Identifying Pathology

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No. This is the wrong diagnosis.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

 

Foundations: The Book

My book “An Attachment-Based Model of Parental Alienation: Foundations” is due for publication in the next few weeks.  This book is the culmination of my work over the past seven years to redefine the construct of “parental alienation” from entirely within standard and established mental health constructs and principles.

This book will fundamentally alter the current discussion surrounding the construct of “parental alienation” and will provide a solution for targeted parents to their nightmare.  

“Foundations” provides a complete and elaborated description for the construct of “parental alienation” from entirely within standard and established psychological principles and constructs to which mental health professionals can be held accountable.

After reading “Foundations,” mental health and legal professionals will no longer be able to say, “I don’t believe in parental alienation” or “parental alienation doesn’t exist.”  It exists. It is not a matter of belief.  And “Foundations” describes what it is.

We begin the construction of any structure by first laying a solid foundation that can support the structure.  An attachment-based model for the construct of “parental alienation” provides an anchored and substantial description for what “parental alienation” is from entirely within standard and established psychological principles and constructs.

“An Attachment-Based Model of Parental Alienation: Foundations” defines the construct of “parental alienation” on the solid bedrock of established psychological principles and constructs that can be leveraged into a solution.  The entire discussion surrounding “parental alienation” is about to change.

In your fight for your children, “Foundations” will become your lance, your sword, and your shield.  We will end this nightmare. Today.  Now.

In “Foundations” I have provided you with the professional concepts and theoretical structure that you need to enact the solution. I strongly recommend that every targeted parent read this book so that you become knowledgeable and conversant in the coming dialogue, and then we must get this book into the hands of every mental health and legal professional working with this “special population” of children and families. Every child custody evaluator, every therapist, every minor’s counsel, every family law attorney, and every family law judge must read “Foundations.”

It is time to end “parental alienation.”  Today.  Now.  The time has come to restore the loving and affectionate bond of lost children with their parents who so desperately love them and miss them.

It is time for you to take up the lance, the sword, and the shield offered by an attachment-based model of “parental alienation” and engage the battle for your children.  We will end “parental alienation.”  It is a certainty – because we must.  There is no other alternative.

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

Dominoes Part 1: Paradigm Shift

This is the first post of a two-part series.  The second post in the series is “Dominoes Falling: The Sequence


The story is familiar.

Obvious indicators of severe “parental alienation” are evident, and may even be acknowledged by mental health professionals, but key mental health social workers, therapists, and custody evaluators fail to stand up and identify the obvious. 

They avoid acknowledging the obvious pathology by saying,

“I don’t believe in parental alienation.”

How is it that so many people, therapists, social workers, child custody evaluators, child attorneys, judges, can simply dismiss the severely distorting influence on the child by the narcissistic/(borderline) parent? How is that possible? Why does that happen?

The Failure of the PAS Paradigm

The reason people can simply dismiss “parental alienation” is because the Gardnerian PAS paradigm allows it. 

The PAS model described by Gardner in the mid-1980s is an abject failure.

In the 30 years since its introduction, the PAS model has failed to solve the nightmare tragedy of “parental alienation. If any pro-Gardnerian PAS supporter actually wants to argue the point with me, my initial question will be,

“Are you seriously going to look targeted parents in the eye, hear their stories, the years of lost relationships with their children with no end in sight, the utter failure and incompetence of mental heath in recognizing and solving their nightmare, the tens of thousands of dollars spent in endless litigation, and with all this tragedy that surrounds us, you’re seriously going to maintain that the PAS model is a success?”

After 30 years, if it is not a success, it is a failure.  The PAS model is a failure because the nightmare continues.

Targeted parents, and more importantly their children, need a paradigm for the construct of “parental alienation” that successfully resolves the issue now.  Today.  In all cases.

The Solution Must be Efficient

The solution paradigm needs to achieve a full resolution to the pathology of “parental alienation” in less than six months, preferably in less than three months, preferably in less than six weeks – that’s my goal, and I honestly believe this goal is achievable.

Child Developmental Periods:

The developmental periods of childhood appear to have a two-year phase cycle built into them, in which new developmental phases open up about every two years, 4-6 years old; 6-8 years old; 8-10 years old; 10-12 years old; 12-14 years old; 14-16 years old; 16-18 years old.  It is as if the brain has an internal biological clock governing maturation that’s set at a two year rhythm.

There are distinctly different developmental qualities of children during each of these periods, and each active period of brain development during childhood relies on the successful prior development of neural networks created in the preceding developmental phases. Distortions to development in earlier phases create cascading distortions in later development.

When we are faced with problematic child development, we need to restore healthy and normal-range development as quickly as possible so as to lose minimal healthy maturation.

Losing more than 6 months of a 2-year cycle of development to psychopathology is unacceptable.

The severe pathology associated with attachment-based “parental alienation” needs to be fully resolved in less than 6 months, preferably less than 3 months so that we can restore the child’s normal-range developmental trajectory with minimal loss of healthy development.

The Solution Must be Affordable

The solution paradigm must be cost effective and broadly available to all parents and families. It cannot, therefore, rely on proving “parental alienation” in Court since this can take years and is prohibitively expensive for most normal-range families. The financial cost of proving “parental alienation” in Court places any solution that requires proving “parental alienation” in Court beyond the financial reach of most families. 

Any solution that requires proving “parental alienation” in Court will mean that we will wind up abandoning the children to the pathology. This is not acceptable.

The Solution Must Provide Professional Competence

Our children’s healthy development is far too important for us to permit and accept professional incompetence.

The solution paradigm must establish clearly defined standards of professional knowledge and professional practice to which ALL mental health professionals can be held accountable, so that we entirely eliminate ALL professional incompetence in treating this “special population” of children and families.

The issues surrounding the diagnosis and treatment of this “special population” of children and families requires specialized professional knowledge, training, and expertise – let me emphasize that… expertise – to appropriately, accurately, and competently diagnose and treat.

Professional ignorance and incompetence is not acceptable.

The solution paradigm MUST provide DEFINED standards for professional knowledge and competence to ensure professional expertise.

A paradigm shift is needed.

The Gardnerian paradigm for PAS meets NONE of these standards required for a successful paradigm.  An attachment-based model of “parental alienation” meets ALL of these standards for a successful paradigm.

The First Domino: The Paradigm Shift

There needs to be a foundational shift from a Gardnerian PAS definition for the construct of “parental alienation” to an attachment-based definition of “parental alienation.”

The only reason that people can say, “I don’t believe in parental alienation” is that they are allowed to reject Gardner’s proposal of a “new syndrome” in professional psychology that is based on his proposed anecdotal set of clinical signs that have no relationship to any established or validated scientifically based constructs or principles in professional psychology.

Gardner’s model of PAS allows people to believe or not believe it.

The critics of “parental alienation” have steadfastly maintained over thirty years of argument and debate that the Gardnerian PAS model lacks sufficient theoretical foundation… and you know what… they are absolutely right.

Both sides in this unnecessary debate are correct.

Gardner was correct in identifying the existence of a valid clinical phenomenon which he called “parental alienation.”  But then he too quickly abandoned the necessary professional rigor needed to define the construct of “parental alienation” within standard and established psychological principles and constructs. Instead, he took what I would consider an intellectually lazy approach of proposing a “new syndrome” consisting of a set of anecdotal clinical features.

The critics of the PAS model are also correct. They have argued, correctly, that the PAS model lacks scientifically grounded validity. They are absolutely right. But the failure of Gardner to apply the necessary professional rigor required to define the construct of “parental alienation” within scientifically grounded principles and constructs does not mean that there isn’t a valid clinical phenomenon that he recognized, only that Gardner’s description of it lacks robust scientific accuracy.

But instead of accepting the constructive criticism offered by the critics of PAS so as to then apply the necessary professional rigor needed to define the construct of “parental alienation” within standard and established psychological principles and constructs, the Gardnerian PAS advocates have stubbornly tried to argue and prove the existence of a “new syndrome.”   Why?   Take the constructive criticism offered to you and apply the necessary professional rigor needed to define the construct of “parental alienation” within standard and established psychological principles and constructs. Don’t be lazy.

When I first came across the nightmare tragedy of “parental alienation,” I was appalled at the level of professional incompetence in general mental health from professionals who entirely missed seeing the severe degree of pathology involved.  I was also stunned by the apparent sloth displayed by the PAS advocates in steadfastly proposing a “new syndrome” rather that simply applying the professional rigor needed to describe the construct of “parental alienation” using standard and established psychological constructs and principles.

In unraveling what “parental alienation” is, the child’s rejection of a relationship with a normal-range and affectionally available parent is clearly a distortion to the child’s attachment system. So let’s start there.

