagnostic system, and ALL mental health professionals are professionally required to be familiar will ALL diagnoses within the DSM diagnostic system.  Nothing new.

And the very term “borderline” as a descriptive label was derived from these personality organizations being on the “borderline” of neurosis and psychosis.

“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)

Nor is the reenactment of past trauma in current relationships new. A “repetition compulsion” was initially proposed by Freud, and there is significant research evidence supporting the reenactment of past trauma (see for example, Trippany, Helm, & Simpson, 2006; van der Kolk, 1989), and the reenactment of relationship patterns is a foundational component of Bowlby’s theoretical formulation for the functioning of the attachment system. We replicate our attachment patterns in future relationships.

Nothing about an attachment-based model of “parental alienation” is new.  All of the component elements are standard and established psychological principles and constructs.  The construct traditionally described as “parental alienation” represents the triangulation of the child into the spousal conflict through the formation of a cross-generational parent-child coalition between the child and a narcissistic/(borderline) parent.  The addition of parental narcissistic/(borderline) psychopathology transforms the cross-generational coalition into a particularly malignant and virulent form of family pathology.

The cross-generational coalition of the child with a narcissistic/(borderline) parent can be reliably recognized by a definitive set of diagnostic indicators and an associated set of predicted clinical signs (see Diagnostic Indicators and Associated Clinical Signs post).

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

Personality Disorders

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

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

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.

Trauma Reenactment

Freud, S. (1922). Beyond the Pleasure Principle (The Standard Edition). Trans. James Strachey. New York: Liveright Publishing Corporation.

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

van der Kolk, B.A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411

Standards of Practice

Association of Family and Conciliation Courts. (2006) Model standards of practice for child custody evaluation. Madison, WI: Author.

American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct. American Psychologist, 57, 1060-1073.

American Counseling Association. (2005) ACA code of ethics. Alexaandria, VA: Author.

Diagnostic Indicators and Associated Clinical Signs

Diagnostic Indicators

The presence in the child’s symptom display of a characteristic set of three diagnostic indicators represents definitive clinical evidence for the presence of pathogenic parenting by the allied and supposedly “favored” parent as representing the sole cause for the child’s symptomatic rejection of a relationship with the targeted parent.

(for more on the theoretical underpinnings for an attachment-based model of “parental alienation, see Childress, 2013a: Reconceptualizing Parental Alienationon my website or my blog post Three Levels of Analysis”).

The three definitive Diagnostic Indicators for the presence of an attachment-based model of “parental alienation” are:

Criterion 1: Attachment System Suppression

A: The child’s symptom display evidences a selective and targeted suppression of the normal-range functioning of the child’s attachment bonding motivations toward one parent, in which the child seeks to entirely terminate a relationship with this parent (i.e., a child-initiated cutoff in the child’s relationship with a normal-range and affectionally available parent).

B: A clinical assessment of the parenting practices of the rejected parent provides no evidence for severely dysfunctional parenting (such as chronic parental substance abuse, parental violence, or parental sexual abuse of the child) that would account for the child’s desire to completely sever the parent-child bond.

C: The parenting of the targeted-rejected parent is assessed to be broadly normal-range, with due consideration given to the wide spectrum of acceptable parenting practices typically displayed in normal-range families, and with due consideration given to the legitimate exercise of parental prerogatives in establishing family values, including parental prerogatives in the exercise of normal-range parental authority, leadership, and discipline within the parent-child relationship.

