This post is also found on my website:
Dr. Childress Response to a Parent: On Diagnosis
Recently I received the following question from a
parent, and I thought my response to this parent might be helpful to other
parents (and to mental health professionals).
“Hello Dr. Childress, What assessment tools do you use to identify the
possibility of a likely Parental Alienation Dynamic? Would you need to
interview the children? Melissa”
Hello Melissa,
The assessment of "parental alienation" (i.e., pathogenic
parenting) involves clinical interviews primarily with the child, but also with
the targeted parent and child. Additional interviews with the
"alienating" parent can be helpful to confirm the diagnosis but are
not necessary to making the diagnosis of "pathogenic parenting"
associated with "parental alienation" processes.
Three separate symptom features are evident in the child's symptom
display:
1: Suppression
of the normal range functioning of the child's attachment system relative to
one parent.
2. The
presence of a specific set of narcissistic and borderline personality disorder
features in the child's symptom display, involving:
a.) "Splitting,"
in which the child views one parent as overly idealized and the other parent as
overly devalued (see attached Appendix A: Splitting)
b.) A
grandiose judgment of a parent in which the child is in an elevated status
position in the family hierarchy above that held by the targeted/rejected
parent;
c.) A
sense of entitlement in which the child feels justified in inflicting a
retaliatory retribution on the targeted/rejected parent if the child's entitled
expectations are not met to the child's satisfaction;
d.) A
haughty and arrogant attitude of contempt regarding the "fundamental human
inadequacy" of the targeted/rejected parent;
e.) A
complete absence of normal-range empathy and compassion for the feelings of the
targeted/rejected parent;
3. An
intransigently held, fixed and false belief system regarding the fundamental
inadequacy of the targeted/rejected parent and/or the abuse potential
(typically "emotional abuse") of the targeted/rejected parent.
If this specific set of 3 symptoms is present in the child's symptom
display, the only possible origin of this particular symptom set is through
induction. This specific symptom set CANNOT originate authentically to
the functioning of the child's nervous system. This symptom set MUST be
induced through pathogenic parenting - either from the distorted and aberrant
parenting of the targeted/rejected parent, or from the distorted and aberrant
parenting of the allied/idealized parent.
One way or the other, this symptom set only arises from being induced in
the child through aberrant and distorted parenting practices.
The next diagnostic step is to rule-out pathogenic parenting emanating
from the targeted/rejected parent. This involves joint parent-child
sessions in which the parenting behavior of the targeted/rejected parent, and
the child's responses to the parenting behavior of the targeted/rejected parent,
are clinically evaluated.
If the parenting behavior of the targeted/rejected parent is broadly
normal range[1]
(i.e., no evidence of alcoholism, chronic drug use, excessive anger
dysregulation, domestic violence, severely distorted communication processes),
so that the parenting behavior of the targeted/rejected parent could not
reasonably account for the creation of the child's symptom constellation of the
three specific features noted above, then the pathogenic parenting MUST be
originating in the aberrant and distorted parenting of the other parent.
There is no other alternative explanation for the presence of that
specific set of symptoms displayed by the child. That symptom set CANNOT
arise endogenously to the authentic functioning of a child's nervous system.
That specific set of symptoms MUST be induced through interpersonal processes -
i.e., through pathogenic parenting emanating either from the targeted/rejected
parent or from the allied/idealized parent. If the targeted/rejected parent is not inducing that
specific symptom set, then it MUST be induced by the allied/idealized
parent. There is no other
alternative explanation regarding the origins of that specific child symptom
set.
Diagnosis is made from clinical interviews with the child and
targeted/rejected parent. If the allied/idealized parent consents to
clinical interviews, then these interviews can confirm the diagnosis, but they
are not necessary to make the diagnosis.
Associated Clinical Signs:
Additional confirmatory symptoms are also typically present, and while
not necessary for the diagnosis, these additional "associated clinical
signs" can support the diagnosis:
1) Listen
to the Child: The
allied/pathological parent prominently evidences the phrase "...listen
to the child..." - such as "I'm only listening to the child"
- "you [i.e., therapists, attorneys, etc.] should just listen to
the child" - "why isn't anyone listening to the child." This phrase by the allied/pathological
parent comes from a need to empower the child, both to exploit the child’s
expressed rejection for the other parent and also for a specific need to
empower the child, originating from particular psychological dynamics with the
allied/pathological parent. An
associated effort for empowering the child is the allied/pathological parent
advocating that “the child should be
allowed to decide” if he or she goes on visitations with the
targeted/rejected parent. The core
issue is a need to empower the child.
