Category: Diagnosis

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 Alienation” on 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

A clinical psychologist is like a detective.  Both systematically collect evidence to reconstruct what occurred in a particular situation.

In the case of the detective, the goal is to rely on the evidence to identify the cause of a crime, while for the psychologist the goal is to rely on the evidence to determine the cause of the symptoms.

Type of Crime = Presenting Problem

The first important information for the detective is the type of crime being investigated.  Is the crime a murder, a burglary, kidnapping, embezzlement?  Each type of crime will have a typical set of important information associated with it, yet the detective also avoids limiting the initial investigation based solely on the type of crime. Murders can occur as part of a burglary or to cover up embezzlement.

The detective uses the type of crime to initially structure the collection of relevant evidence, yet the detective remains open to following the evidence as it emerges and to altering initial impressions based on where the evidence leads.

For the clinical child psychologist, the “presenting problem” represents the “type of crime” in the analogy to the detective. The presenting problem defines the broad domain of initial information that is relevant to collect.  Is the issue child defiance of parental directives, angry parent-child conflicts, school failure and classroom behavior problems, ADHD, child substance abuse?  Each of these presenting problems will have a different set of important information associated with them. 

However, the clinical child psychologist also remains open to following the clinical evidence into other domains that are not necessarily part of the presenting problem.  For example, school behavior problems can result from ADHD or undiagnosed learning disabilities, and parent-child conflicts could be the product of unidentified child substance abuse, or even problems in the marital relationship.  The psychologist uses the presenting problem to initially structure the collection of relevant clinical evidence, yet the psychologist remains open to following the evidence as it emerges from systematic clinical interviewing, and to altering initial clinical impressions when the evidence suggests alternative or additional issues.

Suspects = Differential Diagnoses

Based on the initial analysis of the evidence, the detective develops a tentative hypothesis of what occurred at the crime scene and begins formulating a set of possible suspects.

Additional evidence is then sought to confirm or dis-confirm these initial tentative hypotheses about the crime and possible suspects.  While forming initial “leads” regarding possible causes and suspects in the crime, the detective avoids a rush to judgment that too quickly shuts down consideration of alternative possibilities. 

The detective considers all possibilities and seeks evidence that may support some leads and that may dis-confirm other possibilities and suspects.  For example, in investigating a possible suspect, it may turn out that this suspect has an alibi and so it becomes less likely that this person committed the crime, while following up another lead may result in additional evidence pointing to an alternative suspect as possibly committing the crime. 

The detective considers all possibilities, forms tentative hypotheses, and follows up by collecting additional relevant evidence to support or dis-confirm these tentative hypotheses.

The clinical psychologist similarly considers all possibilities and then systematically collects information (clinical evidence) that dis-confirms some hypotheses and that supports other hypotheses.  This process is called “differential diagnosis.” Gradually, as the clinical evidence is systematically collected, the evidence begins to constellate around some causal possibilities and begins to rule out other possibilities.

When a preponderance of clinical evidence constellates around one clinical diagnosis and rules out alternative possibilities, so that this diagnosis can be established beyond a reasonable level of clinical doubt, then this becomes the clinical diagnosis regarding the causal origins of the child’s symptoms that is then used to organize the development of a treatment plan.

Interpreting Evidence

The more the detective understands about how crimes occur and the more the science regarding crime scene investigation advances, the more the detective is able to collect relevant evidence that leads to an accurate conclusion regarding the causal origins of the crime. 

Rarely is eye witness testimony or a confession available. Instead, the detective must rely on secondary evidence that leads to a particular suspect. In addition to circumstantial evidence such as history, motive, and opportunity, more sophisticated evidence, such as ballistics evidence, fingerprints, and DNA evidence, can all provide additional indirect evidence regarding possible suspects.

However, if a detective doesn’t understand the value or role of this advanced secondary evidence, such as ballistics, fingerprint, or DNA evidence, then the detective might not collect this evidence at the crime scene or might not correctly interpret and integrate this secondary more sophisticated evidence with other more basic information about the crime.

In analyzing and interpreting sophisticated evidence, the detective has an advantage over the clinical psychologist, since the detective can simply collect the sophisticated evidence and then send it out to a crime lab for analysis and interpretation.  Clinical psychologists do not have that luxury with advanced clinical information. 

The clinical child psychologist must understand the nature, role, and interpretation of advanced clinical information so that the clinical psychologist knows both to collect this clinical evidence and also how to interpret the advanced clinical evidence.  The more knowledgeable and experienced the clinical child psychologist is in understanding advanced psychological principles and constructs, the more evidence becomes available to the psychologist and the more accurately the clinical psychologist can determine the causal origins of the child’s symptoms.

