Socialudvalget 2023-24
SOU Alm.del Bilag 26
Offentligt
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Consultation: Draft Guidance on Responding to allegations of
alienating behaviour
August 2023
CONTENTS
1.
2.
3.
4.
5.
Introduction and Scope of the Guidance
Litigation Journey Overview
Guidance Note on Case Management
Guidance Note on Welfare decisions
Guidance Note on Understanding hostility and psychological manipulation in cases in
which alienating behaviours are alleged
6. Guidance Note on the use of experts in cases in which alienating behaviours are
alleged
Consultation from Dr. Childress to Draft Guidance from FJC
–
Part 2
I am a clinical psychologist in the United States. I have six domains of specialized
knowledge supported by my vitae relevant to court-involved custody conflict and
attachment pathology displayed by the child:
1. Delusional thought disorders
Twelve years on a major UCLA research study on schizophrenia with annual
training in the diagnostic assessment of delusional thought disorders.
2. Attachment pathology
Early Childhood Mental Health specialization.
3. Child abuse and complex trauma
Clinical Director for a 3-university assessment and treatment center for children
ages zero-to-five in foster care.
4. Factitious Disorder Imposed on Another
Training and medical staff position as a pediatric psychologist at Childrens
Hospitals.
5. Family systems
Specialized training track from Pepperdine University’s doctoral program and
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lifelong practice as a family systems therapist
6. Court-involved custody conflict
Ten years in the family courts as a clinical psychologist and expert consultant to
attorneys and their client-parents in custody conflict.
•
Dr. Childress Domains of Specialized Expertise & Vitae
https://drcachildress-consulting.com/wp-content/uploads/2023/01/domains-
of-specialized-expertise-1-1-23-2.pdf
I currently serve as a consultant to attorneys and the Court in family law cases of child
custody conflict. I have provided consultation on both national and international cases. I
have testified as an expert witness in the U.S., Canada, Sweden, and South Africa, and I
have been involved in several matters in Great Britain.
I have had an invited meeting with representatives of the Dutch Ministry of Justice when
I presented at Erasmus Medical Center in the Netherlands, and I recently had an invited
presentation at the University of Novi Sad in Serbia.
I have a Consulting Website that describes more about my court-involved consultation
and the pathology of concern in the family courts.
•
Dr. Childress Consulting Website
https://drcachildress-consulting.com/
The FJC draft Guidance describes the professional expertise desired for the family courts:
From FJC Guidance:
“Given the complexity of these cases and the often-
interacting psychological factors at play in the adults and the children, it is likely
that assessments which will assist the court in determining welfare outcomes are
those offered by HCPC regulated Practitioner Psychologists with competence in
assessing adults and children, e.g., Clinical Psychologists/Counselling
Psychologists.”
I am a clinical psychologist with competence in assessing adults and children for a variety
of pathology, including the attachment pathology in the family courts.
From FJC Guidance:
“These assessments should not be undertaken by academic
psychologists or psychological researchers in the field of alienation. Only HCPC
Registered psychologists have the relevant clinical experience and training to
conduct psychological assessments of people and make clinical diagnoses and
recommendations for treatment or interventions, whereas, academic
psychologists, who should be Chartered, but who are not registered with the
HCPC, would not normally have the clinical experience and training in order to
complete psychological assessments or make clinical diagnoses.”
I am an applied practitioner, a licensed clinical psychologist, not an academic researcher.
My consultation feedback is from the domains of professional clinical psychology
recommended by the JFC draft Guidance.
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4. Guidance Note for the Family Court on Welfare decisions where findings
of alienating behaviours have been made
Diagnosis guides Treatment
There is no such thing as
“parental alienation” – “alienation” – or “alienating
behaviours” –
ignorance solves nothing.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We
always protect
the child. The child’s healthy and normal-range
development is then
recovered, and once stabilized, the child’s contact with the abusive parent is
reestablished with enough safeguards in place to ensure that the child abuse does not
resume when contact with the abusive parent is restored.
Purpose
This Guidance Note is intended to have particular relevance to judges making welfare
decisions where there have been findings of alienation. Whilst there are points of general
application for the courts to consider when determining welfare, this Note is not intended
to be a comprehensive note of all welfare considerations.
Diagnosis guides Treatment
There is no such thing as “parental alienation” – “alienation” – or “alienating
behaviours” –
ignorance solves nothing.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the
child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when contact
with the abusive parent is restored.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
yes
yes
yes
no
no
no
3
yes
no
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•
Child Psychological Abuse (V995.51)
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
4
 SOU, Alm.del - 2023-24 - Bilag 26: Henvendelse af 15/10-23 fra coach Kenneth Nielsen, Stenløse om familieret
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The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Preamble
A finding that a parent has acted to alienate a child from the other parent is usually only one
part of the factual matrix. The court should avoid treating a finding of alienating behaviours
as an automatic trigger for a change in a child’s placement. The court should also examine
very carefully all the welfare ramifications for each child if considering making an order for
the transfer of a child’s care conditional on compliance with a ‘time with’ order.
Just as with findings of other harmful behaviour such as domestic abuse or child abuse, the
fact that a child’s relationship has been disrupted by the behaviours of a parent, is a factor
to be weighed in the balance. The court should bear in mind the wider factual matrix, which
may include associated findings of domestic abuse, alignment or other safeguarding issues,
when considering next steps. A judgment in which the court draws together its conclusions
on the various elements of the factual matrix will be important in helping those asked to
assist the court with welfare options.
Diagnosis guides Treatment
There is no such thing as “parental alienation” – “alienation” – or “alienating
behaviours” –
apply knowledge to solve pathology, ignorance solves nothing.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), then we protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the
child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when contact
with the abusive parent is restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
5
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pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
6
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generational coalition of the child with the one parent
against the other parent?
•
•
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Guidance
Statements
1. Where the court has made findings of alienating behaviour, and/or other forms of
abuse, the court may find it helpful initially to direct statements from the parties in
response to its findings of fact judgment. This will help the court understand the
parents’ level of insight and their willingness to engage in work to
address those
behaviours and the resultant impact.
Diagnosis guides Treatment
7
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There is no such thing as “parental alienation” – “alienation” – or “alienating
behaviours” –
apply knowledge to solve pathology, ignorance solves nothing.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), then we protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized,
the child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when contact
with the abusive parent is restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
yes
no
yes
no
8
 SOU, Alm.del - 2023-24 - Bilag 26: Henvendelse af 15/10-23 fra coach Kenneth Nielsen, Stenløse om familieret
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false belief that the child is being malevolently treated in
some way)?
•
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
9
 SOU, Alm.del - 2023-24 - Bilag 26: Henvendelse af 15/10-23 fra coach Kenneth Nielsen, Stenløse om familieret
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The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
The Guardian
2. The child will generally be a party in such complex cases. The Guardian will often be
able to help with next steps after the court has delivered its fact-finding judgment. In
appropriate cases the Guardian might be available to assist in informing the child in
age-appropriate terms of the progress of the proceedings. If the Guardian would be
assisted by a direction permitting disclosure of the
court’s
judgment, then a direction
could be made to that end. Where a Guardian is appointed the Guardian’s analysis
might consider external interventions which could be of assistance to the children
and parents. The Guardian can be asked to consider the impact of the available
interventions in their analysis of alternative welfare outcomes.
Diagnosis guides treatment.
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
Interim measures
3. In appropriate cases the court, upon making its findings, may want to look straight
away at whether there is any form of intervention that can be adopted more or less
immediately to ameliorate or reduce the impact of alienating behaviours on the
children and the relationship with the other parent. There are a number of options
that may be available and worth considering even if they have been tried before
without enduring success e.g.: the safe and managed use of social media (such as
Snapchat, Instagram, WhatsApp) or third-party interventions (such as involvement
with schools, religious activities etc).
Diagnosis Guides Treatment
–
Child Protection
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. The
child’s healthy and normal-range
development is then recovered, and once stabilized,
the child’s contact with the abusive parent is reestablished with enough safeguards in
place to ensure that the child abuse does not resume when contact with the abusive
parent is restored.
Dialectic Behavior Therapy
10
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Dialectic Behavior Therapy (DBT; Linehan) adapted to family therapy and the pathology
in the family courts would be recommended. DBT is a combination of Cognitive-
Behavior Therapy (CBT), a major school of psychotherapy with substantial empirical
support, with Mindfulness skills training from Eastern meditative traditions. The
Cognitive component of CBT would be helpful in correcting any distortions to
the child’s
thinking and perceptions created by the pathogenic parenting of the allied parent, and
the Behavioral therapy component of CBT uses Applied Behavioral Analysis which can
identify authentic from inauthentic parent-child conflict. The added Mindfulness
component of DBT will help with stress reduction for the child who is coping with the
family conflict and will facilitate
the child’s
development of self-authenticity.
