Online Seminar Available

On July 18, 2014 I presented an online seminar through the Master Lecture Series of California Southern University regarding the theoretical foundations for an attachment-based model of “parental alienation.”

This online seminar is now posted by California Southern University and is available online to the general public at:

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

On November 21, 2014 I will be presenting a second seminar through the Master Lecture Series of California Southern University regarding therapy of attachment-based “parental alienation. This seminar will also be posted online by California Southern University and will be available to the general public.

During the second seminar on therapy, I will assume that the audience is familiar with the content of this first seminar on theory, so I will NOT re-describe the theoretical foundations but will instead move directly into therapy related applications.

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

Nothing New – No Excuse

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

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

Narcissistic and Borderline Personality Disorder

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

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

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

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

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

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

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

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

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

Cross-Generational Parent-Child Coalition

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

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

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

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

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

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

“The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two…

In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer. By ‘coalition’ is meant a process of joint action which is against the third person…

The coalition between the two persons is denied. That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition…

In essence, the perverse triangle is one in which the separation of generations is breached in a covert way. When this occurs as a repetitive pattern, the system will be pathological.” (p. 37)

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

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

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

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

No Excuse

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

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

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

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

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

Nothing New

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Personality Disorders

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

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

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

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

Family Systems

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

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

Trauma Reenactment

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

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

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

Standards of Practice

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

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

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

Diagnostic Indicators and Associated Clinical Signs

Diagnostic Indicators

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

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

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

Criterion 1: Attachment System Suppression

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

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

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

Criterion 2: Narcissistic Personality Symptoms

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

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

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

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

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

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

Anxiety Variant

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

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

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

Criterion 3: Delusional Belief System

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

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

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

DSM-5 Diagnosis

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

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

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

Response to Intervention

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

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

Associated Clinical Signs

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

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

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

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

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

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

The Insensitive Parent

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

Anger Management

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

Doesn’t Take Responsibility

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

Vague Personhood

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

New Romantic Relationship of Parent

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

The Non-forgivable Grudge

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

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

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

Accepting the Rejection

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

Banishment

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

Discipline

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

No Apology

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

Preponderance of Clinical Evidence

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

 Beyond Reasonable Clinical Doubt

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

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

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

Craig Childress, Psy.D.
Psychologist, PSY 18857

References

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

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

The Detective and the Psychologist

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

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

Type of Crime = Presenting Problem

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

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

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

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

Suspects = Differential Diagnoses

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

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

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

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

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

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

Interpreting Evidence

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

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

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

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

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

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

  • the nature and role of the attachment system (Ainsworth, 1989; Bowlby, 1969, 1973, 1980; Bretherton, 1990; 1992; Bretherton & Munholland, 2008; Lyons-Ruth, Bronfman, & Parsons, 1999; van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999),
  • the construct of intersubjectivity in relationships (Cozolino, 2006; Fonagy, Luyten, & Strathearn, 2011; Kaplan & Iacoboni, 2006; Shore; 1994; 1996; 1997; Stern, 2004; Tronick, 2003; Tronick, et al., 1998; Trevathan, 2001),
  • the impact of parental narcissistic and borderline personality disorders on family relationships (Beck, et al., 2004; Kernberg, 1975; Kohut, 1972; Millon, 2011; Linehan 1993)
  • and family systems constructs such as triangulation, boundaries, and coalitions (Goldenberg & Goldenberg, 1996; Haley, 1977; Minuchin, 1974)

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

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

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

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

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

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

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

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

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

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

Planted Evidence

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

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

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

What a horrible detective.

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

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

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

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

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

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

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

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

Preponderance of Evidence

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

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

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

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

References:

Attachment System

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

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

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

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

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

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

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

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

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

Intersubjectivity

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

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

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

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

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

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

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

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

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

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

Narcissistic & Borderline Personality Disorders

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

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

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

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

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

Family Systems

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

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

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

Stark Reality

To targeted parents:

I am often sought out by targeted parents who want my help to the question,

“How can I reestablish a positive and affectionate relationship with my child?”

My answer is… that’s the wrong question.

The Well-Formed Question

Do you really want me to open the child to a positive and affectionate relationship with you? Knowing full well that the child will pay a terrible price for any show of affection toward you, or even for not rejecting you sufficiently, as a result of the retaliation by the narcissistic/(borderline) parent.

The capacity for psychological cruelty by the narcissistic/(borderline) parent is immense. Just think of it for a second. The narcissistic/(borderline) parent is willing to inflict the immense cruelty on you of taking your most precious beloved child from you, so that you no longer have a child, to inflict on you such intense psychological suffering as revenge for your not sufficiently appreciating the “wonderfulness” of the narcissistic/(borderline) parent.

Their capacity for cruelty is immense, and it is without empathy or pity.

If the child shows any affection toward you, or does not reject you with enough display, then the full force of the psychological cruelty that is capable from the narcissistic/(borderline) parent will be turned on the child. The child will have to endure daily hostility, rejection, contempt, and torment. Irrational rules, irrational punishments. Anger. Rejection. Guilt.

The pathological cruelty capable from the narcissistic/(borderline) parent is hard enough for a fully developed adult psyche to endure, it is devastating to the still in-formation psyche of the child.

So are you asking me how you can expose your child to this retaliation? You’re asking me how to open up your child and expose your child’s authenticity and vulnerability to the immense  psychological cruelty capable from the narcissistic/(borderline) parent.  Is that really what you want to do?

“How can I protect my child?”

That’s a much better question.

Until we can protect the child, we cannot expose the child.