If the clinical child psychologist believes that child symptoms are caused by demon possession, then this severely restricts the collection and interpretation of clinical evidence regarding the cause of the child’s symptoms.  If, on the other hand, the clinical child psychologist has a professional understanding for advanced principles of child development and family relationships, such as:

• the nature and role of the attachment system (Ainsworth, 1989; Bowlby, 1969, 1973, 1980; Bretherton, 1990; 1992; Bretherton & Munholland, 2008; Lyons-Ruth, Bronfman, & Parsons, 1999; van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999),

• the construct of intersubjectivity in relationships (Cozolino, 2006; Fonagy, Luyten, & Strathearn, 2011; Kaplan & Iacoboni, 2006; Shore; 1994; 1996; 1997; Stern, 2004; Tronick, 2003; Tronick, et al., 1998; Trevathan, 2001),

• the impact of parental narcissistic and borderline personality disorders on family relationships (Beck, et al., 2004; Kernberg, 1975; Kohut, 1972; Millon, 2011; Linehan 1993)

• and family systems constructs such as triangulation, boundaries, and coalitions (Goldenberg & Goldenberg, 1996; Haley, 1977; Minuchin, 1974)

then this advanced knowledge allows the clinical psychologist to collect valuable secondary evidence that provides a more accurate diagnosis, that then is used to guide the development of an effective treatment plan.

If, however, a detective does not understand the value and role of ballistics, fingerprint, and DNA evidence, then the detective does not look for and collect this evidence and so does not have this advanced level evidence available in solving the crime.

Similarly, if the clinical child psychologist is not knowledgeable about the characteristic “goal-corrected” functioning and dysfunctioning of the attachment system, about intersubjectivity in relationships and the socially mediated neurodevelopment of the brain during childhood, about the characteristic features and influence of parental narcissistic and borderline parenting processes on family relationships, and regarding family systems constructs of triangulation, boundary disturbances, and coalitions, then the clinical psychologist does not look for or collect clinical evidence in these domains and then does not have this advanced level information available in developing a clinical diagnosis.

We would be appalled at a detective who failed to collect, use, and interpret ballistics evidence, fingerprint evidence, or DNA evidence in solving a crime. 

Why then do we accept a such a level of professional ignorance and professional incompetence from mental health professionals? 

It seems we hold mental health professionals to a lesser standard of professional practice than detectives.  I don’t know why.  The failure of the mental health professional to accurately diagnose the child’s symptoms will lead to ineffective treatment that leaves the child symptomatic.  This can have both short-term and long-range negative impacts on the child’s emotional, psychological, and social development that can influence both the child’s latter marital relationship as well as the child’s own parenting with his or her children in the future, thereby transmitting the psychological dysfunction to later generations.

The developmental and psychological costs on the child for the failure of mental health to accurately diagnose the child’s symptoms can be extremely destructive.  So it is beyond me why we should accept and tolerate professional ignorance and incompetence in the diagnosis and treatment of children. 

This blog post has a “Comment” section, perhaps child custody evaluators and mental health therapists who lack an advanced level of understanding for the attachment system, for intersubjectivity and the socially mediated neurodevelopment of the brain during childhood, for the characteristic features and display of parental narcissistic and borderline personality dynamics in family relationships (including the child’s incorporation into a role-reversal relationship with the narcissistic/(borderline) parent and the child’s display of co-narcissistic over-developed social sensitivity and precocious maturity), and for family systems constructs of triangulation, boundary disturbances, and coalitions… perhaps child custody evaluators and mental health therapists who lack a knowledge and understanding for these advanced level domains of psychology can explain to me why they don’t need to know this information, why it is acceptable for them to be ignorant.

In my view, this would be like a detective arguing that he or she doesn’t need to collect and interpret ballistics evidence, or fingerprint evidence, or DNA evidence.  “It’s okay, I don’t need that information.”

That’s a very interesting position.  But one with which I completely disagree.  Our children and families should receive the highest standard of care possible.  Anything less is unacceptable.

Planted Evidence

Imagine a detective who came to investigate a crime scene and found an unsigned typewritten note saying, “My name is Bob Jones and I committed this crime.”

It would be a pretty horrible detective who then said, “Well, I guess this case is solved.  We have a confession from Bob Jones.”  Particularly if the detective subsequently interviewed Bob Jones who denied ever committing the crime and ever having written the note.

