Monday, September 20, 2010

Should Parental Alienation be a Diagnosis?

I believe that some children are alienated against one of their parents for no specific appropriate reason. As a social worker, I believe that alienation can be a form of emotional abuse. As a lawyer, I have won changes of custody related to alienation. However, I do not believe that an alienated child should be diagnosed as having a mental disorder.( see: Don't Alienate The Kids!)

The American Psychiatric Association is currently considering revisions to its Diagnostic and Statistical Manual of Mental Disorders (DSM). The next edition is due to come out sometime in 2012 – the DSM-V (the fifth edition). The APA has decided to consider including Parental Alienation Disorder in the DSM-V. On the surface, this could be a good thing, as it would bring legitimacy to an issue which has been highly controversial and misunderstood. But under the surface, I believe that it would create more problems, for the following five reasons:

1. It will feed the Culture of Blame in Family Courts: If it is a psychiatric diagnosis, then family courts will become further bogged down in fights over the diagnosis and who is the “all-bad” parent causing the parental alienation. Such high-conflict court battles are a significant factor in causing alienation, not solving it. A diagnosis will become a new weapon in the Family Court Culture of Blame – and create more alienation, not less, in high-conflict divorces.

2. It will build resistance to behavior change: I believe that child alienation is the result of high-conflict behavior by at least one person (usually with a personality disorder), but often by several people in a child’s environment – much of it inadvertent. I developed the New Ways for Families program of High Conflict Institute to take out the blaming and put in short-term skills training at the beginning of family court cases before anyone has been judged to be an “all-bad” parent. Once a parent has been identified as the all-bad parent, it is next to impossible to get him or her to change anything in their own behavior. Whereas, before such findings have been made, both parents can learn and use skills for dealing with each other and with their children through programs such as New Ways for Families. It’s much easier to get a parent to try flexible thinking, managed emotions and moderate behaviors, if they don’t have to be defensive about their past behavior.

3. It will further isolate children: Thirty years ago I started working with children as a therapist. They often loved the counseling, but hated having a psychiatric diagnosis. Their families and friends often teased them and they felt awkward, alone and different. If you give a child a diagnosis of parental alienation disorder, what will it mean to the child’s sense of identity growing up? Children of high conflict families often blame themselves already for the family’s problems. It seems to me that it will add more weight to the wrong person. It would be more appropriate to diagnose a parent with a personality disorder, because that is more often the driving force behind child alienation anyway.

4. It will distract from looking for other problems, such as abuse: I’m a social worker and I also believe that child abuse and domestic violence are real. Sometimes these problems are present when a child becomes alienated, and often they are not present. But there will be the temptation to see alienation as the one and only problem and identify one parent as the one and only cause. In many cases, this will cause those trying to help the family to miss other problems that also need attention.

5. It will distract from focusing on solutions: Child alienation (I prefer to call it child alienation rather than parental alienation, to avoid any presumptions that its one parent's fault) is a result of the child’s exposure to excessive amounts of all-or-nothing thinking, unmanaged emotions and extreme behaviors, by one or more people in the child’s environment. The child needs to learn that these three problems are not the way to live, rather than reinforcing them by eliminating one parent and then the other. The favored parent needs to change these behaviors as much as possible, regardless of who has physical custody. Often the rejected parent reinforces these problems by inadvertently getting angry at the child or prematurely giving up on the child (at the child’s insistence). Professionals need to show empathy for both parents and the children, rather than getting emotionally hooked into reinforcing that one parent is “all-good” (their client) and that the other parent is “all-bad.”

For more about my point of view as a therapist and attorney, see my book Don't Alienate the Kids! Raising Resilient Children While Avoiding High Conflict Divorce.
What do you think on this controversial subject? Please leave a comment. Please remember to be respectful of each other’s opinions.


LittleT38 said...

Finally, a therapist and a lawyer who understands the true impact of what could be a terrible ending if parental alienation is approved by the APA. You are a rare find, and I have to say KUDOS.

As a severely alienated mom, I do not want to create more problems/issues but diligently fix the existing ones. Adding more controversy, such as this approval, is simply making my road that much more bumpier.

I would love to see and hear more of you. A guest speaker at the October conference on Parental Alienaiton in New York is a must for you.

Anonymous said...

An interesting perspective, however I'm not sure entry into the DSM automatically means alienation is a psychitric disorder. The DSM is full of adjustment disorders -- short term issues related to stress, anxiety, grief and other emotional issues that are not psychiatric in nature -- they have no medical basis -- yet are included in the DSM to give counselors a foundation for treatment, and a code for billing.