How can we ask the child to show affection toward you unless we can first protect the child from the psychological retaliation of the narcissistic/(borderline) parent that is sure to follow any display by the child of affectionate bonding to you, or even just the child’s insufficient display of rejection of you?

The narcissistic/(borderline) parent REQUIRES the child to reject a relationship with you. If the child shows bonding motivations toward the targeted parent, or even fails to show sufficient rejection of the targeted parent (such as insufficiently dramatic displays of protest at visitation transfers), then the child will be subjected to a withering psychological retaliation from the narcissistic/(borderline) parent.

So, as a therapist, my question to targeted parents is this;

“Do you want me to open the child’s bonding motivations toward you? To stop the child’s displays of rejecting you? To re-form a positive parent-child bond with you? Knowing that to do so will expose the child to an excruciating psychological torment from the retaliation of the narcissistic/(borderline) parent once the child returns to the custody and ‘care’ of the pathological parent.”

As long as the child must live in the world of the narcissistic/(borderline) parent, as long as we cannot protect the child from the psychopathology of the narcissistic/(borderline) parent, the child must find a way to psychologically survive in that world.

My First Exposure

My first case of “parental alienation” involved a 10 year old boy who had to reject a relationship with his mother. I had met with the father on several occasions and the dynamic was obvious. As I sat in the mother-son therapy session with the child sitting apart in a dramatic display of rejection, refusing to play a board game with his mother and me, I decided to reach out with my empathy into the child’s experience.

As I sat talking with the mother, I allowed my empathic resonance to shift over to the child, to the child’s inner experience. I didn’t share this empathic awareness with the child, I just allowed myself to feel what it was like to be him, looking for his authentic self-experience.

As I dropped my empathic awareness into the child’s authenticity, this is what I “heard” in my mind’s imagination,

Child (in my mind’s imagination): “Dr. Childress, can you help me escape from here? I’m trapped, buried deep inside. I don’t want to reject my mother. I love my mother. But I have to reject her because it’s what my dad requires me to do. He’ll torment me if I don’t. Can you rescue me? Can you help me escape from here?

Dr. C (in my mind’s imagination): I’ll see what I can do.

Child (in my mind’s imagination): “But Dr. Childress, don’t get me half the way out. Because if you only get me half the way out my dad will torment me for showing affection for my mom, for not rejecting my mom. If you can’t rescue me, if you can’t get me all the way out, then just leave me here.

Dr. C (in my mind’s imagination): Okay, I’ll see what I can do.

That’s the voice of the child in “parental alienation.”

“Help me. My authenticity is trapped deep inside here. Please, I want you to rescue me. But if you can’t get me all the way out, if you can’t rescue me, then leave me here, because otherwise the pathological parent will torment me if I try to escape but can’t get fully away.”

“At least if my authenticity is buried deep inside, hidden beyond my awareness, then it’s safe. If you expose it but cannot protect it, then the narcissistic/(borderline) parent will destroy it.”

We must first protect the child. Only then can we ask the child to expose his or her authenticity.

Protecting the Child

I am a therapist. I am not the child’s parent. I cannot do what is necessary to protect the child. You must do that.

I can support you. I can write, I can film Youtubes, I can describe what “parental alienation” is for mental health professionals and the Court. I will do everything in my power. But I cannot achieve the child’s protection. Each parent must accomplish that for each child. Every situation has its own individual characteristics, and only you can achieve your child’s protection.

Unless you can protect the child, how can you ask the child to love you? Knowing that to love you will expose the child to the abusive psychological retaliation of the hostage taker?

Or is that just the child’s problem? After all, if we restore the child’s positive relationship with you then you’ll be fine. You’ll have a positive, normal-range relationship with the child. Whatever happens to the child at the other parent’s house, well, that’s the child’s problem.

I know that’s not how you feel. But how, then, can we ask the child to bond to you? We can’t. Not until we achieve the child’s protection from retaliation.

Allies

You, the targeted parent, cannot protect the child unless you have allies. The principle ally is mental health.

It is the responsibility of mental health to recognize the degree of psychopathology and to voice this diagnosis in your support. You are the normal-range and healthy parent. The allied and supposedly “favored” parent is the pathology.  You know that.  I see that.  All of mental health should similarly see it.  But they don’t.

We need to solve that.

Then, once you have a strong ally in mental health, we turn to the Court system. The united voice of mental health can then provide you with the institutional power you need to enlist the power of the Court as your ally, and it is with the power of the Court that we can protect the child.

The solution to “parental alienation” is not through the legal system, it is to be found in the mental health system. When mental health speaks with a single voice, the legal system will be able to act with the decisive clarity necessary to protect the child and solve “parental alienation.”

Until mental health speaks with a single voice, no solution to “parental alienation” is possible. Not for you.  Not for the next parent.  This isn’t because we can’t fix your relationship with your child, it’s because we can fix it.  Yet how can we ask for the child’s authenticity if we are unable to first protect the child’s authenticity?

Do you really want to expose the child to the immense psychological cruelty capable from the narcissistic/(borderline) parent?  If we open the child’s affectionate bonding toward you, that’s exactly what we will be doing.

Securing the Mental Health Ally

Currently, one of the major problems in securing mental health as an ally for targeted parents is the massive level of professional incompetence in both the diagnosis and treatment of “parental alienation.” Mental health doesn’t understand what it’s dealing with, what “parental alienation” is.

The first step to securing mental health as an ally is to clear the field of professional incompetence, so that ONLY professionally knowledgeable and competent mental health professionals treat this “special population” of children and families.