Next, the child is displaying narcissistic/(borderline) symptoms of grandiose judgment of a parent, an absence of empathy for the targeted parent (an extremely concerning child symptom by the way), a haughty and arrogant attitude of contemptuous disdain for the targeted parent, a prominent attitude of entitlement, and splitting.

Q: How does a child acquire these narcissistic/(borderline) symptoms?

A: Through an enmeshed psychological relationship with a narcissistic/(borderline) parent. That’s the ONLY way a child acquires these symptoms.

No sooner than I blink my eyes, and I’m two steps in to unraveling “parental alienation.”

The presence of an enmeshed relationship with a narcissistic/(borderline) parent strongly suggests a role-reversal relationship in which the child is being used as a “regulatory object” to regulate the emotional and psychological state of the parent.  A role-reversal relationship is associated with the “disorganized” category of attachment.

Going deeper.

Hey, you know what… the formation of narcissistic/(borderline) personality organization has also been linked to a disorganized attachment in childhood. So the personality disorder features of the parent are also linked to the attachment system. And the child is displaying severe distortions to the attachment system, and attachment trauma has been demonstrated to be transmitted across generations…

Within a relatively short period of time I was well on the way to uncovering the nature of the pathology from entirely within standard and established psychological principles and constructs.

I then set about researching, reading, poking around, looking up articles, reading, learning, researching, reading.  Connecting the lines of association, unpacking the material.  What does Kernberg say about narcissistic and borderline personalities?  What does Millon say?  What’s the research linking personality disorder formation and attachment? What’s the research on attachment trauma?  Forming the links. Doing the research.  Applying the professional rigor necessary to uncover what “parental alienation” is, and to define the construct of “parental alienation” from entirely within standard and established psychological constructs and principles.

Why?  Because the solution to “parental alienation” requires it.  In order to solve “parental alienation” we must first establish what it is.  The foundations for the construct must be established on the solid bedrock of scientifically valid constructs and principles.

Don’t be lazy.  Accept the criticism of establishment mental health and do the necessary work. If the criticism of PAS is that it lacks scientific foundation, then let’s set about describing what “parental alienation” is using scientifically established constructs and principles. Don’t let them reject the construct, and we do this by accepting and addressing their criticism.

That’s what I set about to do, and that’s what an attachment-based model of “parental alienation” accomplishes.  We now have a paradigm for describing the construct of “parental alienation” from entirely within the scientifically established constructs and principles of the attachment system, personality disorders, and established family systems constructs.

The attachment system isn’t a matter of belief.  It is a scientifically validated fact.

Personality disorders aren’t a matter of belief. They are established facts within the DSM diagnostic system.

Children’s triangulation into the spousal conflict and the formation of cross-generational coalitions aren’t a matter of belief.  These are core principles in a major and primary school of psychotherapy.

All of the constructs associated with an attachment-based model of “parental alienation,” are established and scientifically supported facts, not beliefs

The foundations for an attachment-based model of “parental alienation” are established on the solid bedrock of scientifically valid constructs and principles which will DISALLOW mental health professionals from saying they “don’t believe in parental alienation.” — It’s not a matter of “belief,” it’s a matter of ignorance or knowledge.

The robust scientific foundations surrounding an attachment-based model of “parental alienation” forces disbelievers to change their statement from “I don’t believe in parental alienation” to “I am ignorant and don’t know what I’m talking about.”

These are very different sentences.

None of the constructs used in an attachment-based model of “parental alienation” are a matter of “opinion.” If some ignorant critic wants to argue any of these points, I’ll simply point them to the writings of John Bowlby, Mary Ainsworth, and Mary Mains; to Otto Kernberg, and Theodore Millon, and Aaron Beck; to Salvador Minuchin and Jay Haley. These are the people saying these things, go argue with them.  I’m just applying what these people say.

And “these people” are among the top echelon of preeminent figures in professional psychology.  In all of professional psychology, there are no more respected figures in their respective domains than the experts I just listed.  An attachment-based model of “parental alienation” is grounded solidly on the bedrock of established psychological principles and constructs.

And then there are the next echelon of top-tier experts, Lyons-Ruth, Fonagy, Sroufe; Stern, Shore, Tronick, Masterson, Bowen, van der Kolk, van IJzendoorn. These too are among the preeminent recognized leaders in their respective fields. If you’re arguing with me, take it up with them. I’m simply applying their work to the construct of “parental alienation.”

“Well, Newton, I just I don’t believe in that gravity thing your proposing.”

It’s not a matter of belief, its a scientifically supported fact.

“You know, Galileo, that’s an interesting idea about the earth traveling around sun, but I just don’t believe it.”

It’s not a matter of belief, its a scientifically supported fact.

These are not matters of opinion or belief. They are recognized facts. The issue is not whether you believe them or not, its whether you are knowledgeable or ignorant.

An attachment-based model of “parental alienation” is not an opinion.  It’s a fact.

Changing Paradigms

The Gardnerian PAS description for “parental alienation” is so incredibly poor, and just plain lazy, that it ALLOWS people to believe it or not.

Solving the family tragedy of “parental alienation” is too important to leave it to the beliefs of the ignorant.  It is our responsibility to apply the necessary professional rigor required to define the construct of “parental alienation” within established and scientifically supported constructs, so that there is no question possible that it is a fact; not a belief, not an opinion, a fact.

An attachment-based model accomplishes this. The first domino that needs to fall to achieve a solution to “parental alienation” is to achieve a foundational paradigm shift from a Gardnerian PAS model to an attachment-based model.

Gardnerian Resistance

So far, I’ve been gentle with the Gardnerian contingent of experts, allowing them to come to terms gradually with the impending change in paradigms. The Gardnerian PAS model is going away. It is going to be replaced by a scientifically grounded attachment-based model for the construct of “parental alienation” which will provide targeted parents and their children with an immediate and actualizable solution.

But time is running out for the Gardnerians. The time for sitting on the fence is quickly passing.  The time will come when the current Gardnerians will need to choose their paradigm.

They can switch to the attachment-based paradigm that is based in established principles of professional psychology that will provide targeted parents with an immediate actualizable solution by,

Establishing clear diagnostic criteria for diagnosing attachment-based “parental alienation,”

Establishing standards of practice to which mental health professionals can be held accountable regarding required knowledge and practice standards necessary for professional competence, ,

Establishing a professional mandate for the child’s protective separation from the pathology of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery stabilization,

Or they can hold on to the Gardnerian PAS paradigm.  But why? What advantage does the Gardnerian PAS model provide?  In thirty years it has failed to provide targeted parents with an actualizable solution.  The Gardnerian PAS model requires targeted parents to prove “parental alienation” in Court.  It’s diagnostic indicators are vague and allow for dispersing responsibility between both parents.  It provides no standards of practice to which mental health professionals can be held accountable. I could go on and on about the limitations and inadequacies of the Gardnerian PAS model. 

So why would any mental health professional who cares about providing targeted parents and their children with a solution to their nightmare, a solution that can be actualized immediately, still hold on to an outdated and inadequate Gardnerian model of PAS?

The change in paradigms is coming.

I understand how hard it is to let go of a beloved attachment.  For 30 years the Gardnerians have waged a valiant fight for children and families.  They have become attached to the PAS paradigm.  It has served as a central focus of their professional lives.  And now PAS will disappear.

They have fought so hard and so valiantly for acceptance of PAS, and now, overnight, PAS will never be accepted.  Ever.  Not because it is rejected, but because it is irrelevant.  “Parental alienation” will be solved… but without the PAS model.  PAS isn’t wrong, it’s just unnecessary. Poof.

I’m sorry.

But the paradigm needs to change.  The solution is in an attachment-based model not in the continuation of the PAS paradigm.

I’m hoping that the Gardnerian contingent can come to terms with the changing paradigms, so that they can let go and adapt to the coming changes.  And I invite them to join in changing the paradigm, to bring their fully voiced support to the paradigm shift.  We could use your help.  The new paradigm may seem disorienting at first, but it is rich in possibilities.  Linking “parental alienation” to the attachment system opens up broad and deep vistas for understanding.

Solving “Parental Alienation”

My advice is often sought by targeted parents concerning what they can do to solve the “parental alienation” in their family. But unless we solve “parental alienation” for all families, we cannot solve it for any specific family.

The solution to “parental alienation” requires a paradigm shift to a new model for describing the construct of “parental alienation.”  A model that is based entirely within scientifically valid and established psychological principles and constructs. An attachment-based model for the construct of “parental alienation” provides this model.   Once the paradigm shifts, the first domino will fall.

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

Dominoes Falling: The Sequence

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


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

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

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

The Second Domino: Diagnosis & Defined Standards of Professional Competence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Both sides in the debate were right.

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

AND…

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

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

The Third Domino: Protective Separation

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

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

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

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

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

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

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

V995.51 Child Psychological Abuse, Confirmed.

