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You want to hear something particularly disturbing? Child custody evaluators are actually instructed NOT to identify parental pathology in their reports. That’s right. They are specifically instructed by their Standards of Practice NOT to identify parental psychopathology in their reports.

Here is Standard 4.6c from the Model Standards of Practice for Child Custody Evaluation of the Association of Family and Conciliation Courts (AFCC), the umbrella professional organization for family law attorneys and child custody evaluators:

(c) Evaluators recognize that the use of diagnostic labels can divert attention from the focus of the evaluation (namely, the functional abilities of the litigants whose disputes are before the court) and that such labels are often more prejudicial than probative. For these reasons, evaluators shall give careful consideration to the inclusion of diagnostic labels in their reports. In evaluating a litigant, where significant deficiencies are noted, evaluators shall specify the manner in which the noted deficiencies bear upon the issues before the court.

Now first, let me acknowledge that Standard 4.6c does not specifically say, “don’t identify parental pathology.” It doesn’t say exactly that. It refers to “diagnostic labels” (such as narcissistic and borderline personalities), and it only cautions that evaluators “shall give careful consideration to the inclusion of diagnostic labels in their reports” (a professionally temperate euphemistic statement for don’t do it) because “diagnostic labels can divert attention from the focus of the evaluation.”

Actually, I would strenuously disagree with the premise that “diagnostic labels can divert attention from the focus of the evaluation.”  I firmly believe that diagnostic nomenclature actually advances our understanding of the CENTRAL feature of the evaluation, maintaining the child’s healthy emotional and psychological development. But I’ll defer this particular discussion for a bit.

But the implication of Standard 4.6c is clear, don’t label a parent’s pathology as borderline or narcissistic.

Why not? Because, according to the AFCC, the effects could be more “prejudicial than probative.”

Definition of Prejudicial: harmful to someone or something; detrimental

Definition of Probative: having the quality or function of proving or demonstrating something; affording proof or evidence

So here are my questions:

Question 1. So what are the “harmful” effects of identifying a parent as having a prominent borderline or narcissistic pathology, and are there potential harmful effects of NOT identifying a parent’s borderline or narcissistic pathology?

Question 2: Are there benefits from identifying a parent’s borderline or narcissistic pathology and using a diagnostic nomenclature to capture the description of the pathology.

Diagnostic Labels

Diagnostic labels aren’t just words applied to people, they represent complex psychological constructs of extensive meaning. That’s why we use them. They are a short-hand professional description for a complex network of associated pathologies.

For example, when I use the term narcissistic personality, this has a network of complex pathologies associated with it:

Splitting:  There is very likely to be splitting pathology in which perceptions of other people are polarized into all-good and all-bad extremes.

Projection:  There is likely to be a prominent use of projection. This means that the accusations that this person makes toward other people, such as the other spouse, are likely to be an indication of the narcissistic personality’s own psychological processes.

Pathological Mourning:  This person will have prominent difficulty processing sadness, grief, and loss, and we are highly likely to find problematic terminations to relationships involving a complete cutoff of the other person when they fail to provide the narcissistic personality with ongoing “narcissistic supply.”

Delusional Beliefs:  The narcissistic personality readily decompensates into delusional belief systems, so the presence of an encapsulated delusional belief regarding the other spouse is highly likely.

Degradation of Others:  The narcissistic personality is highly judgmental and contemptuous of others, so a demeaning and dismissive attitude toward the ex-spouse is very likely, and is highly likely to be communicated by the narcissistic parent to the children.

Lack of Empathy:  The narcissistic personality completely lacks the capacity for empathy. This means that a narcissistic parent will be unable to empathically attune to the child’s needs. Instead, the narcissistic personality parent will engage the child in a role-reversal relationship in which the child’s authenticity is obliterated and the child is expected to reflect the attitudes and beliefs of the narcissistic parent (including the contemptuous disdain for the other parent).

Subjective Truth:  Truth and reality are subjectively and arbitrarily defined by the narcissistic personality, and can often bear little resemblance to actual truth and actual reality. The narcissist often inhabits a fantasy world of their own construction. They feel that the normal rules that govern the actions of other people do not apply to them, so they frequently disregard restrictions on their behavior and they frequently disregard the rights of others. This creates a nearly impossible co-parenting relationship.

Vengeful: Narcissistic personalities are highly retaliatory and vengeful, particularly toward those who have caused a “narcissistic injury” to them, such as by rejecting the self-perceived magnificence of their narcissist’s grandiosity.

etc.

So the moment any mental health professional uses the diagnostic identification of “narcissistic personality” a whole set of associated meanings also constellate around this term. That’s why we assign terms to designate specific patterns of pathology, so that we don’t have to individually identify all the component aspects each time we discuss the pathology.

The use of diagnostic nomenclature also provides insights into the pathology that may not yet be evident in the clinical interview. For example, if I see a haughty and arrogant attitude and an absence of empathy, then by recognizing these as potential diagnostic indicators of a narcissistic personality I might then look for projective processes and splitting. If these are present, I might become more skeptical regarding this person’s assertions of reality, meaning that I’ll need to verify this person’s interpersonal perceptions with additional information.

The same is true if I identify a pathology as representing the diagnostic construct of a borderline personality structure. Immediately, a whole set of associated clinical constructs become active, such as abandonment fears, splitting, potential childhood sexual abuse, presentation as the “victim,” etc.

The reason we use this diagnostic nomenclature is because it conveys a complex network of meaning. If we restrict ourselves from using this diagnostic nomenclature, then we are reduced to identifying each component of an organized pathology as if it was a separate psychological process. It’s not. It’s all part of a single organized psychological process, a single pathological organization.

For mental health professionals to intentionally withhold information about parental psychopathology is highly questionable and it sounds manipulative. Rather than sharing accurate mental health information regarding the parents, we are seeking to intentionally influence the recipient’s response to the pathology by not disclosing the nature of the pathology. We are essentially colluding with the pathology by attempting to hide the pathology.

In my view, Standard 4.6c should state:

“If parental pathology is evident, then the extent and implications of this pathology should be described and explained.”

That’s it. Period. If that includes providing the relevant diagnostic nomenclature to organize the description of the pathology, then that’s fine; identify the nomenclature and the implications of the pathology.

If the parent’s behavior would meet diagnostic criteria for Bipolar Disorder, then the custody report should say that the parent’s behavior meets diagnostic criteria for Bipolar Disorder.

If the parent’s behavior would meet diagnostic criteria for Schizophrenia, then the custody report should say that the parent’s behavior meets diagnostic criteria for Schizophrenia.

If the parent’s behavior displays prominent narcissistic or borderline personality traits, then the custody report should say the parent’s behavior evidences prominent narcissistic or borderline personality traits.

The truth is what it is. Intentionally withholding or trying to “soften” the truth to protect the pathological parent, particularly with regard to legal/family decisions of profound consequence to the child, is, in my view, highly inappropriate professional behavior.

The truth is what it is.   We should not withhold psychological nomenclature from the court in an effort to influence the court’s decision.  The court should have access to all the relevant psychological information, including relevant psychological nomenclature for parental pathology, and it is then up to the court to determine how to weigh that information.

Consideration of Question 1: Prejudicial Impact

Question 1. So what are the “harmful” effects of identifying a parent as having a prominent borderline or narcissistic pathology, and are there potential harmful effects of NOT identifying a parent’s borderline or narcissistic pathology?

Someone is going to have to answer this for me, because I don’t see the harmful effects of identifying a parent’s narcissistic or borderline pathology in a child custody evaluation. The identification of parental pathology will lead to a better decision in support of the child’s healthy emotional and psychological development.

Hmmm, harmful to whom?  To the child?  How would identifying parental pathology in a child custody report be harmful to the child?  Nope. Don’t see it.  Harmful to the targeted parent?  Nope. Don’t see how identifying the parental pathology of one parent is harmful to the other parent.  Harmful to the pathological parent?  That seems to be the implication.  Don’t identify parental pathology because doing so will be harmful to the pathological parent.

That seems an odd mandate, for the AFCC to suggest that custody evaluators intentionally act to protect the pathological parent. That appears to represent the intentional imposition of an inherent bias into the evaluation process in favor of the pathological parent. When there is significant parental pathology, shouldn’t our sole focus be on protecting the child from the pathology of the parent?  And wouldn’t overtly identifying the nature and severity of the parental pathology help us to protect the child?

The identification of parental narcissistic or borderline psychopathology may mean that the narcissistic/borderline parent does not obtain custody of the child, or that the contact of this parent with the child may be restricted in some way due to the impact of this parental psychopathology, and I suppose someone could say that the narcissistic/borderline parent was therefore “harmed” by the identification of their pathology – but I find that kind of rationale highly convoluted.

The pathology of the parent is what it is. We are considering the healthy development of the child. I am not willing to sacrifice the child’s healthy emotional and psychological development to collude with the psychopathology of the parent by hiding the nature and extent of the parent’s psychopathology. If the parent has prominent narcissistic/borderline personality traits then the parent has prominent narcissistic/borderline personality traits. The truth is the truth. If the child needs to be protected from the psychopathology of the narcissistic/borderline parent then child needs to be protected from the psychopathology of the narcissistic/borderline parent. The truth is the truth.

To suggest that we somehow bend or distort the truth is, in my view, highly unprofessional conduct. The truth is what it is. Yet the AFCC appears to be instructing child custody evaluators to consciously introduce bias in favor of the pathological parent into child custody reports by consciously withholding relevant information about the organized pattern of pathology evidenced by the parent.  What we should do is deal with the truth. Let’s roll up our sleeves and get to work. We don’t shut our eyes and pretend it doesn’t exist.

Diverting Attention?

The AFCC believes that:

“the use of diagnostic labels can divert attention from the focus of the evaluation”

I absolutely 100% disagree. The use of professionally sound diagnostic nomenclature to describe parental psychopathology can highlight the issues CENTRAL to the focus of the evaluation. The presence of profound parental psychopathology, such as narcissistic and borderline personality pathology is of CENTRAL importance to comprehending the pathology and conflict within the family and evaluating the healthy developmental needs of the child.

In my view, the AFCC is trying to protect the pathology of the narcissistic/borderline parent from exposure, and is doing so at the expense of the child. The truth is the truth.

If schizophrenic pathology is present in a parent, say so.  

If bipolar pathology is present in a parent, say so.

If obsessive-compulsive hoarding pathology is present in a parent, say so.

If narcissistic/borderline personality pathology is present in a parent, say so.

To attempt to manipulate the response of the court to the truth by withholding or distorting the information we provide to the court is, in my opinion, unprofessional conduct. And, in my opinion, it is reprehensible to protect exposing the pathology of the parent at the expense of the child’s healthy development.

In my view, Standard 4.6c of the AFCC is seeking to prevent the exposure of the narcissistic/borderline parent’s psychopathology at the expense of protecting the child’s healthy development.

Q: Are there potential harmful effects of NOT identifying a parent’s borderline or narcissistic pathology?

Yes, absolutely.  When we intentionally withhold relevant psychological information in an effort to influence the outcome of decisions, we foster and support ignorance in decision making.  From the ignorance we foster regarding the full nature of the pathology evidenced by the parent, ignorance which is created when we intentionally withhold relevant psychological information (the diagnostic nomenclature describing a coherent complex pattern of parental pathology), we increase the likelihood that an incorrect decision regarding the child’s well-being will be made. Because we have intentionally withheld relevant psychological information from the court, the court may not fully appreciate the nature and extent of the parental psychopathology or the need to protect the child from the distorting effects of the parental psychopathology.

Our professional obligation is to provide the court with the psychological facts. All the psychological facts. Our role is not to shade the facts in this way or that in an effort to influence the outcome in some way. We are serving as psychological consultants to the court. The court has THE RIGHT to the psychological facts… all of the psychological facts… including the psychological nomenclature describing the organized pattern of psychopathology evidenced by a parent.

In my view, the AFCC is 100% wrong in trying to manipulate an outcome in favor of the pathological parent by shading the facts presented to the court.  The truth is the truth, including the appropriate psychological nomenclature used in professional psychology to describe the organized pattern of pathology evidenced by the parent.

We should simply speak the whole truth.

FBI Analogy:  What if the policies and procedures of the FBI crime lab were to routinely not report on some category of ballistic evidence because it might have a prejudicial effect on the outcome of the trial. That’s not a decision for the FBI crime lab to make. They are to analyze the ballistic data and report on the findings… ALL of the findings.

Same for psychologists. The truth is what it is. We should provide the court with the full psychological truth. If this includes the psychological nomenclature for describing the pattern of pathology evidenced by a parent, then this includes the psychological nomenclature for the pattern of pathology evidenced by a parent.

I am both surprised and appalled that it is acceptable to the court that the information they receive from child custody evaluations is systematically distorted in favor of not identifying parental pathology, which introduces a systematic bias into child custody evaluations in favor of the pathological parent. And this is okay?

Apparently it is… at least for the present.

Question 2: Benefits to Disclosing Pathology

Question 2: Are there benefits from identifying a parent’s borderline or narcissistic pathology and using a diagnostic nomenclature to capture the description of the pathology.

I think there are. Recognizing standard and established forms of pathology grounds our assessment in standard and established psychological principles and constructs. 

The use of appropriate professional categories for identifying pathology organizes our assessment process and provides theoretical coherence to the interpretation of the clinical information. The use of appropriate professional nomenclature for pathology identifies the disparate aspects of parental psychopathology as representing an organized pattern of problematic parenting with predictable expressions and predictable consequences on family relationships.

The truth is the truth.  Recognizing and identifying the truth allows us to make better decisions than would otherwise occur through intentionally withholding relevant psychological information from the court.

The court has a right to know.  It is not up to us to decide what professional information to make available to the court and what information to withhold from the court in an effort to influence the decision the court makes.  Our professional obligation is to provide the court with the relevant psychological information.  What the court does with this information is the court’s responsibility.

RICO

Systematically distorting the reporting of parental pathology in an effort to hide the nature and severity of this parental pathology is only one of a number of highly problematic features associated with child custody evaluations.  My prediction is that within the next five years the AFCC, the APA, and child custody evaluators are going to be hit with a class action RICO lawsuit. The practice of child custody evaluations in the family law system is an organized racket for financial gain.

No Scientific Validity

There is no scientific evidence for the validity of the conclusions and recommendations of child custody evaluations.  None.  There is no evidence of construct validity, no evidence of content validity, no evidence of predictive validity, no evidence of concurrent validity, no evidence of discriminant validity.  None.  There is no scientific evidence for the validity of the conclusions and recommendations of child custody evaluations. NONE.

No Theoretical Foundation

While child custody evaluations involve extensive data collection (which, by the way, is what makes them so exceedingly expensive – it’s the data collection process not the quality of the findings that makes child custody reports so expensive), no established psychological models from professional psychology are applied to the interpretation of this data. No established psychoanalytic model, no established humanistic or existential model, no family systems model, no cognitive-behavioral model, no established model of professional psychology is applied to the interpretation of the collected data. Child custody evaluators simply make up whatever interpretations, conclusions, and recommendations they want without reference to any established psychological model, principles, or constructs (even the DSM-5 is prohibited by Standard 4.6c according to the AFCC).

The conclusions and recommendations of child custody evaluations are simply made up, with no inherent linkage to any of the data they collected earlier. I’m hoping that an attorney is beginning to see the RICO lawsuit.  It’s an organized racket.  Charge for extensive data collection, but then simply make up the findings and recommendations however you like.  There is NO linkage of the conclusions and recommendations to the extensive (and expensive) data collection phase, and there is no consistent or reliable application of established psychological principles or constructs to the interpretation of the collected data or the recommendations made by the evaluation.

No Key Definitions

There are no operational definitions for the two key constructs of child custody evaluations, “parental capacity” and the “best interests of the child.” Without operational definitions for these key constructs, these constructs are without defined meaning. This allows the custody evaluators to essentially make up whatever conclusions and recommendations they want, and then post hoc, after the fact, define these conclusions and recommendations as being in the “best interests of the child” (simply because the custody evaluator says so, and this is acceptable because there are no operational definitions for what these terms mean).

An Organized Racket

There is absolutely NO VALIDITY to the conclusions and recommendations of child custody evaluations. Zero.

That’s a bold and assertive statement. There is a comment section to this post. I challenge anyone to cite me the research support for the construct validity, content validity, predictive validity, concurrent validity, or discriminant validity of the conclusions and recommendations made by child custody evaluations… <crickets>  There is none.

At $20,000 to $40,000 per single child custody evaluation, it is a very lucrative organized racket. By providing “standards” for child custody evaluations, the AFCC becomes the organized syndicate, and the evaluators are the capos.  The parents are “the marks” in a confidence scheme, a shell game.  I suspect a RICO lawsuit is coming in the next five years.

If an attorney wants to know exactly where to go to uncover the shell game, look to the interface between the two parts of the custody evaluation.  Part 1 is the data collection and report writing that documents the collected data. This is where all the money is made by conducting exceedingly extensive data collection without clear theoretical focus.  They substitute quantity of information collected for focused quality of information.  They do this because they don’t know what they’re looking for.  And in truth, it actually doesn’t matter what they’re looking for because they just make up Part 2, the interpretation and recommendations, anyway, so it doesn’t really matter what the data is.

The two parts to the child custody evaluation:

Part 1 – Data Collection and Reporting:

The first part is an exhaustive (and expensive) collection and reporting of data. This involves interviewing all the family members on multiple occasions, conducting home visits and observations, administering, scoring, and interpreting a variety of test instruments, interviewing collateral informants and reviewing collateral documents, and then there is the report writing in which they document all the information that was collected.

All of this time is billed at hundreds of dollars an hour. This would be fine if this data collection actually meant something, but it doesn’t. It doesn’t mean a damn thing, because of Part 2 – Data Interpretation and Recommendations.

Part 2 – Interpretation and Recommendations

There are absolutely NO guidelines for how the data collected in Part 1 is interpreted, nor are there any guidelines governing what recommendations should be made from this data. Child custody evaluators just make it up. Seriously. They just make this part up.

The Public: “Surely you’re exaggerating, Dr. Childress. They’re not just making up their interpretations and recommendations.”

Dr. Childress: No, actually I’m not exaggerating. They are entirely making up their interpretations of the data and their recommendations based on whatever whim moves them at moment.

I’ll explain this more fully in future posts. But the racketeering issue is what occurs between Part 1 (the billable hours part of data collection) and Part 2 (the make-it-up interpretation and recommendations part).

It’s a shell game. Watch the moving shells of data collection, interviews, testing, home observation, all to distract you from the key moment when the custody evaluation switches from data collection to data interpretation. At that moment the custody evaluator palms the pea.

So which shell is the pea under? Oooooo, so sorry. Better luck next time and thanks for playing. That will be $30,000 please. Next. Step right up. Try your luck at custody evaluation.

Parent: But what about the clearly evident psychopathology of the other parent?

I’m sorry, we don’t identify psychopathology. It might prejudice the case against the pathological parent. Don’t blame me, it’s the AFCC’s rules… don’t identify pathology, too prejudicial against the pathological parent if we identify their pathology.

RICO, RICO, RICO.