Key to achieving professional competence is defining “standards of practice” to which ALL mental health professionals can be held accountable. A Gardnerian PAS model does not allow us to establish professional standards of practice because Gardner too quickly abandoned established and accepted psychological constructs to describe what he thought was a new “syndrome.” We need to return to the foundations and re-define the construct of “parental alienation” entirely from within standard and established psychological constructs, so that we can then use this definition to establish “standards of practice” for ALL mental health professionals who work with this “special population.”

That’s what I set about to do, and that’s what I have accomplished with an attachment-based model of “parental alienation.”

I cannot enact the protection of your child. You must accomplish that. But I can give you the weapons from within professional psychology to achieve your child’s protection and the recovery of your child’s authenticity.

The Next Step

The next step in achieving mental health as your ally is to establish these “standards of practice” within mental health, so that ALL diagnosing and treating mental health professionals are knowledgeable and competent.

If you are going to rely on me for that, I would anticipate that this will take between 10 to 15 years for an attachment-based model of “parental alienation” to achieve professional acceptance.

Within two years I will submit for publication. It will take about a year and a half for the article to be published. It will languish in obscurity for another two years, when my second and third articles become published. A little more interest will emerge. I’m currently 60 years old. Within the year I’m going to be shifting my focus back to my primary professional practice domain of ADHD (I’ve actually solved what “ADHD” is and how to treat and resolve it, and in order to accomplish this I had  to advance child therapy into the 21st century, so I need to get back to these areas of prime importance. Solving “parental alienation” is a side-track for me). At some point in the next decade I’ll retire. At some point I’ll pass away. Then my work will gradually be “discovered” and picked up by younger therapists and researchers, and it will gradually find its way into the professional mainstream.

My estimate is that if you leave it to me to carry the solution, it will take between 10 to 15 years to achieve mental health as an ally.

What I’ve tried to do is give you the professional weapons you need to carry the fight for your children. I’ve defined the theoretical foundations for the construct of “parental alienation” on the solid and scientifically supported bedrock of attachment theory and personality disorder dynamics. From a professional psychology standpoint, I’ve done the heavy lifting for you. You now have a theoretical foundation built on solid bedrock that you can leverage to achieve the solution. But the fight for your children must be yours.

If you take up this fight to establish an attachment-based model of “parental alienation” within mental health, to require a “standard of professional practice” with this “special population” of children and families, then you may perhaps shorten the time-frame needed to acquire mental health as an ally. Perhaps to as little as a year or two. The theoretical foundations are extremely solid. You have everything you need.

Along the way, I’m willing to do whatever I can to support your voice within mental health.

Stark Reality

Because of my understanding of what “parental alienation” is, I’m often asked by targeted parents what they can do to restore a relationship with their child.

The stark reality is, nothing.

How can we ask the child to love you, to bond with you, to expose their authenticity, if we cannot also protect them from the torment of psychological retaliation that is sure to be inflicted on them by the narcissistic/(borderline) parent?

We must first protect the child.

Then, and only then, does a solution become available. And in order to protect the child we MUST have the strong and steadfast support of mental health. This requires that we clear the field of professional incompetence by establishing professional “standards of practice” for ALL mental health professionals who work with this “special population” of children and families.

An attachment-based model of “parental alienation” provides the necessary theoretical foundations on the established bedrock of attachment theory and personality disorder dynamics.  An attachment-based model of “parental alienation” can be leveraged into standards of professional practice for ALL mental health professionals who work with this “special population” of children and families.

How long this solution takes to enact, how long before we are able to protect our children… that’s up to you.

Craig Childress, Psy.D.

Standards of Practice for Court Ordered Parent-Child Therapy

The Court has the right to expect the highest standards of professional practice from psychotherapists who conduct therapy in response to Court orders.

The professional practices of therapists who provide Court-ordered psychotherapy to children and families should therefore reflect the highest standards of professional practice.

Professionally established guidelines exist that define standards of professional practice for forensic psychologists (Specialty Guidelines for Forensic Psychology, 2013) and guidelines have been proposed for professional standards of best practice regarding child custody evaluations (Patel, & Choate, 2014), yet no professional guidelines have been proposed or established for mental health therapists providing Court-ordered therapy.

I would propose that this is easily rectified: Mental health therapists should always render services at the highest professional standard of practice.

If our child had cancer, wouldn’t we want THE BEST doctors and THE BEST treatment available anywhere for the treatment of our child.  Why should we expect any less from psychotherapy?  Children’s futures, their healthy or unhealthy development, their future success, struggles, and pain, can all depend on the quality of the psychotherapy services they and their families receive.  This is an awesome professional responsibility.

Mental health therapists should provide to their clients exactly the same standard of professional care that the therapist would want for his own daughter or for her own son.  For our own children we would want the best possible treatment, whether for cancer or psychological issues. Why should we provide less professional competence to our client children and families than we would want for our own children and families?

Mental health therapists should always render services at the highest standard of professional practice.

And Courts have the right to expect the highest standard of professional practice for child and family litigants referred by the Court for therapy.

Defining the Quality of Care

For many years now I have taught clinical assessment and treatment planning to Master’s level students seeking to become psychotherapists. Prior to my entering private practice I served as a psychologist on medical staff at Children’s Hospital of Orange County where I supervised pre-doctoral and post-doctoral psychology interns and fellows in the APA accredited internship at the hospital. I later served as the Clinical Director for a children’s assessment and treatment center, where I trained and provided clinical supervision in child and family therapy for psychology interns and post-doctoral fellows treating young children who were primarily referred through the Department of Children’s Services and the foster care system.

The following framework for clinical assessment represents the professional standard of practice that I would EXPECT from any graduate student I teach or therapist I supervise if they were to provide Court-ordered family therapy to restore a fractured parent-child relationship, and the following framework would definitely be what I would expect of therapists at the professional level who provide Court-ordered psychotherapy to children and families.