Here’s the linkages:

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

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

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

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

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

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

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

3.  They can conduct their own independent investigation.

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

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

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

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

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

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

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

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

The Fourth Domino: Treatment

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

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

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

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

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

This last domino is in the works.

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

The Solution

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

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

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

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

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

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

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

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

Subjective Reality of the Narcissistic/(Borderline) Parent

Preface:

Equivalence of Core Narcissistic and Borderline Personality Dynamics

Narcissistic and borderline personalities are variants of the same underlying core dynamics.  While their superficial presentations differ, both the narcissistic and the borderline personality have the same underlying core structures.

Narcissistic and borderline personality structures represent the coalesced product of the “internal working models,” or “schemas,” of the attachment system. 

The attachment system creates “internal working models” regarding expectations for self-in-relationship and other-in-relationship.  Within the attachment system for both the narcissistic and borderline personality structures, the internal working model for self-in-relationship is “I am fundamentally inadequate as a person” and the other-in-relationship expectation is that “I will be abandoned by the other because of my fundamental inadequacy.”

The difference between the narcissistic and borderline personalities is that the borderline personality experiences these core beliefs directly and continually, resulting in continually disorganized emotions and relationships, whereas the narcissistic personality is able to develop a psychological defense of narcissistic self-inflation that prevents the direct experience of self-inadequacy and fears of abandonment.  Instead, the narcissistic personality projects the self-inadequacy onto others, who the narcissist then devalues and rejects for their inadequacy.  Puncture the narcissistic defense, however, and the underlying borderline emotional disorganization becomes evident in hostile tirades of venom and vitriol.

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

“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.” (p. xiii)

Subjective Reality

For the narcissistic-borderline personality structure, truth and reality are fluid constructs that are subject to the ever changing emotional needs of the moment.

For both the narcissistic and borderline personality structure, regulating their intense emotional distress originating from their core sense of primal self-inadequacy and fear of abandonment takes precedence over external restrictions, even the external restrictions placed on them by truth and reality.  If they need truth or reality to be different in order to regulate their emotions, then they simply assert a different truth, a different reality.

“Narcissists are neither disposed to stick to objective facts or to restrict their actions within the boundaries of social custom or cooperative living… Free to wander in their private world of fiction, narcissists may lose touch with reality, lose their sense of proportion, and begin to think along peculiar and deviant lines.” (Millon, 2011, p. 415)

For the narcissistic/borderline personality, there is no objectivity to reality or truth. Reality and truth are subjective experiences that can change as the subjectivity of the narcissistic or borderline personality requires.  If the narcissistic/borderline personality requires the sky to be red, they simply assert the sky is red, and that becomes reality. If 10 minutes later they need the sky to be green,  they simply assert that the sky is green and that becomes reality.

For the narcissistic and borderline personality structure, “truth and reality are what I assert them to be.”

If we try to hold them accountable to a set and verifiable reality, the narcissistic/borderline personality will unleash a hostile assault of accusations, creating communication chaos with unrelated accusations, fabricated distortions, and flat denial of reality that follow so rapidly upon one another that the factual accuracy of any accusation or denial can’t be addressed.

The ability to assert whatever truth and reality is required in the moment thrives in chaos and dies in clarity. As long as chaos reigns, the narcissistic/borderline personality is free to assert and change reality and truth as needed.

Theodore Millon, one of the premier experts in personality disorders, describes the narcissistic propensity to dissolve into idiosyncratic thinking that is unconnected to reality,

“Were narcissists able to respect others, allow themselves to value others’ opinions, or see the world through others’ eyes, their tendency toward illusion and unreality might be checked or curtailed. Unfortunately, narcissists have learned to devalue others, not to trust their judgments, and to think of them as naïve and simpleminded. Thus, rather than question the correctness of their own beliefs they assume that the views of others are at fault. Hence, the more disagreement they have with others, the more convinced they are of their own superiority and the more isolated and alienated they are likely to become. These ideational difficulties are magnified further by their inability to participate skillfully in the give-and-take of shared social life… They are increasingly unable to assess situations objectively, thereby failing further to grasp why they have been rebuffed and misunderstood. Distressed by these repeated and perplexing social failures, they’re likely, at first, to become depressed and morose. However, true to their fashion, they will begin to elaborate new and fantastic rationales to account for their fate. But the more they conjecture and ruminate, the more they lose touch, distort, and perceive things that are not there. They may begin to be suspicious of others, to question their intentions, and to criticize them for ostensive deceptions…

“Deficient in social controls and self-discipline, the tendency of CEN narcissists to fantasize and distort may speed up. The air of grandiosity may become more flagrant. They may find hidden and deprecatory meanings in the incidental behavior of others, becoming convinced of others malicious motives, claims upon them, and attempts to undo them. As their behaviors and thoughts transgress the line of reality, their alienation will mount, and they may seek to protect their phantom image of superiority more vigorously and vigilantly than ever. Trapped by the consequences of their own actions, they may become bewildered and frightened as the downward spiral progresses through its inexorable course. No longer in touch with reality, they begin to accuse others and hold them responsible for their own shame and failures. They may build a “logic” based on the irrelevant and entirely circumstantial evidence and ultimately construct a delusion system to protect themselves from unbearable reality.” (p. 415)

Yet the narcissistic/borderline personality can superficially present well, so that the extent of their psychopathology goes unnoticed, even by mental health professionals.  According to Cohen (1998),

“The perception [of narcissism in a patient] is hampered by the fact that narcissistic individuals may well be intelligent, charming, and sometimes creative people who function effectively in their professional lives and in a range of social situations (Akhtar, 1992; Hendler, 1975)… While narcissism is recognized as a serious mental disorder, its manifestations may not be immediately recognized as pathological, even by persons in the helping professions, and its implications may remain unattended to. (p. 197)

Beck et al., (2004) note that narcissists can display “a deceptively warm demeanor” (p. 241) and Millon (2011) describes that “when not faced with humiliating or stressful situations, CENs [confident-egoistic-narcissists] convey a calm and self-assured quality in their social behavior. Their untroubled and self-satisfied air is viewed by some as a sign of confident equanimity” (p. 388-389).

The borderline personality can also present well superficially. The borderline style will present as a victim of cruelty from others that elicits a nurturing/protective response from unsophisticated mental health professionals.  As long as these mental health professionals do not challenge the constructed “reality” presented by the borderline personality, then these mental health professionals will be co-opted into becoming allies within the splitting dynamic of the borderline personality, and will be rewarded with displays of gratitude as the all-good wonderfully understanding and protective other within the borderline’s splitting dynamic. 

Being the idealized, all-wonderful, perfectly understanding and protective other can be quite seductive for the naive and unsophisticated mental health professional, who is by nature a helpng person.  But it represents a failure of professional knowledge and understanding in favor of the personal ego-gratification of the mental health professional.

The borderline personality is quite adept at presenting in the victim role to elicit protective nuturance from others.  A leading figure in personality disorders, Aaron Beck, notes that is is often difficult even in his own clinic to recognize the borderline personality presentation,

“Underdiagnosis constitutes a big problem that results in insufficient treatment. In many cases we saw, it took years of fruitless attempts to treat these patients before it became clear they were in fact suffering from BPD [borderline personality disorder].” (Beck et al., 2004, p. 196)

Special Population

The children and families evidencing attachment-based “parental alienation” represent a “special population” requiring specialized professional knowledge, training, and expertise to professionally diagnose and treat. 

Among the domains of knowledge necessary is a professional level of expertise regarding the presentation features and underlying dynamics of narcissistic and borderline personality structures.  Expertise in narcissistic and borderline personalities is not typical for most child and family therapists since personality disorders are an extremely rare presentation in children, and a rare presentation in parents. 

Child and family therapists tend to focus on the common disorders of childhood, child oppositional-defiant behavior, attention deficits and hyperactivity, autism-spectrum problems.  A professional level of expertise in narcissistic and borderline personality characteristic presentations and dynamics is typically not something most child and family mental health professionals possess. 

In most, if not nearly all, cases of typical child and family issues the therapist can trust that the reports of parents are within an acceptable range of truth and reality.  This assumption is not necessarily accurate when interacting with narcissistic and borderline personalities.  Mental health professionals working with this “special population” of children and families require specialized professional knowledge, training, and expertise related to narcissistic and borderline personality characteristics and dynamics so that they may be alert for the profound distortions of truth and reality associated with narcissistic/borderline personality processes.

In addition, narcissistic and borderline personality dynamics are not necessarily easily recognizable.  However, narcissistic and borderline personality dynamics are DIRECTLY RELEVANT to the diagnosis and treatment of attachment-based “parental alienation” so that these personality dynamics are directly relevant to professional competence with this “special population” of children and families.

Professionals who are diagnosing and treating attachment-based “parental alienation” require specialized professional knowledge, training, and expertise for professional competence with this “special population” of children and families, and one of the most important domains of specialized expertise is in the recognition of narcissistic and borderline personality dynamics within the family.