Another benefit of adapting DBT for family court pathology is that Dialectic Behavior
Therapy was developed for the treatment of borderline personality pathology, which is
among the spectrum of personality pathologies of concern in the family courts
(narcissistic-borderline-dark personality parents), so DBT therapists are trained in
relevant personality disorder pathology. Outcome Measures monitoring
the child’s
symptoms of concern should be collected and used to monitor treatment progress and
the achievement of treatment goals. The collection and use of Outcome Measures is a
standard part of treatment plans in clinical psychology and should be fully familiar to a
DBT therapist.
4. Cafcass offer a short-term piece of work under their
Improving Child and Family
Arrangements Programme.
Cafcass Cymru are also looking at other programmes to
support children. Some local authority areas have public and private professional
services available to assist children and families. The process of reporting, accessing
and monitoring interventions can take time and can lead to delay. Identifying who
will deliver any work with the children and parents must be considered with
reference to the children’s welfare and the reality of the lives of the family.
With proper training, Cafcass could conduct a proper risk assessment for child abuse to
the appropriate differential diagnoses for each parent. If not Cafcass, then referral
should be made to qualified and competent mental health professionals who can
conduct a proper risk assessment for child abuse to the appropriate differential
diagnoses for each parent.
Development of both levels of professional services are recommended, with a second-
opinion obtained on the initial assessment, or even a third opinion. When possible child
abuse is a considered diagnosis, the diagnosis returned must be accurate 100% of the
time.
From Improving Diagnosis in Health Care: “Clinicians
may refer to or consult
with other clinicians (formally or informally) to seek additional expertise about a
patient’s health problem. The consult may help to confirm or reject the working
diagnosis or may provide information on potential treatment options. If a
patient’s health problem is outside a clinician’s area of expertise, he or she can
refer the patient to a clinician who holds more suitable expertise. Clinicians can
also recommend that the patient seek a second opinion from another clinician to
verify their impressions of an uncertain diagnosis or if they believe that this
would be helpful to the patient.”
Differential Diagnosis for Targeted Parent:
11
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Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
12
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implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Assessments
5. In some cases, the court may be invited to direct a whole family psychological
assessment to consider the family dynamics and functioning. Additional expert
assessments are not always necessary but when one is considered to be so, the court
should be mindful of the need to appoint an expert with the relevant qualifications
and expertise to conduct a whole family assessment. The court and the parties
should take particular note of the guidance from the President in
Re C (Parental
Alienation)
[2023] EWHC 345 (Fam) together with the recent Revised Guidance on
Psychologists as Expert Witnesses. The court will also wish to caution itself against
appointing experts to assess a family where the expert has a financial interest in the
delivery of subsequent services.).
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
13
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or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires considerable
experience. The primary-care physician will frequently desire formal psychiatric
consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought
Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
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•
•
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
6. When considering the ambit of an expert assessment, the court should bear in mind
the nature, duration, and impact of the disruption in the relationship between the
alienated child and parent against the wider factual matrix, to ensure that any
assessment is both balanced and comprehensive.
A pilot program for the family courts with university involvement for evaluation
research could develop the diagnostic assessment and treatment protocols
appropriate for the differential diagnoses involved.
The
child’s
timetable
7. For some children, time and appropriate support can be effective in reversing the
harm consequent on alienating behaviours. In some cases, children will have been
15
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alienated from the
parent’s
wider family of the non-resident parent and reparative
work may help to re-establish those safe relationships. The court must remain
mindful
of the child’s
timetable and the need to manage the court process. Where
interventions are found to be outside the
child’s
timetable the court should avoid
delay in making difficult final decisions.
Diagnosis Guides Treatment
–
Child Protection
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. The child’s
healthy and normal-range development is then recovered, and once stabilized, the
child’s contact with the abusive
parent is reestablished with enough safeguards in place
to ensure that the child abuse does not resume when contact with the abusive parent is
restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s
psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
16
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2767476_0017.png
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
17
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2767476_0018.png
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Parent’s
attitude to reparative work
8. An order transferring a child from the care of one parent to the care of another
solely on findings of alienation, will be rare. The court should avoid making orders
for the transfer of the care of children solely as a sanction for a
parent’s
refusal to
help restore the disrupted relationship. Whilst family courts are often asked to
transfer care of a child between parents in the private law family arena, there is a
qualitative difference as to the likely impact on a child where the child does not have
a positive (or indeed any) relationship with the non-resident parent. The court must
similarly consider the consequences for a child’s welfare when considering making
an order that would result in a change of placement as a consequence of non-
compliance with a
‘time
with
order’.
Diagnosis Guides Treatment
–
Child Protection
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. The child’s
healthy and normal-range development is then recovered, and once stabilized, the
child’s contact with the abusive parent is reestablished with enough safeguards in place
to ensure that the child abuse does not resume when contact with the abusive parent is
restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
18
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validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
yes
no
19
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•
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Welfare the paramount consideration
9. The court must remind itself that the welfare of the child/children remains
paramount. A parent from whom a child might be moved is highly likely to perceive
the prospect of a transfer of care as punitive. It may affect their presentation in
court as well as their mental health. Whilst non-compliance with a court order is a
serious matter the court must not conflate non-compliance with welfare. Non-
compliance with a court order is not, of itself, a reason for a transfer of care albeit
non-compliance and capacity to take up and act on professional support and
guidance may be relevant factors in the welfare determination.
Standards of Professional Practice
Diagnosis guides treatment. There is no such thing as “parental alienation” –
“alienation” – or “alienating behaviours” –
ignorance solves nothing.
Court Orders
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Court orders should always be followed. Parents should always follow court orders.
Parents should teach their children to always follow court orders.
If a parent teaches their child that disregarding court orders is okay, then a DSM-5
diagnosis of Child Neglect (V995.52) should be considered. Court orders should always
be followed.
Diagnosis Guides Treatment
–
Child Protection
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. The child’s
healthy and normal-range development is then recovered, and once stabilized, the
child’s contact with the abusive parent
is reestablished with enough safeguards in place
to ensure that the child abuse does not resume when contact with the abusive parent is
restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
yes
no
21
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creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
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patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Factors to be weighed in the balance
10. Whilst every case must be considered on its own facts there are a number of
potential considerations for the court that must be weighed in the balance when
considering welfare after a finding of alienating behaviours. A non-exhaustive list of
matters that might impact the child, particularly where their relationship with one of
their parents has been disrupted, may include:
Standards of Professional Practice
There is no such thing as “parental alienation” – there is no such thing as “alienation” –
there is no such thing as “alienating behaviours” –
as defined constructs in clinical
psychology.
“parental
alienation”
= unicorns: both are mythical things.
There are shared delusional disorders. There are factitious disorders imposed on
another. There are cross-generational coalitions and emotional cutoffs. There are
narcissistic, borderline, and dark personality parents. There is Child Psychological Abuse
(DSM-5 V995.51). But there is NO defined pathology in clinical psychology called
“parental alienation” –
it is mythical thing that people just make up.
The use of the construct of “parental alienation”
in a professional capacity is
substantially beneath professional standards of practice in clinical psychology and is in
violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict is:
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
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Apply knowledge to solve pathology. Ignorance solves nothing.
Diagnosis Guides Treatment
–
Child Protection
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be conducted
to the appropriate differential diagnoses for each parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. The child’s
healthy and normal-range development is then recovered,
and once stabilized, the child’s
contact with the abusive parent is reestablished with enough safeguards in place to
ensure that the child abuse does not resume when contact with the abusive parent is
restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by the
allied parent
using the child as the weapon
, then the mental health professional and/or the
Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Competence Concerns
No established scientific or professional knowledge from any domain of professional
psychology has been applied as the bases for the professional judgments offered in this
Guidance. Professional concerns exist that the authors of this Guidance may not know the
established professional knowledge of the discipline required to work with the pathology
in the family courts.
•
Competence in Delusional Thought Disorders:
Are the authors of this Guidance competent in the diagnostic
assessment and treatment of delusional thought disorders based
on their education, training, and experience?
From Walters & Friedlander:
“In some RRD families [resist-
refuse dynamic], a parent’s
underlying encapsulated delusion
about the other parent is at the root of the intractability (cf.
Johnston & Campbell, 1988, p. 53ff; Childress, 2013). An
encapsulated delusion is a fixed, circumscribed belief that
persists over time and is not altered by evidence of the
inaccuracy of the belief.”