The Court and our clients have the right to expect the highest standard of professional practice from psychotherapists who provide Court-ordered psychotherapy to children and families, and therapists who provide Court-ordered psychotherapy to children and families should expect to provide the highest quality of care to their clients.

Source of Clinical Information

Therapists conducting Court-ordered therapy to treat and resolve parent-child conflict should collect appropriately comprehensive clinical data necessary to develop an accurate case conceptualization which is needed for the development of an effective treatment plan.

For child and family issues, the collection of appropriately comprehensive clinical information would typically involve collecting information from the following sources:

Parental Clinical Interviews: Clinical interviews conducted with each parent individually to obtain each parent’s perspective on background history and symptom information. 

Parent-Child Assessment: Initial parent-child therapy assessment sessions with the parent and child who are the clients targeted for treatment, to observe and conduct clinical probes of individual functioning and conjoint relationship dynamics, including client responses to clinical intervention probes.

Child Assessment: Separate child clinical assessment interviews that include clinical probes and assessment of the child’s emotional and psychological functioning.

Relevant Collateral Sources: Review of relevant reports and documents and clinical interviews with relevant collateral sources of information, such as additional family members.

Written Case Conceptualization and Treatment Plan

Therapists providing Court-ordered psychotherapy to restore a fractured parent-child relationship should, within 4 to 6 weeks of the initial intake assessment, produce a written case conceptualization and treatment plan.

Content Domains of the Case Conceptualization

This written case conceptualization should document the following:

  • Presenting Problem:  A brief introduction to the issues and symptoms that necessitate therapy
  • History of the Presenting Problem:  A description of how the presenting problem emerged, its developmental course over time, and its severity
  • Family History:  A description of current family relationships, the family’s history, and relevant information about the parents’ family of origin history
  • Academic & Work History:  A description of the child’s school behavior and academic performance, and the work history of the parents
  • Additional Relevant History:  A description of additional relevant information, such as possible trauma history within the family (including in the childhood of the parents or with the grandparents), histories of alcoholism and substance abuse within the family (including in the parent’s childhood or with the grandparents), and histories of psychiatric diagnoses within the family (including the extended family). Additional relevant social, legal, and medical histories should be documented.

Jones, K. D. (2010). The unstructured clinical interview. Journal of Counseling and Development, 88, 220-226.

  • Case Conceptualization: The symptoms to be addressed by therapy should be specified and a theoretically substantiated clinical determination should be made regarding the apparent origins of these symptoms.

The theoretical framework that organizes the case conceptualization can be from any of the six primary schools of psychotherapy; psychodynamic, humanistic-existential, cognitive-behavioral, family systems, post-modern social constructionism, neuro-social developmental, or can draw from and integrate several theoretical models (the anticipated length of this case conceptualization would be 1-2 pages and would assume the reader has a professional level knowledge of the theoretical foundations).

Content Domains of the Treatment Plan

The written treatment plan should specify a set of theoretically substantiated treatment interventions that are directly linked to the clinical case conceptualization regarding the origins of the symptoms.

The written treatment plan should specify an estimated timeframe for accomplishing the resolution of the identified symptoms, with due consideration given to the variability of treatment related influences that may arise and alter this estimated timeframe. The written treatment plan should also offer an estimated prognosis for recovery of normal-range development and relationships.

If the estimated timeframe for resolving the symptoms exceeds six months, then a six month benchmark of anticipated gains should be identified and the reasons for the longer than six month estimate of therapy should be documented.

Treatment Progress Updates

At six-month intervals during the course of therapy, the therapist should provide written treatment progress updates specifying the treatment gains to date and the estimated timeframe for achieving a resolution of the symptoms.

If treatment progress has not been substantial in six months of therapy, then an explanation of the barriers to treatment should be documented, and adjusted interventions should be identified to address these barriers.

There are a variety of possible reasons for the failure to achieve substantial treatment progress in six months,

Neuro-biological limitations. These include factors such issues as autism-spectrum limitations, prenatal child exposure to drugs or alcohol that affects cognitive and behavioral development, parental psychiatric disturbances such as bipolar disorder or schizophrenia, etc. These types of issues present an inherent limitation to the treatment gains that can be expected, and realistic treatment expectations need to be established.

Therapist failure. The therapist may lack adequate knowledge and expertise to enact the therapy, or the client-therapist fit may not promote treatment success. A change in therapists may be indicated.

Inaccurate case conceptualization. The initial case conceptualization may have been in error leading to treatment interventions that were off-target to the origins of the symptoms. A revision in the case conceptualization and the treatment plan may be necessary.

Note: Research in psychotherapy efficacy finds that all theoretical orientations are effective (Wampold, 2001). According to the empirical research, the key determinative feature in psychotherapy efficacy is that the therapist has a model of psychotherapy for case conceptualization and that the client accepts this model as an explanation for the problem.

Client factors. A client within the family system may be resistant to the goals of treatment, resulting in slowed treatment progress. The nature of the client factors affecting therapeutic progress should be identified and revised treatment interventions to address and adjust to client factors should be specified.

Inadequate time. Treatment progress is being made, but the prior issues creating the symptoms are complex and deeply embedded and require a longer period of time to resolve. The underlying issues slowing treatment progress should be documented along with an estimated time frame and prognosis, and the factors affecting prognosis should be identified.

Treatment expectations:

  • In most cases of parent-child conflict, substantial treatment progress should be expected from six months of therapy.
  • Treatment should be expected to resolve the symptoms in no longer than one year of therapy.
  • Failure to meet these expectations should generate documentation as to the reasons for the failure of therapy to meet these expectations.