Think I’m wrong…

I challenge professional psychology, the APA or AFCC, to cite for me the research support for the construct validity, content validity, predictive validity, concurrent validity, or discriminant validity of the conclusions and recommendations of child custody evaluations.

I challenge professional psychology, the APA or AFCC, to provide me with the operational definitions for the key constructs of “parental capacity” and “best interests of the child” that are used in interpreting the data of child custody evaluations.

I challenge professional psychology, because they know I’m right.  They know that establishing the validity of an assessment procedure and operationally defining the key constructs used in the assessment are foundational to ALL assessment procedures.  Personality assessment, Intelligence assessment.  Achievement testing.  They know that.

I teach courses in Assessment and Psychometrics at the graduate level.  I know that establishment mental health knows that demonstrating validity and providing operational definitions for the key constructs of the assessment are foundational to the assessment process. Establishment psychology, you know that, and I know you know that. So why aren’t you doing what’s right? Why aren’t you demanding that your professional membership do scientifically sound and professional assessments.

“Because we don’t know what that is with regard to child custody.”

Exactly.  Once you admit that, then we can begin the process of building professionally sound and scientifically supported assessments.  We can do it.  We did it for the constructs of intelligence.  We did it for the constructs of personality.  We can do it for the constructs of parental capacity and the best interests of the child.  Is it hard?  Yep.  Is it complicated?  Yep.  So’s intelligence, so’s personality. 

We start by offering definitions for the constructs “parental capacity” and “best interests of the child.” Then someone disagrees and offers a counter definition.  Then five different groups offer five alternative definitions… and we set about the process of defining the constructs.

Then, once we have the constructs defined (even if we have yet to settle on a consensus definition) we set about developing the methods for how we assess for that operationally defined construct. And once we have developed our assessment procedures, we subject our assessments to reliability and validity studies.  We absolutely know how to do this.  So why aren’t we doing it?

Establishment mental health, you may not like what I’m saying in calling out the racket of child custody evaluations, and you may see me as your enemy, but I’m actually your best friend.  I’m actually on your side.  We know how to do the right thing, and the current practice of child custody evaluations is NOT it.  Intelligence testing is the right way.  Personality testing is the right way.  The Rorschach lacked scientific validity. So Exner fixed it.  We know what to do.  Do the right thing.  I know you know what that is.  The RICO lawsuit is on its way.  I’m just trying to alert you.  I’m your best friend.

If an assessment process lacks scientifically established validity and lacks operational definitions for its key constructs, then it is not professionally acceptable. Establishment psychology knows that, and I know they know it. So the question for establishment mental health becomes, what are you going to do about it?

It is directly analogous to the NFL and the issue of player concussions. The medical evidence of football-related concussions leading to long-term brain damage in NFL players was there for decades, but the NFL turned a blind eye because football was so financially lucrative. The NFL tried to suppress this medical information, and eventually it took a players’ lawsuit to bring the medical evidence to light and achieve an $870 million dollar settlement against the NFL.

The professional organizations in psychology now face a similar moment of truth. There is no scientific support for the practice of child custody evaluations. Zero. It is a shell game.  Watch the moving data collection while the pea is palmed in the interpretation and recommendations.

There’s no point attacking me.  I’m not the problem.  The lack of scientifically established validity and operational definitions for key constructs is the problem.  I’m just the kid on the side of the road saying, “Hey look mommy, the emperor has no clothes.”

I’m not the problem. If you want to be wearing some clothes, then go put some clothes on.

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

Kay offered a Comment to my On Notice post, and I wanted to respond more fully, so I decided to respond as a separate blog.

It warms me, Kay, that you were with your son again at his 19th birthday and my prayers are with you in your journey of healing.

The trauma was created several generations ago through a profound absence of parental empathy that deeply injured a child. That child victim of childhood attachment trauma then grew up to transmit their own childhood trauma to the next generation, again through a profound absence of empathy, a quality they never acquired from their own childhood. This pathology is one of great suffering, transmitted from one generation to the next; from one person to the next.

But we can bring it to a close… through empathy. The children of alienation were lost. The world of the narcissistic/borderline parent is an upside-down world where truth and reality change on the whim of the unstable parent, up is down, night is day, and love is conditional on their surrender to the parent.

To the child; we understand that. No worries. Welcome back. It is very much like waking up, and it’s good to have you back.

My goal is to heal this pathology for all parents and all children, from ages 4 to 40. And when the pathology begins to show itself after a divorce, any divorce, my goal is to have professional mental health jump on it in the first six months and stop it before it becomes established. That’s the goal.

We will be solving this pathology in stages.

The first immediate and pressing need is to stop the “bleeding out” of currently active “parental alienation” cases. This requires that we end the unproductive and extremely damaging debate within mental health regarding whether the pathology even exists.  It exists.  It is the expression of narcissistic and borderline personality pathology into family relationships following divorce, in which the child is being used as a “regulatory object” by the narcissistic/borderline parent to stabilize the pathology of this parent.

We need to wake up professional mental health from its decades-long slumber. Forget about PAS – old news – old debate. Gardnerian PAS is an old and stale debate.

We’re talking about the impact of narcissistic and borderline personality pathology on a family following divorce; following the rejection of the narcissistic/borderline parent by their spouse. In order to stabilize their own personality disorder pathology, the narcissistic/borderline parent engages the child into a role-reversal relationship in which the child is used as a regulatory object to stabilize the pathology of the parent.

While this may seem like foreign words to a targeted parent, this is standard mental health stuff to a competent mental health professional. Narcissistic/borderline personality; role-reversal relationship; regulatory object… yeah, I’ve got it. Makes total sense.

But so many in mental health are simply incompetent. They don’t know what they’re doing. We must clear them from the field of working with your children and families. How do we do this?

Two ways…

1. The APA

First we demand that the primary professional organization for mental health professionals, the American Psychological Association, step up to their responsibility under Standard 2.01 of their own ethics code and clear these incompetent mental health professionals from practice with your families. You must demand that the APA recognize your children and families as a “special population” requiring specialized professional knowledge and expertise to assess, diagnose, and treat.

It is NOT up to you to educate your therapist. Your therapist should ALREADY BE educated in the required information needed to accurately diagnose and effectively treat your children and familes.

But the APA has been locked into an unproductive debate as to whether the pathology even exists. This is a product of an extremely poor Gardnerian PAS model that allows the allies of the pathogen to discredit it as scientifically unsound. We MUST drop the Gardnerian PAS model in order to end the debate and activate the response of the APA. We must define the pathology entirely from within standard and accepted forms of psychopathology to which ALL mental health professionals can be held ACCOUNTABLE.

That’s what Foundations does.

So now, using the definition of the pathology provided by Foundations, it is up to you to DEMAND that the APA formally acknowledge that 1) the pathology of narcissistic and borderline personalities exists and will impact family relationship processes surrounding divorce, and 2) that your children and your families represent a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

If you’re sold a bad car, don’t stand there arguing with the salesperson, take the issue up to the manager, take it to the owner of the dealership, take it to the manufacturer. Go to the top. Don’t stand there arguing with the ignorant lackey. Give the salesperson a chance to make it right. If they don’t, ask to speak to the manager, then to the dealership owner, then take it to the manufacturer, and up and up the chain of command. Oftentimes it’s best to start at the top and let the letter of reprimand come down from one boss onto the head of the lower boss, onto the heal of the lower boss, onto the head of the salesperson.

Many of you are only thinking of your specific case. You’re locked by your suffering into your own self-centered world. But we cannot solve “parental alienation” for any specific family until we solve it for ALL families. It is the mental health system itself that is failing you. We must first fix the mental health system so that you won’t have to educate the therapist, so that the therapist will ALREADY BE educated. This means that you must come together and target the APA. Demand that they REQUIRE professional competence consistent with Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct.

They’ll respond that they don’t accept Garnderian PAS. You respond that you’re not talking about Gardnerian PAS, you’re talking about the impact of narcissistic and borderline personality pathology (as identified by the DSM diagnostic system) on family relationships following a divorce. You’re talking about the role-reversal use of the child by a narcissistic/borderline parent as a regulatory object to stabilize the pathology of the narcissistic/borderline parent following a divorce. You’re talking about the trans-generational transmission of attachment trauma (disorganized attachment) from the childhood of the narcissistic/borderline parent into the current family relationships. Who’s talking about Gardnerian PAS?  Not you. So they need to respond to what you’re talking about, the pathology of a narcissistic/borderline parent following divorce. This pathology exists. And it’s assessment, diagnosis and treatment requires specialized professional knowledge and expertise. Because of this, your families deserve formal recognition as a “special population” requiring specialized professional knowledge and expertise in personality disorder pathology, attachment trauma pathology, and family systems pathology.

I will not abandon you. Don’t abandon each other. Don’t fight for just your child, fight for all of the children. In solving this for all of the children we will solve it for your child. Demand that the APA enforce its requirement for professional competence. Demand that they acknowledge the pathology of narcissistic and borderline personality pathology that can distort family relationships following a divorce. Demand that they formally recognize your children and your families as a “special population” who require specialized knowledge and expertise in the assessment, diagnosis, and treatment of personality disorder pathology, attachment trauma pathology, and family systems pathology.

Do not abandon each other to fight this alone. Come together and go to the top. Let the boss send a letter of reprimand to the underboss, who sends a letter of reprimand to the underboss, who takes to task the ignorant and incompetent salesperson. Don’t stand there arguing unproductively with the salesperson. They’re an idiot. Go to the top. Come together. Fight for your neighbor’s children and let them fight for yours. Do not abandon each other.

The most fierce warriors on any battlefield are not the ones fighting to keep themselves alive, they’re the ones fighting for their buddies next to them.   Ask any combat veteran. They’re not fighting for themselves, they’re fighting for their buddies. Come together, fight for each other.

We’re not talking about Gardnerian PAS, we’re talking about personality disorder pathology. We’re talking about the trans-generational transmission of attachment trauma from the childhood of the narcissistic/borderline parent into the current family relationships. These things exist. They understand these things exist. So let’s move the discussion to what do we do about these things and end this unnecessary and devastatingly destructive debate created by Gardnerian PAS as to whether this pathology even exists.  It exists.  Narcissistic and borderline personality pathology exists. Cross-generational coalitions exist. The reenactment of attachment trauma exists.

The domestic violence and child abuse people will raise concerns about “parental alienation” invalidating authentic domestic violence and authentic child abuse.  Agree that these things also exist.  No argument there.  Domestic violence and child abuse exist – dogs exist.  Personality disorder pathology also exists – cats exist.

Not all animals are dogs. Sometimes they’re cats. The existence of cats does not nullify the existence of dogs. Both dogs and cats exist. So can we please move on now to having a productive discussion within professional mental health regarding how we reliably identify cats from dogs – about the diagnostic features that differentiate a child’s response to authentic abuse from a role-reversal relationship with a narcissistic/borderline parent in which the child is being used as a regulatory object to stabilize the pathology of the parent (which has traditionally been called “parental alienation”). Can we begin to have that discussion please? Because there are thousands and thousands of children and parents who are currently being abandoned by professional mental health to the pathology of a narcissistic/borderline parent. Professional mental health can end this, but they first need to acknowledge that the pathology exists.

Let’s stop arguing about Gardnerian PAS. That just continues the unproductive debate. Fine. We’ll give up and let go of the Gardnerian PAS model. BUT… in its place we have a more detailed attachment-based model of the pathology. Let’s talk about the attachment-based model. The pathology exists, and an attachment-based model describes it in full and complete detail across three separate and integrated levels of analysis. Cats exist.

Once we have mental health as your ally, the next set of dominoes will begin to fall quickly.

The pathology of attachment-based “parental alienation” is already in the DSM-5 – it’s on page 719: V995.51 Child Psychological Abuse, Confirmed – pathogenic parenting that is producing severe developmental pathology (diagnostic indicator 1), personality pathology (diagnostic indicator 2), and psychiatric pathology (diagnostic indicator 3) which then results in the loss for the child of a normal range affectionally bonded relationship with a normal-range and affectionally available parent, all in order to stabilize the pathology of a narcissistic/borderline personality parent, represents the psychological abuse of the child by the narcissistic/borderline parent.

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

2. Become Dangerous

The second way to clear out professional incompetence is to become exceedingly dangerous to incompetence.

The goal is to make professional practice in this sub-specialty area of psychology extraordinarily dangerous to mental health professionals.

If they make a diagnosis of V995.51 Child Psychological Abuse, Confirmed then they will face a licensing board complaint from the narcissistic/borderline parent:

“How dare you say I’m abusing my child, we have a wonderful relationship. You’re incompetent.”

If, on the other hand, they DON’T make a diagnosis of V995.51 Child Psychological Abuse, Confirmed when the three diagnostic indicators of the pathology are present, then they will face a licensing board complaint from the targeted parent:

“By not accurately identifying the pathology when the diagnostic indicators of the pathology were present, you lack the professional knowledge and expertise in personality disorder pathology, attachment trauma pathology and family systems pathology necessary to competently assess, diagnose, and treat my children and my family, in possible violation of Standards 2.01 and 9.01, which has caused harm to my children and myself, in possible violation of Standard 3.04.

Either way, no matter what they do, the mental health professional is going to face a licensing board complaint. Pretty much guaranteed.

So then what are they going to do?

Many will simply stop accepting this type of case. It’s simply too dangerous.

Good. This is exactly what we want. If the mental health professional withdraws because you, the targeted parent, have become empowered to demand professional competence, this is EXACTLY the binding-site-of-ignorance we want to clear out. This is exactly what we want.

Your allies in mental health, the mental health professionals who get it, who understand the pathology – we will remain. We will NOT be intimidated by the threats of the narcissistic/borderline parent. The number of mental health professionals in your area treating this type of pathology may drop from 100 to 2, but the two that remain will know what they’re doing – and the two that remain WILL MAKE the diagnosis of V995.51 Child Psychological Abuse, Confirmed when it is warranted by the presence of the three diagnostic indicators in the child’s symptom display.

And… these mental health professionals will be hit with a licensing board complaint from the narcissistic/borderline parent. That’s what you, the targeted parent, need to understand. When competent mental health professionals make an accurate diagnosis of V995.51 Child Psychological Abuse, Confirmed they will be hit with a retaliatory licensing board complaint from your narcissistic/borderline ex-.

If you want mental health professionals to stand up and face the sure-to-follow retaliation of the narcissistic/borderline parent, then you MUST protect them.

We cannot expect the child to reveal authentic love for you unless we are FIRST able to protect the child from the retaliation of the narcissistic/borderline parent.

We cannot expect mental health professionals to stand up for you and your child unless we are also able to protect them from the retaliation of the narcissistic/borderline parent.

How do we protect them?

First, by Foundations. That’s one of the reasons I had to work out the pathology in such detail. In Foundations I provide mental health professionals with the theoretical justification for making the diagnosis of V995.51 Child Psychological Abuse, Confirmed. The mental health professional can stand on the solid bedrock of Foundations in making the diagnosis of Child Psychological Abuse, Confirmed.

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Chart Note in the Patient’s Record:

“According to the model described by Childress (2015), the child met the three diagnostic indicators for the pathology of an attachment trauma reenactment pathology of the parent. As articulated by Childress (2015), when the three diagnostic indicators for this pathology are present in the child’s symptom display, the appropriate DSM-5 diagnosis is:

DSM-5 Diagnosis

309.4 Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

A diagnostic checklist of the child’s symptom presentation was completed and is included in the patient’s record. On this symptom checklist, the child evidenced all three of the diagnostic indicators described by Childress (2015) and also evidenced numerous diagnostically confirming associated clinical signs of the pathology. The presence in the child’s symptom display of the three diagnostic indicators of the pathology detailed by Childress (2015) warrant a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed. This DSM-5 diagnosis activates this psychologist’s duty to protect, which was discharged by filing a suspected child abuse report with the appropriate child protection agency. Met with both the mother and father and explained this diagnosis and the recommended treatment plan needed to restore the child’s healthy development.”

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If the mental health professional makes a chart note such as this, then I am optimistic that the mental health professional will be safe from a retaliatory licensing board complaint by the narcissistic/borderline parent. Not only does Foundations provide the mental health professional with the theoretical foundations for the diagnosis, but child abuse reporting laws typically indemnify the therapist from complaints for having filed the suspected child abuse report.

Through this type of documentation, the mental health professional is showing professionally responsible practice grounded in established psychological principles and constructs in which patient protection considerations were of primary concern. I would be exceeding surprised if the licensing board takes any action under these circumstances.

Is it dangerous? Working with narcissistic and borderline personality pathology is always professionally dangerous. These types of personalities are extremely revengeful and retaliatory, and truth and reality have little relevance to them. So, of course it’s professionally dangerous. So is working with suicidal patients, yet we still work with suicidal patients. We just need to know what we’re doing and document appropriately and we’ll be safe.

You, the targeted parent, can also help protect your mental health allies from the retaliation of the your narcissistic/borderline ex-.  How?  In the same way as before, get the APA to formally acknowledge the existence of the pathology and the need for specialized professional knowledge and expertise in the assessment, diagnosis, and treatment of the pathology. This will alert everyone, child protective services, licensing boards, educational institutions, that the pathology of a narcissistic/borderline parent distorting family relationships following divorce is a recognized pathology within the domain of professional psychology. Then, when your narcissistic/borderline ex-spouse tries to retaliate, the licensing board will understand the pathology and will recognize the responsible professional practice of the therapist.

In addition, once the APA acknowledges the pathology and formally designates your families as a “special population,” then this will also alert all Child Protection Services agencies regarding the existence of this type of pathology, so that when the mental health professional files a suspected child abuse report with them they will apply the same diagnostic criteria, reach the same diagnostic conclusion, and will potentially enact the protective separation of the child from the pathogenic parenting of the narcissistic/borderline parent for the active phase of the child’s treatment and recovery stabilization. The pathology of “parental alienation” is not a child custody issue, it is a child protection issue.

The goal is to obtain the needed protective separation through Child Protective Services, sparing the targeted parent from having to enter the court system to obtain the necessary protective separation.

This solution is coming in stages. There’s a battle ahead of us. The battle is not for your specific child and family, it is for all children and all families. Don’t fight for yourself alone, come together and fight for your neighbor and let them fight for you. The focus of our struggle is the citadel of establishment mental health, the APA. We want them to formally acknowledge that the pathology of narcissistic/borderline parents exists and can severely distort family relationships following divorce, and we want them to designate your children and families as a special population requiring specialized professional knowledge and expertise to assess, diagnose, and treat.

To our colleagues overseas, my goal is to re-take the citadel of the American professional psychology, the APA.  This will hopefully trigger the citadels of establishment mental heath in other countries to follow suit.  If you reclaim your citadel of establishment mental health before we reclaim ours, great, this will signal our APA to follow suit.  We are all in this together.

I know you understand this, Kay. I’m glad my determination to bring an end to this terrible suffering helped inspire you to continue in your struggle. I am also confident that your steadfast determination will help inspire and lead others in finally achieving a solution to the nightmare of “parental alienation.”

My best wishes, to you and to your children, and to all of the authentic parents of wonderful children who are trying to protect, recover, and restore the authenticity of your children. We will not abandon you in your struggle, we will not abandon your children to the pathology.