(Walters & Friedlander, 2016, p. 426;
Family Court Review)
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From Walters & Friedlander:
“When alienation is the
predominant factor in the RRD [resist-refuse dynamic}, the theme
of the favored parent’s fixed delusion often is that the rejected
parent is sexually, physically, and/or emotionally abusing the
child. The child may come to share the
parent’s encapsulated
delusion and to regard the beliefs as his/her own (cf. Childress,
2013).” (Walters
& Friedlander, 2016, p. 426;
Family Court
Review)
•
Competence in Attachment Pathology:
Are the authors of this Guidance competent in the diagnostic
assessment and treatment of attachment pathology based on
their education, training, and experience?
•
Competence in FDIA:
Are the authors of this Guidance competent in the diagnostic
assessment and treatment of a Factitious Disorder (factitious
attachment pathology and a delusional thought disorder)
Imposed on Another based on their education, training, and
experience?
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
yes
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent have
a persecutory delusion surrounding the other parent, and
does the child share this persecutory belief (a fixed and false
belief that the child is being malevolently treated in some
way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
yes
no
yes
no
•
yes
no
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•
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in implementation.
Following the recommendations of this Guidance will lead to un-diagnosed and un-
treated Child Psychological Abuse in the family courts by pathological parents
(narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be conducted
to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in
reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires considerable
experience. The primary-care physician will frequently desire formal psychiatric
consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Wishes and feelings of the child
a) Although likely to reflect a desire for the status quo, opportunities for the child to
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express their wishes and feelings may offer indications of the viability of reparative
work, remaining with the resident parent or moving to live with the non-resident
parent or another family member.
Children do not make custody decisions. Asking the child’s preference will directly
triangulate the child into the spousal conflict and provoke loyalty binds for the child.
The child’s beliefs and experiences should be properly considered within the context
of the clinical diagnostic assessment for child abuse to the appropriate differential
diagnoses for each parent.
It is possible that the child’s beliefs and opinions are influenced and compromised
by the manipulative psychological control of a pathological (narcissistic-borderline-
dark personality) parent. Diagnostic clinical interviewing of the child should be
informed with the necessary professional knowledge required for competence.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict is:
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
Psychological Control
Barber, B. K. (Ed.) (2002). Intrusive parenting: How psychological control affects
children and adolescents. Washington, DC: American Psychological Association.
Definition
From Barber & Harmon:
“Psychological control refers to parental behaviors
that
are intrusive and manipulative of children’s
thoughts, feelings, and attachment to
parents. These behaviors appear to be associated with disturbances in the
psychoemotional boundaries between the child and parent, and hence with the
development of an independent sense of self and identity.”
(Barber & Harmon,
2002, p. 15)
Barber, B. K. and Harmon, E. L. (2002). Violating the self: Parenting psychological
control of children and adolescents. In B. K. Barber (Ed.), Intrusive parenting (pp.
15-52). Washington, DC: American Psychological Association.
Behavioral vs. Psychological Control
Stone, Buehler, & Barber:
“The central elements of psychological control are
intrusion into the child’s psychological world
and self-definition and parental
attempts to manipulate the child’s
thoughts and feelings through invoking guilt,
shame, and anxiety. Psychological control is distinguished from behavioral
control in that the parent attempts to control, through the use of criticism,
dominance, and anxiety or guilt induction, the youth’s
thoughts and feelings
rather than the youth’s behavior.” (Stone, Buehler, & Barber, 2002, p. 57)
Stone, G., Buehler, C., & Barber, B. K.. (2002) Interparental conflict, parental
psychological control, and youth problem behaviors. In B. K. Barber (Ed.),
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Intrusive parenting: How psychological control affects children and adolescents.
Washington, DC: American Psychological Association
Methods of Psychological Control:
From Soenens and Vansteenkiste:
“Psychological
control can be expressed
through a variety of parental tactics, including (a) guilt-induction, which refers to
the use of guilt inducing strategies to pressure children to comply with a
parental request; (b) contingent love or love withdrawal, where parents make
their attention, interest, care, and love contingent upon the children’s
attainment
of parental standards; (c) instilling anxiety, which refers to the induction of
anxiety to make children comply with parental requests; and (d) invalidation of
the child’s
perspective, which pertains to parental constraining of the child’s
spontaneous expression of thoughts and feelings.” (Soenens
& Vansteenkiste,
2010, p. 75)
Soenens, B., & Vansteenkiste, M. (2010). A theoretical upgrade of the concept of
parental psychological control: Proposing new insights on the basis of self-
determination theory. Developmental Review, 30, 74–99.
Family Systems & Psychological Control:
Stone, Buehler, and Barber:
“The concept of triangles “describes the way
any
three people relate to each other and involve others in emotional issues between
them” (Bowen, 1989, p. 306). In the anxiety-filled
environment of conflict, a third
person is triangulated, either temporarily or permanently, to ease the anxious
feelings of the conflicting partners. By default, that third person is exposed to an
anxiety-provoking and disturbing atmosphere. For example, a child might
become the scapegoat or focus of attention, thereby transferring the tension
from the marital dyad to the parent-child dyad. Unresolved tension in the marital
relationship might spill over to the parent-child relationship through parents’
use of psychological control as a way of securing and maintaining a strong
emotional alliance and level of support from the child. As a consequence, the
triangulated youth might feel pressured or obliged to listen to or agree with one
parents’
complaints against the other. The resulting
enmeshment and cross-
generational coalition would exemplify parents’
use of psychological
control to
coerce and maintain a parent-youth emotional alliance against the other parent
(Haley, 1976; Minuchin, 1974).” (Stone, Buehler, & Barber, 2002, p. 86-87).
Stone, G., Buehler, C., & Barber, B. K.. (2002) Interparental conflict, parental
psychological control, and youth problem behaviors. In B. K. Barber (Ed.),
Intrusive parenting: How psychological control affects children and adolescents.
Washington, DC: American Psychological Association
Family Systems Diagrams
–
Minuchin & Nichols:
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Physical, emotional, and educational needs
b) The
child’s
future relationship with the non-resident parent if there is only indirect
contact
c) A total cessation of contact both direct and indirect
d) The impact of continuity or change of schooling/educational arrangements will often
need to be considered
e) The practical and physical arrangements for care of the child during and after any
change of residence
f) Therapeutic support for the family
Diagnosis guides treatment.
•
•
•
In the absence of child abuse, parents have the right to parent according to their
cultural values, their personal values, and their religious values.
In the absence of child abuse, each parent should have as much time and
involvement with the child as possible.
In the absence of child abuse, to restrict either parent’s time and involvement
with the child would damage that child’s attachment bond to that parent, thereby
harming the child and harming that parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the child’s contact with the abusive
parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when
contact with the abusive parent is restored.
The likely effect on the child of any change in their circumstances
g) Different contact arrangements for siblings or possible separation from siblings
h) Separation from the resident parent
i) Contact plans for any new family configuration
Diagnosis guides treatment.
•
•
•
In the absence of child abuse, parents have the right to parent according to their
cultural values, their personal values, and their religious values.
In the absence of child abuse, each parent should have as much time and
involvement with the child as possible.
In the absence of child abuse, to restrict either parent’s time and involvement
with the child would damage that child’s attachment bond to that parent, thereby
harming the child and harming that parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
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(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the child’s contact with the abusive
parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when
contact with the abusive parent is restored.
Any harm the child has suffered or is at risk of suffering
Risk of the
child’s
living
arrangements with the resident parent breaking down
j)
Central to the court’s evaluation of welfare will be the risk of harm to the child from
exposure to continuing alienating behaviours (and disruption to the relationship with
the parent) in the
resident parent’s home weighed against the risk of harm to the
child from being uprooted and moved to a parent with whom the child has been
reluctant or resistant or refusing to engage
k)
Risk of the
child’s
living arrangements breaking down if the child is moved to the current
non-resident parent
Diagnosis guides treatment.
•
•
•
In the absence of child abuse, parents have the right to parent according to their
cultural values, their personal values, and their religious values.
In the absence of child abuse, each parent should have as much time and
involvement with the child as possible.
In the absence of child abuse, to restrict either parent’s time and involvement
with the child would damage that child’s attachment bond to that parent, thereby
harming the child and harming that parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when
contact with the abusive parent is restored.
How capable each parent (and any other person in relation to whom the court considers the
question to be relevant) is of meeting the
child’s
needs
l) A deterioration in the mental health of a resident parent (e.g., where contact with a
non-resident parent is imposed) (PD12J)
m) A deterioration in the mental health of a non-resident parent (e.g., after direct
contact is suspended or where re-introduction fails)
n) The non-resident
parent’s
capacity to have the child live with them after an
interruption in the parent/child relationship
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Diagnosis guides treatment.