“Well, even though you deny the crime and deny writing the note, I have the note saying you committed the crime, so that’s the evidence I’m going to rely on.  Therefore, you committed the crime.”

What a horrible detective.

Any even marginally competent detective would consider the possibility that the unsigned typewritten note was PLANTED evidence trying to frame Bob Jones for the crime. So in addition to investigating whether Bob Jones did indeed commit the crime (i.e., Bob may remain a suspect), the detective would also entertain the possibility that this supposed “confession note” was planted evidence designed to frame Bob Jones and distract the investigation from the true source of the crime.

The detective would then collect evidence, including ballistics, fingerprint, and DNA evidence, and follow wherever the evidence led.

The child’s symptoms of rejection for the targeted parent in cases of attachment-based “parental alienation” represent PLANTED “evidence” designed to frame the targeted parent as being a bad parent.

The key to recognizing the child’s symptoms as PLANTED evidence are the “psychological fingerprints” all over the child’s symptoms of psychological influence and control by a narcissistic/(borderline) parent.  Chief among this “psychological fingerprint” evidence is a specific set of five narcissistic and borderline personality traits evidenced in the child’s symptom display toward the targeted parent.

We cannot psychologically control and induce symptoms in a child without leaving “psychological fingerprints” of our control and influence of the child in the symptom display of the child.

The three diagnostic indicators of attachment-based “parental alienation” (see Diagnosis of Attachment-Based Parental Alienation), and particularly the presence of a specific set of a-priori predicted narcissistic and borderline personality disorder traits in the child’s symptom display, represent the definitive “psychological fingerprint” evidence that the child’s symptomatic rejection of a relationship with the normal-range and affectionally available targeted parent is the result of pathogenic parenting by the allied and supposedly “favored” narcissistic/(borderline) parent.

There is no other possible explanation for this specific set of child symptoms other than the pathogenic influence on the child by an allied and supposedly favored narcissistic/(borderline) parent.

The presence in the child’s symptom display of the three characteristic diagnostic indicators of attachment-based “parental alienation” (see Diagnosis of Attachment-Based Parental Alienation) represents definitive clinical evidence beyond a reasonable doubt that pathogenic parenting by the allied and supposedly “favored” parent represents the sole causative agent for the child’s symptomatic rejection of a relationship with the other, normal-range and affectionally available targeted parent.

Preponderance of Evidence

There are also additional clinical signs evidenced in the child’s symptom display toward the targeted parent that offer additional clinical evidence that the child’s symptomatic rejection of the targeted parent is being induced by the distorted pathogenic parenting practices of the allied and supposedly “favored” parent. 

Taken together with the three definitive diagnostic indicators, the presence of additional clinical indicators results in a preponderance of clinical evidence constellating around the interpretation of the child’s symptom display toward the targeted parent as representing PLANTED evidence designed to frame the targeted parent as a bad parent, while the actual cause of the child’s symptoms lay in the severely distorted pathogenic parenting practices of the allied and supposedly “favored” narcissistic/(borderline) parent.

Only an atrocious psychological detective would miss collecting and interpreting this definitive clinical evidence.

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

References:

Attachment System

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

Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment, . 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. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11, 237-252.

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

Bretherton, I., & Munholland, K. (2008). Internal working models in attachment relationships:  Elaborating a central construct in attachment theory.  In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 102-130). New York: Guilford Press.

Lyons-Ruth, K., Bronfman, E. & Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. In J. Vondra & D. Barnett (Eds.) Atypical patterns of infant attachment: Theory, research, and current directions. Monographs of the Society for Research in Child Development, 64, (3, Serial No. 258).

van IJzendoorn, M.H., Schuengel, C., & Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249.

Intersubjectivity

Cozolino, L. (2006): The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. WW Norton & Company, New York.

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

Kaplan, J. T., & Iacoboni, M. (2006). Getting a grip on other minds: Mirror neurons, intention understanding, and cognitive empathy. Social Neuroscience, 1(3/4), 175-183.

Shore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Earlbaum.

Shore, A.N. (1996). The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Development and Psychopathology, 8, 59-87.

Shore, A.N. (1997). Early organization of the nonlinear right brain and development of a predisposition to psychiatric disorders. Development and Psychopathology, 9, 595-631.

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

Tronick E.Z., Brushweller-Stern N., Harrison A.M., Lyons-Ruth K., Morgan A.C., Nahum J.P., Sander L., Stern D.N. (1998). Dyadically expanded states of consciousness and the process of therapeutic change. Infant Mental Health Journal, 19, 290-299.