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

I am sometimes asked by an attorney representing their client to provide expert testimony in an ongoing court case involving the pathology of attachment-based “parental alienation.”   These requests will typically ask that I provide my expert opinion from the perspective of clinical psychology, child and family therapy, and child development, regarding information provided to me, such as child custody evaluations and treatment progress reports from therapists.

My consultation services were recently engaged by a parent for a slightly different purpose than expert testimony in child custody litigation. This parent (a father) had endured a year and a half of incompetent family therapy from a court-appointed “parenting coordinator” who had been tasked by the court with resolving the parent-child conflict between the children and their father.

The father provided me with five treatment progress reports by this “parenting coordinator” to the court over the year and a half period of intermittent treatment, as well as the child custody evaluation and additional reports from the visitation monitor.

Based on this information, I was asked to provide my professional analysis as a clinical psychologist regarding the professional practices of the “parenting coordinator” who was tasked by the court with “reunifying” the father with his children. The father was not seeking my analysis to use in any ongoing custody litigation, the custody litigation is a separate issue. Instead, he wanted my analysis of the treatment progress reports to potentially support a licensing board complaint and malpractice lawsuit toward the “parenting coordinator.”

In my professional work I strive to enter each situation without an agenda. I don’t care what the puzzle picture turns out to be – I don’t care whether the puzzle turns out to be a picture of “boats on a lake” or “train in the mountains” or “horses in the meadow” or “cats in the garden” – it doesn’t matter to me what the puzzle is. Once we see what the puzzle is, we can set about fixing the situation. The important thing is not what the puzzle is, it’s that we have an accurate picture of that puzzle to work from. So in each case I simply begin putting the puzzle pieces together to describe what the puzzle picture is that’s created when we put the puzzle pieces together.

Based on my analysis of the clinical data I reviewed, I believe that the professional practices of the “parenting coordinator” warrant administrative review by her licensing board for potential violation of multiple ethical standards of the American Psychological Association. A malpractice lawsuit may also be warranted. If the father decides to pursue these options, my analysis as contained in my report will be available to possibly support his complaint to the licensing board and his malpractice lawsuit.

In the body of my report I provide a detailed analysis of the professional practices of the “parenting coordinator” as evidenced in each of her progress reports. Her combined progress reports to the court are about 50 pages long. My analysis of these progress reports is also about 50 pages long.

My analysis begins with an opening summary regarding the professional practice areas of concern evidenced in the clinical data that will be addressed – in detail – in the body of the report. I then provide a detailed analysis of the treatment progress reports of the “parenting coordinator,” one by one, relative to documenting these broader areas of concern. I conclude my report with a summary of the areas of professional practice which may have been in violation of APA Standards of professional practice.

I have de-identified the opening summary of my report and the closing summary of my report, and have posted this de-identified extract from my report to my website. A direct link to these opening and closing summaries is:

De-Identified Summaries of Report Regarding Domains of Professional Concern

I am making these de-identified opening and closing summaries available for two educational purposes.

1. Model of Complaint Structure

I am offering these opening and closing summaries as a possible model for targeted parents regarding how to frame a licensing board complaint about the professional practices of a mental health professional. The licensing board does not care about the specifics of your case. They are not going to micro-manage treatment to decide if the right diagnosis was made or the right treatment implemented. Your saying, “the therapist didn’t identify parental alienation” will have no effect.

The licensing board is only concerned as to whether there were violations of professional standards of practice. For psychologists, these are defined by the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association. You must identify what standards of practice were violated and then provide supporting reasons for your contention that a violation of professional standards of practice occurred.

Standard 2.01: Boundaries of Competence

In cases of attachment-based “parental alienation” the potential violations likely center on Standard 2.01: Boundaries of Competence, in which the mental health professional failed to possess the necessary knowledge and professional competence in personality disorder pathology, family systems pathology, and attachment trauma pathology necessary to assess, diagnose, and treat the particular type of pathology being evidenced in your family.

The term “parental alienation” has NO power. There is no such thing as “parental alienation.” There are, however, defined pathologies of personality disorders (involving the pathology of “splitting”), family systems pathologies (involving the triangulation of the child into the spousal conflict through the formation of a cross-generational coalition with one parent against the other parent), and attachment trauma pathology (including the trans-generational transmission of attachment trauma through the delusional reenactment of childhood trauma patterns into current family relationships).

The domains of competence must be defined within established and accepted forms of psychopathology. I define these domains of professional competence in Chapter 11 of Foundations, specifically on pages 341-351. I did this for you. You can use the description of the required “Domains of Professional Competence” for the pathology of an attachment-based model of “parental alienation” (i.e., attachment-trauma reenactment pathology mediated by narcissistic/borderline personality pathology) to establish the boundaries of professional competence required under Standard 2.01 (and 9.01) of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

But the words “parental alienation” will have no power. In my 50-page analysis of the psychologist’s progress reports, I never once use the term “parental alienation.” Not once. In Foundations I have given you the necessary professional words of power to define the pathology entirely from within standard and established forms of existing psychopathology. Briefly stated:

Family Systems – Personality Disorder Description:  The pathology involves the addition of the “splitting” pathology of a narcissistic/borderline parent to the child’s triangulation into the spousal conflict through a cross-generational coalition with one parent (the allied parent) against the other parent (the targeted parent). The addition of splitting pathology to a cross-generational coalition transforms the already pathological cross-generational coalition (i.e., the “perverse triangle” described by Haley, 1977) into a particularly malignant form that seeks to entirely terminate the child’s relationship with the other parent (as a reflection of the splitting pathology of the narcissistic/borderline parent).

Personality Disorder – Attachment Trauma Description: The pathology involves the trans-generational transmission of attachment trauma (disorganized attachment) from the childhood of the allied narcissistic/borderline parent to the current family relationships, mediated by the personality disorder pathology of the allied parent that is itself a product of the childhood attachment trauma experienced by this parent.

Fundamentally, it’s not important that you fully understand these professional words of power, it is important that the therapist understand them (i.e., boundaries of competence) and that the licensing board understands them (i.e., boundaries of competence). I define the necessary “Domains of Professional Competence” in Chapter 11 of Foundations and you can reference this in any complaint you may choose to file.

“Childress (2015) defines the domains of professional competence needed to competently assess, diagnose, and treat the pathology evidenced in my family situation. This description of the necessary domains of knowledge for professional competence is appended as Appendix 1 to this complaint.”

Childress, C.A. (2015). An Attachment-Based Model of Parental Alienation: Foundations. Claremont, CA: Oaksong Press

The goal of any board complaint or malpractice lawsuit is NOT to retaliate or get revenge. Retaliation and revenge are narcissistic personality traits.

Nor is the goal of any board complaint or malpractice lawsuit to hurt the mental health professional (although it might have that effect).

The goal is to require professional competence in the assessment, diagnosis, and treatment of your children and your families pursuant to Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Standard 9.01: Competent Assessment

A second potentially relevant Standard is 9.01 requiring competent professional assessments. Standard 9.01 states:

9.01 Bases for Assessments
(a) Psychologists base the opinions contained in their recommendations, reports and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings.

If the mental health professional did not conduct an adequate assessment of the personality disorder pathology, family systems pathology, and attachment trauma pathology “sufficient to substantiate their findings” contained in their “recommendations, reports and diagnostic or evaluative statements, including forensic testimony” then they may be in violation of Standard 9.01.

If the therapist only met with the child (and allied parent), and never met with the targeted parent to obtain relevant family history information from this parent’s perspective, then this may represent insufficient information to “substantiate” the diagnostic findings of the mental health professional, in possible violation of Standard 9.01.

If the therapist failed to properly consider and assess the potential influence of the narcissistic/borderline personality pathology of the allied parent on the child’s expressed pathology toward the targeted parent, then this may represent insufficient information to “substantiate” the diagnostic findings of the mental health professional, in possible violation of Standard 9.01.

If the therapist failed to properly consider and assess the potential role-reversal relationship of the child with the allied parent in which the child is being triangulated into the spousal conflict through the formation of a cross-generational coalition with the allied parent against the targeted parent in order to stabilize the pathology of the allied narcissistic/borderline parent, then this may represent insufficient information to “substantiate” the diagnostic findings of the mental health professional, in possible violation of Standard 9.01.

Standard 3.04: Do No Harm

If the absence of professional competence and/or inadequate professional assessment results in harm to the client, this may then be a violation of Standard 3.04 which states:

3.04 Avoiding Harm
Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

Duty to Protect

Mental health professionals also incur an obligation to protect their clients, which is referred to as a professional “duty to protect.”

If the distorted parenting practices of a narcissistic/borderline parent are inducing severe developmental pathology (attachment system suppression), personality disorder pathology (narcissistic/borderline personality traits), and psychiatric pathology (delusional beliefs) in a child as a direct result of  highly aberrant and distorted parenting practices, in order to stabilize the narcissistic/borderline psychopathology of the parent, and this then results in the loss for the child of a normal-range and affectionally bonded relationship with a normal-range and affectionally available parent, this reasonably represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, either at the lower threshold of “Suspected” or more reasonably at the higher threshold of “Confirmed” based on the pathology evident in the child’s symptom display.

Mental health professionals are responsible for knowing all of the diagnoses in the DSM-5 and for making the appropriate and relevant diagnoses when indicated. If the mental health professional fails to make the DSM-5 diagnosis of V995.51 Child Psychological Abuse when this DSM-5 diagnosis is warranted, then this may represent a failure in the mental health professional’s “duty to protect.”

If the mental health professional makes a DSM-5 diagnosis of V995.51 Child Psychological Abuse, then this requires that the mental health professional take some form of affirmative protective action to discharge the mental health professional’s “duty to protect,” and this affirmative protective action needs to be documented in the patient record (if it’s not documented in the chart it never happened). Failure to take an affirmative protective action and document this action in the patient record when a diagnosis of V995.51 Child Psychological Abuse is made may represent a failure in the mental health professional’s “duty to protect.”

To Mental Health Professionals:

I am no nonsense on this. We’re playing hardball. If the DSM-5 diagnosis of V995.51 Child Psychological Abuse is warranted… then make it.

If you don’t make the diagnosis of V995.51 Child Psychological Abuse (either Suspected or Confirmed – I’d say Confirmed by the pathology evident in the child’s symptom display) when it is warranted, then this may represent a failure in your professional duty to protect, and you can discuss this with your licensing board and we’ll let your licensing board decide which of us is correct.  If you’re fine with that, so am I.  It’s not my license at risk.

If you do make the diagnosis of V995.51 Child Psychological Abuse, then you must do something to protect the child (i.e., to discharge your duty to protect). I’d recommend filing a suspected child abuse report with the appropriate child protection agency, but it’s up to you what affirmative action you take. But whatever affirmative action you take to protect the child, you must document this action in the patient record.

If you make the diagnosis of V995.51 Child Psychological Abuse and yet don’t take any affirmative action to protect the child, then this may represent a failure in your professional duty to protect, and you can discuss this with your licensing board and we’ll simply let your licensing board decide which of us is correct.

I am deadly serious on this. Mental health professionals are NOT ALLOWED to collude with psychopathology that destroys the lives of children.  

Mental health professionals are NOT ALLOWED to abandon children to psychological child abuse.

The pathology of attachment-based “parental alienation” (attachment-trauma reenactment pathology) is not a child custody issue, it is a child protection issue. Mental health professionals must step-up and do the right thing to protect the child from the evident psychopathology of a narcissistic/borderline parent who is using the child in a role-reversal relationship to stabilize the pathology of the parent by inducing the child’s rejection of the normal-range and affectionally available targeted parent.

Mental health professionals need to step-up and do the right thing, make the proper diagnosis, and take affirmative action to protect the child from the severe psychopathology of a narcissistic/borderline parent that is inducing severe developmental pathology, personality pathology, and psychiatric pathology in the child that is then resulting in the loss for the child of a normal-range and affectionally bonded relationship with a normal-range and affectionally available parent.

Coming Together

Targeted parents need to come together into workshop self-help groups to assist each other in the phrasing and procedures of licensing board complaints.

It’s too expensive for you to hire me as your individual consultant on each and every specific case. Save the money you’d be spending on my consultation and use it for your child’s college education. Come together into self-help workshops with more experienced parents helping less experienced parents navigate the mental health system to achieve professional competence. I’ve given you the tools you need, Foundations, Professional Consultation, and the Single Case ABAB protocol.

Some initial suggestions:

• Request the treatment records of the mental health professional. Your state will have laws governing the release of mental health treatment notes. Research the laws in your state and help each other understand your rights to access the treatment records of your children. The laws governing California are on my website.

• Request the vitae of the mental health professional. Review this vitae for evidence of professional training and experience in personality disorder pathology, family systems pathology, and attachment pathology.

• Read the ethics codes governing the various categories of mental health professionals: psychologists, MFTs, MSWs. Identify the relevant ethical standards in each of the codes. Help each other frame complaints in terms of violations of ethical standards of practice rather than specifics of the individual case.

I don’t have the time to work with 10,000 targeted parents individually and it is too expensive for you. Put the money you save toward your kid’s college education. Come together into self-help groups. This is your fight.  It’s up to you to become strong enough to rescue your children.  I am not your warrior, I am your weapon.

We are expecting – we are requiring – professional competence under Standards 2.01 and 9.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

I’m not likely to be making many friends within professional psychology. The Gardnerians will be upset with me because their paradigm is being replaced. Establishment mental health will be upset with me because I’m empowering targeted parents to file licensing board complaints. But you know what? Don’t care. This is a child protection issue. Professional collusion with psychopathology that destroys the lives of children needs to stop. Today. Now.

Parents have the right to both expect and demand professional competence in the diagnosis and treatment of their children and families. That’s all we’re asking for.

The APA can solve this quickly by changing their position statement to acknowledge the existence of the pathology and designating your children and families as a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat. Done. We won’t need to enforce professional competence because the APA is requiring it.

Otherwise, until the APA requires professional competence from its membership, we will be forced to require competence one binding-site-of-ignorance at a time, and it will be painful to the professionals involved. Sorry. Don’t want to do it. But you are not allowed to be ignorant and incompetent, and destroy the lives of children and families. Not allowed. Know what you’re doing and do the right thing.

2. Putting Mental Health Professionals On Notice

The second reason I am posting to my website the de-identified opening and closing summaries from my report is to educate mental health professionals. If you are not competent, this might be what you’re looking at.

Do you really want Dr. Childress reviewing your assessment, your diagnosis, and your treatment – in detail – and writing a 50-100 page critical analysis of your professional practices for the targeted parent to use as support for a licensing board complaint against you? Do you REALLY want that? Then know what you’re doing and do the right thing.

If you choose to remain ignorant and incompetent then understand this: that all of the force and power of Foundations will be brought down upon your head with the sole goal of having sanctions placed on your license. If you choose to remain ignorant and incompetent then you will have to defend yourself against the theoretical formulations described in Foundations.

If, however, you stand-up and do the right thing, then all of the theoretical formulations described in Foundations come to your aid.

I’ve given you diagnostic checklists.

I’ve specified the three definitive diagnostic indicators for you.

I’ve specified the complete DSM-5 diagnosis for you when the three definitive diagnostic indicators are present.

And I’ve given you a strong and integrated theoretical foundation to stand on. If you stand-up and do the right thing, you can stand on the solid bedrock of Foundations.

If you choose to remain ignorant and incompetent, if you choose to continue to collude with the psychopathology of the narcissistic/borderline parent, if you continue to destroy the lives of children and families because you steadfastly choose to maintain your ignorance and professional incompetence, despite reasonable efforts to educate you and guide you into professional competence, then I will become your worst nightmare.

I’d be happy to provide a 50-100 page detailed analysis of your professional practices, reviewing your notes and progress reports – in detail. Do you REALLY want that?

It’s not my license on the line, so I’m up for it if you are.

The destruction of children’s lives needs to stop. The deep sorrow and tragedy inflicted on targeted parents needs to stop. The collusion of mental health professionals with the psychopathology of a narcissistic/borderline parent needs to stop. The psychological abuse of children by the pathology of a narcissistic/borderline parent needs to stop. All of it needs to stop. Today. Now.

To mental health professionals: As of October 1, 2015 you are on notice.  If you choose to remain ignorant, if you choose to remain incompetent, if you continue to collude with the pathology, and if through your ignorance and incompetence you continue to destroy the lives of children and families… look for me… because I’m coming for you.  

I’ve already started my second report, this time on a child custody evaluation.  You don’t think I’m coming for you?  I am.  Professional collusion with the psychopathology of a narcissistic/borderline parent that destroys the lives of children will stop.

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

Mental health professionals need to stand-up, make the correct diagnosis, and do the right thing to protect the healthy development of children from the psychopathology of a narcissistic/borderline parent.  On this, there will be no compromise.

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

The “bystander” role in the trauma reenactment narrative is critical. 

The choice before the mental health professionals, attorneys, and the court in their role as the “bystander” in the trauma reenactment narrative is to either abandon the child to the psychological abuse inflicted on the child by the psychopathology of a narcissistic/borderline parent, or to enact their duty to protect and rescue the child from the psychological abuse being inflicted on the child by the pathology of the parent, and to thereby restore the child’s healthy and normal-range development.

Descriptions of the Pathology: 

The pathology of “parental alienation” represents the addition of the splitting pathology of a narcissistic/borderline parent into a cross-generational coalition of the parent with the child against the other parent.

The pathology of “parental alienation” represents the reenactment of attachment trauma from the childhood of the allied narcissistic/borderline parent into the current family relationships, mediated by the personality disorder pathology of the allied parent, which is in the false trauma-reenactment pattern of “abusive parent”/”victimized child”/”protective parent.”

Perlman and Courtois (2005) identify four roles in the trauma reenactment narrative,

“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” (p. 455; emphasis added).

In the pathology traditionally called “parental alienation,” therapists, attorneys, and the courts enact the role of “bystander” in the false and delusional trauma reenactment narrative. To ignorantly and unwittingly enact the role of the bystander in the false and delusional trauma reenactment narrative is to collude with the psychological abuse of the child.

To ignorantly and unwittingly enact the role of the bystander in the false and delusional trauma reenactment narrative is to collude with the psychological abuse of the child.

Inducing significant developmental pathology (diagnostic indicator 1), personality pathology (diagnostic indicator 2), and psychiatric pathology, (diagnostic indicator 3) in a child in order to stabilize the psychopathology of the parent reasonably represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Failure to make this DSM-5 diagnosis when it is warranted represents a failure in the mental health professional’s duty to protect.

Making a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed engages the mental health professional’s duty to protect requiring the mental health professional to take some form of affirmative action to discharge this duty to protect, and to document this affirmative action in the patient’s record.

Failure to take an affirmative action to discharge the mental health professional’s duty to protect, and to then document this affirmative action in the patient’s record, represents a failure in the mental health professional’s duty to protect.

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

The choice for the “bystander” mental health professionals, attorneys, and the court is whether they will abandon the child to the psychological child abuse being inflicted on the child by the psychopathology of a narcissistic/borderline parent and thereby allow, and indeed collude with, the child abuse and destruction of the normal-range development of the child, or whether they will rescue the child from the psychological child abuse inflicted by the psychopathology of the narcissistic/borderline parent, and restore the child’s healthy and normal-range development.