Note on Child Development:

The developmental phases of childhood are relatively brief and each phase is associated with important child experiences and emerging developmental capacities that build sequentially and cumulatively upon earlier developmental maturation.

Child developmental phases occur at approximately three-month intervals during the first year, six-month intervals during the second year, and then express a roughly two-year interval pattern between subsequent developmental phases:

Ages
0-1 infancy development, early emergence of foundational brain systems
1-2 toddler development, socio-language integration and exploratory locomotion
2-4 preschool socio-emotional-behavioral integration
4-6 early school entry and more elaborated socio-cognitive development
6-8 increasing stability in self-regulation and enhanced maturation in family bonding
8-10 elaborated personal and peer (social) achievement motivations
10-12 enhanced social awareness and modeling of same-gender parent, enhanced early proto-adult cognitive reasoning
12-14 increasing independence in self-identity, physio-social puberty changes
14-16 stabilization of adult-like cognitive reasoning and enhanced adult-like self-independence, gender-bonding motivations emerge
16-18 emergence of adult-level cognitive and social maturation
18-20 transition into young adult responsibilities and self-reliance

A six month time period reflects fully ¼ of the timeframe for a developmental phase. Disruptions to normal-range development lasting longer than six months will have increasingly deleterious effects on healthy child development, as the phased sequencing of later developmental experiences become increasingly desychronized with developental readiness.

When treating children, therapy should have as its goal, and should make significant efforts toward achieving, a substantial resolution of treatment-related issues within six months, and no longer than one year.

Failure to achieve this goal, important to maintaining the healthy developmental trajectory of the child, should receive examined scrutiny to identify the reasons why therapy was unable to achieve this goal, leading to appropriate treatment modifications to address and resolve the limitations to the extent possible and in the least amount of time feasible.

Therapy lasting one year is fully ½ of a developmental phase. Therapy should achieve substantial resolution of developmental child symptomatology within a year. Given the critical importance of time-related factors in child development, failure to achieve this standard should receive review and require specific documentation of the factors limiting therapeutic progress. Substantial alteration of the treatment context and organization of therapy may be indicated.

Clinical Review of Treatment

In any initial review of the case conceptualization and treatment plan, broad latitude should be granted to the therapist’s identification of the theoretical framework for case conceptualization and treatment planing. Later reviews should expect moderate to substantial treatment progress with due consideration for legitimate barriers to treatment progress identified in the update report and within the context of the therapist’s responsibilities to resolve the family conflicts.

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

References

Professional Practice Guidelines

Specialty guidelines for forensic psychology. (2013). American Psychologist, 68(1), 7-19

Patel, S.H. & Choate, L.H. (2014). Conducting child custody evaluations: Best practices for mental health counselors who are court-appointed as child custody evaluators. Journal of Mental Health Counseling, 36, 18-30

Jones, K. D. (2010). The unstructured clinical interview. Journal of Counseling and Development, 88, 220-226.

Psychotherapy Research

Wampold, Bruce E. (2001). The Great Psychotherapy Debate: Models, Methods and Findings. Routledge.

On Unicorns, the Tooth Fairy, and Reunification Therapy

The Myth of “Reunification Therapy”

The emperor has no clothes.

There is no such thing as “reunification therapy.”

There is psychoanalytic therapy (e.g., object relations therapy: Kohut, 1977; or self-psychology, Stolorow & Atwood, 1987),

There is humanistic-existential therapy (e.g., client-centered therapy, Rogers, 1961; or existential therapy, Yalom, 1980)

There is cognitive-behavioral therapy (e.g., CBT, Beck, 1976;  with general “Learning Theory” defining child behavior therapy; Patterson, 1982)

There is family systems therapy (e.g., Structural Family Systems therapy, Minuchin, 1974; or Strategic Family Systems therapy, Haley, 1963, Madanes, 1981; or Humanistic family systems therapy, Satir 1967)

There are post-modern therapies (e.g., solution focused therapy, Berg, 1994; or narrative therapy, White and Epston, 1990)

But there is NO model of therapy that has ever been proposed for what constitutes “reunification therapy,” meaning that therapists can essentially do whatever they want under the label of “reunification therapy.”

If therapists wish to describe the type of therapy they are conducting, they should use actual and established models of psychotherapy rather than vague and imprecise descriptive terms that do not increase understanding but that give the appearance of credibility without the substance of credibility.

The construct of “reunification therapy” is a haven, and a cover, for professional ignorance and incompetence.

The construct of “reunification therapy” is a mythical entity of no defined substance. Any therapist that uses the term “reunification therapy” is a charlatan. There is no defined thing as “reunification therapy” and they know it. If they are doing family therapy, then they should say, “family therapy,” in which case a follow up question could be, which model of family therapy are they employing?

I recognize that this is a strong accusation on my part. This weblog post has a comment section. I challenge any therapist to provide a reference citation for what “reunification therapy” entails… <crickets> … there is none.

Professional psychology should be ashamed of itself for knowingly perpetuating the myth of “reunification therapy” by not challenging the use of this construct.  There is NO SUCH CONSTRUCT as “reunification therapy” that has ever been defined within professional mental health.

If the therapist is doing family therapy, then the therapist should say this, which allows for the follow-up question of which model of family therapy is the therapist employing?

Establishment psychology blasts Gardner’s model of PAS as “junk science” yet allows the mythical construct of “reunification therapy” to go unchallenged. Professional psychology should be ashamed of itself.