•
•
•
In the absence of child abuse, parents have the right to parent according to their
cultural values, their personal values, and their religious values.
In the absence of child abuse, each parent should have as much time and
involvement with the child as possible.
In the absence of child abuse, to restrict either parent’s time and involvement
with the child would damage that child’s attachment bond to that parent, thereby
harming the child and harming that parent.
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the
child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when contact
with the abusive parent is restored.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
yes
no
yes
no
•
yes
no
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•
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
The range of the powers available to the court in the proceedings in question
o) The bridging options (e.g., where there is no current relationship between the child
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and non-resident parent)
p) Contact with the members of the wider family members of the alienated parent
q) Contingency planning will be important.
Diagnosis guides treatment. The involved mental health professionals should provide
the court with 1) an accurate diagnosis of the pathology in the family, and 2) an effective
treatment plan to fix the identified (diagnosed) pathology.
When the recommended treatment plan is implemented, it should fix the pathology.
That’s the obligation of the mental health system.
There are only two possible explanations for failed treatment, 1) misdiagnosis (cancer
is being treated with insulin), or 2) incompetent treatment. Because if the diagnosis is
accurate and the treatment for that diagnosis is competently delivered, then the
treatment should fix the pathology.
For treatment, the Court should receive a written treatment plan with Goals specified in
measurable ways, Interventions identified for each Goal, estimated Time Frames for
Goal accomplishment, and Outcome Measures to monitor treatment prog. The
treatment should reach its Goals in a reasonable amount of time based on the nature of
the diagnosis (the treatment for autism is more involved and complex than the
treatment for ADHD).
11. Even if on some dimension another care-giving environment may be better than the
child’s current one, decision-making
should assign considerable weight to the value
of continuity of “good-enough” care. ( See Forslund et al., (2022)
Attachment goes
to court: child protection and custody issues).
The court must remain mindful that
the trauma of removal and the manner of it must be weighed in balance when
considering a fundamental change in the child’s living arrangements.
The citation to Attachment goes to court: child protection and custody issues is noted. I
have specialty clinical background in Early Childhood Mental Health, with Certification
in Infant Mental Health from Fielding Graduate Institute, and a served as the Clinical
Director for a three-university assessment and treatment center for children ages zero-
to-five in foster care
–
spot-on attachment and child abuse pathology.
Turn to Tronick and Gold (2020) The Power of Discord for the clinical application of
attachment. We always repair. The worst thing we can possibly do, the Ugly, is to leave a
breached attachment bond un-repaired.
From Tronick & Gold:
“We prefer to capture the range of a child's experience with a
different set of terms:
the good, the bad, and the ugly. Good stress
is what happens in
typical everyday interactions, what we have seen in our videotaped interactions as
moment-to-moment mismatch and repair.
Bad stress
is the stress represented in the
still face experiment by the caregiver’s sudden inexplicable absence…
Ugly stress
occurs when the infant has missed out on the opportunity for repeated experiences
of repair, as in situations of emotional neglect, and’ thus cannot handle any sort of
bigger stressful event.” (Tronick & Gold, 2020, p. 134)
From Tronick & Gold:
“Children growing up with insufficient experiences of
mismatch and repair are at a disadvantage for developing coping mechanisms to
regulate their physiological behavioral and emotional reactions. We use the term
regulatory scaffolding
to describe the developmental process by which resilience
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grows out of the interactive repair of the micro-stresses that happen during short
lived, rapidly occurring mismatches. The caregiver provides “good-enough”
scaffolding to give the child the experience of overcoming a challenge, ensuring there
is neither too long a period to repair nor too close a match with no
room for repair.”
(Tronick & Gold, 2020, p. 135)Diagnosis guides treatment.
Protecting the child from child abuse is never traumatic for the child. Diagnosis guides
treatment. If child abuse is misdiagnosed, the consequences to the child are devastating.
•
•
•
In the absence of child abuse, parents have the right to parent according to their
cultural values, their personal values, and their religious values.
In the absence of child abuse, each parent should have as much time and
involvement with the child as possible.
In the absence of child abuse, to restrict either parent’s time and involvement
with the child would damage that child’s attachment bond to
that parent, thereby
harming the child and harming that parent.
The question of concern is whether there is child abuse?
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive
parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when contact
with the abusive parent is restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false
(delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
yes
yes
no
no
34
yes
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•
•
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
no
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
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conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
The
Guardian’s
role
12. The Guardian may invite the court to make a direction for the local authority to
prepare a section 37 report pursuant to the guidance of Wall J (as he then was) in
CDM v CM
[2003] 2 FLR 636 and attaching an ICO. Wall J observed;
“The
action contemplated (removal of the children from the residential parent's care either
for an assessment or with a view to a change of residence) must be in the children's best
interests. The consequences of the removal must be thought through: there must, in short,
be a coherent care plan of which temporary or permanent removal from the residential
parent's care is an integral part.”
Diagnosis guides treatment.
•
•
•
In the absence of child abuse, parents have the right to parent according to their
cultural values, their personal values, and their religious values.
In the absence of child abuse, each parent should have as much time and
involvement with the child as possible.
In the absence of child abuse, to restrict either parent’s time and involvement
with the child would damage that child’s attachment bond to that parent, thereby
harming the child and harming that parent.
The question of concern is whether there is child abuse?
If the returned diagnosis from a proper risk assessment is Child Psychological Abuse
(V995.51) by the allied parent (i.e., creating shared persecutory delusion and factitious
attachment pathology in the child), we always protect the child.
For all child abuse diagnoses, professional standards of practice and duty to protect
obligations require the child’s protective separation from the abusive parent. We always
protect the child. The child’s healthy and normal-range
development is then recovered,
and once stabilized, the child’s contact with the abusive parent is reestablished with
enough safeguards in place to ensure that the child abuse does not resume when contact
36
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with the abusive parent is restored.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent
using the child as the weapon
, then the mental health professional and/or
the Court become participants in the spousal psychological abuse of the targeted parent
because of their misdiagnosis of the pathology in the family.
Best Interests of the Child
It is always in the best interests of the child to restore healthy and normal-range
attachments to both parents.
It is always
in the child’s best interests to protect the child from all forms of child abuse,
physical (V995.54), sexual (V995.53), neglect (V995.52), and psychological abuse
(V995.51). All forms of child abuse are equally devastating for the child, they differ only
in the type of damage done, not in the severity of damage done to the child.
Psychological child abuse destroys the child from the inside out.
It is always in the child’s best interests to fix the pathology (problem) in the family and
restore the to the child a normal-range and healthy childhood.
The involved mental health professionals should conduct a proper risk assessment for
child abuse to reach an accurate diagnosis that will guide the development of an
effective treatment plan to fix the diagnosed (identified) pathology in the family. The
court should be presented with the diagnosis (and second opinion confirmation) along
with a written treatment plan to fix the diagnosed pathology.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
yes
no
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gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
38
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or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest,
most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
13. The Guardian will make a recommendation about whether a move from one parent
to another is appropriate and/or practical. The Guardian is not in a position to assist
with the mechanics of a move should one be proposed. Cafcass have no authority to
take charge of a child or to be practically or physically involved in a transfer of care.
In all cases of child abuse, we always protect the child.
14. In appropriate cases the Guardian may make a referral to the local authority if they
consider that a child is at risk and provide the relevant safeguarding information. A
local authority may provide a bridging placement for a child to stabilise before a
move of residence or to act as a neutral base from which they can build up / develop
a relationship with the non-resident parent where there has been an absence of
opportunity for them to spend time together. There may be very rare cases where
the child is unable to continue to live within the family.
In all cases of child abuse, we always protect the child. Diagnosis guides treatment.
Review
15. Even where the court has conducted its own welfare analysis and carefully weighed
in the balance the risks of harm to the child under the various options, the court
should keep its decision under careful review consistent with the
child’s
welfare and
a potentially changing landscape.
The standard of practice in clinical psychology is that the written treatment plan
provided by professional psychology should include the following:
1. Goals specified in measurable ways,
2. Interventions identified for each Goal,
3. Estimated Timeframes for Goal accomplishment,
4. Outcome Measures to monitor treatment progress and Goal accomplishment.
The court should be provided with an accurate diagnosis and a written treatment plan
to fix the identified (diagnosed) pathology in the family.
Conclusion
16. Where a
child’s
relationship with a parent has been fundamentally undermined, the
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welfare decisions will always be difficult. The consequent orders made are not a
punishment or admonishment albeit the family are likely to feel them to be so. In
the extreme cases the child may lose all contact with a non-resident parent and at
the other extreme, experience a change of placement. The court will no doubt wish
to ensure that its decision is delivered as sensitively as possible. A short summary of
the
court’s
decision in child friendly terms or a letter to the child, may help the child
understand and in appropriate cases leave open the option for a relationship with
the non-resident parent at a later date.