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

References

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

Cohen, O. (1998). Parental narcissism and the disengagement of the non-custodial father after divorce. Clinical Social Work Journal, 26, 195-215

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

The Regulatory Other

This post will discuss the concept of the “regulatory other,” which is an important parent-child relationship construct from early childhood mental health. The concept of the “regulatory other” will become a key construct in understanding how the “alienation” is created with the child.

A common misconception is that the “alienation” is produced by the narcissistic/(borderline) parent making disparaging criticisms of the other parent in front of the child.  This is not true.  This is not how the “alienation” occurs.  There are a variety of factors involved in creating the “alienation” of the child, but one of the primary constructs is the concept of the “regulating other.”

However, before directly addressing the construct of the “regulating other” I am going to lay some foundational context for the construct in the scientific evidence emerging from research in child development and the neuro-development of the brain during childhood.  I ask your patience with this foundational material.  I think the payoff in understanding the construct of the regulatory other will reward your patience.

Key Construct: Regulation

The constructs of “regulation” and “dysregulation” have become primary concepts regarding the organized functioning of brain systems and their expression in emotional and behavioral displays.

The concepts of “regulation” and “dysregulation” of brain systems, behavioral systems, and emotional systems can best be understood through an analogy to a thermostat that “regulates” a room’s temperature. If the room temperature becomes too warm, the thermostat registers this change and automatically turns on the air-conditioner to bring the room temperature back into a comfortable mid-range. If the room temperature becomes too cold, the thermostat picks this up and automatically turns on the heater to bring the room temperature back into a comfortable mid-range. The thermostat “regulates” the room’s temperature, keeping the temperature within the optimal range of comfort.

As an aside, thermostats regulate the room temperature around a “set-point” which is the desired room temperature around which the actual room temperature fluctuates. There is evidence of “set-points” in the regulatory systems of the brain that differ from person to person. For example, people vary in their “set-points” for social regulation. Some people are highly social and gregarious (a high-set point for regulating social interaction) while other people are reserved and shy (i.e., a low set-point for regulating social interaction).  Our regulatory systems keep our behavioral, social, emotional, and brain functioning in an integrated optimal range for adaptive functioning around various set-points.

Basic Brain Principles

1. Behavior is a symptom. The brain is the cause.

The disorganized and dysregulated functioning and integration of various brain systems produce disorganized and dysregulated behavior and emotional displays.  

Because dysregulated child behavioral and emotional displays are annoying to us, we used to call these displays “problem behaviors.”

However, as we have learned more about how the brain works we have come to recognize that these child displays of dysregulated behavior play an important role in healthy child development, and we have shifted the term we use to describe these behaviors from “problem behaviors” because they annoy us, to “protest behaviors”  that are designed to elicit the involvement of the caregiver… by annoying us so that we intervene to make these behaviors stop.

What the brain wants is for us to intervene.  It accomplishes this by making “protest behaviors” annoying.

Understanding the neuro-developmental role of child protest behavior is one of the major advancements in our understanding of child development during the past 50 years.  Unfortunately, most mental health professionals are not aware of the conceptual shift because of their ignorance regarding the scientific advances made in the neuro-developmental research regarding child development.

The qualities and patterns of the child’s disorganized and dysregulated behavior and emotions reveal what features of the underlying brain systems are not properly integrated in their functioning. This is diagnosis.

Diagnosis involves using the features of the child’s emotional and behavioral dysregulation to understand what features of the child’s underlying brain systems are problematic. In some cases the problem is inherent to the maturation of the child’s brain systems, in other cases the problem lay in the parent’s responses to the child. In some cases it’s both. The features of the child’s behavioral and emotional displays will answer the causal-origin question for us.

Mental health professionals who are knowledgeable in a neuro-social approach can become pretty good at reading the underlying state of the integrated or non-integrated functioning of brain systems based on the external behavioral and emotional displays of the child. The first step in this process is to understand what the various brain systems are, how they function, and also how they interact with each other to create regulated and organized behavior. The second step is to understand the various patterns indicating dysfunction in the separate brain systems and in their integrated organization.

Most mental health professionals, however, never learn about brain development. In my experience, this sort of advanced training only occurs in the early childhood specialty, and those mental health professionals that enter early childhood mental health usually do so because they like working with infants, so that they typically don’t return to working with older children and adolescents. They like infant mental health and they stay in early childhood mental health.  So you’ll likely not find many therapists working with older children or adolescents who understand brain development in childhood.

The mental health professionals currently working with older children and families have typically never received training on brain processes in child development, and are still using outmoded and archaic models of behaviorism from the 1940s-50s or humanistic “play therapy” models from the 1950s-60s, models that were created well before the major advances in the scientific research on brain and child development that have occurred since the mid-1980s.

The current state of “child therapy” generally is appallingly inadequate. But that’s a topic for another time.

In response to child “protest behaviors” the intervention of the parent acts as a “regulatory other” for the child by helping to restore the organized and regulated functioning and integration of the child’s brain systems, which then restores the organized and regulated behavioral and emotional displays of the child. This pattern represents a healthy parent-child relationship.

Teaching parents how to respond effectively as a “regulatory other” for their child is therapy.  Or at least this is what therapy should be. It is not what most therapists do since most therapists don’t know how the brain works and develops during childhood.  When I work with children and families, I’m actually monitoring and intervening on the underlying brain systems, whereas most mental health professionals are simply intervening on the level of behavior.

Behavior is the symptom. The brain is the cause.

If we simply seek to suppress the symptom then we continually need to engage in symptom suppression efforts since we have never resolved the underlying cause of the symptom. If, however, we use the symptom to diagnose the cause, then we treat the cause, resolve the cause, and the symptom goes away, often without our ever having to directly address the actual symptom itself.

Imagine if we had an infection that caused a fever.  We could treat the fever, the symptom, with Tylenol or aspirin but we would continually need to suppress the fever because we haven’t addressed the underlying cause, the infection.  Now imagine if we used the symptom of the fever to diagnose an infection so that we then treat the infection with antibiotics, cure the infection, and the fever goes away without ever having to directly address it.

Behavior is the symptom, the brain is the cause.  We need to read the symptom of the behavior for what it says about the underlying integrated or non-integrated functioning of the underlying brain systems.

However, outside of early childhood mental health, very few therapists possess the knowledge of brain systems and their integrated functioning necessary to work at an neuro-systemic level, so that very few therapists operate from this type of scientifically based neuro-social approach. This approach, however, is common in early childhood diagnosis and treatment, which has a heavy focus on relationship-based diagnosis and treatment relative to the functioning of the various brain systems involved.

The Primary Brain Systems:

There are six primary brain systems and three overarching brain systems.  The six primary brain systems are:

  1. Physical sensory-motor systems
  2. Emotion systems
  3. Language and communication systems
  4. Relationship systems (attachment and intersubjectivity)
  5. Cognitive/executive function systems
  6. Three motivational systems

Active exploratory learning: Traditionally called “play,” this motivational system is primarily embedded in the sensory-motor and emotional networks, it is an early activating motivational system during childhood that has a basic agenda of “seek pleasure and avoid pain.”

Goal-directed motivating system: Traditionally called “work,” this motivating system is embedded in the executive function networks and involves a sequencing of three phases. First, establishing an overarching goal that organizes attention and behavior; second, applying effort toward achieving the goal; and third, accomplishing the goal, at which point the brain produces a burst of positive brain chemical that tells the neural networks used in achieving the goal to keep whatever changes were made because they were successful in achieving the goal. The more effort is applied toward achieving a goal, the larger the burst of positive brain chemical released upon achieving the goal.

Relationship motivating systems: The relationship systems of attachment and intersubjectivity are primary motivational systems at the same level as the other primary motivational systems for food and reproduction. There is an inhibitory network from the two relationship systems back to the play-based and goal-directed motivational systems, so that the relationship motivating systems always take precedence. Only if the two relationship systems are satisfied and quiescent will the play-based or goal-directed motivating systems be allowed to fully organize and direct activity. If either of the two relationship motivating systems are active, then the child’s primary motivational agenda will be to satisfy the relationship needs, and the activated relationship needs will inhibit the ability of the child to achieve a full activation of either the play-based or goal-directed motivational networks.

The three (interrelated) overarching brain systems are:

  1. The Self-system
  2. Memory systems
  3. Meaning Attribution systems

2. Brain Principles: “We build what we use”

Brain systems develop interconnections based on the principle of “we build what we use.” The renowned neuroscientist, Donald Hebb, referred to this as “neurons that fire together, wire together.” In the scientific literature, this process is called the “canalization” of brain networks (like building “canals” or channels in the brain).