If any therapist says that he or she does “reunification therapy” – run. That therapist is incompetent and is hiding his or her incompetence behind a mythical label. There is no such thing as “reunification therapy.”

If a therapist says that he or she does “reunification therapy,” ask for a citation reference regarding what “reunification therapy” is so that you can read up on “reunification therapy.” You will get no reference citation, because none exists. No model of “reunification therapy” has ever been proposed at any time, anywhere.

When engaging the services of a therapist to treat “parental alienation,” ask the therapist which of the five standard models of psychotherapy the therapist employs in “reunification therapy.”

Psychoanalytic – Psychodynamic
(generally “object relations”; Kohut)

Humanistic – Existential
(generally “client-centered”, Rogers, or existential therapy, Yalom, for adults; Ayers for humanistic “play therapy” with children, Oaklander for gestalt therapy with children)

Cognitive-Behavioral Therapy
(generally Beck for CBT; or “Learning Theory” involving operant and classical conditioning for child “behavior therapy”)

Family Systems Therapy
(generally Minuchin for Structural Family Systems therapy, occasionally others)

Post-Modern Therapy
(generally Berg for solution focused therapy)

Sometimes the therapist may say “eclectic” or “integrative.” This means that the therapist applies several of the above models depending on the situation and needs of the client. If the therapist responds “I’m eclectic” or “I use an integrative approach,” ask which models they tend to prefer and which models they tend to integrate.

If the therapist cannot describe which models of psychotherapy they are employing, then they are just making things up based on their whims at the moment and calling it “psychotherapy.”  Run.

If you are hiring an attorney to handle a divorce, you want a family law attorney not a corporate attorney. Ask. What area of law do you specialize in?  If you are getting cosmetic surgery, you want a plastic surgeon not a cardiac surgeon. Ask. What type of surgery do you do?  As a consumer, you may not know the technicalities of the various types of law or medicine – or psychotherapy models – but the professional should.  A professionally competent psychotherapist should be able to explain to you the treatment model being used. This is a part of the INFORMED consent process.

You have the right to consent to therapy, and in order to consent to therapy you the right to be informed about what therapy will involve. How does the therapist conceptualize the issues? How is treatment going to resolve these issues?  This is called the “treatment plan.”  Ask for a written “treatment plan.”

I am a clinical psychologist… I know what is out there passing itself off as “psychotherapy”…

“The emperor has no clothes.”

Do not trust that the psychotherapist knows what he or she is doing. Your family and your child are too important. I would recommend that you become an informed consumer by learning about the various models of psychotherapy.

But if you don’t want to personally learn about the various available models of psychotherapy, then at least ask the treating therapist to explain his or her approach, and how the therapist sees this approach to psychotherapy as solving your specific problems with your child.

If your child had cancer, the doctor would explain to you the treatment options, such as surgery, chemotherapy, radiation, or some newer form of treatment. You would be presented with the available options and recommendations, and you would be able to ask questions in order for you to make an informed treatment decision. Psychotherapy is no different.

Your child is too important, and your relationship with your child is too important.

Application of Therapy Models to Attachment-Based “Parental Alienation”

Treatment Structure:

Individual child therapy is NOT the appropriate treatment approach for attachment-based “parental alienation.” The issue in attachment-based “parental alienation” is interpersonal involving the parent-child relationship. Therapy sessions should be structured as conjoint parent-child relationship therapy. Some individual sessions with just the child or just the parent(s) may be appropriate (within a family systems model), but the focus is on treating the relationship.

Imagine a therapist conducting marital therapy but only seeing the wife individually.  Marriage therapy involves the relationship. Marriage therapy sessions involve BOTH the husband and the wife to resolve their relationship issues.  The same is true for the treatment of attachment-based “parental alienation.”  The treatment focus is on the parent-child relationship and therapy sessions should involve BOTH relationship partners.

Individual therapy with the child is NOT the appropriate model for resolving attachment-based “parental alienation.”

Treatment Models

Psychodynamic psychotherapy (generally object relations therapy) for attachment-based “parental alienation” is NOT the appropriate treatment model for attachment-based “”parental alienation.” It will be entirely ineffective for resolving the parent-child relationship, although it would be an appropriate model for treating the narcissistic/(borderline) personality dynamics of the alienating parent.

Psychodynamic psychotherapy is generally, if not always, individual therapy, and it does not have a theoretical structure for conjoint in-session relationship therapy.  Could it be adapted to conjoint in-session relationship therapy?  Perhaps, but I’ll leave that to others to propose such a model appropriate to treating the parent-child relationship issues of attachment-based “parental alienation.”

To Psychotherapists: Kohut does have some extremely important constructs related to empathic failure and narcissistic processes that are directly relevant to both the interpersonal trauma issues and the treatment of attachment-based “parental alienation” – it’s just that an individualistic object relations therapy model is not an appropriate treatment framework.

Kohutian theory, however, is directly relevant.

Humanistic-existential therapy, including all forms of non-directive client-centered and play therapy models, is CONTRA-INDICATED for the treatment of attachment-based “parental alienation.” Client-centered treatment models will collude with the psychopathology and will make things worse.

Humanistic-existential therapy assumes an authentic individual.  However, in attachment-based “parental alienation” the child is being induced/(seduced) into a role-reversal relationship in which the child is being used as a “regulating other” by the narcissistic/(borderline) parent to regulate the parent’s psychopathology.  The child’s psychological authenticity has been nullified, and continues to be nullified, by the psychopathology of the narcissistic/(borderline parent). 

Under these conditions, humanistic-existential models of therapy are NOT appropriate and will only serve to collude with the psychopathology.