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.

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

Narcissistic & Borderline 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.

Kohut, H: Thoughts on narcissism and narcissistic rage. Psychoanalytic Study of the Child 1972; 27:560-400.

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.

Family Systems

Goldenberg, I. and Goldenberg, H. (1996). Family therapy: An overview. 4th Ed. 
Pacific Grove, CA: Brooks-Cole Publishing Company

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.

Dr. Childress is a psychologist, not an attorney. This essay is not meant as legal advice.  For legal advice, consult an attorney and follow the counsel of your attorney.  This article discusses the possible application of psychological constructs in a legal setting.  Dr. Childress is a psychologist.

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The “Puppet Master”

If the details of “parental alienation” need to be proven through the legal system, then the targeted-rejected parent is in trouble. The solution for attachment-based “parental alienation” is to be found through the mental health system, not through the legal system. When mental health speaks with a single voice the legal system will be able to rely on the testimony of mental health, and so can act with the necessary clarity to solve “parental alienation.”

In the meantime, however, targeted-rejected parents may need to turn to the legal system in order to protect and defend their children from the psychopathology of the narcissistic/(borderline) parent.  Attachment-based “parental alienation” is not a child custody issue, it is a child protection issue.

Proving Gardner’s model of Parental Alienation Syndrome (PAS) in court can be extremely difficult, if not nearly impossible, because the theoretical understructure of PAS is based on anecdotal clinical indicators with no foundation in established psychological principles or constructs .

The psychopathology of the narcissistic/(borderline) parent is insidious, so that it can be hidden from general view by the veneer of the child’s induced and adopted role as “the victim” and the role adopted and displayed by the narcissistic/(borderline) parent as the supposedly “understanding” and “protective” parent.  The script for the displayed drama is well written and rehearsed, and the theater can be convincing to the susceptible.

Through the highly distorted parenting practices of the narcissistic/(borderline) parent, the child is induced-seduced into psychologically surrendering to the controlling influence of the narcissistic/(borderline) parent (see “The Hostage Metaphor” article on my website; http://www.drcachildress.org).  Once the child surrenders into adopting the “victim role” relative to the other parent, the narcissistic/(borderline) parent then places the child into the front, into the leadership position, in expressing the child’s supposed “victimization” by the supposedly “abusive” targeted parent.  It is the child who holds the pathology, but it is the narcissistic/(borderline) parent who is the source of this pathology.

By placing the child in front as the supposed “victim” of the the allegedly “abusive” parenting of the other parent, the actual source of the pathology within the family (i.e., the narcissistic/(borderline) parent) is hidden from view.  Placing the child into the leadership position in expressing the pathology directs the focus of mental health professionals and the legal system onto scrutinizing the parenting of the supposedly “abusive” targeted parent who is accused by the child’s adopted and presented role as a “victim,” an induced role that is then actively supported by the narcissistic/(borderline) parent,

“Oh you poor child, I can’t believe the other parent is so abusively insensitive of your emotional needs.”

“I know just how the child feels, the other parent was the same way with me during our marriage.”

In the child’s presentation as a “victim,” our attention is drawn to the puppet and away from the puppet master.  And if the targeted parent tries to expose the controlling influence on the child that is being exercised by the narcissistic/(borderline) parent, then the targeted parent is accused of “not taking responsibility” for his or her supposedly bad parenting practices.  The focus remains on the puppet show, and away from the puppet master.  It’s the perfect manipulative control.

Inducing the child into adopting the “victim” role (supposedly occurring at the hands of the “abusive” parenting of the targeted parent) allows the narcissistic/(borderline) parent to then adopt and display as the coveted and narcissistically desired “all wonderful” and “protective” parent.  And the false roles within this artificially constructed drama are readily believed by the susceptible.

The appearance of bonding between the child and the narcissistic/(borderline) parent is NOT a sign of a positive parent-child relationship, but is instead a symptom of severe psychopathology called a role-reversal relationship, with its source in the pathogenic parenting of a narcissistic/(borderline) parent.

The narcissistic/(borderline) parent draws “narcissistic supply” as the “all-wonderful” perfect parent from the child’s induced  surrender to the psychological control of the narcissistic/(borderline) parent, and the apparent bonding is actually a very pathological role-reversal relationship in which the child is being used to meet the psychological needs of the narcissistic/borderline parent.

“Prove It”

When we try to expose the narcissistic/(borderline) parent as the puppet master, the response of the narcissistic/(borderline) parent is essentially, “prove it.”