2) Exploiting
the Child’s Symptoms: An exploitation
of the child's symptoms by the allied/pathological parent to
limit, restrict, disrupt, and nullify the ability of the targeted/rejected
parent to form a relationship with the child.
3) Protecting
the Child: The
allied/pathological parent prominently presents in the role as the "protector"
of the child from the abuse (typically emotional abuse) of the
targeted/rejected parent. The need to "protect the child" can reach almost obsessional levels.
4) Selective
Parental Incompetence: The
allied/pathological parent presents as selectively incompetent, typically using
the phrase "...what can I do, I can't make the child..." - for
example; "I encourage the child to go on visitations with the other
parent, but what can I do, I can't make the child go if the child
doesn't want to go." - "I tell the child to cooperate with the other
parent, but what can I do, I can't make the child be nice to the
other parent. I'm not there, how am I supposed to make the child be nice
to the other parent?" The presence of this phrase has to do with the
narcissistic exploitation of the child's symptoms.
5) Justifying
– “I know just how the child feels…”: The selective incompetence of the allied/pathological parent
is often accompanied by a statement of understanding for the child's hostility
and rejection of the other parent - "I tell the child to be cooperative,
but what can I do, I can't make the child be cooperative, I'm not there.
And, actually, I know just how the child feels. The other parent
acted just like that with me during our marriage."
6) Typical
Complaints: The typical complaints regarding the targeted/rejected parent
are,
A) too insensitive, the
targeted/rejected parent doesn't “listen to the child;”
B) too rigid, inflexible and controlling,
the targeted/rejected parent always has to have things his (or her) way;
C) anger management issues, the
targeted/rejected parent has anger management problems;
D) too selfish and self-centered,
combines doesn't listen to the child and always has to have things his or her
own way.
7) Disregard
of Court Orders: The
allied/pathological parent displays a cavalier disregard for the authority of
Court orders, so that the targeted/rejected parent must continually return to
Court seeking enforcement of Court orders. This represents the expression
of narcissistic personality processes of the allied pathological parent.
Narcissists to not recognize (i.e., perceptually register) the construct
of "authority" - only the power to compel. For the narcissist,
the construct of "authority" (such as the Court's authority) is
synonymous with the "power to compel." If the Court does not compel,
then the Court has no authority in the mind of the narcissist.
Appendix A: Splitting
Linehan, M. M. (1993).
Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford
Linehan on Splitting:
“They tend to
see reality in polarized categories of “either-or,” rather than “all,” and
within a very fixed frame of reference. For example, it is not uncommon for such individuals to
believe that the
smallest fault makes it impossible for the person to be “good” inside.
Their rigid cognitive style
further limits their abilities to entertain ideas of future change and
transition, resulting in feelings of being in an interminable painful
situation. Things once defined do
not change. Once
a person is “flawed,” for instance, that person will remain flawed forever.” (p. 35; emphasis added)
American
Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(Revised 4th ed.). Washington, DC: Author.
“Splitting: The individual deals with emotional conflict or internal
or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative
qualities of the self or others into cohesive images. Because
ambivalent affects cannot be experienced simultaneously, more balanced views
and expectations of self or others are excluded from emotional awareness. Self and object images tend to alternate
between polar opposites: exclusively loving, powerful, worthy, nurturant, and
kind – or exclusively bad, hateful, angry,
destructive, rejecting, or worthless.”
(p. 813; emphasis added)
Borderline
Personality Disorder Criterion 2:
“A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes
of idealization and devaluation” (p. 710; emphasis added)
Siegel, J.P. (2006). Dyadic
splitting in partner relational disorders. Journal of Family Psychology, 20(3), 418–422.
“Splitting
is an identified symptom of both borderline and narcissistic personality
disorders.” (p. 419)
Watson P. J. and Biderman, M.D.
(1993). Narcissistic personality inventory factors, splitting, and
self-consciousness. Journal of Personality Assessment, 61 (1), 41-57.
“Splitting is often thought to be central to pathological
narcissism” (p. 44)
[1] Consider normal-range
parenting – not perfect parenting.
What type of parental behavior occurs in most typical homes? Does this less than “perfect” parenting
(i.e., typical parenting) result in the type of child reactions evidenced in
the child’s symptom display? Parents
frequently become angry at children, set rules for children, deny children a
favored toy or activity, and none of these parenting practices results in the
child displays of total rejection and excessive hostility seen with “parental
alienation” processes (e.g., the child’s haughty and arrogant attitude of
contempt, verbal abuse, complete lack of empathy, and desire to completely sever
the relationship with a parent).