The role of the “bystander” is critical.  It is in their hands to either abandon the child to the child’s psychological abuse, and to the destruction of the child’s normal-range and healthy development, or they can rescue the child from the psychological child abuse and restore the child’s healthy and normal-range development.  That is their choice.

The following excerpt is from my book, Foundations, regarding the role of the “bystander” in the trauma reenactment narrative.

From Foundations (p. 252-258):

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The Bystander Role

Perlman and Courtois (2005) identify four characteristic roles in the reenactment of trauma; the “roles of victim-perpetrator-rescuer-bystander.” The three primary roles in the trauma reenactment of attachment-based “parental alienation” are:

• The “abusive parent” role, corresponding to the “perpetrator” role identified by Perlman and Courtois,

• The “victimized child” role, corresponding to the “victim” role identified by Perlman and Courtois

• The “protective parent” role, which corresponds to the “rescuer” role of Perlman and Courtois.

In addition to these three primary trauma reenactment roles, the “bystander” role identified by Perlman and Courtois also plays an important part in the trauma reenactment narrative of attachment-based “parental alienation.” The role of the “bystander” in attachment-based “parental alienation” is filled by all the various therapists, attorneys, judges, teachers, and extended family members. These “bystanders” serve three separate functions in the trauma reenactment narrative of attachment-based “parental alienation.” The role of the “bystander” is first to legitimize the “truth” of the reenactment narrative. The second role of the “bystander” in the trauma reenactment narrative is to publicly shame the targeted parent. The “bystander” role also acts to provide “narcissistic supply” by legitimizing the wonderful-parent presentation of the narcissistic/(borderline) parent.

Legitimize the Reenactment Narrative

By accepting the reenactment narrative as being true, the “bystanders” validate the legitimacy and authenticity of the reenactment narrative. The trauma reenactment narrative of attachment-based “parental alienation” actually represents a false drama created by the narcissistic/(borderline) parent. In truth, the targeted parent is not abusive, the child is not a victim, and the narcissistic/(borderline) parent is not protecting the child. In truth, the targeted parent is a normal-range and affectionally available parent, the child is a normal-range child who loves both parents, and the narcissistic/(borderline) parent is using the child as a weapon to inflict suffering on the targeted parent. The reenactment narrative created by the narcissistic/(borderline) parent is a delusion.

Yet when the “bystander” therapists and attorneys accept the trauma reenactment narrative as being a reasonable explanation for the child’s rejection of the targeted parent, they are allowing their power and authority in their role as therapist or attorney to be used by the pathology of the narcissistic/(borderline) parent to confirm the legitimacy of the trauma reenactment narrative. Their acceptance of the reenactment narrative legitimizes the truth of the reenactment narrative. The reenactment narrative of “abusive parent”/”victimized child”/”protective parent” becomes true because the “bystanders” in the trauma reenactment narrative accept it as being true. The role of the “bystander” in attachment-based “parental alienation” is to validate the truth of the trauma reenactment narrative.

When therapists and children’s attorneys accept the validity of the false drama created by the pathology of the narcissistic/(borderline) parent in attachment-based “parental alienation,” they are inadvertently fulfilling their “bystander” roles within the trauma reenactment narrative. By conferring legitimacy to the delusional construction of the narcissistic/(borderline) parent, these “bystander” mental health professionals and attorneys are actively colluding with the psychopathology. Through their ignorance regarding the psychopathology involved in attachment-based “parental alienation,” these “bystander” mental health professionals and attorneys are allowing their professional standing to be exploited by the psychopathology of the narcissistic/(borderline) parent to confer legitimacy to a delusional belief and false drama that ultimately destroys the lives of both the child and the targeted parent.

Shaming of the Targeted Parent

The “bystander” role in the trauma reenactment narrative of attachment-based “parental alienation” also serves to confer public shaming onto the targeted parent. The “bystanders” bear public witness to the exposed parental (personal) inadequacy of the targeted parent. The “bystanders” provide the audience for the public humiliation of the targeted parent, who is being rejected by the child for being an “abusive” and inadequate parent (person).

The divorce represents a narcissistic injury in which the inadequacy of the narcissistic/(borderline) parent as a spouse is publicly exposed. The narcissistic/(borderline) parent is being publicly rejected as a spouse by the targeted parent because of the inadequacy of the narcissistic/(borderline) personality. This public exposure of the inadequacy of the narcissistic/(borderline) parent threatens to collapse the narcissistic defense against the experience of primal self-inadequacy. The processes of attachment-based “parental alienation” represent the efforts of the narcissistic/(borderline) parent to restore the narcissistic defense by projectively displacing onto the targeted parent the fears of inadequacy and abandonment. The child’s rejection of the targeted parent defines the targeted parent as being the inadequate and rejected parent (person).

The role of the “bystander” is to provide social validation for the inadequacy and abandonment of the targeted parent. Within the reenactment narrative, the fundamental inadequacy and “abusive” parenting of the targeted parent is being publicly exposed to the social community, represented by the “bystanders” in the trauma reenactment narrative. The public display to the “bystanders” through the trauma reenactment narrative of the child’s rejection of the targeted parent represents a public shaming of the targeted parent for his or her primal inadequacy as a parent (person).

The “bystanders” act as the social community for this public shaming of the targeted parent. By publicly exposing the fundamental inadequacy and abandonment of the targeted parent to the social community represented by the “bystanders,” the narcissistic/(borderline) parent is able to counteract and repair the public exposure of his or her own inadequacy as a spouse that was triggered by the targeted parent through the divorce.

Witness to Narcissistic Grandiosity

The “bystanders” in the trauma reenactment narrative also serve as public witness to the displayed magnificence of the narcissistic/(borderline) parent as the wonderfully nurturing and “protective parent.” In choosing to reject the “abusive” and inadequate targeted parent in favor of being with the narcissistic/(borderline) parent, the child is used to validate to the “bystanders” the magnificence of the narcissistic/(borderline) parent as being the ideal and wonderful parent. The possession of the narcissistic object of the child represents a symbol of the narcissistic/(borderline) parent’s superiority and victory over the targeted parent. It is the targeted parent who is rejected as the inadequate parent (person) by the child. The narcissistic/(borderline) parent is the all-wonderful and perfect parent (person) who is being selected by the child.

The narcissistic/(borderline) parent is secure in the child’s well-rehearsed criticisms of the targeted parent:

• The child hates being with the targeted parent because of some past parental failure or inadequacy. This past parental failure by the targeted parent is simply too heinous to be forgiven.

• The child is afraid of the targeted parent, having panic attacks and stress at simply the thought of being with the targeted parent, or at having the targeted parent attend the child’s event or activity.

• The targeted parent never spent enough special time with the child in the past, and is too involved with the new spouse.

• The targeted parent is too controlling and never listens to what the child wants. The targeted parent is too insensitive to the child’s feelings.

• The child wants to be allowed to “decide” which parent the child wants to be with, and maybe, if the targeted parent “respects the child’s wishes” and allows the child to be completely with the allied and supposedly favored narcissistic/(borderline) parent, then maybe the child might want to spend time with the targeted parent sometime in the future (maybe).

Confident in the child’s oft-rehearsed criticisms of the targeted parent, the narcissistic/(borderline) parent will eagerly present the child to the “bystanders” of therapists and attorneys, which allows the narcissistic/(borderline) parent to conspicuously display for the “bystanders” the coveted role as the wonderfully nurturing and understanding “protective parent.”

Having psychologically surrendered to the will of the narcissistic/(borderline) parent, the child eagerly embraces the “victimized child” role by offering to the “bystander” therapists and attorneys a litany of well-rehearsed criticisms of the targeted parent, both as a parent and also as a person. The child fully expects that these criticisms will be met with the same understanding support from the “bystander” as they received from the narcissistic/(borderline) parent. If, perchance, the “bystander” somehow challenges the legitimacy of the child’s rehearsed criticisms, the child will become confused and disoriented, and the reporting of criticism begins to break down.

If a “bystander” therapist fails to validate the reenactment narrative and challenges the legitimacy of the child’s criticisms, then the narcissistic/(borderline) parent will quickly seek to have this therapist removed from treatment. For the narcissistic/(borderline) parent, the purpose of therapy is not to have the child get better and restore a relationship with the targeted parent. For the narcissistic/(borderline) parent, the purpose of therapy is for the “bystander” therapist to validate the legitimacy of the trauma reenactment narrative of “abusive parent”/”victimized child”/”protective parent.” If the therapist fails in their “bystander” role in the trauma reenactment narrative, then the narcissistic/(borderline) parent will replace this “bystander” therapist with one who will validate the legitimacy of the reenactment narrative.

There are two ways that the narcissistic/(borderline) parent can remove a non-cooperative “bystander” therapist from treatment. The first way is to simply withdraw parental consent for treatment with the non-cooperative “bystander” therapist. The most effective way of ensuring that the therapist fulfills the “bystander” role in the reenactment narrative is for the narcissistic/(borderline) parent to only consent to the child’s treatment with providers who legitimize the trauma reenactment narrative.

If withdrawing parental consent for treatment with the non-cooperative “bystander” therapist is not possible as a means to remove a non-cooperative “bystander” therapist, then the narcissistic/(borderline) parent will employ a tried-and-true method of achieving power and control; i.e., inducing and then exploiting child symptoms. Following a therapy session, the narcissistic/(borderline) parent will elicit a child criticism of the therapist, typically that the therapist is not sufficiently “understanding” of the child’s feelings (meaning that the therapist does not accept the legitimacy of the trauma reenactment narrative). The narcissistic/(borderline) parent then uses this child complaint to petition the court for a change in therapists to one who is more “understanding” of the child, and with whom the child feels more “comfortable.” In this way, the child is empowered to select a therapist who does not challenge the child’s presentation as a “victim” of the supposedly “abusive” parental inadequacy of the targeted parent.

Together, the narcissistic/(borderline) parent and the child put on their show of the reenactment narrative for the audience of “bystanders,” with the child in the leadership position of offering a well-rehearsed set of criticisms of the targeted parent around select themes that were previously provided to the child by the narcissistic/(borderline) parent during the induction process. Meanwhile, the narcissistic/(borderline) parent takes the opportunity to make a full display to the “bystanders” of being the perfectly nurturing and concerned “protective parent.” The role of the “bystander” therapists and attorneys is to accept and thereby validate the legitimacy of the reenactment narrative; that the targeted parent is the “abusive” and inadequate parent who is being rejected by the child for being a fundamentally inadequate parent (person).

The failure of mental health and legal professionals to recognize the extreme degree of psychopathology involved with attachment-based “parental alienation” will result in their seduction by the psychopathology into adopting their collusive role as the legitimizing “bystander” in the trauma reenactment narrative. In this “bystander” role, therapists and attorneys will wind up actively supporting and colluding with the psychopathology in the family, to the psychological and developmental harm of the child and the emotional and psychological harm of the targeted parent.

Attachment-based “parental alienation” is not a child custody issue, it is a child protection issue. Mental health professionals and legal professionals assigned to represent the child’s interests must possess the level of professional competence necessary to serve the best interests of the child. Failure to recognize the extraordinary severity of the pathology involved in attachment-based “parental alienation,” and failure to protect the child from the profound psychological and development harm associated with attachment-based “parental alienation,” is to collude with the pathology and psychological abuse of the child.

Childress, C.A. (2015). An Attachment-Based Model of Parental Alienation: Foundations. Claremont, CA: Oaksong Press. (p. 252-258)

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

Let the trumpets sound to rouse the warriors from their slumber. Let the drums of battle bring courage to our hearts. The battle comes. The time is now. Come bring your banner to the battlefield and join us, the time for our battle has arrived.

The pathogen sees us and it is evaluating our threat. It has sent its minion skirmishers out to test our mettle, and it has felt our resolve.

We will not waver, we will stand and fight with steadfast determination because we fight for your children. And when this battle day is finished, the minions of the pathogen will lie at our feet and your banners will fly from the citadel of establishment mental health. This is the battle to reclaim mental health as your ally, for you and your children. The citadel of establishment mental health belongs to you, not to the pathogen. Take it back.

I will stand in the center of this battlefield. The pathogen will attack me with savage viciousness that will seek not only to defeat the content of what I say, but will seek to destroy me personally. You’ve seen already how the pathogen weaves personal attacks into the assaults from its minions. Distortions and innuendo layered into personal attacks. And the pathogen is not constrained by any limits imposed by truth or accuracy or reality. You know this better than any, because you have personally felt the savage fury of its venom, its lies, and its distorted  falsehoods.

It will now bring this to me. It will attack me, not just the content of what I say. It will attack me personally. It will seek to destroy me at a personal level. It will search every crevice of my life, my family, my career, seeking some vulnerability that it can exploit to destroy me. Because I threaten to expose it.

I am ready.  I will stand and fight.  And we will prevail because we fight for your children.

I will not abandon you, I will not abandon your children. I will not waver. I will stand in the center of this battlefield and fight against this pathology with ferocity and steadfast resolve, but with different weapons than those used by the pathogen. We fight with weapons forged in truth and knowledge and love.

We are unstoppable. We fight for your children.

Let the drums of battle call forth our warriors. Steel your hearts and set fast your will. Wake your neighbors from their slumber and call them to us. The battle for your children has arrived.

The Battlefield

The minion of Mercer was right about only one thing, the battlefield of Gardnerian PAS is a swamp. When we fight on that battlefield the ground gives way beneath our feet, the marsh clings to our boots and we stumble and fall.  We cannot move and maneuver, we become bogged down, and the pathogen devastates our forces with archers from afar. This is not the battlefield on which we want to fight.

No. There will be no Gardnerian PAS battle flag on this battlefield. We fight under the banner of Foundations.

If someone brings the banner of Gardnerian PAS onto this battlefield, I will attack you myself.

Foundations provides us with the solid bedrock of established psychological principles and constructs on which we can firmly plant our feet. With Foundations, WE hold the high ground.

You saw how I dealt with the minion of Mercer.

“I will in no way defend the Gardnerian PAS model.” 

Immediately we are free from the swamp and have claimed the high ground.  Immediately ALL of the arguments against the Gardnerian PAS model are made irrelevant – completely and totally irrelevant.

The Pathogen: How do you diagnose…?

Dr. Childress:  The three diagnostic indicators in the child’s symptom display and the entire puzzle that forms the picture of three cats in the garden.

The Pathogen:  But what about authentic child abuse?

Dr. Childress:  An authentically abused child does not display five specific a-priori predicted narcissistic and borderline personality traits toward the authentically abusive parent.  The authentically abused child therefore does not meet Diagnostic Criterion 2 for an attachment-based model of “parental alienation.”

Stimulus Control:  Furthermore, in authentic parent-child conflict the child’s behavior is under the stimulus control of the parent’s behavior.  

You saw me weave these responses.  There are more. I’m ready.

The Pathogen:  Peer-reviewed research – show us the peer-reviewed research.

Dr. Childress: See Chapter 11 of Foundations or see my first response to Mercer.

What do you want peer-reviewed research about? The existence of personality disorders?  The existence of attachment trauma?  The existence of family systems theory?  What?  What – specifically – do you want peer reviewed research about?

The Pathogen:  Where is the peer-reviewed research about Dr. Childress’ model?

Dr. Childress:  It’s NOT my model. It’s Aaron Beck, it’s Theodore Millon, it’s John Bowlby and Mary Ainsworth.  It’s Salvador Minuchin.  It’s Jay Haley.  It’s Marsha Linehan and Otto Kernberg.

It is not me.  The attachment-based description of the pathology comes from the preeminent figures in mental heath.  If you have a problem with the model, take it up with them – because they’re the ones that said it, not me. 

You want their quotes regarding the pathology?  Here, let me tell you what they said.  Let me tell you how Jay Haley and Salvador Minuchin defined the cross-generational coalition.  Let me tell you how the American Psychiatric Association has defined the splitting pathology.  Let me tell you what Aaron Beck says about the pathology of the narcissistic and borderline personalty and what Theodore Millon says about the decompensation of the narcissistic personalty into delusional beliefs. Let me tell you about what Marsha Linehan has said about the “invalidating environment.”

It’s not me.  It’s not Dr. Childress.  It’s them.  It is the preeminent figures in mental health who have said this.

In his account of the Gallic wars, Julius Caesar said that you will win the battle when you choose where and when to fight. We fight this battle on the battlefield of our choosing. We fight on the battlefield of personality disorder pathology, attachment-trauma pathology, and family systems pathology. We fight this battle on the solid ground of established theoretical Foundations.

We are NOT asking mental health to accept anything. Because the principles and constructs on which our Foundations are grounded are ALREADY firmly established and accepted constructs within mental health.

Personality disorder pathology is already accepted, with an extensive peer-reviewed literature base.

Family systems pathology is already accepted, with an extensive peer-reviewed literature base,

Attachment trauma pathology is already accepted, with an extensive peer-reviewed literature base.

There is NOTHING for establishment mental health to accept or reject. It has already been accepted.

This is key for you to understand. For too long you have been forced by the Gardnerian PAS model to fight for a “new syndrome” to be accepted in mental health. No. This stops. The pathology is NOT a “new syndrome.” It is a manifestation of well-established and well-defined forms of already accepted psychopathology.

If you want to explain it quickly, here it is…

“It is the addition of the splitting pathology of a narcissistic/borderline parent (as defined by the American Psychiatric Association) to a cross-generational coalition of the child with one parent against the other parent (as defined by the preeminent family systems theorists, Jay Haley and Salvador Minuchin).

There. Done. That’s what the pathology is.

“It’s the addition of the splitting pathology of a narcissistic/borderline parent to a cross-generational coalition of the child with one parent against the other parent.”

If someone wants a more in-depth explanation, tell them to talk to me and I will provide it (or have them read Foundations). If they ask for “peer-reviewed” literature, tell them to talk to me and I’ll provide it, or refer them to my first response to Mercer, (or have them read Foundations – Chapter 11 on professional competence).

If they ask for the DSM-5 diagnosis of the family pathology it’s on pages 663-666 of the DSM-5; Borderline Personality Disorder, it’s on pages 669-672 of the DSM-5; Narcissistic Personality Disorder, and it’s on page 719 of the DSM-5; Child Psychological Abuse, Confirmed.

If they want the specific DSM-5 diagnosis of the pathology which is given to the child, it is

DSM-5 Diagnosis

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

See. The pathology is already in the DSM-5. There is nothing to accept or reject. ALL we need is professional competence. That’s it. That’s all we are seeking – and that’s also what we are requiring.

Under a Gardnerian PAS banner you must seek to have the citadel accept a “new syndrome” within mental health.  No.  This belief that we need to have something accepted by establishment mental health (by the DSM diagnostic system) is deeply embedded into the very fabric of your psyche. ROOT IT OUT.

Under the battle flag of Foundations, there is NOTHING that needs to be accepted by establishment mental health – because ALL of the constructs and principles on which Foundations are grounded are ALREADY well-accepted, well-defined, and well-established psychological principles and constructs.

Personality Disorder Pathology:  DSM-5; Millon; Beck; Kernberg; Linehan

Attachment Trauma Pathology:  Bowlby, Ainsworth, Mains, Sroufe, Fonagy, van der Kolk

Family Systems Pathology: Bowen, Minuchin, Haley

We are not asking establishment mental health to accept anything. They have already accepted everything.