Criterion 2: Narcissistic Personality Symptoms

The child’s symptom display toward the targeted-rejected parent evidences a specific set of five narcissistic and borderline personality disorder symptoms that are diagnostically indicative of parental influence on the child by a parent who has narcissistic/(borderline) personality traits. The specific set of narcissistic and borderline personality disorder symptoms displayed by the child toward the targeted-rejected parent are,

Grandiosity: the child displays a grandiose self-perception of occupying an inappropriately elevated status in the family hierarchy above that of the targeted-rejected parent, from which the child feels entitled to sit in judgment of the targeted-rejected parent as both a parent and as a person. (DSM-5 Narcissistic Personality Disorder criterion 1)

Entitlement: an over-empowered sense of child entitlement in which the child expects that his or her desires will be met by the targeted-rejected parent to the child’s satisfaction, and if the rejected parent fails to meet the child’s entitled expectations to the child’s satisfaction, the child feels entitled to enact a retaliatory punishment on the rejected parent for the judged parental failure. (DSM-5 Narcissistic Personality Disorder criterion 5)

Absence of Empathy: a complete absence of empathy for the emotional pain of the targeted-rejected parent that is being caused by the child’s hostility and rejection of this parent. (DSM-5 Narcissistic Personality Disorder criterion 7)

Haughty and Arrogant Attitude: the child displays an attitude of haughty arrogance and contemptuous disdain for the targeted-rejected parent. (DSM-5 Narcissistic Personality Disorder criterion 9)

Splitting: the child evidences the psychological process of splitting involving polarized extremes of attitude, expressed in the child’s symptoms as the differential attitudes the child holds toward his or her parents, in which the supposedly “favored” parent is idealized as the all-good and nurturing parent while the rejected parent is entirely devalued as the all-bad and entirely inadequate parent. (DSM-5 Borderline Personality Disorder criterion 2)

Anxiety Variant

Some children may display extreme and excessive anxiety symptoms toward the targeted-rejected parent rather than narcissistic and borderline personality disorder traits.

In the anxiety variant of attachment-based “parental alienation” the child’s anxiety symptoms will meet DSM-5 diagnostic criteria for a Specific Phobia.

The type of phobia displayed by the child will be a bizarre and unrealistic “father type” or “mother type.”

Criterion 3: Delusional Belief System

The child’s symptoms display an intransigently held, fixed and false belief (i.e., a delusion) regarding the fundamental parental inadequacy of the targeted-rejected parent in which the child characterizes a relationship with the targeted-rejected parent as being emotionally or psychologically “abusive” of the child.

The child may use this fixed and false belief regarding the supposedly “abusive” inadequacy of the targeted parent to justify the child’s rejection the targeted parent (i.e., that the targeted parent “deserves” to be rejected because of the supposedly “abusive” parenting practices of this parent).

The presence of all three symptoms in the child’s symptom display represents definitive diagnostic evidence for the presence of pathogenic parenting emanating from the allied and supposedly “favored” parent as being the direct and sole causal agent for the cutoff of the child’s attachment bonding motivations toward the other parent.

DSM-5 Diagnosis

When this particular symptom set is displayed by the child, the appropriate DSM-5 diagnosis is:

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

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

Response to Intervention

When these diagnostic indicators are sub-threshold for a clinical diagnosis of attachment-based “parental alienation,” then a 6-month Response to Intervention (RTI) trial can be initiated addressing a non-alienation interpretation of the child’s symptomatology to clarify the diagnosis.

The additional presence of the theoretically grounded associated clinical signs of attachment-based “parental alienation” can also help confirm a diagnosis of an attachment-based model of “parental alienation” when the three definitive diagnostic indicators are present but may be sub-threshold for a firm diagnosis of attachment-based “parental alienation.”

Associated Clinical Signs

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent is made solely on the presence in the child’s symptom display of the three primary diagnostic indicators:

  1. Attachment system suppression
  2. Five specific narcissistic & borderline personality disorder symptoms
  3. The presence of delusional beliefs about the supposedly inadequate parenting of the targeted-rejected parent

Additional associated clinical signs are also often present in attachment-based “parental alienation.” The associated clinical signs, however, are not diagnostic. There are potentially a variety of other factors that can result in the presence of any individual associated clinical sign, and the absence of the associated clinical signs does not influence the diagnosis of pathogenic parenting by the allied and supposedly “favored” parent when the three primary diagnostic indicators of an attachment-based model of “parental alienation” are present in the child’s symptom display.