We are then required to “prove” the psychological control of the child that is evident from careful inspection but that is so insidious as to be hidden from common gaze. The evidence of the control is present, but recognizing it requires an advanced understanding of psychological processes, too advanced for many in the mental health system and too advanced for the ready comprehension of the legal system. The legal system must rely on the testimony of psychology.

While the psychological evidence is complicated, the legal system does not need to litigate the advanced principles of psychology that are involved but can instead rely on the testimony of professional psychology.  Yet for the legal system to rely on the testimony of professional psychology, all of professional psychology must speak with a single voice. Dissent within professional psychology fractures the testimony to the Court which allows the pathology to remain hidden.

An attachment-based model of “parental alienation” is an accurate description of the psychological processes involved.  An attachment-based description of these psychological processes is based entirely within established and scientifically supported psychological constructs and principles, so that an attachment-based model of parental alienation” can serve to unite professional psychology into a single voice.

And it can both identify the psychopathology and “prove it.” Key to understanding this proof, is that the psychological control of a child by a narcissistic/(borderline) parent will leave “psychological fingerprints” in the symptoms of the child.

“Psychological Fingerprints”

The psychologist is like a detective investigating a murder… the murder of the authentic child who loves the targeted-rejected parent.   The murder weapon is the symptomatic child, who is being used by the narcissistic/(borderline) parent to kill the authentically loving child of that parent. The targeted parent used to have a loving child. But that child is gone. That child is dead.

And there are no eye witnesses to the murder. The killing of the authentic child is committed outside of public view. Yet without an eye witness how can the murder of the authentic child be proven?

Yet even without an eyewitness to the murder of the authentic child, there is nevertheless substantial and convincing evidence that the allied and supposedly “favored” parent is the perpetrator, who is using the symptomatic child as the murder weapon.  The psychological control of a child by a narcissistic/(borderline) parent will leave “psychological fingerprints” of the control in the symptom display of the child.

These “psychological fingerprints” are most directly evident in the narcissistic and borderline symptoms of the child that occur in association with the suppression of the normal-range functioning of the child’s attachment system and along with a delusional belief system displayed by the child that the parenting practices of the other parent, the targeted parent, are somehow “abusive” in their inadequacy, when they are not. The parenting practices of the targeted-rejected parent are normal-range.

This set of three symptoms in the child’s symptom display represent definitive diagnostic indicators of the distorting influence on the child of pathogenic parenting practices by a narcissistic/(borderline) parent that are inducing severe developmental, personality, and psychiatric symptoms in the child.  There is NO OTHER EXPLANATION possible for the presence in the child’s symptom display of this disparate set of a-priori predicted specific symptoms other than the pathogenic parenting of a narcissistic/(borderline) parent, in which the child acquires and expresses the psychological state of the narcissistic/(borderline) parent, hence the presence in the child’s symptom display of narcissistic and borderline personality traits.

This definitive and specific set of three diagnostic indicators, 1) attachment system suppression, 2) narcissistic and borderline traits in the child’s symptom display, and 3) a delusional belief expressed by the child regarding the supposedly “abusive” parenting of the targeted-rejected parent, represent the “psychological fingerprints” in the child’s symptoms (i.e., on the “murder weapon”) of the pathogenic psychological control and influence of the child by a narcissistic/(borderline) parent that is inducing severe developmental psychopathology (i.e., distortions to and suppression of the normal-range functioning of the child’s attachment system), personality distortions (i.e., the child’s acquisition of prominent narcissistic and borderline personality traits), and psychiatric symptoms (i.e., a delusional belief system that is resulting in the loss for the child of an affectionally bonded relationship with a normal-range and affectionally available parent).

Severely distorting pathogenic parenting practices by a narcissistic/(borderline) parent that are inducing severe developmental, personality, and psychiatric psychopathology in the child would seemingly warrant a DSM-5 diagnosis of “V995.51 Child Psychological Abuse, Confirmed” and would raise serious child protection concerns that rise beyond simple child custody and visitation considerations.

The Detective Metaphor

The psychologist is like a detective at a crime scene, collecting clinical evidence of what occurred.  The report of a child custody evaluation contains the clinical evidence collected by the custody evaluator, and if this evidence is correctly interpreted the “psychological fingerprints” of the child’s control by a narcissistic/(borderline) parent become evident.  However, the interpretation of the clinical evidence  collected through child custody evaluations sometimes (often) fails to recognize the degree of psychopathology within the family, and fails to “dust” for the “psychological fingerprints” of control by a narcissistic/(borderline) parent on the “murder weapon” of the symptomatic child.