In explaining this to parents, I’ll often use the metaphor of raindrops falling on a dirt hillside. The first raindrop can go any direction, but whatever path it takes it will remove a little dirt with it as it glides down the hillside. Gradually, as more and more raindrops fall, channels or “canals” begin to be grooved into the hillside directing the flow of subsequent raindrops.

Whenever we use a brain pathway or system, changes take place along the neural pathway that create structural and chemical channels or “canals” in the brain that make it more likely that this neural pathway or set of brain cells will be used in the same interconnected pattern in the future. “Neurons that fire together, wire together.”

Two of the primary neural processes involved in the “canalization” of brain pathways (i.e., “we build what we use”) are called “long-term potentiation” and “synaptogenesis.” There is some very interesting work on the neuro-structural and chemical underpinnings of the canalization process done with sea slugs because their neural networks are simple and their neural cells are relatively large, making their study easier. The neural-structural processes of canalization actually involve triggering and altering genetic code, and are quite complex involving neuro-modulators and secondary and tertiary feedback systems (Kandel, 2007). The brain is a very interesting place.

The canalization of neural pathways is called the “use-dependent” development of the brain, and the role of the parent in facilitating the child’s use of particular neural pathways in response to different child behaviors is called “scaffolding,” like building a supportive scaffold around a structure as its being constructed.

Child development isn’t about rewards and punishments, these are mechanisms of social control. Child development is about the scaffolding support provided by parental relationship and communication qualities for the integrated functioning of the various brain systems. Current “behavioral” and “play therapy” approaches to child therapy are woefully out of touch with the scientific advances that have occurred in the past 50 years. In the domain of child therapy, the level of professional ignorance regarding child development and the development of the brain during childhood is disturbing.

The brain possesses a variety of regulatory networks that seek to maintain the brain’s integrated functioning in the optimal range for organized and adaptive functioning. When system elements begin to become too active or inactive, various regulatory systems will activate to turn up or down the levels of various brain systems seeking to keep the overall functioning of the brain in an organized and regulated state for optimal adaptive functioning.

During childhood, the immature development of the child’s brain means that the integrated functioning of the child’s various brain systems will often become dysregulated by maturation challenges that the child cannot independently master. This disorganization in the integrated functioning of the various brain systems will produce disorganized displays of behavior and emotions (behavior is a symptom, the brain is the cause). 

These displays of disorganized and dyregulated emotions and behavior are called “protest behaviors”  whose developmental purpose is to elicit the involvement of the parent (i.e., of a more mature nervous system) to act as a “regulatory other” for the child. The parent then responds to the child’s protest behavior by “scaffolding” the child’s transition back into an organized and regulated brain state reflected in organized and regulated behavior.

In the process of “scaffolding” the child’s state transition from a disorganized and dysregulated brain state (and behavior) back into an organized and regulated brain state (and behavior), all of the brain pathways that were used as part of this state-transition become “canalized” through “use-dependent” neural processes, thereby making this state-transition more likely to occur in the future.

Gradually, over repeated “scaffolding” by the “regulatory other” of the parent for the child’s state transitions from disorganized and dysregulated brain states to organized and regulated brain states, the child’s brain develops (“canalizes”) the neural pathways for this state transition through use-dependent structural and chemical processes, so that eventually the child is able to make this transition from an impending dysregulated brain state/behavior into a regulated brain state/behavior independently of the need for scaffolding support from the “regulatory other” of the parent. This is called the child’s development of “self-regulation.”

One type of this self-regulation development that the general public may be familiar with is called “frustration tolerance” which occurs through the repeated exposure and successful processing of minor and gradually increasing frustration experiences.

All brain systems are subject to this use-dependent development of self-regulation capacities. This is the current science on child development.

Shore (1997), for example, identifies the shift from the behaviorist paradigm to a neuro-developmental paradigm,

“The basic unit of analysis of the process of human development is not changes in behavior, cognition, or even affect, but rather the ontogenetic appearance of more and more complex psychobiological states that underlie these state-dependent emergent functions.” (Shore, 1997, p. 595).

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.

Sroufe (2000) describes the development of self-regulation through parental scaffolding,

“In the typical course of events, caregivers quickly learn to “read” the infant and to provide care that keeps distress and arousal within reasonable limits.” (Childress comment: the parent is acting as a “regulatory other.”)

“And they do more. By effectively engaging the infant and leading him or her to ever longer bouts of emotionally charged, but organized behavior, they provide the infant with critical training in regulation.”

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

3. Brain Principles: Protest Behavior

The following principles regarding the developmental role of “protest behavior” are important for understanding the child’s anger and rejection that is being expressed toward the targeted parent in attachment-based “parental alienation.”  Children’s authentic protest behavior is designed to elicit greater involvement from the parent who acts as a “regulatory other” for the child’s protest behavior, helping the child transition from a dsyregulated state (evidenced by the protest behavior) back into an organized and regulated state (evidenced by a pleasant attitude of cooperation).

Authentic protest behavior is never designed to sever the parent-child relationship. From the perspective of evolution, severing of the parent-child relationship exposed children to predation and other environmental dangers. Genes allowing the severing of the parent-child bond were selectively removed from the gene pool throughout millions of years of evolution.

Furthermore, regarding the authentic functioning of the brain, when children are dealing with parental behaviors that are unresponsive and problematic, this problematic parental behavior dysregulates the integrated functioning of the child’s brain systems so that the child produces disregulated emotional and behavioral displays (i.e., protest behavior) designed to elicit the involvement of the parent to serve as a “regulating other” for the child in providing scaffolding support for the child’s transition back into a regulated state, thereby building all of the neural networks associated with the developmental challenge that the child had difficulty independently mastering.

That’s how the brain works.

Sometimes the child may seek to limit involvement with a problematic parent, but this is always a regulatory strategy arising from the disorganized functioning and integration of the underlying brain systems. It is not the product of a motivated desire to sever the parent-child bond.

One of the often prominent features of the child’s anger and hostility toward the targeted parent in attachment-based “parental alienation” is that the child’s anger emerges from an organized and well-regulated child brain state. When this occurs, it means that the anger and hostility directed toward the targeted parent is not authentic to the parent-child interaction but represents a conscious choice by the child.

Authentic protest behavior is a product of a disorganized/dysregulated brain.  Behavior is a symptom, the brain is the cause.

Dysregulated behavior and a regulated brain are incompatible, and so are not authentic. Dysregulated behavior is caused by a dysregulated brain.

A regulated brain means that the child is making a conscious choice to display the apparently dsyregulated behavior of engaging in the parent-child conflict with the targeted parent, which is very different from an authentic parent-child conflict that results from an underlying disorganized and dysregulated integration of brain systems.

Important Concept:

Authentic problematic parenting dysregulates the child’s brain systems, thereby producing dysregulated child behavior, i.e., the child’s protest behavior.

If the child’s brain state is well-regulated as the child is emitting protest behavior, then the emitted protest behavior is NOT being caused by problematic parenting.

Behavior is a symptom. The brain is the cause.

The more that mental health professionals understand about the neurodevelopment of the brain during childhood, the easier it becomes to differentiate authentic from inauthentic parent-child conflict.

With my background in early childhood mental health and the neurodevelopment of the brain during childhood, spotting inauthentic displays of parent-child conflict associated with attachment-based “parental alienation” is extraordinarily easy. Might as well put up a neon sign saying, “Parental Alienation Here.”

This also means that I am able to spot with equal clarity false allegations of “parental alienation” in which the child’s conflicts with the targeted parent represent authentic responses to the problematic parenting behavior of the targeted parent.

Not everything is “parental alienation,” and the goal of all mental health professionals should be to follow the clinical data into an accurate diagnosis, not to promote an agenda or confirm pre-existing ideas.

My client is the child.  The child is displaying symptoms.  My job is to read the symptoms to accurately identify their causal origin so that we can intervene to restore the healthy development of the child.

If the problem is the parenting practices of the targeted parent (i.e., authentic parent-child conflict), that’s pretty easy to solve. We simply instruct the targeted parent in the appropriate parental responses that will act as a “regulatory other” for the child’s dysregulated behavior and emotional displays (the child’s protest behavior).  As soon as the parental responses are appropriate to the parental role as a “regulatory other” for the child’s displays of dysregulated brain states, the child’s protest behavior resolves.

Differentiating authentic versus inauthentic parent-child conflict is not about identifying specific child behaviors, although the differences are evident in certain features of behavior, it’s more about identifying the underlying brain states producing those behaviors. To do this, however, requires a professional level understanding for the socially-mediated neurodevelopment of the brain during childhood. Most mental health professionals do not possess this knowledge. They should. But they don’t.

Knowing what I know about the socially mediated neurodevelopment of the brain during childhood and its implications for child and family therapy, I am strongly of the opinion that we should require that all mental health professionals who are diagnosing and treating children possess the current scientific knowledge regarding child development and the development of the brain during childhood.