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent is made solely on the presence in the child’s symptom display of the three primary diagnostic indicators.

In order to limit the length of this blog post, the following is simply a “Headings” list description of the associated clinical signs, and a more complete elaboration of each clinical sign and the underlying theoretical justification for its presence from within an attachment-based model of “parental alienation” will be described separately in subsequent blog posts for each clinical sign individually.

  • Child Empowerment: Efforts by the allied and supposedly “favored” parent to empower the child’s active agency in rejecting the targeted parent by advocating that the child be allowed to “decide” issues related to custody and visitation (“we should listen to the child”), including efforts by the allied and supposedly “favored” parent to have the child testify in Court.
  • “Abuse”: The use of the terms “abuse” or “abusive” by the allied and supposedly “favored” parent to inaccurately characterize the parenting practices of the other parent.
  • Display of the “Protective Parent” Role: Displays by the allied and supposedly “favored” parent of the coveted role as the all-wonderful protective parent (e.g., “I only want what’s best for the child”), including the display of protective behaviors (e.g., unnecessarily providing the child with food or clothing to take to the other parent’s home) or “retrieval behaviors” (e.g., excessive or hidden phone calls, texts, and emails to the child when the child is in the care of the other parent).
  • Child Placed in Front: The allied and supposedly “favored” parent places the child in the leadership position of rejecting a relationship with the other parent, particularly at visitation transfers, and then adopts a “helpless stance” of parental incompetence (e.g., “What can I do, I can’t make the child go on visitations with the other parent.”).
  • Shared Victimization: The allied and supposedly “favored” parent and child support each other in their bond of “shared victimization” by the targeted-rejected parent (e.g., “I know just what the child is going through, the other parent treated me the same way during our marriage.”)
  • Repeated Disregard of Court Orders: The allied and supposedly “favored” parent repeatedly disregards Court orders for visitation and custody, which requires that the targeted-rejected parent repeatedly return to Court to seek enforcement of prior Court orders.
  • Characteristic Themes Offered for the Child’s Rejection:

The Insensitive Parent

  • “She always thinks of herself, she never considers what other people want.”
  • “It always has to be his way. He never does what I want to do.”

Anger Management

  • “He gets angry about the littlest things. He has anger management problems.”
  • “She can’t control her temper. She’s always getting angry over nothing.”

Doesn’t Take Responsibility

  • “I don’t trust my mother. She’s such a liar. She doesn’t take responsibility for anything she does wrong.”

Vague Personhood

  • “I don’t know, it’s just something about the way she says stuff… it’s so irritating… like her tone of voice or something.”
  • “He just bothers me. He’ll ask me questions and things. It’s just annoying. I just want him to leave me alone.”

New Romantic Relationship of Parent

  • The theme is that the targeted parent is neglecting giving attention to the child because of the parent’s new romantic relationship or spouse
  • “He is always spending time with his new girlfriend. He doesn’t spend enough special time with just me.” (“… so that’s why I never want to see this parent again, because I want more special time with this parent.” – ???)

The Non-forgivable Grudge

  • “I can’t forgive my mother for what she did in the past. I just can’t get over what happened in the past.”
  • “She deserves being rejected for what she did in the past”

(the assertion or implication that the targeted parent “deserves” to be punished for some past failure as a parent/(person) is highly characteristic of attachment-based “parental alienation”)

  • Vacancy of Attachment System
  • Absence of possessive ownership of the parent (e.g., the child refers to the targeted parent by his or her first name, or the child uses the parental label of “mother” or “father” for the step-parent/spouse of allied and supposedly “favored” parent)
  • Characteristic Double-Binds for Targeted Parent

Accepting the Rejection

  • If the targeted parent does not comply with the child’s desire to discontinue their relationship, then this is used as “evidence” that the rejected parent isn’t being sensitive to what the child wants. (i.e.g, “Maybe I’d want to spend time with my mom if she’d just let me live with my dad.”)
  • If the targeted parent complies with the child’s expressed desire to discontinue their relationship, then the child (and alienating parent) use the absence of the targeted-rejected parent’s involvement as “evidence” that the targeted parent doesn’t care about the child.