In healthcare, the diagnosis is always delivered by the doctors (licensed mental
health professionals) who are trained in delivering difficult diagnoses. It is the
professional obligation of the mental health team to deliver the diagnosis to the
family members.
From Improving Diagnosis in Health Care:
“The
working diagnosis should be
shared with the patient, including an explanation of the degree of uncertainty
associated with a working diagnosis. Each time there is a revision to the working
diagnosis, this information should be communicated to the patient.”
From Improving Diagnosis in Health Care:
“When
the diagnostic team
members judge that they have arrived at an accurate and timely explanation of
the patient’s health problem, they communicate that explanation to the patient
as the diagnosis.”
5.
Guidance Note for the Family Court: Understanding
hostility and psychological manipulation in cases in which
alienating behaviours are alleged
What does hostility look like?
In clinical psychology, child
hostility as a symptom is called “protest behavior” and is
designed to reestablish bonding that has been breached, or to gain adult caregiver
assistance with a developmental task that the child cannot independently master.
Recommended Reading:
Tronick and Gold (2020)
1
:
The Power of Discord
From Tronick & Gold:
“We prefer to capture the range of a child's experience
with a different set of terms:
the good, the bad, and the ugly. Good stress
is what
happens in typical everyday interactions, what we have seen in our videotaped
interactions as moment-to-moment mismatch and repair.
Bad stress
is the
stress represented in the still face experiment by the caregiver’s sudden
inexplicable absence…
Ugly stress
occurs when the infant has missed out on the
opportunity for repeated experiences of repair, as in situations of emotional
neglect, and’ thus cannot handle any sort of bigger stressful event.” (Tronick &
Gold, 2020, p. 134)
Tronick, E. & Gold, C. (2020).
The Power of Discord: Why the Ups and Downs of
Relationships Are the Secret to Building Intimacy, Resilience, and Trust.
New York : Little,
Brown Spark, 2020.
1
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From Tronick & Gold:
“Children growing up with insufficient experiences of
mismatch and repair are at a disadvantage for developing coping mechanisms
to regulate their physiological behavioral and emotional reactions. We use the
term
regulatory scaffolding
to describe the developmental process by which
resilience grows out of the interactive repair of the micro-stresses that happen
during short
lived, rapidly occurring mismatches. The caregiver provides “good-
enough” scaffolding to give the child the experience of overcoming a challenge,
ensuring there is neither too long a period to repair nor too close a match with
no room for repair.” (Tronick
& Gold, 2020, p. 135)
It is easy to assume that a child’s negative reaction, in particular their initial reaction, is a
stable and pervasive indication of a decision about their desire for a relationship with a
parent, or that hostility at some level will be implacable/unchanging. In response to a parental
separation children may be expected to experience a wide range of emotions and react with
initial anger or resentment due to the situation they find themselves in, and for this to be
directed at the parent that they perceive to be at fault for the relationship rupture.
Citation of support from the research is requested for these assertions.
From Ainsworth:
“I define an “affectional bond” as a relatively long-enduring
tie in which the partner is important as a unique individual and is
interchangeable with none other. In an affectional bond, there is a desire to
maintain closeness to the partner. In older children and adults, that closeness
may to some extent be sustained over time and distance and during absences,
but nevertheless there is at least an intermittent desire to reestablish proximity
and interaction, and pleasure
–
often joy
–
upon reunion. Inexplicable
separation tends to cause distress, and permanent loss would cause
grief.”
(p.
711)
2
From Ainsworth:
“An “attachment” is an affectional bond, and hence an
attachment figure is never wholly interchangeable with or replaceable by
another, even though there may be others to whom one is also attached. In
attachments, as in other affectional bonds, there is a need to maintain
proximity, distress upon inexplicable separation, pleasure and joy upon
reunion, and
grief
at loss. (p. 711)
The child responds to grief at separation or loss (Ainsworth, 1989)
From Bowlby:
“The
deactivation of attachment behavior
is a key feature of
certain common variants of
pathological mourning.”
(p. 70)
3
This hostility may include a range of behaviours from refusing to speak to or see a parent,
throwing away things that they associate with them, to angry or challenging reactions to that
parent, e.g., in response to typical parental boundary setting. It can also include making
derogatory remarks about that parent to others, e.g., a teacher, or being critical about them.
None of these behaviours can be taken to indicate evidence of exposure to alienating
behaviours by the other parent in their own right. It can be helpful to consider the reaction
Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-
716.
2
3
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. NY: Basic.
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to the relationship breakdown around them as a loss reaction, and to consider that observed
behaviour may alter over time as this loss is processed by the child.
Citation to supporting research requested for these assertions.
These are statements of opinion that are not supported by professional knowledge or
research. The authors seem to be seeking to avoid diagnosing child psychological abuse
by the allied pathological parent (narcissistic-borderline-dark personality) and are
placing barriers in the way of protecting the child from psychological child abuse by a
pathological parent.
Walters and Friedlander (2016) in the journal
Family Court Review:
From Walters & Friedlander:
“In some RRD families [resist-refuse
dynamic], a
parent’s underlying encapsulated delusion about the other parent is at the root of
the intractability (cf. Johnston & Campbell, 1988, p. 53ff; Childress, 2013). An
encapsulated delusion is a fixed, circumscribed belief that persists over time and
is not altered by evidence of the inaccuracy of the belief.”
(Walters & Friedlander,
2016, p. 426)
From Walters & Friedlander:
“When alienation is the predominant factor in the
RRD [resist-refuse
dynamic}, the theme of the favored parent’s fixed delusion
often is that the rejected parent is sexually, physically, and/or emotionally
abusing the child. The child may come to share the parent’s encapsulated delusion
and to regard the beliefs
as his/her own (cf. Childress, 2013).” (Walters &
Friedlander, 2016, p. 426)
The American Psychiatric Association describes the pathology of a shared delusion that
can develop in families, with the children adopting the parent’s delusional
beliefs.
From the APA:
“Usually the primary case in Shared Psychotic Disorder is
dominant in the relationship and gradually imposes the delusional system on the
more passive and initially healthy second person… Although most commonly
seen in relationships of only two people, Shared Psychotic Disorder can occur in
larger number of individuals, especially in family situations in which the parent is
the primary case and the children, sometimes to varying degrees, adopt the
parent’s delusional beliefs.” (American Psychiatric Association, 2000)
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
yes
no
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gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
43
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or is there no discernible basis in
reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
It is important to recognise that there will be situations in which there is no obvious cause or
reason that can be identified for a child demonstrating such hostility. The lack of a rationale
or explanation may cause there to be concern that the child has been exposed to alienating
behaviours/psychological manipulation, but the absence of an identified justification does not
in isolation evidence alienating behaviours.
Incompetence
There exists a diagnosis, there exists
a causal explanation, it’s just that the
involved
mental health professionals tasked with diagnosing the problem (pathology) are not
competent in their understanding and assessment of the pathology.
Google incompetence:
inability to do something successfully.
Based on the admission of the authors of this Guidance that they are unable to diagnose
the pathology (identify the cause of the problem), the authors appear to be admitting to
the incompetence in the mental health support received by the Court.
Perhaps the incompetence in identifying the problem (the inability to diagnose the
pathology) is related to ignorance (lack of knowledge or information) of the necessary
domains of professional knowledge needed to understand and resolve the pathology in
the family courts.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict is:
•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
If the authors of this Guidance (or involved mental health professionals) are unable to
identify what the cause of the problem is (are unable to diagnose the pathology), I would
suggest the everyone stop making up new forms of pathology and instead learn the
necessary knowledge.
Standards of Professional Practice
There is no such thing as “parental alienation” – “alienation” – “alienating behaviours” –
there is no defined pathology in clinical psychology of “parental alienation.” It is a made
44
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up thing.
“parental alienation” = unicorns; they are mythical things that do not exist.
The use of the construct of “parental
alienation”
(“alienation”)
in a professional
capacity is substantially beneath professional standards of practice in clinical
psychology and is in violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
Competence Concerns
Based on their reliance on of a made-up
construct (“parental alienation” – “alienation” –
“alienating behaviours”) and their admission of incompetent diagnosis (failure to
successfully identify the pathology), prominent professional concerns exist that the
authors of this Guidance may not know the knowledge needed for the pathology they
are working with.
Do the authors know the domains of knowledge necessary for professional competence
with the pathology in the family courts?
APA Standard 2.01 Boundaries of Competence
(a) 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.
•
Competence in Delusional Thought Disorders:
Are the authors competent in the diagnostic assessment and
treatment of delusional thought disorders based on their
education, training, and experience?