It is deeply disturbing to me that we don’t require more advanced knowledge from child and family therapists, and that we accept professional ignorance when it comes to diagnosing and treating our children. Our children and their healthy development are too important and should be paramount in determining the educational curriculum and training of therapists. Our child and family therapists should be the most exceptional of professionals in mental health. It’s too important.

The Regulatory Other in “Parental Alienation”

One of the central concepts in the neurodevelopment of self-regulatory abilities in childhood is the role of the parent as a “regulatory other” for the child. When the child begins to enter a disorganized and dsyregulated state, the parent responds in a way that restores the child’s regulated functioning. The child is using the parent as a “regulatory other” for the child’s own internal state.

Shore (1997) describes the specific relationship features of the parental “regulatory other” role function,

“The mother must monitor the infant’s state as well as her own and then resonate not with the child’s overt behavior but with certain qualities of its internal state, such as contour, intensity, and temporal features.” (Shore, 1997, p. 600)

Tronick (2003) also describes the relationship features of the “regulatory other” parent-child relationship,

“In response to their partner’s relational moves each individual attempts to adjust their behavior to maintain a coordinated dyadic state or to repair a mismatch (Tronick & Cohn, 1989). When mutual regulation is particularly successful, that is when the age-appropriate forms of meaning (e.g., affects, relational intentions, representations; see Tronick 2002c, d) from one individual’s state of consciousness are coordinated with the meanings of another’s state of consciousness — I have hypothesized that a dyadic state of consciousness emerges.” (Tronick, 2003, p. 475)

“A dyadic state of consciousness has dynamic effects. It increases the coherence of the infant’s state of consciousness and expands the infant’s (and the partner’s) state of consciousness (Tronick et al., 1998; Tronick 2002b, c.)” (Tronick, 2003,p. 475)

“Thus, dyadic states of consciousness are critical, perhaps even necessary for development” (Tronick and Wienberg, 1997),” (Tronick, 2003, p. 475)

In severely pathological parent-child relationships, however, this role-relationship of the parent and child is reversed, so that it is the parent who uses the child as a “regulatory other” to regulate the parent’s own pathology.

This is called a “role-reversal” relationship in which the child is being used as a “regulatory other” for the parent, instead of a healthy and developmentally vital parent-child relationship in which the child is using the parent as “regulatory other.”

In the Journal of Emotional Abuse, Kerig discusses the problematic development created by role-reversal relationships involving parent-child boundary violations such as the parent using the child as a “regulatory other” for the parent’s emotional state,

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

“In the throes of their own insecurity, troubled parents may rely on the child to meet the parent’s emotional needs, turning to the child to provide the parent with support, nurturance, or comforting (Zeanah & Klitzke, 1991).” (Kerig, 2005, p. 6)

(Childress comment: the parent is using the child as a “regulatory other” for the parent’s emotional state.)

Ultimately, preoccupation with the parents’ needs threatens to interfere with the child’s ability to develop autonomy, initiative, self-reliance, and a secure internal working model of the self and others (Carlson & Sroufe, 1995; Leon & Rudy, this volume).” (Kerig, 2005, p. 6)

“When parent-child boundaries are violated, the implications for developmental psychopathology are significant (Cicchetti & Howes, 1991). Poor boundaries interfere with the child’s capacity to progress through development which, as Anna Freud (1965) suggested, is the defining feature of childhood psychopathology.” (Kerig, 2005, p. 7)

“Examination of the theoretical and empirical literatures suggests that there are four distinguishable dimensions to the phenomenon of boundary dissolution: role reversal, intrusiveness, enmeshment, and spousification. (Kerig, 2005, p. 8)

Enmeshment in one parent-child relationship is often counterbalanced by disengagement between the child and the other parent (Cowan & Cowan, 1990; Jacobvitz, Riggs, & Johnson, 1999). (Kerig, 2005, p. 10)

“However, an emotionally needy parent who is threatened by the child’s emergent sense of individuality may act in ways so as to prolong this sense of parent-infant oneness (Masterson & Rinsley, 1975). By binding the child in an overly close and dependent relationship, the enmeshed parent creates a psychologically unhealthy childrearing environment that interferes with the child’s development of an autonomous self.” (Kerig, 2005, p. 10)

“Barber (2002) defines psychological control as comprising “parental behaviors that are intrusive and manipulative of children’s thoughts, feelings, and attachments to parents, and are associated with disturbances in the boundaries between the child and the parent” (p. 15) (see also Bradford & Barber, this issue).” (Kerig, 2005, p. 12)

“As Ogden (1979) phrased it, “It is as if the parent says to the child, if you are not what I need you to be, you do not exist for me” (p. 16).” (Kerig, 2005, p. 12)

“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.” (Kerig, 2005, p. 12)

“In order to carve out an island of safety and responsivity in an unpredictable, harsh, and depriving parent-child relationship, children of highly maladaptive parents may become precocious caretakers who are adept at reading the cues and meeting the needs of those around them. The ensuing preoccupied attachment with the parent interferes with the child’s development of important ego functions, such as self organization, affect regulation, and emotional object constancy.” (Kerig, 2005, p. 14)

“There is evidence for the intergenerational transmission of boundary dissolution within the family. Adults who experienced boundary dissolution in their relationships with their own parents are more likely to violate boundaries with their children (Hazen, Jacobvitz, & McFarland, this volume; Shaffer & Sroufe, this volume).” (Kerig, 2005, p. 22)

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

The seduction of the child into the role as a “regulatory other” for the pathological parent is a result of the disorganized and intense emotional displays by the pathological parent. In response to the parent’s unpredictable displays of intense anxiety, sadness, or anger, the child learns to become hyper-vigilant regarding the parent’s internal state so that the child can respond in ways that prevent the parent from collapsing into a disorganized emotional state of excessive anxiety, sadness, or anger.

The child becomes the “regulatory other” for the parent, so that the child becomes adept at responding to the pathological parent in ways that keep the pathological parent in an organized and regulated state. Once the child becomes the “regulatory other” for the pathological parent, the parent simply needs to provide the child with subtle emotional and communicative cues as to how to maintain the parent’s regulated emotional state and the child will actively become what the parent needs the child to be.

In healthy parent-child relationships, the parent acts as the “regulatory other” for the child.

In the psychopathology of the “role-reversal” relationship, the child acts as the “regulatory other” for the parent.

A role-reversal relationship is extremely destructive to the healthy emotional and psychological development of the child.

Role-reversal relationships are associated with the “disorganized” category of attachment (Lyons-Ruth, Bronfman, & Parsons, 1999), which is considered to be the most severely pathological attachment category, and disorganized attachment, in turn, is associated with the development of borderline personality processes (Beck, 2004).

In attachment-based “parental alienation” the narcissistic/(borderline) parent’s attachment classification is likely to be “disorganized,” which in adults is called “unresolved trauma.” As a manifestation of the internal working models of relationship contained within the narcissistic/(borderline) parent’s attachment networks, the narcissistic/(borderline) parent forms a role-reversal relationship with the child, using the child as a “regulatory other” for the narcissistic/(borderline) parent’s own emotional regulation.

Parental Anxiety Regulation

For the narcissistic/(borderline) parent, the interpersonal rejection inherent to the divorce represents a “narcissistic injury” that threatens to collapse the narcissistic defense against the experience of primal self-inadequacy.  

The interpersonal rejection of the divorce also activates an intense fear of abandonment associated with borderline personality processes.

At the attachment system level, the attachment system forms “internal working models,” also called “schemas,” for expectations of self-in-relationship and other-in-relationship. For the “disorganized” category of attachment, the self-in-relationship expectation is that “I’m inadequate,” while the expectation of the other-in-relationship is that “I will be abandoned by the other because I’m inadequate.”

These “internal working models” within the attachment system coalesce during later childhood and adolescence into stable personality structures, with the “I’m inadequate” self-in-relationship schema reflected in narcissistic personality processes, while the abandoning other-in relationship expectation becomes reflected in borderline personality processes of an intense fear of abandonment.

Both the narcissistic and the borderline personality processes have the same underlying attachment schemas of “I’m inadequate” and “I will be abandoned because of my inadequacy.” The difference between the borderline and narcissistic personality processes is that the borderline personality experiences these internal core attachment beliefs directly, which leads to overtly disorganized behavior, emotions, and relationships, whereas the narcissistic personality has adopted a defensive veneer of narcissistic self-inflation against the direct experience of these internal core attachment schemas. However, if the narcissistic defensive veneer is threatened, the narcissistic personality responds with a disorganized tirade of intense anger consistent with the underlying borderline personality organization.

