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A distraught mother reports that when her formerly loving daughter returns from vacations at her father's house, the child treats her with disrespect and hostility.

A divorced father of a 12-year-old boy who lives primarily with his mother says that his son insists that he does not want any contact with his father: "If I have to see him even in a session I will hurt myself!”

may seem obvious in these cases. Yet, as LInda Kase-Gottlieb explains and Edward Kruk reiterates in a recent post on this website, recognizing potential alienation, correctly diagnosing it, and providing treatment for this phenomenon can prove challenging to the point that many if not most mental health professionals get it wrong.

Recognized earlier but first given a name in the 1980s by child psychiatrist Dr. Richard A. Gardner, parental alienation occurs when an alienating parent turns a child against a targeted (alienated) parent via deprecating innuendos (often based on ), name-calling (“he’s a nitwit”), exaggeratedly negative reports of minor mishaps, and false accusations.

Alienated children parrot the alienating parent’s excessively negative views of the targeted parent, expressing these as their own much as cult followers parrot the beliefs of a cult .

Gardner detailed 8 characteristics of an alienated child, plus criteria for distinguishing between mild, moderate, and severe presentations. The result is a child’s unwarranted hostility (mild alienation), resistance to time (moderate alienation), and/or severance of contact (severe alienation) with the targeted parent. Amy Baker explains these three levels further as follows:

Mild Parental Alienation: Refers to cases in which the child objects to and criticizes the targeted parent, but yet enjoys the presence of the targeted parent once time passes or when the location is no longer in close proximity to the alienating parent.

Moderate Parental Alienation: Refers to cases in which all eight primary manifestations of PA are likely to be present and each is more advanced than in mild cases, but less pervasive than in severe cases. Children will usually go with the targeted parent after expressing and demonstrating significant reluctance. Also, moderately alienated children will express consistent negative feelings toward the targeted parent whether or not the alienating parent is present. Although these children may enjoy the time they spend with the targeted parent, they will not admit this in the presence of the alienating parent.

Severe Parental Alienation: Severe cases of alienation are differentiated from mild and moderate cases by the extent of the child’s rejection and degree of negativity in the attitudes and behavior toward the targeted parent. Severely alienated children have little if anything positive to say about the targeted parent and often rewrite the history of their relationship with the targeted parent. They seem content to avoid all contact with the targeted parent, may reject an entire branch of their extended family, and often threaten to defy court-ordered parenting plans that schedule them to be under the care of the targeted parent

Diagnosis of Parental Alienation

Let's start with why therapists and evaluators often miss alienation.

Psychopathology assessment

Targeted parents may present as , depressed, and angry. At the same time, beneath these desperate situational reactions generally lies psychological health.

Alienating parents, by contrast, generally often calm, cool, and charming and therefore look more attractive. They lie convincingly. Alienator and child appear credible by telling similar stories.

Yet beneath the alienator’s smooth exterior lie one or more Cluster-B character disorders: (1) borderline emotional hyperreactivity, splitting, etc. (2) ignoring of the child's needs in favor of using the child as their foot soldier against the targeted parent (3) antisocial and harming others without . Parents without character disorders rarely, if ever, alienate.

What hypotheses need to be generated and evaluated in potential alienation cases?

Explore the following two possible causes of the child's negative view of one parent. Note that more than one of these factors may be occurring.

Danger from verbal, sexual, and/or physical abuse Brain-washing of the child by an alienating parent

When a child's negative reaction stems from verbal, phyiscal or , children still want a relationship with the abusive parent. In addition however, accusations that a targeted parent has been abusive need to be assessed thoroughly to be certain that these kinds of abuse are not occurring, and if so, addressed directly.

In contrast, when a child's negative reaction stems from the abuse of alienation, the child becomes resistant, increasingly hostile, and eventually rejects altogether the targeted parent.

Severely alienated children also manifest splitting, which is not at all characteristic of children who suffer other kinds of abuse. They insist that the alienating parent is all good; they totally reject the all-bad targeted—though, in reality, emotionally healthier—parent. While mildly alienated children do not show the full spilitting phenomenon, it is vital to stop the alienation as early as possible as the phenomenon tends to be progressive.

What about parent-child attachment patterns?

Alienating parents mingle nurturing with anxiety-provoking interactions such explosions, creating an insecure —pathologically enmeshed, unreliable, controlling, parentified, or spousifed. As Richard Warshak points out in his book Divorce Poison, " is usually a precondition to brainwashing" because it "increases psychologicall dependence on the bad-mouthing and bashing parent (page 144)."

C. A. Childress's book An Attachment-Based Model of Parental Alienation and also his internet writings and videos decribe the development of this attachment pathology in detail. In the parent-parent-child triangle, alienating parents, by poisoning the child with negative comments about and distorted or of the targeted parent, pulls the child too psychologically close to themselves and distances the child from the targeted parent. Thus, in spite of prior normal-to-excellent parenting and secure attachment, the child’s bond with the targeted parent progressively deteriorates.

Amy Baker and Paul Fine (2008) delineate 17 strategies of alienating parents, then offer suggestions for targeted parents about how to respond to these tactics.

In a recent Psychological Bulletin article, Harman, Kruk, & Hines (2018) clarified that alienation is child abuse with consequences potentially more damaging than from physical or sexual abuse: , anxiety, addictions, poor relationships, and .