From Walters & Friedlander:
“In some RRD families [resist-
refuse dynamic], a parent’s underlying encapsulated delusion
about the other parent is at the root of the intractability (cf.
Johnston & Campbell, 1988, p. 53ff; Childress, 2013). An
encapsulated delusion is a fixed, circumscribed belief that
persists over time and is not altered by evidence of the
inaccuracy of the belief.”
(Walters & Friedlander, 2016, p. 426;
Family Court Review)
From Walters & Friedlander:
“When alienation is the
predominant factor in the RRD [resist-refuse dynamic}, the
theme of the favored parent’s fixed delusion often is that the
rejected parent is sexually, physically, and/or emotionally
abusing the child. The child may come to share the parent’s
encapsulated delusion and to regard the beliefs as his/her own
(cf. Childress, 2013).” (Walters
& Friedlander, 2016, p. 426;
Family Court Review)
The assessment of delusional thought disorders is a Mental
Status Exam of thought and perception as described by (Martin,
1990).
From Martin:
“Thought and Perception.
The inability to process
information correctly is part of the definition of psychotic
45
yes
no
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thinking. How the patient perceives and responds to stimuli is
therefore a critical psychiatric assessment. Does the patient
harbor realistic concerns, or are these concerns elevated to the
level of irrational fear? Is the patient responding in exaggerated
fashion to actual events, or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination,
the evaluation of a potential thought disorder is one of the most
difficult and requires considerable experience. The primary-care
physician will frequently desire formal psychiatric consultation
in patients exhibiting such disorders.”
•
Competence in Attachment Pathology:
Are the authors competent in the diagnostic assessment and
treatment of attachment pathology based on their education,
training, and experience?
•
Competence in Trauma Pathology:
Are the authors
competent in the diagnostic assessment and treatment of
child abuse and trauma pathology?
Competence in Personality Pathology:
Are the authors
competent in the diagnostic assessment of narcissistic,
borderline, and dark personality pathology based on their
education, training, and experience?
Competence in FDIA:
Are the authors competent in the
diagnostic assessment and treatment of a Factitious Disorder
(false attachment pathology) Imposed on Another based on
their education, training, and experience?
Competence in Family Systems Pathology:
Are the authors
competent in the diagnostic assessment and treatment of
family systems pathology based on their education, training,
and experience?
yes
no
yes
no
•
yes
no
•
yes
no
•
yes
no
Several issues are concerning, 1) the reliance on a made-up
pathology of “parental
alienation”, 2) the
failure to apply any established scientific or professional knowledge
from professional psychology (i.e., the DSM-5 diagnostic system, the attachment system,
child abuse and complex trauma, personality disorder pathology, family systems) as the
bases for the professional judgments offered by this Guidance, and 3) the admission that
they are often unable to diagnose the cause of the attachment pathology displayed by
the child, prominent professional concerns exist that the authors of this Guidance do not
know the relevant domains of professional knowledge needed for competence in the
pathology on which they are opining, in violation of ethical standards of practice (APA
Standard 2.01 Boundaries of Competence).
Apply knowledge to solve pathology. Ignorance solves nothing. There is no such thing as
“parental alienation” – “alienation” – “alienating behaviours”.
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. Less severe parenting produces an insecure attachment in various patterns.
The only thing that creates a child rejecting a parent is child abuse range parenting by
one parent or the other.
The diagnostic question to be answered is which parent is abusing the child? In all cases
46
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of severe attachment pathology displayed by the child surrounding court-involved
custody conflict, a proper risk assessment for child abuse needs to be conducted to the
appropriate differential diagnoses for each parent.
Diagnosis in Healthcare
From Improving Diagnosis in Health Care: “The
working diagnosis may be
either a list of potential diagnoses (a differential diagnosis) or a single potential
diagnosis. Typically, clinicians will consider more than one diagnostic hypothesis
or possibility as an explanation of the patient’s symptoms
and will refine this list
as further information is obtained in the diagnostic process.”
From Improving Diagnosis in Health Care: “As
the diagnostic process
proceeds, a fairly broad list of potential diagnoses may be narrowed into fewer
potential options, a process referred to as diagnostic modification and
refinement (Kassirer et al., 2010). As the list becomes narrowed to one or two
possibilities, diagnostic refinement of the working diagnosis becomes diagnostic
verification, in which the lead diagnosis is checked for its adequacy in explaining
the signs and symptoms, its coherency with the patient’s context (physiology,
risk factors),
and whether a single diagnosis is appropriate.”
From Improving Diagnosis in Health Care: “Throughout
the diagnostic
process, there is an ongoing assessment of whether sufficient information has
been collected. If the diagnostic team members are not satisfied that the
necessary information has been collected to explain the patient’s health problem
or that the information available is not consistent with a diagnosis, then the
process of information gathering, information integration and interpretation, and
developing a working diagnosis continues.”
From Improving Diagnosis in Health Care: “When
the diagnostic team
members judge that they have arrived at an accurate and timely explanation of
the patient’s health problem, they communicate that explanation to
the patient as
the diagnosis. It is important to note that clinicians do not need to obtain
diagnostic certainty prior to initiating treatment; the goal of information
gathering in the diagnostic process is to reduce diagnostic uncertainty enough to
make optimal decisions for subsequent care (Kassirer, 1989; see section on
diagnostic uncertainty).
From Improving Diagnosis in Health Care: “In
addition, the provision of
treatment can also inform and refine a working diagnosis, which is indicated by
the feedback loop from treatment into the information-gathering step of the
diagnostic process. This also illustrates the need for clinicians to diagnose health
problems that may arise during treatment.”
From Improving Diagnosis in Health Care: “Clinicians
may refer to or consult
with other clinicians (formally or informally) to seek additional expertise about a
patient’s health problem. The consult may help to confirm or reject the working
diagnosis or may provide information on potential treatment options. If a
patient’s health problem is outside a clinician’s area of expertise, he or she can
refer the patient to a clinician who holds more suitable expertise. Clinicians can
also recommend that the patient seek a second opinion from another clinician to
verify their impressions of an uncertain diagnosis or if they believe that this
would be helpful to the patient.”
When possible child abuse is a considered diagnosis, the diagnosis returned must be
accurate 100% of the time. The consequences of misdiagnosing child abuse are too
47
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devastating for the child.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent using the child as the weapon, then the mental health professional
and/or the Court become participants in the spousal psychological abuse of the targeted
parent because of their misdiagnosis of the pathology in the family.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
yes
no
yes
no
•
yes
no
•
yes
no
48
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Family Systems Pathology
•
•
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Crucially, it is when there is no known justification for the hostility/rejection of a parent in
combination with evidence of psychological manipulation that it may be determined that the
child is in what is sometimes referred to as an ‘alienated position’ in the family dynamic.
There is no such thing as an “alienated position” –
stop making things up.
There exists a diagnosis, there exists
a causal explanation, it’s just that the
authors of
49
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this Guidance (or involved mental health professionals) are not competent in their
understanding and assessment of the pathology (the problem).
Competence Concerns
Google incompetence:
inability to do something successfully
Based on the admission by the authors of this Guidance that they are sometimes unable
to diagnose the pathology, the authors appear to be admitting to their incompetence (by
definition of the English language, i.e., failure to do identify the pathology successfully).
Perhaps the incompetence (inability to diagnose the pathology) is related to the use of
made-up things like
“parental alienation” and “alienating behaviours” instead of
applying actual knowledge.
I would suggest the authors discontinue their practice on display in this proposed
Guidance of simply making up new forms of pathology that have no research or
theoretical support, and that they instead rely on the application of the established
scientific and professional knowledge of professional psychology as the bases for their
professional judgments.
The established scientific and professional knowledge of the discipline required for
application with court-involved custody conflict is:
•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
Based on the reliance by the authors on of a made-up
construct (“parental alienation” –
“alienation” – “alienating behaviours”) and their admission of incompetent diagnosis
(failure to do identify the pathology successfully), prominent professional concerns exist
that the authors of this Guidance are not competent in the pathology on which they are
opining.
Do the authors know the domains of knowledge necessary for professional competence
with the pathology in the family courts?
APA Standard 2.01 Boundaries of Competence
(a) 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.
•
Competence in Delusional Thought Disorders:
Are the authors competent in the diagnostic assessment and
treatment of delusional thought disorders based on their
education, training, and experience?
From Walters & Friedlander:
“In some RRD families [resist-
refuse dynamic], a parent’s underlying encapsulated delusion
about the other parent is at the root of the intractability (cf.
Johnston & Campbell, 1988, p. 53ff; Childress, 2013). An
50
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no
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2767476_0051.png
encapsulated delusion is a fixed, circumscribed belief that
persists over time and is not altered by evidence of the
inaccuracy of the
belief.”