What we are asking them for – we are REQUIRING of them – is to enforce their existing Standards for professional competence.

We have established ourselves on the high ground in this battle.  The high ground is ours.

We have claimed the battle flags of the APA Ethics Code.

Standard 2.01 – Professional Competence

Standard 9.01 – Professionally Competent Assessment

Standard 3.04 – Do No Harm

These battle flags of the APA ethics code are ours. 

These are the battle flags you will carry in your assault on the citadel of establishment mental health. We hold the high ground.

We are not asking them to accept anything.  We are requiring that they live up to their established Standards of practice.  We are seeking – we are requiring – professional competence in the assessment, diagnosis, and treatment of existing and established forms of personality disorder pathology, family systems pathology, and attachment trauma pathology.

And when the pathogenic parenting practices of a narcissistic/borderline parent are creating

Developmental Pathology:  Attachment system suppression

Personality Disorder Pathology:  Five narcissistic/borderline traits in the child’s symptom display

Psychiatric Pathology:  Shared psychotic delusional beliefs (and sometimes an additional phobic anxiety)

we are seeking – we are requiring – that mental health professionals fulfill their “duty to protect” by making the proper DSM-5 diagnosis of

V995.51 Child Psychological Abuse Confirmed. 

The pathology of “parental alienation” is already in the DSM-5. There is nothing for the DSM-5 to accept or reject.  The DSM-5 diagnosis for the pathology of an attachment-based model of “parental alienation” is V995.51 Child Psychological Abuse, Confirmed – p. 719.

All we are seeking is professional competence – we are demanding professional competence.

Battle Plans

In the coming days I will engage the pathogen in the center of the battlefield.  Once the battle is engaged, it will attack me with great viciousness and it will seek to destroy me personally – because I am a threat.

It will bring out its tried and true attacks:

That an attachment-based model represents a “new theory of Dr. Childress” – because this worked with Gardnerian PAS.

It won’t work this time.

It will seek to destroy me personally – because this worked with Richard Gardner and PAS

It won’t work this time.

It will throw out the buzz words of “peer-reviewed” – because this worked with Gardnerian PAS.

It won’t work this time.

It will claim that we’re sending children back to be with an abusive rejected parent – because this worked with Gardnerian PAS.

It won’t work this time.

I will stand, square in the middle of this battlefield, and I will engage the fight.

Your job is to storm the citadel of establishment mental health.  You are not asking them to accept anything – you are demanding professional competence in assessing, diagnosing, and treating established forms of accepted psychopathology; personality disorder pathology, family systems pathology, attachment-trauma pathology.

Make them argue that professional ignorance and incompetence are acceptable standards of practice.

Make them argue that narcissistic and borderline personalities don’t exist. 

Make them argue that inducing severe developmental, personality disorder, and psychotic psychiatric pathology in a child is acceptable, that this is NOT a form of psychological child abuse.

Make them argue this.  These are untenable positions for establishment mental health to take.  Make them take these positions or relent to your demands for professional competence in the assessment, diagnosis, and treatment of this pathology.

The pathology exists – we want them to acknowledge that fact.

The existence of cats (personality disorder pathology) does not nullify the existence of dogs (authentic child abuse); and not all animals are dogs.  Cats exist.  We just want them to acknowledge that cats (personality disorder  pathology) exists and adversely affects family functioning following a divorce.  That’s the structure of our position.

Make them acknowledge that personality disorder pathology exists and make them put the acknowledgement into their position statement on “parental alienation” pathology.

Break the pathogen’s veil of concealment.

Demand that the complexity of this pathology requires specialized professional knowledge and expertise to competently assess, diagnose, and treat.  Make them argue that professional ignorance and incompetence are acceptable standards of practice. They won’t be able to take this position. 

Demand that your children and families be acknowledged as a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

Storm the citadel of establishment mental health carrying the banner of Standard 2.01 of their own ethics code, the Ethical Principles of Psychologists and Code of Conduct that REQUIRES professional competence.  Make them either renunciate their own ethics code or else live up to their ethical principles and code of conduct.

Storm the citadel of establishment mental health carrying the banner of Standard 9.01 that requires assessment “sufficient to subtantiate” “the opinions contained in their recommendations, reports and diagnostic or evaluative statements, including forensic testimony.”  Make them live up to their ethical principles and established code of conduct.

This pathology is not some “new form of pathology.” It is the manifestation of narcissistic and borderline personalty pathology (as fully described in Foundations).  Every single mental health professional who is assessing, diagnosing, and treating this pathology MUST be professionally competent in the assessment, diagnosis, and treatment of narcissistic and borderline personality pathology as it is expressed in family relationships.

Accept nothing less.  Demand more.  This pathology is a manifestation of attachment trauma from the childhood of the narcissistic/borderline parent into the current family relationships, mediated by the personality disorder pathology that is itself a product of this childhood trauma.

Every single mental health professional who is assessing, diagnosing, and treating this pathology MUST be professionally competent in the assessment, diagnosis, and treatment of attachment trauma as manfested trans-generationally (through “schema” patterns; Beck et al., 2004).

Expect nothing less. And demand more. This pathology is a manifestation of the child’s triangulation into the spousal conflict through the formation of a cross-generational coalition with the allied parent against the targeted parent (a “perverse triangle”; Haley, 1977).  Every single mental health professional who is assessing, diagnosing, and treating this form of family pathology MUST be professionally competent in family systems theory and family therapy.

Expect nothing less.  Demand professional competence consistent with Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Storm the citadel of establishment mental health.  Take the citadel of establishment mental health – and plant your banners and those for your children upon the walls and turrets of the citadel. Reclaim establishment mental health as your ally against this family pathology and the psychological abuse of the child.

We want a change to the APA’s position statement that

1.)  Acknowledges the pathology exists, using whatever terminology they want.

2.)  Identifies the children and families experiencing this type of pathology as representing a “special population” requiring specialized professional knowledge and expertise to competently assess, diagnose, and treat.

The moment you take the citadel, the attacks on me will cease and the pathogen will flee from the field of battle to seek the dark crevices of the world in which to hide.

Wake Up

I am not your warrior, I am your weapon. Foundations empowers you to take the citadel of establishment mental health.  The time for battle has arrived 

Like great Ajax before the walls of Troy, I’ve seen Howie take on the pathogen over and over again with truth and power. Kay, like wise Ulysses, seeks to lead with wisdom and eloquence. Leadership will emerge from within your ranks.  Follow them.

Wake up your allies who are lulled into the slumber of their victimization.  You are victims no more.  The time for battle has come.  The time to recover your children is now. 

Google is wonderful.  The American Psychological Association has a website.  Each state has a professional psychological association.  Many large cities have professional psychological associations.  Look them up.  Who’s in charge?  What’s their address?  Alert your colleagues.  Make the citadel aware of you.  Demand professional competence.

Be Kind

Be kind, but be relentless. 

If you approach with anger you will trigger a defensive response.  You will trigger the release of brain chemicals in the listener which will take them into lower, more primitive brain systems for fight or flight, and which will shut off higher order cognitive processing and openness.

When we feel threatened we move into lower brain systems and essentially stop thinking.  We want others to think. Be kind, be relentless but be kind.

When you interact with others you represent all targeted parents and all of your supporters.  Represent us well. 

Kind is not weak. Kind is strong. Gandhi was an extraordinarily tough adversary.  But he fought without anger.  He fought with unrelenting love and kindness.

Our goal is to end division and argument.  Our goal is to bring both sides together.  Both sides are “equally valid poles” in the dialogue.  Many of those who are concerned about Gardnerian PAS are reasonable people who have valid concerns about discounting a child’s report of “abuse” and about overriding a child’s expressed reluctance to be with a parent.  Recognize that dogs exist.

And in your reasonableness and gentle understanding of their legitimate concerns, help them realize that cats (personality disorders) also exist.  We want to protect 100% of the children 100% of the time from ALL forms of child abuse.  Agree that Gardnerian PAS was an inadequate model.  Come together in a middle ground of agreement.

Dogs exist and cats exist.  The existence of one does not preclude the existence of the other.  Right now we’re talking about cats.

For the minions of the pathogen, offer them an opportunity to understand.  They may actually be reasonable people with valid concerns.  Your kindness and reasonableness will expose their motives.  If they respond with reason, offer dialogue. If they expose their narcissistic and borderline personalities, move on.

The hallmark of the narcissistic/borderline personality is the absence of empathy.  If there is no empathy, then there is pathology.

Avoid the splitting pathology of demonizing the other side.  There are no sides.  We are all on the same side of protecting children’s healthy emotional and psychological development.  Cats exist and dogs exist.  Lets work together to identify what animals are cats and what animals are dogs, 100% of the time.  It can be done.

My goal is to bring an end to the pathology of “parental alienation” by Christmas of 2016.  Join me in this goal.  It can be accomplished because we are merely seeking professional competence in the assessment, diagnosis, and treatment of already accepted and already established forms of pathology.

The time is now.  The battle to reclaim mental health as your ally has arrived.

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

I received the following Comment from Dr. Mercer.  Since it requires a more elaborated response than I can provide in the Comment section of this blog, I decided to respond as a post.

Here is the Comment from Dr. Mercer:

Can you tell me what was the age of the youngest child you have ever treated? Can you tell me how you ascertain whether or not there is a “good reason” for the child’s rejection? Can you tell me how often you find that you must tell a rejected parent that there seems to have been a reason for the child’s rejection, so you cannot use your treatment to address the problem?

I don’t have a treatment to suggest, and if I did that fact would be irrelevant to the empirical questions I’m asking. As I said to one of your advocates, the burden of proof is on you, not on me. But right now I’m not asking for proof, I’m just asking for a couple of details that I would think would be easy for you to supply. If you prefer not to answer, please just say so and save time for both of us.

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My goodness, Dr. Mercer. I apologize. I thought you were interested in having a professional dialogue about a very serious form of psychopathology involving the child’s triangulation into the spousal conflict through a cross-generational coalition with a narcissistic/borderline parent that is inducing severe developmental, personality, and psychiatric psychopathology in the child. I’m sorry, I didn’t realize you just wanted a “couple of details” that you believe would be easy for me to supply.

Oh, by the way, have you read my book,

An Attachment-Based Model of Parental Alienation: Foundations

I devote all of Chapter 9 to Diagnosis.

You know, Dr. Mercer, I’m beginning to suspect that you don’t want to actually address the pathologies that affect children and families, but that you may have some sort of personal agenda you want to advance.

I’ve tried to address your questions at a well-balanced professional level of discussion, citing references for my statements and my concerns. You have not responded to any of this content material, but have become fixated on how early a narcissistic/borderline parent can distort a child’s functioning. Not only that, you have personalized it as to what is the youngest child I’ve ever treated. What’s it matter to the issues we’re discussing?

And you haven’t even read Foundations.  I’m not sure at this point that you actually want a professional level discussion.

So I apologize, I didn’t realize that you just wanted answers to a few specific “details” rather than a discussion of the broader constructs relevant to the pathology.

So here are my answers:

Detail 1:  “What was the age of the youngest child you have ever treated?”

Actually, I was the Clinical Director for an early childhood assessment and treatment center (ages 0-5) working primarily with children in the foster care system. So the youngest child I’ve personally treated was about 2 ½ years old, although I’ve supervised the treatment of a wide variety of ages, from infancy to five years old at the clinic.

In the area of early childhood, my specialty area is the preschool age range, from three to five years old.

I’m trained to clinical competence in the relationship-based interventions of Watch, Wait, and Wonder (used to improve the infant-mother bond) and Circle of Security (used to improve attachment bonding in preschool-age children).

I’m also trained to clinical competence in the DC-03 diagnostic system (an early childhood alternative to the DSM diagnositic system) and the ICDL-DMIC diagnostic system dealing with the assessment, diagnosis, and intervention for developmental and emotional disorders, autistic spectrum disorders, multisystem developmental disorders, regulatory disorders involving attention, learning and behavioral problems, cognitive, language, motor, and sensory disturbances.

Before developing my sub-specialty expertise in early childhood mental health, my primary focus was ADHD in school-age children and adolescents. One of the reasons I went into early childhood was to increase my professional understanding for the early childhood development of emotional-behavioral regulatory disorders (ADHD). My work with ADHD-spectrum issues spans the school-age and adolescent periods of child development.

My work with school-age kids and adolescents has involved extensive work with Oppositional Defiant Disorder (a co-morbid disorder with ADHD) and severe parent-child conflict. So I am well-familiar with “normal-range,” and by that I mean clinically “normal-range,” parent-child conflict (i.e., severe expressions of parent-child conflict associated with Oppositional Defiant Disorder).

My work in high-conflict divorce began in 2008 with a 10 year old child who had been rejecting a relationship with his mother for two years. The reason he offered for his rejection of his mother was that two years prior she was playing with him on the bed and she playfully held his feet over his head which compressed his diaphragm. He told his mom of his discomfort and she dropped his feet.  That’s why he doesn’t want to have anything to do with his mother for the rest of his life.  And nothing she can do will alter that. —— Yeah. Doesn’t make any sense does it? Didn’t make any sense to me either.

As I worked it out, it became evident the child was being triangulated into the spousal conflict by the father through the formation of a cross-generational coalition with the child against the mother. Standard family systems stuff.

Through a series of meetings with the father, it became evident that the father had prominent narcissistic personality traits with histrionic overtones. The father was angry at the mother for having rejected his self-perceived magnificence and he was using the child’s rejection of the mother as his weapon of revenge. The family process had domestic violence overtones, except instead of using his fists to beat the mother for leaving him, he was using the child.

The child was compliant, because the father would psychologically torment the child with irrational rages if the child deviated from the parentally desired behavior. If the child showed any signs of bonding to the mother, in fact, if the child did not make sufficient displays of rejecting his mother, then the father would subject the child to withering psychological torment.  By rejecting his mother, the child kept the father in a regulated emotional state and avoided the father’s rageful retaliation.

At the time I had never heard of “parental alienation.” But I immediately recognized the nature and severity of the pathology from within standard and established types of pathology; i.e., the child’s triangulation into the spousal conflict by the father through the formation of a cross-generational coalition with the father against the mother in which the child was being used as a regulatory object to stabilize the father’s pathology. When I started to treat the cross-generational coalition rather than validating the child’s rejection of his mother, the father terminated therapy. I decided to look into this more and discovered the construct of Parental Alienation Syndrome and the controversy surrounding it. This pathology is not a new “syndrome.” It is a manifestation of standard and established forms of pathology.

So I set about working out the pathology at a high-level of analysis. I anticipated that the narcissistic and borderline personality pathology with which we are dealing would attack any effort to disrupt the pathology with great vitriol and irrationally based accusations characteristic of the narcissistic/borderline process of splitting. So I needed to make sure that the theoretical foundations for the explanation of this pathology were rock solid. For seven years I’ve been uncovering the linkages within this pathology.

All the while I’ve been posting to my website and blog to make information available as quickly as possible to the parents and children suffering from this form of pathology. In my book, An Attachment-Based Model of Parental Alienation: Foundations, I describe the complexity of this pathology within three separate and distinct levels of analysis, the family systems level, the personality disorder level, and the attachment-trauma level, AND I integrate the analysis across all three levels, explaining how the childhood attachment trauma creates the narcissistic/borderline personality structure, and how the narcissistic/borderline personality structure creates the family systems pathology. No model of a pathology could explain the pathology both within and across three distinct levels of analysis unless it was accurate. The description of the pathology in Foundations is accurate.

You feel I have a “burden of proof,” Dr. Mercer? Foundations is my answer. I suggest you read it before developing opinions about my work.

Detail 2: “Can you tell me how you ascertain whether or not there is a “good reason” for the child’s rejection?”

This is a complex question. As the Clinical Director for an early childhood assessment and treatment center working with children in the foster care system I saw trauma and child abuse up close and personal. I know what authentic child abuse and trauma look like. Because of this, I also know what authentic child abuse trauma doesn’t look like.

This up close and personal experience with treating the sequelae of authentic child abuse trauma helps with the differential diagnosis of the child’s role-reversal relationship with a narcissistic/borderline parent who is using the child as a “regulatory object” to stabilize the parent’s pathology. There is a distinctive difference from the symptom presentation with authentic child abuse trauma.

Among a wide variety of indicators (differential diagnosis is not about any single puzzle piece, it is about the entire picture created by ALL the puzzle pieces) children exposed to authentic child abuse do not display five specific narcissistic/borderline personality symptoms in their symptom display, 1) grandiosity, 2) entitlement, 3) absence of empathy, 4) a haughty and arrogant attitude, and 5) splitting.

On the other hand, children who are in an enmeshed cross-generational coaltion with a narcissistic/borderline parent against the other parent do display all five of these specific narcissistic personalty traits. The only way a child acquires five specific a-priori predicted narcissistic/borderline personality symptoms is through an enmeshed psychological relationship with a narcissistic/borderline parent.  Do you disagree?  Do authentically abused children display a haughty and arrogant attitude of grandiose entitlement toward their abuser? Of course not.  They’re afraid of their abuser.

But differential diagnosis is not about any single indicator, it’s about the entire picture created by the symptoms and family processes. Another important indicator of authentic versus inauthentic parent-child conflict is the locus of “stimulus control” over the child’s behavior. The construct of “stimulus control” is a behavioral (learning theory) construct regarding the cueing of behavior. It is best understood by way of analogy:

Our driving behavior is under the “stimulus control” of traffic lights. When the light is green, we go. When the light is red, we stop. Yellow is a transitional warning. Our driving behavior is under the “control” of the “stimulus” of the traffic light.

In authentic parent-child conflict, the child’s behavior is under the stimulus control of the parent’s behavior.

In inauthentic parent-child conflict the child’s behavior is NOT under the stimulus control of the parent’s behavior.

Since our driving behavior is under the stimulus control of the traffic light, when we change the color of the traffic light we see a corresponding change in the driving behavior. If the child’s behavior is under the stimulus control of the parent’s behavior, then when we change the parent’s behavior we should see a corresponding change in the child’s behavior.

In inauthentic parent-child conflict, however, if we change the parent’s behavior we see no change in the child’s behavior. That’s because the stimulus control for the child’s behavior is in the behavior of the allied narcissistic/borderline parent and the role-reversal, “regulatory object” role of the child in stabilizing the parent’s pathology.

But this is still only another single puzzle piece of the entire puzzle picture. The puzzle “cats in the garden” isn’t this puzzle because of just a few specific pieces. The puzzle is “cats in the garden” because when we put ALL of the puzzle pieces together they display a picture of three cats, one orange cat, one grey cat, and one black and white cat, frolicking among flowers. There is a watering can over here and a fence post in this location. There is a butterfly above these yellow flowers. That’s what makes the puzzle “cats in the garden.”

Authentic trauma, which I diagnosed and treated while serving as the Clinical Director for an early childhood assessment and treatment center treating children in the foster care system, creates a puzzle picture of “boats on a lake.” Both puzzles contain blue pieces and red pieces and yellow pieces. But when we put ALL the puzzle pieces together, one creates a picture of cats frolicking in the garden, and the other creates a picture of boats on a lake.