“Most of these [narcissistic] patients present an underlying borderline personality organization.” (Kernberg, 1975, p. 16)

In response to the interpersonal rejection inherent to the divorce (i.e., narcissistic injury and abandonment), the narcissistic/(borderline) parent engages the child in a role-reversal relationship as a “regulatory other” in order to regulate the intense anxiety experienced by the narcissistic/(borderline) parent associated with the threatened collapse of the narcissistic defense against the experience of primal inadequacy and a tremendous fear of abandonment.

As the child adopts the role as the “regulatory other” for the narcissistic/(borderline) parent’s pathology in order to avoid the emotional collapse of the narcissistic/(borderline) parent into chaotic and unpredictable displays of intense parental anxiety, sadness, or anger it becomes relatively easy for the narcissistic/(borderline) parent to then communicate to the child through clear but subtle “emotional signals” and “relational moves” that the parent’s emotional regulation is dependent on the child adopting the “victimized child” role in the narcissistic/(borderline) parent’s trauma reenactment narrative.

In the role as a “regulating other” for the narcissistic/(borderline) parent, the child readily adopts the parentally-desired role as the “victimized child” of the other “abusive parent” in order to keep the narcissistic/(borderline) parent from collapsing into intense emotional states of anxiety, sadness, or anger.

The induction of child symptoms is NOT accomplished by the narcissistic/(borderline) parent overtly “alienating” the child by saying derogatory things about the other parent. The induction process is much more insidious and complex.

The child is induced into becoming the “regulatory other” for the narcissistic/(borderline) parent in order to avoid parental displays of anger and rejection (or in some cases parental displays of intense sadness or anxiety), and the child is seduced into psychologically surrendering to the influence of the narcissistic/(borderline) parent through parental displays of affection and narcissistic indulgence provided to the child for cooperating as the “regulatory other” for the narcissistic/(borderline) parent.

In response to the intense and unpredictable emotional displays by the narcissistic/(borderline) parent, the child becomes hyper-vigilant regarding the emotional and psychological state of the narcissistic/(borderline) parent in order to prevent the parent’s collapse into intense, dysregulated emotional displays of anxiety, sadness, or anger, and the child becomes what the parent needs (i.e., the “regulatory other” for the parent) in order to keep the parent in a regulated emotional state.

The child enters a role-reversal relationship to become a “regulatory other” for the narcissistic/(borderline) parent’s emotional state.

The narcissistic/(borderline) parent then communicates non-verbally to the child that what the parent needs from the child in order for the parent to remain emotionally regulated is that the child adopt the role of the “victimized child” relative to the other “abusive parent.”

The moment the child adopts the “victimized child” role within the trauma reenactment narrative of the narcissistic/(borderline) parent (see Trauma Reenactment in Parental Alienation post), this immediately imposes on the targeted parent the trauma reenactment role as the “abusive parent,” and allows the narcissistic/(borderline) parent to adopt and prominently display the coveted role as the all-wonderful “protective parent” within the trauma reenactment narrative.

Inducing the child into accepting the “victimized child” role is relatively easy. The narcissistic/(borderline) parent simply seeks a child criticism of the other parent through motivated and directive questioning by the narcissistic/(borderline) parent, and the child will readily comply in offering this parentally-desired criticism of the other parent in the child’s role as a “regulating other” for the narcissistic/(borderline) parent’s emotional state.

Once the narcissistic/(borderline) parent has elicited a child criticism of the other parent, the narcissistic/(borderline) parent then distorts, exaggerates, and inflames this elicited child criticism of the other parent into supposed evidence of the “abusive” parenting of the other parent. In the process the narcissistic/(borderline) parent supplies to the “regulating other” of the child the appropriate themes for denigrating the other parent.

Narcissistic/(borderline) parent: “How were things at your mother’s house?”

Child: Pretty good, we had pizza.” <The child responds authentically>

N/(b) parent: “Oh, I guess you like the food better better over there. Does she have better food over there than we have? <The father’s sharply hostile tone signals to the child that the child provided the wrong answer, and that the narcissistic/(borderline) parent is threatening to dysregulate into anger and rejection.>

Child: “No, I actually didn’t like it. It had pepperoni on it and I hate pepperoni.” <The child reads the parental cues and quickly corrects the response to one of criticism of the other parent to keep the narcissistic/(borderline) parent in an emotionally regulated state. The child actually likes pepperoni and liked the pizza he had at his mom’s house, but truth and accuracy are sacrificed in the service of keeping the narcissistic/(borderline) parent in a regulated emotional state.>

N/(b) parent: “Yeah, that’s just like her. She never considers what other people want, it’s always what she wants. She’s so selfish and inconsiderate. Hey, how about a snack. If she didn’t feed you well over there why don’t you grab some chips from the pantry and have a snack.” <The father’s return to a normal emotional tone signals to the child that the criticism was the correct response to keep the narcissistic/(borderline) parent emotionally regulated. The narcissistic/(borderline) parent then provides the child with the acceptable theme to use in criticizing the other parent (i.e., that his mom is selfish and self-centered) and the father provides the child with a narcissistic indulgence for providing the proper response of criticizing the mother.  All the while it APPEARS as if it is the child who is criticizing the other parent and that the narcissistic/(borderline) parent is simply being the “wonderfully nurturing and understanding” parent, i.e., the coveted “protective parent” role in the trauma reenactment narrative.)

N/(b) parent: “Did you and your mom do anything?” <The father isn’t satisfied, he’s seeking another criticism from the child. Perhaps the father wants to more firmly establish the interaction pattern since the child initially said everything was okay with his mom>

Child: “Yeah, she took me over to her parents’ house, but I didn’t have any fun over there.” <The child actually likes going to his grandparents’ house. He loves his grandparents and they dote on him.  But as a “regulatory other” for the narcissistic/(borderline) parent the child is hyper-vigilant for cues regarding how to keep the narcissistic/(borderline) parent in a regulated emotional state. The child recognizes that the parent wants the child to criticize the mother, so the child provides the father with the parentally-desired response that he didn’t have fun going to his grandparents house, So that while the child actually likes seeing his grandparents and actually had a good time over at their house, truth and accuracy are sacrificed at the moment in order to keep the narcissistic/(borderline) parent regulated. The only relevant consideration for the child is how to keep the narcissistic/(borderline) parent out of an angry retaliatory state that the father earlier signaled was imminent if the child did not provide the correct responses.>

N/(b) parent: “Oh God, I’m so sorry she dragged you over there. Her parents are just awful. They just drone on and on. It’s so boring. I’m sorry you had to endure that. Hey, why don’t we go buy you a new video game.” <The father inflames the child’s elicited criticism and in doing so he provides the theme for criticizing the grandparents in the future, so that later the child will report to the therapist, “I hate going over to my grandparents, it’s awful, they just talk on and on about stuff, I hate going over there.” And the therapist will never suspect that this criticism and theme were co-created with the allied and seemingly favored narcissistic/(borderline) parent. The father provides the child with another narcissistic indulgence for the child’s cooperation in psychologically surrendering to the narcissistic/(borderline) parent by adopting the “victimized child” role.>

N/(b) parent: “So, did you and you mom get along okay?  Did you have any arguments about anything?” <The father is still not satisfied.  He wants a more direct criticism of the mother so he asks the child directly for this criticism, first in general terms but then provides a specific prompt for the child.  The criticism of the other parent is elicited by directive and motivated questioning.  The child, as a regulatory other feels obligated to provide the father with the sought-for response, and the child realizes from previous interactions with the father that if he doesn’t get the desired criticism of the mother then he will be in an angry, hostile, and punitive mood. The child wants to avoid his father’s dysregulation into anger so the child needs to provide the parentally-desired response.  The problem is that the child and his mother had a good time together.  There were no arguments.  But the child needs to come up with something.>

Child:She got upset at me for leaving my stuff in the living room.” <Actually, the mother was simply annoyed that the child left his shoes and jacket in the living room and asked him to take his stuff to his room. But truth and accuracy are sacrificed in order to provide the narcissistic/(borderline) parent with the desired response to avoid the intense and unpredictable emotional displays that can result from a frustrated narcissistic/(borderline) parent.

N/(b) parent: “Oh my god! Really? She got angry at you for that?  She’s so controlling.  Everything has to be her way or she flies off into her rages.  I swear, she has anger management issues.  It was just like that in our marriage.  I know exactly what you’re talking about.  I can’t believe how controlling she is.  I’m sorry you have to put up with that  I wish she wouldn’t get so angry about the littlest thing. Come here and give me a hug.  I’m sorry she does that.” <It doesn’t take much of a criticism, the narcissistic/(borderline) parent will take even the smallest of criticism as the seed for distortion and exaggeration into supposed evidence of the other parent’s “abusive” parenting.  Notice how the child’s characterization of the mother as being “upset” is distorted and inflamed by the father into “angry” and ultimately into “rages.” The father also provides the child with the desired and acceptable themes for criticizing the mother, that she is “controlling” and has “anger management issues.” Notice too, the loss of boundaries, “I know exactly what you’re talking about,” as the father brings the marital relationship into the discussion, “she was just like that in our marriage.”  Finally, the father signals his approval of the child for criticizing his mother..>

As these parent-child interactions are continually repeated, the child comes to understand his role in the drama, to provide a criticism of the mother, the more extreme the criticism the better, until eventually when the child returns from a visitation with the mother and receives the father’s invitation for the criticism, the child responds with a full measure of antagonism for his mother,

N/(b) parent: “How were things at your mom’s house?” <the parental invitation for the criticism>

Child: “Horrible, I hate it over there. She’s so controlling. It always has to be what she wants or she gets so angry.  She gets angry over the littlest things. I hate it over there.”