To Psychotherapists:  Rogerian interpersonal conditions of empathy, unconditional positive regard, and genuineness remain vitally important components of the therapeutic relationship.  It’s just that a non-directive therapy is not an appropriate treatment model for attachment-based “parental alienation.”  The therapist needs to be an active interventionist, consistent with a Structural or Strategic Family Systems (or Humanistic, Satir) model of unbalancing family “homeostasis” to create interpersonal change within and across family relationships.

Empathy, unconditional positive regard, and genuineness remain vitally important components of the therapeutic relationship.

Humanistic-existential therapy tends to be individual therapy. The therapist will meet with the child individually and the parent will seldom be involved in therapy. Avoid humanistic-existential therapy, it will be harmful and will only make the situation worse.

Cognitive-behavioral therapy (CBT) involves altering distorted and false beliefs that are creating distorted emotional responses. With a skilled CBT therapist, this treatment model could be helpful in treating attachment based “parental alienation,” particularly to the extent that the therapist challenges the irrational beliefs of the child.

However, a comprehensive CBT model for treating the specific issues associated with the family dynamics of attachment-based “parental alienation” has yet to be proposed. Of central importance is that the CBT therapist reads the work of Arron Beck on personality disorders (Beck, et al., 2004).  The quality of the CBT work will improve substantially to the extent that the therapist understands the underlying “schemas” of personality disorders and their interpersonal manifestations.

Child behavior therapy involves delivering positive and negative “consequences” for appropriate and inappropriate child behavior. While child behavior therapy has a good intention, it will likely only make matters worse.

The targeted parent will be directed by the therapist to establish reward and punishment contingencies and to deliver these “consequences” for the child’s “problem behavior.” In attachment-based “parental alienation,” however, the child will be unresponsive to rewards and “positive attention” and will instead frequently provoke negative consequences (punishments) that will then create increasingly negative and hostile parent-child exchanges, that will be used by the child (and by the narcissistic/(borderline) parent) as “evidence” of the targeted parent’s insensitivity to the child’s needs, and as reasons and justifications for the child’s wanting to terminate the child’s relationship with the targeted parent.

To Psychotherapists: The reason for this treatment failure is that the child’s behavior is not under the “stimulus control” of the behavior of the targeted-rejected parent.  Instead, the child’s behavioral responses to the targeted-rejected parent are under the “stimulus control” of the child’s relationship with the allied and supposedly “favored parent.”  The focus of behavior change must target the correct locus of the stimulus control for the child’s behavior in the relationship cues, reinforcers, and punishments within the child’s relationship with the allied and supposedly “favored” parent.

It is possible that high quality behavior therapy combined with cognitive restructuring can be helpful, particularly if the child is separated from the ongoing distorting influence of the narcissistic/(borderline) parent during the active phase of treatment.  A key feature of effective behavior therapy will be focusing on a quality of the interaction called the “stimulus control” of the child’s behavior. 

Currently, in attachment-based “parental alienation,” the stimulus control for the child’s distorted behavior toward the targeted-rejected parent is in the child’s relationship with the allied and supposedly “favored” narcissistic/(borderline) parent.  Effective behavior therapy would need to alter the locus of this stimulus control away from the child’s relationship with the narcissistic/(borderline) parent and back onto the authentic source of stimulus control in the child’s relationship with the targeted parent.

Family systems therapy is the appropriate and indicated therapy model for treating attachment-based “parental alienation,” with Structural Family Systems theory being the primary indicated treatment framework, although a Strategic Family Systems model can also be effective. Family systems therapy involves multiple family members in the sessions (although it is highly unlikely that the involvement of the the narcissistic/(borderline) parent directly in the parent-child therapy sessions with the targeted parent will be warranted based on a variety of treatment considerations), and the family systems therapist will be an active participant in therapy. Initially, the therapist will seek to alter, disrupt, and “unbalance” the unhealthy “homeostasis” (relationship stability) within the family relationships in order to then re-structure family relationship patterns without the symptom present.

To Psychotherapists:  There may be circumstances in which conjoint sessions with the targeted parent and the allied and supposedly “favored” parent could be productive. The family therapy issue is helping the family transition from an intact family structure to a separated family structure. The locus for the family’s difficulty is in the narcissistic and borderline vulnerabilities of one of the spousal partners.  Helping the spousal relationship, and particularly this vulnerable spousal partner, effectively navigate the experience of loss and grief regarding the end of the marital bond can resolve the expression of pathology within the family.  It is skilled family systems work, but it is possible in some cases.

If a conjoint-spousal intervention is attempted, the child should NOT be present for these conjoint parental sessions (the child must be de-triangulated from the spousal conflict), although the child can be made aware that these parental sessions are occurring as part of the therapy process.  By the therapist taking over the caregiving role for the narcissistic/(borderline) parent, this may help release the child from the necessity of maintaining a role-reversal caregiving relationship for the vulnerable narcissistic/(borderline) parent.

However, a family systems approach with attachment-based “parental alienation” becomes challenging precisely because it will be effective.  As the therapy creates change in the child’s symptoms, the allied and supposedly “favored” narcissistic/(borderline) parent will apply ever increasing psychological pressure on the child to resist the influence of therapy and remain symptomatic.

The resistant pressures applied on the child by the pathological narcissistic/(borderline) parent for the child to remain symptomatic, even as family systems therapy is applying treatment-related resolutions encouraging the child’s release of symptoms and the restoration of normal-range relationships within the family, will turn the child into a psychological battleground between the forces of effective therapy that are resolving the child’s symptomatic state and the continuing and increasing psychological pressures being applied on the child by the narcissistic/(borderline) parent to remain symptomatic.