I also don't agree with the concept of the courts role in the decision making process. While it is true that some courts may get more bogged down if alienation is included in the DSM, other cases may get resolved more quickly. In any event, I'm not sure that the judicial system's ability to address an issue is reason to include, or exclude, a mental health issue from the profession's bible. Family court is an institution with a multitude of issues that need to be addressed. Making decision to avoid these issues is just enabling the issues to continue.


mike jeffries
Author, A Family's Heartbreak: A Parent's Introduction to Parental Alienation

Kay Sell said...

I agree with Little T38, I am a severely alienated mom, and totally agree with Anonymous. PA or PAS is easily diagnosed and has extreme harmful effects on children and adults. If brain SPECTS were done and compared to normal brain functions at that age, I am convinced they would show negative or impaired brain development. We don't have the option or the uxury to have an opinion about whether or not their is a brain, (you call it a mental), disorder. It is child and adult abuse and it is a crime. PA or whatever you want to call it NEEDS validity to draw attention. If I hear one more person tell me that "it's just a 13 year old boy thing", I'm going to have a cow. (not exactly the words I'd like to use.)

I grieve the loss of my son: not only our relationship, but his empathy, his intelligence, his creativity, and his physical talent. He had the ability to change the world in a positive way but now is deliquent, has no empathy for others, and is confused and hurt. We both bleed inside from the knief that is turned everyday.

I haven't seen him in 7 months and he lives 6 blocks from me. The police wouldn't enforce 50:50 placement. Child protective services won't get involved because it is a "placement" issue. So, the only option was to start a case in the Family Law Courts, which, in most cases take so long that the delay allows the alienating parent to escalate damage.

My rally cry is Put it in the "DSM-V and take it out of the courts." 7 months in the Family Courts and not one minute of therapy with no hope in sight. God Help Us.

Anonymous said...

As a social worker, I also do not like labels. However, it is a reality of our system (managed care).I concur; It is not fair to label the kid. It should be the alienating parent. Yet, I am not sure how many will voluntarily seek to change their ways. Given the fact that about 1% (Bernet, et al.)of US kids are alienated, it may be likely there are ex-spouses that refuse to co-parent. Moreover, studies indicate that some alienating parents have personality disorders & defy court orders (Kelly, 2010; Fidler & Bala;& Jafee et. al).

It makes sense to work with the parent that desires help and wants what is in the kids best interest. But, if it is not in the DSM how are they to get the help? The entry would deem this issue as important. For some families, that cannot self- pay to avoid labels, they are counting on help. Most alienating parents will not sign up for counseling or parenting classes on their own.

Not sure what is worse between the two evils: a diagnosis or no help at all. If PA is not in the DSM, it will not get recognition, that in turn, comes along with more research. I also wonder: why in cases of DV do we not ask in what way the victim contributed? answer: The reason is it is insulting. He or she did not have to do anything. Or, the bullied kid? sometimes, people are victimized through no fault of their own. The same is said of PA. Sure, there are multiple factors for the cause of a divorce. But, that is not what matters. It is the kids. The reality is some parents do not have their kids best interest in mind; they simply desire revenge by using the child as a pawn.


social worker

Chris said...

Labels have a use. If you can't name something, it is much harder to discuss it.

Likewise, inaccurate labels cause confusion.

Bill has a good point about calling it "child alienation" rather than "parental alienation". Often child are encouraged to dislike not just one parent but an entire side of their families. Some are even encouraged to dislike everybody but the alienating parent. Consider the Holly Collins case, she even alienated the kids from her own mother, their grandmother.

Family law judges have too much discretion and incentive to pick sides and make conflicts intensify. The divorce industry causes far more harm to children and families than any good it does.

Bill Eddy, LCSW, Esq. said...

To All Who Have Commented,

I really appreciate your thoughtful comments on this difficult issue and recognize how difficult it must be to have no contact with a child. Child alienation definitely needs to be discussed more and recognized as a serious problem. Some good points have been raised about it getting more attention and study if its in the DSM and if there is an accepted "label" for the problem.

On the other hand, it has had a tremendous amount of attention and publicity since the mid-1980's, (when the term Parental Alienation Syndrome was first used), and much of the publicity has been negative, controversial and unhelpful. What we need now, I believe, is to educate parents and professionals about this without the controversy, so that parents can get some help with their children - and children can learn skills for peaceful problem-solving that don't include eliminating one parent.

I agree that the DSM issue shouldn't be tied to Family Court, but it is so intertwined that I believe its first use - if accepted as a child diagnosis - will be to use it in Family Courts as a weapon.

Of course, one other solution (perhaps a compromise) would be to include it as a "Parent-Child Relational Problem" in the DSM (a category which already exists). This would avoid pinning it on the child, while still giving it more attention as a serious mental health problem in a family.

This is such an important issue, I'm going to leave this topic up for another week for others to comment.


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