(Walters & Friedlander, 2016, p. 426;
Family Court Review)
From Walters & Friedlander:
“When alienation is the
predominant factor in the RRD [resist-refuse dynamic}, the
theme of the favored parent’s fixed delusion often is that the
rejected parent is sexually, physically, and/or emotionally
abusing the child. The child may come to share the parent’s
encapsulated delusion and to regard the beliefs as his/her own
(cf. Childress, 2013).” (Walters
& Friedlander, 2016, p. 426;
Family Court Review)
The assessment of delusional thought disorders is a Mental
Status Exam of thought and perception as described by (Martin,
1990).
From Martin:
“Thought and Perception.
The inability to process
information correctly is part of the definition of psychotic
thinking. How the patient perceives and responds to stimuli is
therefore a critical psychiatric assessment. Does the patient
harbor realistic concerns, or are these concerns elevated to the
level of irrational fear? Is the patient responding in exaggerated
fashion to actual events, or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination,
the evaluation of a potential thought disorder is one of the most
difficult and requires considerable experience. The primary-care
physician will frequently desire formal psychiatric consultation
in patients
exhibiting such disorders.”
•
Competence in Attachment Pathology:
Are the authors competent in the diagnostic assessment and
treatment of attachment pathology based on their education,
training, and experience?
•
Competence in Trauma Pathology:
Are the authors
competent in the diagnostic assessment and treatment of
child abuse and trauma pathology?
Competence in Personality Pathology:
Are the authors
competent in the diagnostic assessment of narcissistic,
borderline, and dark personality pathology based on their
education, training, and experience?
Competence in FDIA:
Are the authors competent in the
diagnostic assessment and treatment of a Factitious Disorder
(false attachment pathology) Imposed on Another based on
their education, training, and experience?
Where and how did they acquire this competence?
•
Competence in Family Systems Pathology:
Are the authors
competent in the diagnostic assessment and treatment of
family systems pathology based on their education, training,
yes
no
yes
no
yes
no
•
yes
no
•
yes
no
51
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and experience?
Based on 1) their reliance on a made-up
pathology of “parental alienation”, 2) their
failure to apply any established scientific or professional knowledge from professional
psychology (i.e., the DSM-5 diagnostic system, the attachment system, child abuse and
complex trauma, personality disorder pathology, family systems) as the bases for their
professional judgments, and 3) their admission that they are often unable to diagnose
the cause of the attachment pathology displayed by the child, prominent professional
concerns exist that the authors of this Guidance do not know the relevant domains of
professional knowledge needed for competence in the pathology on which they are
opining, in violation of ethical standards of practice (APA Standard 2.01 Boundaries of
Competence).
Apply knowledge to solve pathology. Ignorance solves nothing. There is no such thing as
“parental alienation” – “alienation” – “alienating behaviours”.
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. Less severe parenting produces an insecure attachment in various patterns.
The only thing that creates a child rejecting a parent is child abuse range parenting by
one parent or the other.
Participation in Child Abuse & Spousal Abuse
One of the prominent professional dangers of misdiagnosing a shared persecutory
delusion is that if the mental health professional and/or the Court misdiagnoses the
pathology of a shared persecutory delusion and believes the shared delusion as if it was
true, then the mental health professional and/or the Court become part of the shared
delusion, they become part of the pathology. When that pathology is the psychological
abuse of the child by an allied pathological parent, then the mental health professional
and/or the Court become participants
in the parent’s psychological abuse of the child by
validating to the child that the child’s false (delusional) beliefs are true when they are, in
fact, symptoms of an induced persecutory delusion.
When that pathology is also the psychological spousal abuse of the targeted parent by
the allied parent using the child as the weapon, then the mental health professional
and/or the Court become participants in the spousal psychological abuse of the targeted
parent because of their misdiagnosis of the pathology in the family.
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
52
yes
no
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2767476_0053.png
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
53
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2767476_0054.png
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in
reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Psychological manipulation
Psychological Control
From Cui et al:
“Specifically,
psychological control has historically been defined
as psychologically and emotionally
manipulative
techniques or parental
behaviors that are not responsive to children’s psychological and
emotional
needs (Barber, Maughan, & Olsen, 2005). Psychologically controlling parents
create a coercive, unpredictable, or negative emotional climate in the family,
which serves as one of the ways the family context influences children’s emotion
regulation (Morris, Silk, Steinberg, Myers, & Robinson, 2007; Steinberg, 2005).”
(Cui et al. 2014)
4
The manipulative psychological control of the child by a parent is a scientifically
established family relationship pattern in dysfunctional family systems. In his book
regarding parental psychological control of children,
Intrusive Parenting: How
Psychological Control Affects Children and Adolescents,
5
published by the American
Psychological Association, Brian Barber and his colleague, Elizabeth Harmon, identify
over 30 empirically validated scientific studies that have established the construct of
parental psychological control of children. Barber and Harmon (2002)
6
provide the
following definition for the construct of parental psychological control of the child:
From Barber & Harmon:
“Psychological control refers to parental behaviors
that
are intrusive and manipulative of children’s
thoughts, feelings, and attachment to
parents. These behaviors appear to be associated with disturbances in the
psychoemotional boundaries between the child and parent, and hence with the
Cui, L., Morris, A.S., Criss, M.M., Houltberg, B.J., and Jennifer S. Silk, J.S. (2014). Parental
Psychological Control and Adolescent Adjustment: The Role of Adolescent Emotion
Regulation. Parenting: Science and Practice, 14, 47–67.
4
Barber, B. K. (Ed.) (2002). Intrusive parenting: How psychological control affects
children and adolescents. Washington, DC: American Psychological Association.
5
Barber, B. K. and Harmon, E. L. (2002). Violating the self: Parenting psychological control
of children and adolescents. In B. K. Barber (Ed.), Intrusive parenting (pp. 15-52).
Washington, DC: American Psychological Association.
6
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development of an independent sense of self and identity.”
(Barber & Harmon,
2002, p. 15)
The difference between behavioral and psychological control is described by Stone,
Bueler, and Barber (2002),
7
Stone, Buehler, & Barber:
“The central elements of psychological control are
intrusion into the child’s psychological world and self-definition
and parental
attempts to manipulate the child’s
thoughts and feelings through invoking guilt,
shame, and anxiety. Psychological control is distinguished from behavioral
control in that the parent attempts to control, through the use of criticism,
dominance, and anxiety or guilt induction, the youth’s
thoughts and feelings
rather than the youth’s behavior.” (Stone, Buehler,
& Barber, 2002, p. 57)
Soenens and Vansteenkiste (2010)
8
describe the various methods parents use to
achieve parental psychological control of the child,
From Soenens and Vansteenkiste:
“Psychological
control can be expressed
through a variety of parental tactics, including (a) guilt-induction, which refers
to the use of guilt inducing strategies to pressure children to comply with a
parental request; (b) contingent love or love withdrawal, where parents make
their attention, interest, care, and love contingent upon the children’s
attainment of parental standards; (c) instilling anxiety, which refers to the
induction of anxiety to make children comply with parental requests; and (d)
invalidation of the child’s
perspective, which pertains to parental constraining
of
the child’s spontaneous expression of thoughts and feelings.” (Soenens
&
Vansteenkiste, 2010, p. 75)
Stone, Buehler, and Barber (2002)
9
provide an explanation for the process of intrusive
psychological control of children surrounding divorce,
Stone, Buehler, and Barber:
“The concept of triangles “describes the way any
three people relate to each other and involve others in emotional issues
between them” (Bowen, 1989, p. 306). In the anxiety-filled
environment of
conflict, a third person is triangulated, either temporarily or permanently, to
ease the anxious feelings of the conflicting partners. By default, that third person
is exposed to an anxiety-provoking and disturbing atmosphere. For example, a
child might become the scapegoat or focus of attention, thereby transferring the
tension from the marital dyad to the parent-child dyad. Unresolved tension in
the marital relationship might spill over to the parent-child relationship through
parents’
use of psychological control
as a way of securing and maintaining a
strong emotional alliance and level of support from the child. As a consequence,
Stone, G., Buehler, C., & Barber, B. K.. (2002) Interparental conflict, parental
psychological control, and youth problem behaviors. In B. K. Barber (Ed.), Intrusive
parenting: How psychological control affects children and adolescents. Washington, DC:
American Psychological Association.
7
Soenens, B., & Vansteenkiste, M. (2010). A theoretical upgrade of the concept of parental
psychological control: Proposing new insights on the basis of self-determination theory.
Developmental Review, 30, 74–99.