Turning the child into a psychological battleground will be psychologically harmful to the child.  The only way to resolve this dilemma is to either,

1) Terminate effective therapy and discontinue efforts to resolve the child’s psychopathology, thereby choosing to leave the child in a symptomatic state of a cut-off relationship with a normal-range and affectionally available parent that is the product of the distorted parenting practices of a narcissistic/(borderline) parent who is using the child in a role-reversal relationship to meet the needs of the pathological parent, or

2) Provide the child with a protective separation from the ongoing pathogenic influence of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery.

Family systems therapy will be effective, but this becomes a problem because the effectiveness of family systems therapy will be met with active resistance by the pathology of the narcissistic/(borderline) parent who will place increasing psychological pressure on the child to remain symptomatic. Turning the child into a psychological battleground between the goals of therapy and the pathology of the narcissistic/(borderline) parent is not recommended. But the only alternative is to terminate effective therapy.

Ineffective Therapy

There is a third alternative, which is to conduct entirely pointless ineffective “therapy” that lasts for years and produces absolutely no change (except the further strengthening and entrenchment of the child’s hostile rejection of the parent), and unfortunately this is far too often the type of “therapy” currently being employed with attachment-based “parental alienation.” 

Usually the ineffective mode of therapy is a non-directive “wing-it” style of Humanistic-oriented therapy, typically involving “validating the child’s feelings” in an apparent hope by the therapist that this will have some sort of magical “self-actualizing” impact on the child that will somehow stop the parent-child conflict.  The “wing-it” component sometimes involves encouraging the targeted-rejected parent to apologize to the child for supposed past parental failures. That these alleged “parental failures” in the past never actually occurred or are gross distortions of the actual events doesn’t seem to be relevant to the therapist in the “wing-it” style of “therapy,” and the therapist-elicited parental apologies to the child never produce the hoped for change in child attitude or behavior.

The Required Therapeutic Context for Effective Therapy

Therapy must begin with the child’s protective separation from the psychopathology of the narcissistic/(borderline) parent during the active phase of the child’s treatment and recovery.

We cannot ask the child to change and to relinquish the symptoms if we cannot first protect the child from the psychological retaliation of the narcissistic/(borderline) parent for any change the child makes.

Professional Expertise

An additional problem with the family systems models of psychotherapy is that there are a limited number of trained and knowledgeable family systems therapists available.  Family systems therapy is sophisticated, and so requires a high level of professional knowledge and skill.  Only a limited number of therapists will seek out the post-graduate training necessary to become professionally competent in family systems therapy.

In the absence of established knowledge and formal training in family systems models of therapy, many therapists simply choose to “wing it” and do whatever they think is best under any given circumstances.  Unfortunately, this is more common than one might imagine.  Many therapists are simply not competent to be doing family-related therapy.

Another limitation is that few child therapists and family systems therapists have experience treating personality disorders.

Most therapists in general, adult therapists included, have very limited experience and exposure to treating narcissistic personality disorders because narcissistic personalities very rarely present for therapy. Narcissistic personalities do not desire self-insight and would much rather maintain their grandiose self-opinion and judge others to be inferior rather than to engage in self-reflection regarding their own possible inadequacy. Borderline personalities will present to therapy because of the chaotic drama in their lives and intense depression, but most therapists do not treat borderline patients and those that do tend to be adult-oriented therapists who work from individual models of psychotherapy. 

For child therapists, the lack of exposure to narcissistic and borderline personality processes is even more acute, since personality disorders are rarely a feature of child therapy.  Most child therapists lack professional knowledge related to recognizing and treating personality disorder dynamics.

However, narcissistic and borderline personality features are prominent components of attachment-based “parental alienation” so that family systems therapy with attachment-based “parental alienation” will be improved considerably to the extent that the therapist is knowledgeable about personality disorders, such as Beck et al. (2004) and/or Millon (2011).

Post-Modern Therapies

Post-modern therapies would represent an intriguing application of social constructionism to the pathology of attachment-based parental alienation, but it is unclear how the principles of solution-focused or narrative psychology could be applied to the distorted family processes involved in attachment-based “parental alienation.” I would invite solution focused therapists and narrative therapists to attempt the application of their theoretical frameworks to the treatment of the trans-generational transmission of attachment trauma associated with the pathology of attachment-based “parental alienation.”

I suspect that there are intriguing applications of these models to the issues in attachment-based “parental alienation,” but I’m unsure on how to actualize this application since, while I am familiar with the theoretical constructs of these models, they are not directly within my area of professional expertise.

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

References

Psychoanalytic – Psychodynamic Therapy

Kohut, H. (1977). The Restoration of the Self. New York: International Universities Press.

Stolorow, R., Brandchaft, B., and Atwood, G. (1987). Psychoanalytic Treatment: An Intersubjective Approach. Hillsdale, NJ: The Analytic Press.

Humanistic-Existential Therapy

Rogers, C.R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston: Houghton Mifflin.

Yalom, I.D., Existential Psychotherapy. New York: Basic Books, 1980.

Cognitive-Behavioral Therapy

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: Meridian.

Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.

Family Systems Therapy

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

Haley, J. (1963). Strategies of psychotherapy. New York: Grune and Stratton.

Madanes, C. (1981) Strategic Family Therapy. San Francisco: Jossey-Bass Inc., 

Satir, V. (1967). Conjoint Family Therapy: A Guide to theory and technique. Palo Alto, California: Science and Behavior Books, Inc.

Post-Modern Therapy

Berg, Insoo Kim (1994) Family Based Services: A solution-focused approach. New York: Norton.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W. W. Norton.

Personality Disorder Dynamics

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

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