With regard to diagnosis, because the term parental alienation has not yet been incorporated into the Manual, the diagnosis options are:

V61.20, parent-child relational problem

V61.29, child affected by parental relationship distress,

V995.51 Child , Confirmed (pathogenc parenting)

Treatment of Parental Alienation

Treatment of alienation is basically the same for mild, moderate, and severe cases—with one exception. For successful treatment of severe cases, additional measures that require from the court are essential.

Mild to moderate parental alienation

Effective reunification therapy depends on the child and alienated parent participating together in treatment. When an alienated child says, “I don’t want to see my father; I’m too anxious,” the therapist nonetheless must bring them together. Extended individual therapy with an alienated child consolidates alienation instead of relieving it and therefore is counter-indicated.

While initial preparatory individual sessions may be helpful, treatment of alienation begins with therapeutic parent/child interactions. The therapists' job is to foster positive parent-child connecting. One technique is to ask the parent to bring memorabilia of fun prior experiences they can recall together.

Once a child and parent are re-experiencing warmth and affection, the therapist asks the child to tell them all the negative beliefs they can about the parent. The therapist lists them, on a numbered list, saying "Good,..." after each to encourage the child to keep remembering all the negatives in his or her mind. This technique is based on a technique for treating anxiety that I call The 3 Steps.

Once the list feels finished, the therapist circles back to complaint number one, addressing each complaint, one at a time, asking for examples. When the examples are thin or finished on any one item, the therapist can ask the child to tell the alienated parent, "And what are examples of when your parent acted the opposite way, eg, instead of being mean was kind to you?" The therapist then can ask the targeted parent to add to that list of positive examples. In this way, the therapist and parent together begin to evolve a yes-and to replace the either-or thinking pattern of an alienated child.

Lastly, the therapist explains alienation to immunize the child against future alienation attempts. It is especially important to explain the nature of projection, that is, that many of the critiques the child has heard from the alienating parent actually fit that parent better than the targeted parent. Going through the criticisms list again to test which of the complaints are actually projections can be particularly enlightening. I often have found that this new way of hearing the complaints from the alienating parent elicits from the children—the laughter of relief from understanding the criticisms in a new way.

Source: (c) JackF/fotosearch

Treatment of severe alienation

Pioneering alienation therapist Linda Gottlieb emphasizes that severe alienation—when an alienator blocks designated parenting-plan time, withholds school or medical information—requires court orders:

Transferring the child to the targeted parent’s home for a period of at least three months Prohibiting the alienator from any and all contact with the child (in-person, text, phone, email, social media.) Specifying sanctions such as fines or even jail for violations Prohibiting further alienating behaviors, and perhaps also mandating therapy with a therapist knowledgable about alienation.

Court-ordered and court-enforced temporary separation are essential in severe alienation in order to free children from loyalty conflicts that would prevent a successful reunification. Severely alienated children do not dare to allow themselves to enjoy the targeted parent. They believe that they are totally dependent on the alienating parent. Affection for the targeted parent, and especially allowing the alienating parent to know that they have been interacting with and even experiencing positive feelings toward the targeted parent, could incur the alienating parent's wrath or abandonment.

Treatment for the alienating parent

Therapists first need to convey clearly that alienating behaviors harm the child. This article by Kruk clarifies particularly well the negative impacts on children of alienation.

Specifying what behaviors alienate children is essential, perhaps by going through the Baker & Fine 17 strategies list (see link above) and asking the client to give instances of when they have, wittingly or unwittingly, done each. Building this awareness, and clarifying how it harms their child, is essential.

I then recommend the Best Possible Light technique, illustrated in this video. This helps alienators to understand what their alienating behaviors are attempting to accomplish, and then to find healthier ways to accomplish the same .

Exploration of family of origin patterns regarding alienation is essential. Alienation is often handed down from generation to generation. Check whether the alienator's mother or father is currently an active participant in the current problem.

Note that the goal of this treatment is not character change. Rather, it is problem-specific: to end the alienating behaviors. At the same time, addressing anger, anxiety, and depression may also be important.

Treatment for the targeted parent.

Information soothes, or at least is helpful for, the targeted parent's initial panic and confusion.

The parent also is likely to suffer significant depression, anger, and anxiety. For rapid treatment of these negative emotional states, I mainly use the techniques in my book and website Prescriptions Without Pills. Other and techniques also could be appropriate.

When the child is hostile to a parent, what are the parent's immediate response options? The Baker and Fine article referenced above offers much .

Local support groups often prove reassuring to targeted parents as they convey that they are not alone. Group members may share information also about helpful resources such as lawyers and therapists who are knowledgable about alienation. The meetup website often can point targeted parents to support groups in their area. In addition, these two groups, this one and this one, offer free support for targeted parents.

In addition, national groups like this one and this one keep mental health and legal professionals, as well as targeted parents and grandparents, informed of the latest developments in the alienation field. Memership in both of these organizations is free.

Finally, the therapist ideally can help targeted parents choose an action pathway. Make the best with what contact they do have? Find a good lawyer and fight for the child? Give up, grieve, and move on? These decisions can be difficult and have no single best answer.

Beware

Communities worldwide all need more therapists who can knowledgeably assess and treat alienation. At the same time, therapists need serious study and specific training to work effectively with these poignant, challenging, yet highly rewarding cases.

© Susan Heitler, Ph.D.

Special thanks to William Bernet, MD and the organization he founded, Parental Alienation Study Group. My attendance at the excellent recent PASG conference motivated me to write this article.

Suggestion: Do read the Comments below. Readers offer many insightful questions and ideas. Thank you for sharing!