Without the “psychological fingerprint” evidence, the presence of other circumstantial evidence is usually not deemed sufficient to “convict” the allied and supposedly “favored” parent of inducing the suppression of the child’s attachment bonding motivations toward the other parent, so that the custody evaluator often recommends joint custody, or primary custody to the allied and supposedly “favored” parent, along with therapy for the child and  targeted-rejected parent.

But the child in attachment-based “parental alienation” is essentially being held as a psychological hostage to the psychopathology of the narcissistic/(borderline) parent (see my article “The Hostage Metaphor” on my website, http://www.drcachildress.org).  Therapy will be ineffective unless and until we are first able to protect the child from psychological retaliation by the narcissistic/(borderline) parent if the child dares to show attachment bonding to the targeted parent, or even fails to show sufficient rejection of the targeted parent.

A more advanced review of the clinical data contained in the custody evaluation, however, can often reveal the “psychological fingerprints” of the child’s control by a narcissistic/(borderline) parent.  If the three characteristic diagnostic indicators of attachment based “parental alienation” are evident in the child’s symptom display, then this represents definitive clinical evidence for the child’s psychological control by a narcissistic/(borderline) parent.

It is NOT necessary to formally diagnose the allied and supposedly “favored” parent as having narcissistic and borderline personality traits, although evidence of these traits in the allied and supposedly “favored” parent would serve as confirming clinical evidence.

In other words, it is NOT necessary to have direct “eye witness” evidence regarding the “murder.”  The presence in the child’s symptom display of the three characteristic diagnostic indicators (i.e., the “psychological fingerprints”) of the child’s psychological influence and control by a narcissistic/(borderline) parent represents sufficient and definitive clinical evidence that the symptomatic child-initiated cut-off of the child’s relationship with the other parent is the direct result of the pathogenic parenting practices of a narcissistic/(borderline) parent (i.e., the allied and supposedly “favored” parent), who is using the child in a role-reversal relationship as a “regulatory other” (see my blog essay: Parental Alienation as Child Abuse: The Regulating Other) for the psychopathology of the narcissistic/(borderline) parent.

The Clinical Evidence

In the evidence reported in the child custody evaluation, the mental health professional (i.e., the “psychological detective”) will want to look for the following “psychological fingerprint” evidence in the child’s symptom display:

1.  Splitting:  The child maintains dichotomous black-and-white perceptions of his or her parents, in which one parent (the allied and supposedly “favored” parent) is perceived as the “all-good,” wonderful and perfect parent, while the other parent is perceived as the “all-bad,” devalued and degraded parent. (DSM-5 Borderline Personality Disorder criterion 2; American Psychiatric Association, 2013)

2.  Grandiosity:  The child perceives himself or herself to be in an elevated role status within the family above that of the targeted-rejected parent, and from which the child feels entitled to judge the targeted-rejected parent as a parent and as a person. (DSM-5 Narcissistic Personality Disorder criterion 1; American Psychiatric Association, 2013)

3.  Entitlement:  The child feels entitled to have his or her every desire met by the targeted-rejected parent to the child’s satisfaction, and if the targeted-rejected parent fails to meet the child’s entitled expectations to the child’s satisfaction, the child then feels entitled and justified in exacting a retaliatory retribution against the targeted-rejected parent for the judged parental failure. (DSM-5 Narcissistic Personality Disorder criterion 5; American Psychiatric Association, 2013)

4.  Absence of Empathy:  The child displays a complete absence of empathy for the emotional suffering of the targeted-rejected parent that is the result of the child’s behavior and attitude toward this parent.  The child may actually make immensely cruel and hurtful statements to the targeted-rejected parent without apparent distress or remorse from the child. (DSM-5 Narcissistic Personality Disorder criterion 7; American Psychiatric Association, 2013)

5.  Haughty and Arrogant Attitude:  The child displays a haughty and arrogant attitude of dismissive contempt for the personhood of the targeted-rejected parent, as if this parent “deserved” to suffer because of the fundamental unworthiness of the targeted-rejected parent. (DSM-5 Narcissistic Personality Disorder criterion 9; American Psychiatric Association, 2013)

This set of “psychological fingerprints” in the child’s symptom display is only possible through the psychological control of the child by a narcissistic/(borderline) parent. There is no other explanation possible for this set of clinical evidence in the child’s symptom display.

Craig Childress, Psy.D.
Licensed Clinical Psychlogist, PSY 18857