Banishment

  • The child banishes the parent from activities
  • “I don’t want my mom to come to my dance performance (baseball games, graduation, etc). It just stresses me out and I can’t concentrate.”
  • The rejected parent is then placed in a double-bind: Go to the child’s event and be blamed for not being “sensitive” to what the child wants, or don’t go to the event and be blamed for not caring about the child and for not being involved with the child.

Discipline

  • The child provokes parental discipline by being rude, defiant, or disrespectful,
  • If the targeted parent responds with discipline, then the child (and alienating parent) use this parental disciplinary response as “evidence” of the overly harsh and punitive parenting practices of the targeted-rejected parent, which is then used to justify the child’s rejection of the targeted parent.
  • If the targeted-rejected parent ignores or accepts the child’s defiance or verbal abuse, then this is offered as “evidence” of the poor parenting skills of this parent that is causing the child’s behavior problems with this parent.

No Apology

  • The child makes the accusation that the targeted-rejected parent never listens to the child’s complaints and/or never apologizes for parental wrongdoing. The child then offers a distorted and inaccurate characterization of a past episode that places the parent in a double-bind:
  • If the targeted-rejected parent tries to correct the child’s false and inaccurate characterization of the event, then this is used as “evidence” that the parent doesn’t listen to the child and doesn’t apologize for past wrongdoing.
  • If, however, the parent accepts the child’s distorted characterization, or apologizes for his or her parental response (often at the misguided and insistent prompting of the therapist), then this gives credence to the child’s false and distorted characterization of the event, which the child then uses from that point on as “evidence” to justify the child’s hostility and rejection of the targeted parent (“I just can’t forgive him/her for what happened in the past”)

Preponderance of Clinical Evidence

While not diagnostic, the presence of the associated clinical signs of attachment-based “parental alienation” in addition to the three primary diagnostic indicators represents supportive diagnostic evidence. When added to the three primary diagnostic indicators, the presence of additional clinical signs results in the clear preponderance of clinical data all constellating around the same clinical diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation.”

 Beyond Reasonable Clinical Doubt

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent creating the child’s symptomatic rejection of a relationship with a normal-range and affectionally available parent is based SOLELY on the diagnostic features evident in the child’s symptom display.

It is NOT NECESSARY to diagnose the allied and supposedly “favored” parent as a having a personality disorder in order to establish pathogenic parenting inducing the child’s symptom display, since there is no other clinical diagnosis available that could account for the features of the child’s symptom display other than pathogenic parenting associated with an attachment-based model of “parental alienation.”

The diagnosis of pathogenic parenting (associated with attachment-based “parental alienation”) is based SOLELY on the child’s symptom display, and the presence in the child’s symptom display of the three characteristic diagnostic indicators of attachment-based “parental alienation” represents definitive clinical evidence for the presence of pathogenic parenting by the allied and supposedly “favored” parent creating the child’s symptomatic rejection of a relationship with the other parent.

Craig Childress, Psy.D.
Psychologist, PSY 18857

References

Childress, C.A. (2013a). Reconceptualizing Parental Alienation: Parental Personality Disorder and the Trans-generational Transmission of Attachment Trauma. Retrieved 11/18/13 from http://www.drcachildress.org/asp/Site/ParentalAlienation/index.asp

Childress, C.A. (2013b). DSM-5 Diagnosis of “Parental Alienation” Processes. Retrieved 11/18/13 from http://www.drcachildress.org/asp/Site/ParentalAlienation/index.asp