I would also refer you to my blog post on parent-child conflict, Parenting and Protest Behavior.

Detail 3:  “Can you tell me how often you find that you must tell a rejected parent that there seems to have been a reason for the child’s rejection, so you cannot use your treatment to address the problem?”

First let me correct something, it’s not “my treatment,” it’s family systems therapy. 

Because of my expertise in the pathology of attachment-based “parental alienation” I am sometimes sought out by the targeted-rejected parent for help in resolving this pathology. In about 20% to 30% of these cases I have declined treatment or altered the treatment goal to address the pathology of the supposedly targeted parent because the narcissistic parent actually turned out to be the supposedly targeted-rejected parent. However, my personal experience should not be considered representative of the frequency of this in the general population because I am getting a self-selected sample of clientele in my private practice because of my expertise with this form of pathology.

Once we move beyond the current professional impasse of recognizing that both cats (personality disorder pathology) and dogs (authentic child abuse) exist, we can then begin to conduct research on this exact question. But before we reach that point we first have to recognize that both cats and dogs exist. The existence of cats does not nullify the existence of dogs; and not all animals are dogs. Cats exist.

So hopefully, I’ve addressed your “couple of details” that you think would be easy for me to supply an answer for.

And to you, Dr. Mercer, thank you for answering my previous question. It’s unfortunate that you don’t have any idea how to treat the pathology of a child’s cross-generational coalition with a narcissistic/borderline personality parent in which the child is used as a regulatory object to stabilize the parent’s pathology.

Are you aware that the premier family systems therapist Jay Haley refers to this type of pathology as a “perverse triangle”?  Do you know why he calls it “perverse”?

So I guess if you have no idea how to treat the pathology, then you don’t really have much of relevance to add to the discussion of the treatment for this type of pathology. That’s unfortunate. I guess you’ll just have to defer opinions regarding the treatment of this type of pathology to those of us who know what we’re doing.

Since I’ve addressed your “couple of details,” perhaps you could answer just one question for me. You suggest that I have some sort of “burden of proof.” What I’m wondering is how did you become the arbiter for truth in this? Was it posted on Craigslist, “Wanted: Arbiter of Truth” – or is it just a role you’ve assigned yourself?

Best wishes,

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

This is my response to Dr. Mercer regarding her desire to discuss treatment.

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Hello Dr. Mercer,

First, let me say it’s a pleasure to meet you and to engage you in this professional dialogue. Thank you for your response to my previous post.

Second, let me say, I am not a fan of the Gardnerian PAS model. I will in no way defend the Gardnerian PAS model. Needless to say, I suspect my criticisms of the PAS model have left me few friends among the current PAS advocates. Don’t care. The PAS model isn’t very good.

I’m a conservative clinical psychologist, and I believe we should remain within scientifically established psychological principles and constructs and work at the highest level of professional knowledge, based in the scientifically established literature.

Also, I’ve worked in the foster care system as the Clinical Director for a children’s assessment and treatment center, and I am experienced with authentic child abuse up close and personal. Whatever solutions we develop must protect 100% of children 100% of the time.

Based on your blog and Comment, I recognize your interest in moving into a discussion of treatment, but I would respectfully suggest that a discussion of treatment would be premature before we have an agreed understanding regarding the pathology we are trying to treat.

While I must plead ignorance regarding your work, I suspect you have a strong concern for protecting children from authentic child abuse and a strong reluctance to discount the reports from the children. If I’m correct in my assumptions, your position would be understandable and I would agree with it.

What I’m worried about is a very small population of children who are being parented by a narcissistic and/or borderline personality parent.

A 2008 study regarding the prevalence of Narcissistic Personality Disorder (Stinson, et al., 2008) estimates the prevalence of Narcissistic Personality Disorder at 6%.

A 2008 study regarding the prevalence of Borderline Personality Disorder (Grant, et al., 2008) estimates the prevalence of Borderline Personality Disorder at 6%.

I’m not going to quibble on numbers, but my point is it’s a small, but not insubstantial, group of families. This pathology, the narcissistic and borderline personality pathology, is also likely to be highly represented in high-conflict divorce. The association of this type of personality pathology with disorganized attachment would mean that these spouses/parents have no organized strategy for repairing relationship breaches, such as encountered in the divorce. In addition, the divorce hits dead center on the narcissistic vulnerability of primal self-inadequacy (rejection of the narcissistic personality spouse by the attachment figure of the other spouse), and dead center on the core borderline vulnerability of abandonment fears (by the attachment figure of the other spouse).

So a more florid display of narcissistic and borderline personality pathology surrounding divorce should be expected. So the clinical question becomes, what would that display look like?

In discussing the narcissistic and borderline personality structure, Otto Kernberg notes that,

“They are especially deficient in genuine feelings of sadness and mournful longing; their incapacity for experiencing depressive reactions is a basic feature of their personalities. When abandoned or disappointed by other people they may show what on the surface looks like depression, but which on further examination emerges as anger and resentment, loaded with revengeful wishes, rather than real sadness for the loss of a person whom they appreciated.” (Kernberg, 1977, p. 229)

The divorce experience is a loss, so it will produce a grief response. But if the narcissistic/borderline personality structure is characterologically unable to process sadness and grief, but instead translates it into “anger and resentment, loaded with revengeful wishes” then what we may be looking at is what Bowlby called disordered or pathological mourning.

“Disturbances of personality, which include a bias to respond to loss with disordered mourning, are seen as the outcome of one or more deviations in development that can originate or grow worse during any of the years of infancy, childhood and adolescence.” (Bowlby, 1980, p. 217)

I don’t want to go too technical in our discussion at this point, but I don’t feel I’m cherry-picking Bowlby. It think that attachment theory and personality disorder pathology can add considerably to the quality of the discussion that has thus far been dominated by a woefully inadequate proposal of PAS. Personally, I’m going to be leaving the construct of PAS behind as an interesting historical curiosity, and I intend to engage in a more scientifically and clinically anchored discussion of the pathology.

As I said in my post Cats Are Not Dogs, there is a genuine pathology, and it is linked to the pathology of a narcissistic and borderline personality parent. That’s the group of parents and their children that I am concerned about. Not all animals are cats. Not all animals are dogs. And the existence of cats does not discount the existence of dogs. Both cats and dogs have four legs, fur, and a tail. So we don’t want to get them confused. But there are also differences; cats have retractable claws, dogs don’t; dogs bark, cats meow. So once we know what we’re looking for, then we can begin to identify the specific features that clinically differentiate cats and dogs.

Recognizing that you may reasonably disagree with the order of my listing of extremely bad parenting, I would rank order my list of worst possible parents as:

1. Sexual abuse – incest
2. Narcissistic and borderline personality parent
3. Physical abuse
4. Neglect and depression
5. Actively bipolar and schizophrenic

Reasonable people can disagree on the specific order of this list, and even trying to develop a list at this extreme level of pathology may be a fool’s errand. But my point is that narcissistic and borderline personality parents are extremely bad parents.

In this regard, you may also be interested in a wonderful study by Moor and Silvern (2006) regarding the mediating role of parental empathic failure in the subsequent outcome from various forms of childhood trauma exposure. They describe in their study that,

“Only insofar as parents fail in their capacity for empathic attunement and responsiveness can they objectify their children, consider them narcissistic extensions of themselves, and abuse them. It is the parents’ view of their children as vehicles for satisfaction of their own needs, accompanied by the simultaneous disregard for those of the child, that make the victimization possible.” (p. 104)

“An empathically responsive environment precludes abuse and objectification of children. Correspondingly, the act of child abuse by parents is viewed in itself as an outgrowth of parental failure of empathy and a narcissistic stance towards one’s own children. Deficiency of empathic responsiveness prevents such self-centered parents from comprehending the impact of their acts, and in combination with their fragility and need for self-stabilization, predisposes them to exploit children in this way.” (p. 94-95)

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

The characterological incapacity for empathy and the role-reversal violation of psychological boundaries associated with the narcissistic/borderline personality pathology is what has me so deeply concerned for the children of these parents (Fonagy, Luyten, & Strathearn, 2011).

Splitting and Triangulation Through the Cross-Generational Coalition

Returning to the narcissistic/borderline parent’s response to divorce, what happens when the splitting pathology of the narcissistic/borderline parent is added to a role-reversal cross-generational coalition as defined by Minuchin (1974) and Haley (1977)? The pathology of splitting cannot accommodate to ambiguity (Juni, 1995). It polarizes perceptions into extremes of all-good or all-bad. This polarization does not involve an actual physical separation of brain networks, but rather a neurological cross-inhibition of these networks.

The borderline personality structure has its origins in disorganized attachment involving incompatible motivational directives for attachment bonding and avoidance. According to Aaron Beck and his colleagues (2004),

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

The pathology of splitting arises to resolve the simultaneous activation of attachment bonding motivations (“haven of safety”) and avoidance motivation (“source of fright”) created by a parent who is “at the same time the source of fright and the potential haven of safety” (creating the disorganized attachment).

Splitting involves the intense neurological cross-inhibition of attachment bonding and avoidance motivations, so that a single coherent motivational directive can be achieved. When one motivating system is on, the other motivating system is entirely turned off (cross-inhibited), so that only one or the other of these motivational systems can be active at any given time, which produces the characteristic polarization of perception into extremes of idealization or devaluation, and the complete absence of ambiguity (i.e., of both networks being on simultaneously which would modulate the perception of the other person).

With the divorce, the spouse becomes an ex-spouse, i.e., the representational networks for the spouse switch from the attachment bonding motivational system to the avoidance motivating system. Since the pathology of splitting cannot accommodate to ambiguity, only one of these motivational networks can be active at any given time, and with the divorce that network for the other spouse/(parent) is the avoidance motivating system. The attachment-bonding networks are entirely turned off (neurologically inhibited). Which means that the narcissistic/borderline parent cannot perceptually register the continuing attachment bond between the child and the other parent because the attachment bonding system in the brain of the narcissistic/borderline parent is being entirely shut down (cross-inhibited by the avoidance system).

This leads to a characteristic feature of this pathology, that the narcissistic/borderline parent cannot recognize, cannot perceptually register, that a normal child’s attachment system would want a relationship with the other parent (the parent who the narcissistic/borderline parent now perceives as being the embodiment of evil because of the splitting pathology).

With the divorce, the spouse has become an ex-spouse, so they must also become an ex-parent. There is no other possibility allowed by the neural networks of the splitting pathology. The ex-husband MUST become an ex-father; the ex-wife an ex-mother. This is a neurologically imposed imperative created by the splitting pathology.

The narcissistic/borderline personality parent accomplishes this goal by engaging the child into a cross-generational coalition (i.e., a role-reversal relationship as a “regulatory object” for the parent) in which the child is induced into rejecting the other parent (actually, the child is induced into adopting a trauma reenactment role of “victimized child” but I don’t want to get too far afield; I describe the symptom induction process in Foundations).

What we’re essentially looking at in the pathology traditionally called “parental alienation” is the manifestation of narcissistic and borderline personality pathology into the family relationships as a consequence of the divorce.

This whole dynamic is much more involved and complex, and I would refer you to Foundations for a complete description of the pathology. My point is that the pathology exists. The pathology of narcissistic and borderline personality disorder exists. And it is this pathology that is creating the child’s symptom display which is traditionally called “parental alienation.” The legions of parents who are claiming that they have been completely cut off from relationships with their children because of the pathological parenting of their ex-spouse are not delusional. The pathology exists as a manifestation into the family processes of narcissistic and borderline personality disorder pathology of the allied and supposedly “favored” parent.

That’s not to say that children do not also reject relationships with parents because of authentic child abuse and domestic violence. Just because cats exist doesn’t nullify the existence of dogs. Both cats and dogs exist.

But right now, I’m discussing cats, not dogs. We can discuss dogs once we recognize the existence of cats. The existence of dogs, while actual, does not nullify the existence of cats. Cats exist. Narcissistic and borderline personality pathology exists.

Treatment

So, returning to your initial desire to discuss treatment, the question becomes what is the treatment for a child’s role-reversal pathology as a regulatory object for a narcissistic/borderline parent? In this regard, my primary concerns would include both the “invalidating environment” described by Linehan (1993) and the role-reversal pathology (Kerig, 2005) in which the child is used as a regulatory object to stabilize the parent’s pathology, both of which are associated with narcissistic and borderline psychopathology.

Linehan and Koerner (1993) describe the invalidating environment,

“A defining characteristic of the invalidating environment is the tendency of the family to respond erratically or inappropriately to private experience and, in particular, to be insensitive (i.e., nonresponsive) to private experience… Invalidating environments contribute to emotional dysregulation by: 1) failing to teach the child to label and modulate arousal, 2) failing to teach the child to tolerate stress, 3) failing to teach the child to trust his or her own emotional responses as valid interpretations of events, and 4) actively teaching the child to invalidate his or her own experiences by making it necessary for the child to scan the environment for cues about how to act and feel.” (p. 111-112)

In their description of the invalidating environment, Fruzzetti, Shenk, and Hoffman, (2005) note the nullification of the child’s self-authenticity,

“In extremely invalidating environments, parents or caregivers do not teach children to discriminate effectively between what they feel and what the caregivers feel, what the child wants and what the caregiver wants (or wants the child to want), what the child thinks and what the caregiver thinks.” (p. 1021)

In the Journal of Emotional Abuse, Kerig (2005) describes the pathology of the role-reversal relationship and notes the nullification of the child’s self-authenticity,

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

“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.” (p. 14)

Rappoport (2005) describes the parenting of a narcissistic personality,

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

In describing the co-narcissist’s relationship with a narcissistic personality, Rappoport (2005) describes the nullification of the other person’s self-experience,

“In a narcissistic encounter, there is, psychologically, only one person present. The co-narcissist disappears for both people, and only the narcissistic person’s experience is important.” (p. 3)

In the family systems literature, the construct would be psychological enmeshment. In the child development literature it would involve the construct of shared “intersubjectivity.”

Ultimately, the role of intersubjectivity is going to become central to understanding the pathology, and the works of Stern, Tronick, Trevarthan, Fonagy, and others is going to become prominent to understanding the pathology and important for understanding treatment.

Stern (2004), for example, describes the neurological underpinnings of shared psychological experience,

“Our nervous systems are constructed to be captured by the nervous systems of others. Our intentions are modified or born in a shifting dialogue with the felt intentions of others. Our feelings are shaped by the intentions, thoughts, and feelings of others. And our thoughts are cocreated in dialogue, even when it is only with ourselves. In short, our mental life is cocreated. This continuous cocreative dialogue with other minds is what I am calling the intersubjective matrix… The idea of a one-person psychology or of purely intrapsychic phenomena are no longer tenable in this light.” (p. 76)

Tronick (2003) refers to this shared psychological state as a “dyadic state of consciousness,”

“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.” (p. 475)

The mirror neuron network represents the neurological substrate for this shared psychological state (Iacoboni, et al, 2005; Kaplan & Iacoboni, 2006).

The concern surrounding the pathological parenting of a narcissistic/borderline parent is that the child is being used in a role-reversal relationship as a regulatory object to stabilize the pathology of the narcissistic/borderline parent, and that this role-reversal pathology has nullified the child’s self-authenticity in order to meet the needs of the narcissistic/borderline parent.

So if you wish to begin a discussion of treatment, then I would pose the question to you as to what you propose the treatment to be for the role-reversal pathology of a child’s cross-generational coalition with a narcissistic/borderline parent in which the child is being used as a regulatory object to stabilize the pathology of the narcissistic/borderline parent?

In order to engage the discussion of treatment, we need to first understand what the pathology is that we are treating.

In my view, a discussion of treatment is a bit premature, but if you want a beginning orientation to my basic views, I would refer you to my blog post, On Unicorns, the Tooth Fairy, and Reunification Therapy in which I discuss a general orientation to therapy for this type of narcissistic/borderline personality pathology within the family from multiple perspectives.

In your blog you drew from one possible idea I’ve put foward, a strategic family systems intervention, for treating the pathology of a role-reversal relationship with a narcissistic/borderline parent in which the child is being used as a regulatory object to stabilize… you know that’s an awfully long sentence to write each time I have to refer to this pathology… isn’t there some shorter label we can give to this type of pathology?

Hmmm… people in the general population appear to be calling it “parental alienation.” The problem is, if I call it “parental alienation” then everyone is going to think I’m talking about a Gardnerian model of PAS, and I’m not. But if I label this pathology something different, then people won’t realize that I’m talking about the same type of pathology they are, of a child’s induced rejection of a parent which they’re calling “parental alienation.”

Okay, how about this. I’ll use the term “parental alienation” but I’ll put it in quotes to indicate that it’s not an actually defined pathology, and then I’ll add the words attachment-based to differentiate this description of the pathology from the Gardnerian PAS model.

So that’s what I’ve done. Going forward, Dr. Mercer, if you’d like to refer to the pathology of a narcissistic/borderline parent inducing a role-reversal relationship… on and on long sentence… by some other label, I’m open to that. My preference, based on my analysis of the pathology in Foundations, would be “attachment-trauma reenactment pathology.” But if you want to call it “Bob” – that’s fine by me.

I don’t care what we call it, we just need to recognize that narcissistic and borderline personality disorders exist and that this form of pathology becomes highly activated surrounding divorce (i.e., the loss of the attachment figure and direct hits on the core vulnerabilities of the narcissistic/borderline parent), and that a narcissistic/borderline parent has an extremely devastating impact on child development. Cats exist. Dogs exist. They both exist.

Parallel Process

One of the dangerous features of working with borderline personality pathology is the parallel process of splitting that can occur among the mental health professionals working with the borderline pathology. Marsha Linehan (1993) refers to this parallel process as “staff splitting.”

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

I am concerned that the parallel process of splitting has infected previous discussions of this pathology surrounding the Gardnerian PAS model, in which hyperbolic exaggerations have been used to characterize reasonable and responsible mental health professionals as somehow being unethical and as seeking the abuse of children.

In moving forward with professionally responsible dialogue, I would desperately want to avoid the parallel process of “staff splitting” described by Linehan. “Sides” are a manifestation of the splitting pathology. There are no sides. We all want to protect children from child abuse. 100% of children 100% of the time. The critics of Gardnerian PAS want to protect children from an authentically abusive parent (dogs exist). The supporters of the “parental alienation” construct want to protect children from the pathology of a narcissistic/borderline parent – although they have not been describing it in this way – (cats exist).

In her wisdom, Marsha Linehan has pointed to the door out from the parallel process of splitting. Each side in the dialogue represents “equally valid poles in a dialectic” and “the starting point for dialogue is the recognition that a polarity has arisen, together with an implicit (if not explicit) assumption that resolution will require working toward synthesis.”

Working toward a reasonable, professionally sound, and scientifically supported synthesis for addressing all forms of emotional, psychological, physical, and sexual abuse of children is what I seek in proposing an attachment-based reformulation for the pathology traditionally called “parental alienation.”

Best wishes,

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.

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

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

Fruzzetti, A.E., Shenk, C. and Hoffman, P. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17, 1007-1030.