N/(b) parent: “I’m so sorry she’s like that. Come here and give me a hug. I hate when she gets like that.  I wish she cared more about how you feel instead of her own stuff.  I’m sorry your mom is like that.  Well you’re home now, so you can relax.  How about a bowl of ice cream to help to get over being with your mom.”

And if anyone asks the child, does your dad say bad things about your mother in front of you, the child says, “No” because from the child’s immature perspective it appears as if it is the child who is offering the criticism of the mother, and that the father is just being “supportive” and “understanding” of the child. 

Also note how truth and accuracy are left behind in the “regulatory other” role of the child. In the psychological world of the narcissistic/(borderline) parent, “Truth and reality are what I assert them to be,” This is a hallmark of the narcissistic and borderline thinking process that the child is acquiring. 

In the moment, while the child is interacting with the unpredictable and emotionally dangerous narcissistic/(borderline) parent, the primary motivation of the child is to keep the narcissistic/(borderline) parent in a regulated emotional state and so avoid the parent’s collapse into hostile-angry-rejecting, overly sad and depressed, or hyper-anxious emotional displays.  If truth is bent or distorted, that’s a small price to pay. 

Gradually through repeated distorting interactions with the psychopathology of the narcissistic/(borderline) parent in which the child psychologically surrenders to the role as the “regulating other” for the narcissistic/(borderline) parent, the child acquires the same psychological characteristics of the narcissistic/(borderline) parent that the child is reflecting for the regulation of the narcissistic/(borderline) parent. 

The child’s acquisition of these parental narcissistic and borderline characteristics through the child’s role as the “regulatory other” for a narcissistic/(borderline) parent represent Diagnostic Indicator 2 for an attachment based model of “parental alienation” (see Diagnostic Indicators and Associated Clinical Signs post). 

These acquired characteristics include the narcissistic/(borderline) characteristic that “truth and reality are what I assert them to be.”  The presence in the child’s symptom display of this characteristic thought process, that “truth and reality are what I assert them to be,” is a particularly distinctive sign of attachment-based “parental alienation” that evidences the influence of a narcissistic/(borderline) parent on the child’s psychological processes.

In the vignette described above, the authentic child hurts at having criticized his mother. The authentic child feels like he betrayed his mother by cooperating in the “mom-bashing” exchange with his father. The child feels guilty. While the child had to criticize the mother in order to keep the narcissistic/(borderline) parent emotionally regulated, the child doesn’t realize this. The role as the “regulatory other” is too subtle and complicated a role-relationship for the immaturity of the child to recognize.

So the child just knows something hurts (i.e., guilt at betraying his mother), but he doesn’t know why he hurts.  All he knows is that his hurt has something to do with his mother.

As this dynamic progresses, the child will come to misinterpret this hurt surrounding his mother (i.e., his guilt at betraying her and his grief at losing a relationship with his beloved mother once the rejection is underway), as being something “bad” about his mother.  In trying to understand what hurts about his mother, the child comes to misinterpret an authentic hurt as meaning that there must be something bad about who his mother is as a person.

Since she’s not actually doing anything bad that he can specifically identify, it must be her very “personhood” that’s bad.   And his father is more than willing to support this misinterpretation that the very personhood of the mother is bad, malicious, and inadequate (i.e., a manifestation of the “splitting” dynamic of the father’s psychopathology; (see Key Concept: Splitting post), so that the mother “deserves” to be rejected by the child.

“If others fail to satisfy the narcissist’s “needs,” including the need to look good, or be free from inconvenience, then others “deserve to be punished”… Even when punishing others out of intolerance or entitlement, the narcissist sees this as “a lesson they need, for their own good” (Beck, et al., 2004, p. 252).

The child’s presentation of a “deserves to be rejected” theme regarding the targeted-rejected parent is another very distinctive and characteristic diagnostic feature of attachment-based “parental alienation.”

Over time, the narcissistic/(borderline) parent will provide the child with an array of “acceptable” themes for why the child hurts relative to the other parent, e.g., the other parent is self-centered and selfish, is insensitive to the child’s needs, that the other parent broke up the family by seeking the divorce, or has a really irritating way of saying things, etc.

Regulating the Psychopathology

This whole process is controlled and directed by the narcissistic/(borderline) parent as a means to regulate the psychopathology of the narcissistic/(borderline) parent.

In the vignette described above, once the trauma reenactment narrative is in place, the father is no longer the inadequate parent (person), the mother is. The father’s threatened exposure of core-self inadequacy is protected by projectively displacing it onto the mother by means of the child’s induced symptomatic rejection of her.she’s the inadequate parent (person), not me.

The father on the other hand, becomes the “all-wonderful” parent, and the father is allowed to display the “wonderfulness” of his “nurturing and protective parenting” to the “bystanders” in the trauma reenactment who are represented by the array of therapists, parent coordinators, teachers, and attorneys who become involved.

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

This narcissistically based “wonderfully perfect nurturing and protective parent” presentation to the “bystanders” in the trauma reenactment is sometimes explicitly expressed by the narcissistic/(borderline) parent in the sentence, “I only want what’s best for the child.” What a wonderful parent, right? Totally unlike the other parent who only cares about his or her selfish desire to have a relationship with the child.  If the other parent really cared about the child they would let the child reject them and never see the child again.  What a selfish parent.

Therapist radar should always be alerted whenever a parent says, “I only want what’s best for the child.”  We all want what’s best for the child.  Normal-range parents almost never make this statement because it is so self-evident.  But the narcissistic/(borderline) parent doesn’t recognize this statement as being self-evident for normal-range parents, and thinks it represents a “wonderful parent” presentation.  It’s not a definitive sign, but it should raise therapist alertness for the presence of the all-wonderful “protective parent” role.

The child’s rejection of the mother also allows the father to psychologically expel his abandonment fears onto the mother – she becomes the entirely abandoned parent (person) – whereas the father becomes the ideal and perfect never-to-be-abandoned parent.

The narcissistic/(borderline) father also gains possession of “the prize,” the child, who represents a “narcissistic object” symbolizing the father’s victory over the mother, and validating the father as being the “good parent.”

“[For the narcissistic personality] instead of learning to accept and master normal and transient feelings of inferiority, these experiences are cast as threats to be defeated, primarily by acquiring external symbols or validation.” (Beck et al., 2006, p. 247)

“[For the narcissistic personality] the need to control the idealized objects, to use them in attempts to manipulate and exploit the environment and to “destroy potential enemies,” is linked with inordinate pride in the “possession” of these perfect objects totally dedicated to the patient. (Kernberg, 1975, p. 33)

Childress commment: “totally dedicated to the patient” represents the “regulating other” role of the child for the narcissistic/(borderline) parent.

And through the child’s rejection of the mother, the father is able to exact revenge on the the mother for the narcissistic injury she inflicted upon him by not recognizing his “wonderfulness.” How dare she not recognize his narcissistic wonderfulness. Well, she’s paying for it now.

“If others fail to satisfy the narcissist’s “needs,” including the need to look good, or be free from inconvenience, then others “deserve to be punished”… Even when punishing others out of intolerance or entitlement, the narcissist sees this as “a lesson they need, for their own good” (Beck, et al., 2004, p. 252).

Court orders and therapist directives for parents to “not talk badly about the other parent in front of the child” are totally irrelevant. Talking badly about the other parent is NOT how the child’s symptomatic rejection of the other parent occurs.

The child is first induced into being a “regulatory other” for the pathology of the narcissistic/(borderline) parent.

From there, the child is induced into adopting the “victimized child” role in the trauma reenactment narrative of the narcissistic/(borderline) parent, which immediately creates and defines the other two trauma reenactment roles of “abusive parent” and “protective parent.”

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

* Regarding the vignette, I used the father as representing the narcissistic/(borderline) parent and the mother as the targeted parent, but these genders could easily be reversed.  There is no gender bias in attachment-based “parental alienation.”  It affects males and females in roughly equal proportions.

References

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

Kandel, E. R. (2007), In Search of Memory: The Emergence of a New Science of Mind, New York: W. W. Norton & Company.

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

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

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).

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.

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.

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

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.