Grant, B.F., Chou, S.P., Goldstein, R.B., Huang, B., Stinson, F.S., Saha, T.D., Smith, S.M., Dawson, D.A., Pulay, A.J., Pickering, R.P., and Ruan, W.J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69, 533-545.

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

Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J., & Rizzolatti, G. (2005). Grasping the intentions of others with one’s own mirror neuron system. Plos Biology, 3(3), e79.

Juni, S. (1995). Triangulation as splitting in the service of ambivalence. Current Psychology: Research and Reviews, 14, 91-111.

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

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

Linehan, M. M. & Koerner, K. (1993). Behavioral theory of borderline personality disorder. In J. Paris (Ed.), Borderline Personality Disorder: Etiology and Treatment. Washington, D.C.: American Psychiatric Press, 103-21.

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

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

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

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

Stinson, F.S., Dawson, D.A., Goldstein, R.B., Chou, S.P., Huang, B., Smith, S.M., Ruan, W.J., Pulay, A.J., Saha, T.D., Pickering, R.P., and Grant, B.F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV Narcissistic Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69, 1033-1045.

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.

This post is a response to Jean Mercer’s analysis of an attachment-based model of “parental alienation” on her blog:

Craig Childress Tries to Drag Attachment Theory Into the Parental Alienation Swamp

I had originally intended to post this response to Dr. Mercer in the Comment section of her blog, but unfortunately the Comment section too severely restricts the number of characters so that my response becomes impractical in that format.

So I instead decided to turn to my blog to respond, and then simply note on Dr. Mercer’s blog that I had responded over here.  Dueling blogs, if you will.  I have posted to the Comment section of Dr. Mercer’s blog the following:

Dr. Mercer, thank you for taking the time to review my work and offer your opinions. I was going to post my response in the Comment section of your blog, but the character limitations of that format are simply too restrictive to allow me a proper response to the issues you raise. So instead, I decided to respond on my blog at drcraigchildressblog.org. Hopefully this will lead to a productive professional dialogue that does justice to the complex issues and family struggles of the children and families we treat. Best wishes, Craig Childress, Psy.D.

So the following is my initial response to Dr. Mercer’s blog which she entitled “Craig Childress Tries to Drag Attachment Theory Into the Parental Alienation Swamp.”

---

First, Dr. Mercer, thank you for your time in reviewing my work, although, based on your analysis of my work, I’m not certain that you’ve read my book, Foundations, yet, which offers a more complete elaboration of the attachment-based foundations to the pathology of “parental alienation” than is provided in my various online writings (although I prefer the more accurate clinical term for the pathology of attachment-trauma reenactment pathology).

Thank you also for crediting me with these ideas. Unfortunately, I cannot take credit for the ideas contained in an attachment-based model as they all represent ideas and constructs derived from the foremost figures in professional psychology, including Theodore Millon, Aaron Beck, John Bowlby, Murray Bowen, Otto Kernberg, Bessel van der Kolk, Salvador Minuchin, Marsha Linehan, Alan Sroufe, Mary Mains, Jay Haley, and Peter Fonagy, among others, and from the established research literature.

In your analysis of my work, you requested a list of references for an attachment-based reformulation for the pathology of “parental alienation,” which leads me to believe that you have not yet read Foundations since I include this list of references in Chapter 11 of Foundations when I discuss the domains of required knowledge necessary for professional competence in the assessment, diagnosis, and treatment of this pathology. So in response to your request, I am including a list of references that I cite in Chapter 11.

I would imagine that since you have decided to critique my work, you have read Foundations in order to offer an informed opinion, and so you have likewise read the material I cited in Chapter 11 and are knowledgeable in the relevant areas of developmental pathology involved in an attachment-based formulation for the pathology traditionally called “parental alienation.” If you have not yet had the opportunity to read the relevant material I cite below, then when you do I would welcome the opportunity to engage in a well-informed discussion of the pathology.

But before turning to the references you requested, let me correct two misrepresentations of me in your analysis, first I am not on faculty at California Southern University. My online lectures for them were part of an invited Master’s Lecture Series that they invited me to present because of my professional knowledge in this area of pathology. Second, your characterization of my treatment recommendations were somewhat distorted, not so much as to be outright misrepresentations, just enough however to be mischaracterizations. I don’t want to distract from the present issue of providing you with the references you requested, so we can address the treatment related issues in future professional dialogue.

In our future discussions of treatment, my hope is that we can engage in a serious professional dialogue rather than relying on rhetorical devices such as setting up a straw-man line of argument.  The nature of the pathology and the family tragedy that is created by a narcissistic and borderline personality parent is too serious for anything but the most sober and reasoned of professional dialogues.

Essentially, the pathology we are treating is a reenactment of childhood attachment-trauma from the childhood of the allied and supposedly favored narcissistic/borderline parent into the current family relationships.  This reenactment of childhood attachment trauma is mediated by the narcissistic and borderline personality pathology of the allied parent, which is itself a product of the childhood trauma.

I am confident that you are not going to deny the existence of narcissistic and borderline personality pathology, as these are both well-established pathologies in both the DSM-5 diagnostic system and the professional literature.

The pathology of both the narcissistic and borderline personality involves a characteristic psychological process called “splitting.” Hopefully, you are not going to deny the pathology of spitting since this pathology was explicitly defined by the American Psychiatric Association in the DSM-IV TR.

The pathology traditionally called “parental alienation” simply represents the addition of the splitting pathology of a narcissistic/borderline personality parent to a cross-generational coalition (as independently defined by the preeminent family systems theorists Salvador Minuchin and Jay Haley) of the child with the narcissistic/borderline parent against the other parent. Hopefully, you are not going to deny a central and well-established tenet of family systems therapy of the child’s triangulation into the spousal conflict.

(I discuss all of this in detail in Foundations.)

So while you graciously attributed the ideas of an attachment-based model to me, I must decline the attribution since the constructs of an attachment-based model of the pathology traditionally called “parental alienation” are actually derived from the most preeminent figures in professional psychology. So here is the reference list you requested, please refer to the following list of references for the original source material for an attachment-based formulation of the pathology

Following this reference list, I provide direct quotes regarding the reenactment of trauma, direct quotes regarding the psychological decompensation of the narcissisistic personality structure into delusional beliefs, direct quotes regarding the triangulation of the child into the spousal conflict through a cross-generational coalition with one parent against the other parent, the definition of the splitting pathology from the American Psychiatric Association, and direct quotes regarding the “invalidating environment.”

I look forward to a sober and professional dialogue that will best serve the children and families we treat.

Best wishes,

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

References for an Attachment-Based Model of “Parental Alienation”

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

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

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

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

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

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

Minuchin, S. (1974). Families and family therapy. Harvard University Press.

Fonagy, P., Target, M., Gergely, G., Allen, J.G., and Bateman, A. W. (2003). The developmental roots of Borderline Personality Disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23, 412-459.

Fonagy P. and Target M. (2005). Bridging the transmission gap: An end to an important mystery in attachment research? Attachment and Human Development, 7, 333-343.

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

Lyons-Ruth, K., Bronfman, E. and 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).

Main, M. and Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M.T. Greenberg, D. Cicchetti, & E.M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). Chicago: University of Chicago Press.

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

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

Macfie, J. Fitzpatrick, K.L., Rivas, E.M. and Cox, M.J. (2008). Independent influences upon mother-toddler role-reversal: Infant-mother attachment disorganization and role reversal in mother’s childhood. Attachment and Human Development, 10, 29-39.

Macfie, J., McElwain, N.L., Houts, R.M., and Cox, M.J. (2005) Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment & Human Development, 7, 51-65.

Pearlman, C.A. and Courtois, C.A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18, 449-459.

Prager, J. (2003). Lost childhood, lost generations: the intergenerational transmission of trauma. Journal of Human Rights, 2, 173-181.

Shaffer, A., and Sroufe, L. A. (2005). The developmental and adaptational implications of generational boundary dissolution: Findings from a prospective, longitudinal study. Journal of Emotional Abuse. 5(2/3), 67-84.

Sroufe, L. A. (2005). Attachment and development:  A prospective, longitudinal study from birth to adulthood, Attachment and Human Development, 7, 349-367.

Bacciagaluppi, M. (1985). Inversion of parent-child relationships: A contribution to attachment theory. British Journal of Medical Psychology, 58, 369-373.

Benoit, D. and Parker, K.C.H. (1994). Stability and transmission of attachment across three generations. Child Development, 65, 1444-1456.

Brennan, K.A. and Shaver, P.R. (1998). Attachment styles and personality disorders: Their connections to each other and to parental divorce, parental death, and perceptions of parental caregiving. Journal of Personality 66, 835-878.

Bretherton, I. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11, 237-252.

Sable, P. (1997). Attachment, detachment and borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training, 34(2), 171-181.

Cassidy, J., and Berlin, L. J. (1994). The insecure/ambivalent pattern of attachment: Theory and research. Child Development, 65, 971−991.

Mikulincer, M., Gillath, O., and Shaver, P.R. (2002). Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality and Social Psychology, 83, 881-895.

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.

van der Kolk, B.A. (1987). The separation cry and the trauma response: Developmental issues in the psychobiology of attachment and separation. In B.A. van der Kolk (Ed.) Psychological Trauma (31-62). Washington, D.C.: American Psychiatric Press, Inc.

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

van Ijzendoorn, M.H. (1992) Intergenerational transmission of parenting: A review of studies in nonclinical populations. Developmental Review, 12, 76-99.

Holmes, J. (2004). Disorganized attachment and borderline personality disorder: a clinical perspective. Attachment & Human Development, 6(2), 181-190.

Lopez, F. G., Fuendeling, J., Thomas, K., and Sagula, D. (1997). An attachment-theoretical perspective on the use of splitting defenses. Counseling Psychology Quarterly, 10, 461-472.

Raineki, C., Moriceau, S., and Sullivan, R.M. (2010). Developing a neurobehavioral animal model of infant attachment to an abusive caregiver. Biological Psychiatry, 67, 1137-1145.

Cozolino, L. (2006): The neuroscience of human relationships: Attachment and the developing social brain. WW Norton & Company, New York.

Siegel, D. (1999). The developing mind: Toward a neurobiology of interpersonal experience (New York: Guilford Press, 1999).

Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J., and Rizzolatti, G. (2005). Grasping the intentions of others with one’s own mirror neuron system. Plos Biology, 3(3), e79.

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

Fraiberg, S., Adelson, E., and Shapiro, V. (1975). Ghosts in the nursery. Journal of the American Academy of Child and Adolescent Psychiatry, 14, 387–421.

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

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

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

Carlson, E.A., Edgeland, B., and Sroufe, L.A. (2009). A prospective investigation of the development of borderline personality symptoms. Development and Psychopathology, 21, 1311-1334.

Juni, S. (1995). Triangulation as splitting in the service of ambivalence. Current Psychology: Research and Reviews, 14, 91-111.

Barnow, S. Aldinger, M., Arens, E.A., Ulrich, I., Spitzer, C., Grabe, H., Stopsack, M. (2013). Maternal transmission of borderline personality disorder symptoms in the community-based Griefswald Family Study. Journal of Personality Disorders, 27, 806-819.

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

Fruzzetti, A.E., Shenk, C. and Hoffman, P. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17, 1007-1030.

Garety, P. A. and Freeman D. (1999) Cognitive approaches to delusions: A critical review of theories and evidence. The British Journal of Clinical Psychology; 38, 113-154.

Hodges, S. (2003). Borderline personality disorder and posttraumatic stress disorder: Time for integration? Journal of Counseling and Development, 81, 409-417.

Levy, K.N. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, p. 959-986.

Stepp, S. D., Whalen, D. J., Pilkonis, P. A., Hipwell, A. E., and Levine, M. D. (2011). Children of mothers with Borderline Personality Disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders: Theory, Research, and Treatment. 1-16.

Svrakic, D.M. (1990). Functional dynamics of the narcissistic personality. American Journal of Psychiatry. 44, 189-203.

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.

Direct Quotes Regarding Trauma Renactment:

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

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

“Victims of trauma respond to contemporary stimuli as if the trauma had returned, without conscious awareness that past injury rather than current stress is the basis of their physiologic emergency responses. The hyperarousal interferes with their ability to make calm and rational assessments and prevents resolution and integration of the trauma.” (van der Kolk, 1989, p. 226)

“People who have been exposed to highly stressful stimuli develop long-term potentiation of memory tracts that are reactivated at times of subsequent arousal. This activation explains how current stress is experienced as a return of the trauma; it causes a return to earlier behavior patterns.” (van der Kolk, 1989, p.226)

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

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

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

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

“When schemas are latent, they are not participating in information processing; when activated they channel cognitive processing from the earliest to the final stages… When hypervalent, these idiosyncratic schemas displace and probably inhibit other schemas that may be more adaptive or more appropriate for a given situation. They consequently introduce a systematic bias into information processing… In personality disorders, the schemas are part of normal, everyday processing of information.”  (Beck et al., 2004, p. 27)

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

“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.” (Pearlman & Courtois, 2005, p. 455)

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

“The conceptualization of the core pathology of BPD [borderline personality disorder] as stemming from a highly frightened, abused child who is left alone in a malevolent world, longing for safety and help but distrustful because of fear of further abuse and abandonment, is highly related to the model developed by Young (McGinn & Young, 1996)… Young elaborated on an idea, in the 1980s introduced by Aaron Beck in clinical workshops (D.M. Clark, personal communication), that some pathological states of patients with BPD are a sort of regression into intense emotional states experienced as a child. Young conceptualized such states as schema modes…” (Beck et al., 2004, p. 199)

“Young hypothesized that four schema modes are central to BPD: the abandoned child mode (the present author suggests to label it the abused and abandoned child); the angry/impulsive child mode; the punitive parent mode, and the detached protector mode… The abused and abandoned child mode denotes the desperate state the patient may be in related to (threatened) abandonment and abuse the patient has experienced as a child. Typical core beliefs are that other people are malevolent, cannot be trusted, and will abandon or punish you, especially when you become intimate with them.” (Beck et al., 2004, p. 199)

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

“Freud suggests that overwhelming experience is taken up into what passes as normal ego and as permanent trends within it; and, in this manner, passes trauma from one generation to the next. In this way, trauma expresses itself as time standing still. Traumatic guilt – for a time buried except through the character formation of one generation after the next – finds expression in an unconscious reenactment of the past in the present.” (Prager, 2003, p. 176)

“Trauma, as a wound that never heals, succeeds in transforming the subsequent world into its own image, secure in its capacity to re-create the experience for time immemorial. It succeeds in passing the experience from one generation to the next. The present is lived as if it were the past. The result is that the next generation is deprived of its sense of social location and its capacity to creatively define itself autonomously from the former… when time becomes distorted as a result of overwhelming events, the natural distance between generations, demarcated by the passing of time and changing experience, becomes obscured. (Prager, 2003, p. 176)

Prager, J. (2003). Lost childhood, lost generations: the intergenerational transmission of trauma. Journal of Human Rights, 2, 173-181.

Direct Quotes Regarding the Decompensation of the Narcissistic Personality 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, p. 407-408; emphasis added)

“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.” (Millon, 2011, p. 415; emphasis added)

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

Direct Quotes on the Cross-Generational Coalition

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

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

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

“An inappropriately rigid cross-generational subsystem of mother and son versus father appears, and the boundary around this coalition of mother and son excludes the father. A cross-generational dysfunctional transactional pattern has developed.” (Minuchin, 1974, p. 61-62)

“The parents were divorced six months earlier and the father is now living alone… Two of the children who were very attached to their father, now refuse any contact with him. The younger children visit their father but express great unhappiness with the situation.” (Minuchin, 1974, p. 101)

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

Definition of Splitting Pathology

“Splitting. The individual deals with emotional conflict or internal or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images. Because ambivalent affects cannot be experienced simultaneously, more balanced views and expectations of self or others are excluded from emotional awareness. Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nuturant, and kind — or exclusively bad, hateful, angry, destructive, rejecting, or worthless.” (American Psychiatric Association, 2000, p. 813)

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

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

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

Direct Quotes Regarding the Invalidating Environment

“A defining characteristic of the invalidating environment is the tendency of the family to respond erratically or inappropriately to private experience and, in particular, to be insensitive (i.e., nonresponsive) to private experience… Invalidating environments contribute to emotional dysregulation by: 1) failing to teach the child to label and modulate arousal, 2) failing to teach the child to tolerate stress, 3) failing to teach the child to trust his or her own emotional responses as valid interpretations of events, and 4) actively teaching the child to invalidate his or her own experiences by making it necessary for the child to scan the environment for cues about how to act and feel.” (Linehan & Koerner, 1993, p. 111-112)

Linehan, M. M. & Koerner, K. (1993). Behavioral theory of borderline personality disorder. In J. Paris (Ed.), Borderline Personality Disorder: Etiology and Treatment. Washington, D.C.: American Psychiatric Press, 103-121.

“In extremely invalidating environments, parents or caregivers do not teach children to discriminate effectively between what they feel and what the caregivers feel, what the child wants and what the caregiver wants (or wants the child to want), what the child thinks and what the caregiver thinks.” (Fruzzetti, Shenk, & Hoffman, 2005, p. 1021)

Fruzzetti, A.E., Shenk, C. and Hoffman, P. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17, 1007-1030.

Dr. Childress Comment: Far more important than these direct quotes from the works of preeminent mental health professionals, is the surrounding context of information in which these quotes are embedded.  If we are to properly assess, diagnose, and treat the pathologies that affect children and families, it is vital to have a substantial base of information regarding the nature of these pathologies.

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

Cats and dogs are similar.  Both have fur, four legs, and a tail, and both live with us.

But cats are not dogs.  They are different species of animal.

Furthermore not all animals are a dog. Neither are all animals cats. There are both cats and dogs. They both exist as separate species of animals. While they are similar to each other, they are distinctly different species of animals.

And we can tell the difference between cats and dogs. Even though both have fur, four legs, and a tail, it’s actually pretty easy to tell if the animal we’re looking at is a cat or a dog.  Try it if you don’t believe me… See, it’s pretty easy.  Cats and dogs look fundamentally different.

I recently received the following critical Comment to my blog post regarding my Online Seminar on Attachment-Based “Parental Alienation” (it seems the pathogen has located me, which is a good thing).

“You think you’re pretty smart eh?  Have you been physically and psychologically beaten on before?  Interrogated?  Your parenthood been fabricated?  Shame on you for dismissing women abuse!”

This is a common type of argument levied against the existence of the “parental alienation” pathology.  The argument is that to identify the pathology of “parental alienation” is to somehow deny the legitimacy of authentic domestic violence and child abuse. We can even see the remnants of this argument in the Position Statement on Parental Alienation of the American Psychological Association, which begins with a cautionary statement that all allegations of domestic violence need to be taken seriously.

But this is a spurious argument offered up by the allies of the pathogen. Cats are not dogs.  They are different animals.

Just because cats exist (i.e., the delusional reenactment of childhood attachment trauma into current family relationships) does not in any way discount or nullify the existence of dogs (authentic domestic violence and child abuse).  Dogs exist… and cats exist.  Dogs are not cats, and cats are not dogs.

And we can actually tell the difference between cats and dogs.

Authentic violence against women and children exists. The trans-generational transmission of childhood trauma into current family relationships through the personality disorder pathology of the parent, that is itself a product of the childhood trauma, also exists.  Dogs exist and cats exist.

They are two different species of similar types of animal (trauma). Actual violence against women and children is the enactment of trauma in this generation of children and families. The pathology of attachment-based “parental alienation” is the enactment of similar pathology, just one generation removed. The trauma was enacted in the childhood of the current narcissistic/borderline parent and is now being reenacted in the current family relationships in the delusional attachment-trauma pattern of “abusive parent”/”victimized child”/”protective parent.”

But just because cats exist (trauma reenactment) doesn’t mean that dogs don’t also exist (authentic domestic violence and child abuse).  Both types of animal exist.  Both dogs AND cats exist.

And it’s actually pretty easy to tell the difference between dogs and cats once you know what to look for.

The folks who are concerned about domestic violence and child abuse are worried that if we identify the pathology of “parental alienation” as existing (cats) then all animals will become cats and we will no longer identify authentic cases of domestic violence and child abuse (dogs). That’s a valid concern, but it’s also ridiculous.

It’s incredibly easy to tell what’s a cat and what’s a dog. First off, cats have retractable claws and climb trees, dogs don’t. Dogs bark, cats don’t (cats purr). And cats look fundamentally different than dogs. I doubt if anyone over the age of three actually gets confused if the animal in question is a dog or a cat.

Similarly, the pathology of a delusional reenactment of childhood trauma has distinctly different characteristic indicators from authentic violence against women and children. Authentic violence against women and children presents with one set of characteristic indicators while the delusional reenactment of childhood attachment trauma presents with an entirely different set of characteristic indicators. It’s actually pretty easy to tell the difference between cats and dogs once you know what to look for.

The three diagnostic indicators of attachment-based “parental alienation” (Foundations) can reliably and consistently differentiate the delusional trauma reenactment pathology of “parental alienation” from authentic incidents of domestic violence and child abuse (cats have retractable claws – dogs don’t, etc.). Plus, with all of the associated clinical signs, the two forms of pathology look fundamentally different (cats don’t look like dogs).

Not everything is a cat.  Authentic domestic violence and child abuse exists.

Not everything is a dog.  The reenactment of childhood attachment trauma into current family relationships also exists.

The renowned expert in trauma, Bessel van der Kolk, describes the reenactment of childhood trauma into current relationships:

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

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

“Victims of trauma respond to contemporary stimuli as if the trauma had returned, without conscious awareness that past injury rather than current stress is the basis of their physiologic emergency responses. The hyperarousal interferes with their ability to make calm and rational assessments and prevents resolution and integration of the trauma.” (van der Kolk, 1989, p. 226)

“People who have been exposed to highly stressful stimuli develop long-term potentiation of memory tracts that are reactivated at times of subsequent arousal. This activation explains how current stress is experienced as a return of the trauma; it causes a return to earlier behavior patterns.” (van der Kolk, 1989, p.226)

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

Sigmund Freud called this reenactment of childhood trauma “transference” (the patient would “transfer” childhood patterns of relationship onto the analyst).

John Bowlby calls these internalized patterns of relationship expectations “internal working models,” and he describes how we reenact these childhood patterns throughout our lifespan,

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

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

The renowned psychiatrist, Aaron Beck, refers to these patterns as “schemas.”  Beck and his colleagues describe how these schemas influence our interpretation of events and relationships,

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

“When schemas are latent, they are not participating in information processing; when activated they channel cognitive processing from the earliest to the final stages… When hypervalent, these idiosyncratic schemas displace and probably inhibit other schemas that may be more adaptive or more appropriate for a given situation. They consequently introduce a systematic bias into information processing… In personality disorders, the schemas are part of normal, everyday processing of information.”  (Beck et al., 2004, p. 27)

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

Pearlman and Courtois (2005) describe the pattern of the trauma reenactment narrative.

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. (p. 455)

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

Prager (2003) also describes the pathology of trauma reenactment,

“Freud suggests that overwhelming experience is taken up into what passes as normal ego and as permanent trends within it; and, in this manner, passes trauma from one generation to the next. In this way, trauma expresses itself as time standing still. Traumatic guilt – for a time buried except through the character formation of one generation after the next – finds expression in an unconscious reenactment of the past in the present. (p. 176)

Trauma, as a wound that never heals, succeeds in transforming the subsequent world into its own image, secure in its capacity to re-create the experience for time immemorial. It succeeds in passing the experience from one generation to the next. The present is lived as if it were the past. The result is that the next generation is deprived of its sense of social location and its capacity to creatively define itself autonomously from the former… when time becomes distorted as a result of overwhelming events, the natural distance between generations, demarcated by the passing of time and changing experience, becomes obscured. (p. 176)

Prager, J. (2003). Lost childhood, lost generations: the intergenerational transmission of trauma. Journal of Human Rights, 2, 173-181.

The trauma-reenactment pathology of attachment-based “parental alienation” exists.  Cats exist.

This is not to deny that dogs ALSO exist.  Both cats and dogs exist.

To equate the existence of cats (trauma reenactment pathology) with the denial of dogs (authentic domestic violence and child abuse) is stupid.  We are NOT saying that dogs don’t exist.  We are simply saying that cats are NOT dogs.  These are two different animals.

It is the critics of the construct of “parental alienation” who are saying that EVERYTHING is a dog, and that cats don’t exist (“parental alienation” doesn’t exist).

All we are trying to do is get establishment mental health to acknowledge what Freud, van der Kolk, Bowlby, Beck, and others ALREADY acknowledge, that BOTH cats AND dogs exist. They are different animals. Not everything is a dog.

And once we recognize that BOTH cats and dogs exist, it actually becomes pretty easy to tell them apart. But we first need to recognize that there are two different types of animal. Each has fur, four legs, and a tail. But they are different.  Cats are not dogs.

So as we run into this type of distorted argument, in which the person we’re talking to refuses to acknowledge that cats exist because they’re afraid that this denies the existence of dogs, just reassure them that’s not the case, that there are two different types of animal, both with fur, both with four legs, and both with a tail, but that they are entirely different species of animals, and that it’s actually really easy to tell them apart (i.e., the three diagnostic indicators and associated clinical signs of attachment-based “parental alienation”).

Both cats and dogs exist. Both the pathology of trauma reenactment and the pathology of family violence exist. One does not exclude the existence of the other.

All that we are asking for is a change to the APA Position Statement on “parental alienation” to

1.)  Acknowledge that the pathology exists (cats exist)

2.)  Recognize the children and families evidencing the signs of this pathology as representing a “special population” of children and families who require specialized professional knowledge and expertise to competently assess, diagnose, and treat.

(Since both cats and dogs have fur, four legs, and a tail, we want to make sure we don’t misidentify a cat as being a dog, or a dog as being a cat. So we want to require that only experts in cats and dogs identify the animal in question using advanced DNA tests that will determine whether the animal is a cat or a dog).

Once you know what to look for, the difference between cats and dogs is pretty distinctive.

So if anyone runs into this argument that “parental alienation” misidentifies authentic child abuse and domestic violence, just politely reassure the other person that we are talking about different animals. Cats are not dogs.

We’d be happy to talk about the many species of dogs, but that is not addressing the point we are raising that not all animals are dogs. Some animals are cats. We would like to discuss cats, and we need to talk about cats (i.e., the reenactment of childhood attachment trauma into the current family relationships, mediated by the narcissistic and borderline personality pathology of the allied parent that is itself a result of the childhood attachment trauma).

We can discuss dogs at some other time.  Right now we’re discussing cats.

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

I received a Comment from Michelle Jones, LCSW to my blog post Bringing the Era of Gardnerian PAS to a Close.

I found her Comment so articulate and spot-on accurate that I decided to repost it here as a blog.  In my view, her description of the situation is exactly correct.

As preface let me say that the only thing I care about is bringing an end to the family tragedy of “parental alienation.”  And we can accomplish that.  We can bring this family nightmare to an end.  Today.  This instant.  The pathology of “parental alienation” is not some type of new and unique pathology. It is a manifestation of established, well-defined, and well-understood forms of psychopathology that ALL mental health professionals should ALREADY be knowledgeable in, especially if they are working with this type of pathology.

An attachment-based model of “parental alienation” is NOT me… it’s Kernberg, it’s Millon, it’s Beck, it’s Bowlby, it’s Ainsworth, it’s Haley, it’s Minuchin,… it is the work of the preeminent figures in all of psychology. 

All I did was bring this work together and apply it to the pathology commonly referred to as “parental alienation.”  It’s not “my theory.”  It is the fundamental principles within established forms of psychopathology.  Read Kernberg, read Millon, read Beck, read, Bowlby, read… it’s all there.

There is NOTHING new in Foundations.  It is all established and well-defined forms of pathology.

Here is the comment of Michelle Jones, LCSW.  I am in 100% agreement with her.  Solving the pathology of “parental alienation” is the central issue, and it is the ONLY issue.

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From Michelle Jones, LCSW:

As a mental health therapist, I am making this reply directed to mental health therapists. It is difficult for most people to rise above their current situation and see the bigger view of themselves within the context of their own era of history.  Looking back, it’s much easier to see.  As they say, “Hindsight is 20/20.”

When Joseph Lister proved that using antiseptics in surgery could reduce the number of post op infections, you would think the people at that time of history would have shouted for joy that such progress could be made.  Instead it challenged their paradigms and actually caused insult to many of the professionals at the time.  Looking back, we see the ignorance and the extreme shortsightedness of the accepted thinking of that day.  And of course today we all believe in the reality of microbiology and the need for sterile technique, but historically, the idea took some getting used to.  It actually took about a decade for people to start taking Lister seriously.  Further, without Lister’s clear and accurate assessment that “germs” caused infections (and not bad air), there was no way to justify or standardize the use of antiseptics.

We are now in a critical time of change in the history of parental alienation treatment.  I believe it is mandatory to accurately define the pathology of parental alienation in an indisputable, scientifically-based manner, as you have done Dr. Childress–so that we can justify and prescribe the necessary treatments.  We, as mental health therapists should know that our interventions are only as good as our assessments. If we do not accurately identify the pathology, then we cannot justify the necessary and appropriate interventions.

This should not be a debate about whose opinion or construct is better than whose, this should be an objective, scientific and moral endeavor to raise the professional standard of practice across the field of mental health.  If we as professionals truly believe in “doing no harm,” and our focus is truly on helping children and families, who are the foundation of our society, then we need to lay down our egos, and our outdated paradigms, and with integrity and humility, seek truth, even if it challenges us personally.

I am not criticizing Gardner, nor those who have supported the PAS model.  You have all done so much good in the world, and I sincerely appreciate your efforts.  I own and have read most of your books.  What I am asking is, “Is the PAS paradigm really working to the extent that it justifies and allows the needed solutions?”  Gardner did a lot of good to raise awareness, and at great personal expense.  His behavioral observations were accurate, but his theoretical constructs were not complete.  That’s okay.  If he were alive today, I believe he would shout, “That’s okay, just do something that works and stops the abuse!”  After reading many of his articles and books, I truly believe his motives were pure.  But his character and his contributions are not under question and we shouldn’t allow ourselves to be distracted by whether or not we should be loyal to Richard Gardner.  Adopting the constructs of an attachment-based model of parental alienation has nothing to do with being loyal or disloyal to Gardner or the groundwork he laid, it’s about the next step in history and addressing the urgency of bringing about solutions to the devastating problem of parental alienation.

As you have stated, Dr. Childress, staff splitting is a symptom of what happens to the treatment team when working with patients with personality disorders.  Divide and conquer is their MO.  I have spent years working with patients in residential treatment centers (many with personality disorders) and the clinicians would meet once or twice a week in treatment team to collaborate so that we could unite and do effective therapy.  The patients could not be helped without unified treatment interventions.

If we are going to effectively treat parental alienation or pathogenic parenting, it will require the same thing, uniting as a treatment team and implementing appropriate interventions with strict boundaries so that change can actually happen.  How do we determine the needed boundaries and interventions?  Only by first properly and accurately identifying the pathology.  Dr. Childress has painstakingly done this for us in Foundations.  I urge all mental health professionals to read Foundations and see if it fits with the established and accepted therapeutic theories we were trained in. Let’s unite in the spirit of peace and cooperation and reach consensus on the best treatment standards for parental alienation.  And then, let’s unitedly take action.

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I agree 100% with everything Ms. Jones said.

This is only about a scientifically-based description of the pathology so we can move forward in its diagnosis and treatment.  The pathology is NOT a new and unique syndrome, it is a manifestation of entirely understandable and defined forms of psychopathology. 

It is time to end the unnecessary and paralyzing debate in professional psychology and come together in the service of children and families caught in this particular form of pathology.

The focal goal of our efforts needs to be a change in the APA Position Statement on Parental Alienation so that it,

1.)  Acknowledges that the pathology exists, using whatever name establishment mental health wishes to use (“parental alienation,” “pathogenic parenting,” “attachment-trauma reenactment pathology” – or some other label for the pathology).

The pathology of “parental alienation” exists.

2.)  Formally recognize the children and families evidencing this type of pathology as representing a “special population” who require specialized professional knowledge and expertise (in attachment theory, personality disorder pathology, and family systems theory) in order to competently assess, diagnose and treat.

The complex nature of the pathology defines these children and families as a special population who require specialized professional knowledge and expertise to competently assess, diagnose, and treat.

I believe this to be a reasonable and temperate demand on our part.  All we are asking for is professional competence in established domains of professional psychology.

In order to achieve professional competence in established domains of professional psychology, we must first be able to define the pathology within established and existing forms of psychopathology.

That’s what Foundations does.  It establishes the foundations for professional competence. 

It is time to end the divisive and damaging debate within professional psychology and come together, all of us, to meet the very real needs of the children and families experiencing this type of tragic psychopathology.

Thank you for your support Michelle.  Your banner is on the battlefield in support of the children and families who need us.

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

Foundations is not “my theory.”  Here is the source material:

Central References:  Books

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

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

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

Millon. T. (2011). Disorders of Personality: Introducing a DSM/ICD Spectrum from Normal to Abnormal. Hoboken: Wiley.

Beck, A.T., Freeman, A., Davis, D.D., and Associates (2004). Cognitive Therapy of Personality Disorders. (2nd edition). New York: Guilford.

Kernberg, O.F. (1975). Borderline Conditions and Pathological Narcissism. New York: Aronson.

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

• If a mental heath professional is assessing, diagnosing, or treating this population of children and families and has not read these texts by the most preeminent figures in attachment theory, personality disorder pathology, and family systems theory, then the mental health professional is very likely to be practicing beyond the boundaries of his or her professional competence in violation of Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Additional Central References: Research

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

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

Fonagy, P., Target, M., Gergely, G., Allen, J.G., and Bateman, A. W. (2003). The developmental roots of Borderline Personality Disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23, 412-459.

van Ijzendoorn, M.H. (1992) Intergenerational transmission of parenting: A review of studies in nonclinical populations. Developmental Review, 12, 76-99

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

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

Macfie, J., McElwain, N.L., Houts, R.M., and Cox, M.J. (2005) Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment & Human Development, 7, 51-65.

Lyons-Ruth, K., Bronfman, E. and 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).

Main, M. and Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M.T. Greenberg, D. Cicchetti, & E.M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). Chicago: University of Chicago Press.

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

Pearlman, C.A. and Courtois, C.A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18, 449-459.

Prager, J. (2003). Lost childhood, lost generations: the intergenerational transmission of trauma. Journal of Human Rights, 2, 173-181.

Shaffer, A., and Sroufe, L. A. (2005). The developmental and adaptational implications of generational boundary dissolution: Findings from a prospective, longitudinal study. Journal of Emotional Abuse. 5(2/3), 67-84.

van Ijzendoorn, M.H. (1992) Intergenerational transmission of parenting: A review of studies in nonclinical populations. Developmental Review, 12, 76-99

Brennan, K.A. and Shaver, P.R. (1998). Attachment styles and personality disorders: Their connections to each other and to parental divorce, parental death, and perceptions of parental caregiving. Journal of Personality 66, 835-878.

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

Sable, P. (1997). Attachment, detachment and borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training, 34(2), 171-181.

Holmes, J. (2004). Disorganized attachment and borderline personality disorder: a clinical perspective. Attachment & Human Development, 6(2), 181-190.

Lopez, F. G., Fuendeling, J., Thomas, K., and Sagula, D. (1997). An attachment-theoretical perspective on the use of splitting defenses. Counseling Psychology Quarterly, 10, 461-472.

Juni, S. (1995). Triangulation as splitting in the service of ambivalence. Current Psychology: Research and Reviews, 14, 91-111.

Mikulincer, M., Gillath, O., and Shaver, P.R. (2002). Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality and Social Psychology, 83, 881-895.

Garety, P. A. and Freeman D. (1999) Cognitive approaches to delusions: A critical review of theories and evidence. The British Journal of Clinical Psychology; 38, 113-154.

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

Hodges, S. (2003). Borderline personality disorder and posttraumatic stress disorder: Time for integration? Journal of Counseling and Development, 81, 409-417.

Levy, K.N. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, p. 959-986.

Additional Supporting Research

Fonagy P. and Target M. (2005). Bridging the transmission gap: An end to an important mystery in attachment research? Attachment and Human Development, 7, 333-343.

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

Macfie, J. Fitzpatrick, K.L., Rivas, E.M. and Cox, M.J. (2008). Independent influences upon mother-toddler role-reversal: Infant-mother attachment disorganization and role reversal in mother’s childhood. Attachment and Human Development, 10, 29-39

Sroufe, L. A. (2005). Attachment and development:  A prospective, longitudinal study from birth to adulthood, Attachment and Human Development, 7, 349-367.

Bacciagaluppi, M. (1985). Inversion of parent-child relationships: A contribution to attachment theory. British Journal of Medical Psychology, 58, 369-373.

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Bretherton, I. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11, 237-252.

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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.

van der Kolk, B.A. (1987). The separation cry and the trauma response: Developmental issues in the psychobiology of attachment and separation. In B.A. van der Kolk (Ed.) Psychological Trauma (31-62). Washington, D.C.: American Psychiatric Press, Inc.

Raineki, C., Moriceau, S., and Sullivan, R.M. (2010). Developing a neurobehavioral animal model of infant attachment to an abusive caregiver. Biological Psychiatry, 67, 1137-1145.

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

Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J., and Rizzolatti, G. (2005). Grasping the intentions of others with one’s own mirror neuron system. Plos Biology, 3(3), e79.

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Barnow, S. Aldinger, M., Arens, E.A., Ulrich, I., Spitzer, C., Grabe, H., Stopsack, M. (2013). Maternal transmission of borderline personality disorder symptoms in the community-based Griefswald Family Study. Journal of Personality Disorders, 27, 806-819,

Carlson, E.A., Edgeland, B., and Sroufe, L.A. (2009). A prospective investigation of the development of borderline personality symptoms. Development and Psychopathology, 21, 1311-1334.

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Additional Supporting Books

Cozolino, L. (2006): The neuroscience of human relationships: Attachment and the developing social brain. WW Norton & Company, New York.

Siegel, D. (1999). The developing mind: Toward a neurobiology of interpersonal experience (New York: Guilford Press, 1999)