8
Stone, G., Buehler, C., & Barber, B. K.. (2002) Interparental conflict, parental
psychological control, and youth problem behaviors. In B. K. Barber (Ed.), Intrusive
parenting: How psychological control affects children and adolescents. Washington, DC:
American Psychological Association.
9
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the triangulated youth might feel pressured or obliged to listen to or agree with
one parents’
complaints against the other. The resulting
enmeshment and cross-
generational coalition would exemplify parents’
use of psychological control to
coerce and maintain a parent-youth emotional alliance against the other parent
(Haley, 1976; Minuchin, 1974).” (Stone, Buehler, & Barber, 2002, p. 86-87).
It is well established in law that some parents manipulate their children, and this can include
being manipulated to make false allegations in family law proceedings, e.g.,
Re H (Children)
[2014] EWCA Civ 733 (Parker J). Examples of such harmful parental behaviour can include a
parent reinforcing ‘loyalty’ and rejection of the other parent with emotional warmth,
withdrawing emotional warmth in response to perceived disloyalty/a child wishing to
maintain a relationship with the other parent. This can also include engendering a
developmentally inappropriate need to protect the emotional fragility of the parent, e.g.,
through sharing of inappropriate information about the adult relationship or baselessly
portraying the other parent as a source of harm to the wellbeing of that parent.
Standards of Professional Practice
Apply knowledge to solve pathology. Ignorance solves nothing.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict is:
•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
No established scientific or professional knowledge from any domain of professional
psychology is evident in application by the authors of this Guidance, in violation of
Standard 2.04 Bases for Scientific and Professional Judgments of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
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Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
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family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
•
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients
exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms”
(Wikipedia: BPRS).
Children who have experienced loss arising from parental separation may anticipate the loss
of another relationship or threat to the security of that relationship and be motivated by their
attachment needs to protect that relationship over their other competing needs. What is
often described in these scenarios is a parent struggling to maintain a boundary between their
own psychological needs and those of their child
–
the
parent’s
capacity to prioritise a
child’s
emotional and
psychological needs over their own. There may be factors in parent’s own
psychological functioning which may lead them to actively or inadvertently engage in
psychologically manipulative behaviour. Understanding these processes and a parent’s
capacity to change such behaviour with or without support, may require the assistance of an
appropriately qualified psychologist expert.
I am that appropriately qualified expert.
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
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Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
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This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in
reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
6.
Guidance Note for the Family Court: Use of experts in cases
in which alienating behaviours are alleged
Use of experts
It is inappropriate for experts to be asked to step into quasi-fact finding or determination of
alienating behaviours
–
as such, the timing of expert evidence and the type of expert evidence
needed is crucial. In determining the welfare outcome, when the presence of such harmful
behaviours has been identified, it may be necessary to have expert evidence from a
Psychologist expert. Determining the appropriate type of psychologist expert should be in
accordance with the FJC/BPS 2023 guidance (link below). This updated guidance includes
additional guidance in relation to the instruction of psychologist expert witnesses, specifically
the scrutiny of their regulation, their qualifications and their access to psychological tests,
given in
Re C (‘Parental Alienation’)
[2023] EWHC 345 (Fam).
Standards of Professional Practice
There is no such thing as
“parental alienation” – “alienation” – “alienating behaviours” –
“alienating position
-
there is no defined pathology in clinical psychology of “parental
alienation.” It is a made up thing.
“parental alienation” = unicorns; they are both mythical things that do not exist.
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The
use of the construct of “parental alienation” (“alienation”)
in a professional
capacity is substantially beneath professional standards of practice in clinical
psychology and is in violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict are:
•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
Competence Concerns
Do the authors of this Guidance know the necessary knowledge of real things, real
pathology, needed for understanding and resolving the pathology in the family courts?
The authors of this Guidance have yet to apply any established scientific or professional
knowledge from established domains of professional psychology as the bases for their
professional judgments, and they have acknowledged their incompetence (by definition
of the English language, i.e., failure to do something successfully) in identifying the
pathology in the family courts.
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
yes
no
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custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
62
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or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Given the complexity of these cases and the often-interacting psychological factors at play in
the adults and the children, it is likely that assessments which will assist the court in
determining welfare outcomes are those offered by HCPC regulated Practitioner
Psychologists with competence in assessing adults and children, e.g., Clinical
Psychologists/Counselling Psychologists. Although there are differences in their training
competencies, both are trained to assess both adults and children (FJC/BPS 2023 guidance
(footnote)). It is important that the instructions for psychological evidence when there are
allegations of alienating behaviours are not narrowed in focus but have the breadth and scope
typical to holistic psychological assessments of parents and children in the family courts.
https://www.lawsociety.org.uk/topics/family-and-children/instructing-experts-in-family-
and-children-court-proceedings#questions-for-experts
I am a clinical psychologist with specialized professional background, training and
experience in six domains of relevant pathology supported by my vitae:
1. Delusional thought disorders
Twelve years on a major UCLA research study on schizophrenia with annual
training in the diagnostic assessment of delusional thought disorders.
2. Attachment pathology
Early Childhood Mental Health specialization.
3. Child abuse and complex trauma
Clinical Director for a 3-university assessment and treatment center for children
ages zero-to-five in foster care.
4. Factitious Disorder Imposed on Another
Training and medical staff position as a pediatric psychologist at Childrens’
Hospitals.
5. Family systems
Specialized training track from Pepperdine University’s doctoral program and
lifelong practice as a family systems therapist
6. Court-involved custody conflict
Ten years in the family courts as a clinical psychologist and expert consultant to
attorneys and their client-parents in custody conflict.
My opinions offered here represent the professional opinions from the domain of
clinical psychology which was just noted by the authors as being relevant and
important.
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Standards of Professional Practice
There is no such thing as “parental alienation” – “alienation” – “alienating behaviours”
– “alienating
position -
there is no defined pathology in clinical psychology of “parental
alienation.” It is a made up thing.
“parental alienation” = unicorns; they are both mythical things that do not exist.
The use of the construct of “parental alienation” (“alienation”)
in a professional
capacity is substantially beneath professional standards of practice in clinical
psychology and is in violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict are:
•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
Competence Concerns
Prominent questions are present that the authors of this Guidance may not know the
necessary knowledge of real things, real pathology, needed for understanding and
resolving the pathology in the family courts.
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
yes
no
64
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(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
65
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irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest,
most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
These assessments should not be undertaken by academic psychologists or psychological
researchers in the field of alienation. Only HCPC Registered psychologists have the relevant
clinical experience and training to conduct psychological assessments of people and make
clinical diagnoses and recommendations for treatment or interventions, whereas, academic
psychologists, who should be Chartered, but who are not registered with the HCPC, would
not normally have the clinical experience and training in order to complete psychological
assessments or make clinical diagnoses. There is an inherent risk of confirmatory bias if
instructions and assessments are framed solely in terms of allegations of alienating
behaviours.
I am a clinical psychologist with specialized professional background, training and
experience in six domains of relevant pathology supported by my vitae:
7. Delusional thought disorders
Twelve years on a major UCLA research study on schizophrenia with annual
training in the diagnostic assessment of delusional thought disorders.
8. Attachment pathology
Early Childhood Mental Health specialization.
9. Child abuse and complex trauma
Clinical Director for a 3-university assessment and treatment center for children
ages zero-to-five in foster care.
10. Factitious Disorder Imposed on Another
Training and medical staff
position as a pediatric psychologist at Childrens’
Hospitals.
11. Family systems
Specialized training track from Pepperdine University’s doctoral program and
lifelong practice as a family systems therapist
12. Court-involved custody conflict
Ten years in the family courts as a clinical psychologist and expert consultant to
attorneys and their client-parents in custody conflict.
I am not an academic researcher, I am an applied clinician with experience as the
Clinical Director for a three-university assessment and treatment center for children
ages zero-to-five in foster care.
My opinions offered here represent the professional opinions from the domain of
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applied clinical psychology which was just noted by the authors as being relevant and
important.
In healthcare, diagnosis guides treatment. But we always land on treatment. We always
fix the problem. First, we need to know what the problem is, we need a diagnosis, an
accurate diagnosis, to guide the development of an effective treatment plan.
In all cases of severe attachment pathology, we always want to repair the breached
attachment bond. Leaving an attachment bond breached and un-repaired is the worst
possible thing we can do, i.e., the Ugly of Tronic and Gold (2020;
The Power of Discord).
From Tronick & Gold:
“We
prefer to capture the range of a child's experience
with a different set of terms:
the good, the bad, and the ugly. Good stress
is what
happens in typical everyday interactions, what we have seen in our videotaped
interactions as moment-to-moment mismatch and repair.
Bad stress
is the stress
represented in the still face experiment by the caregiver’s sudden inexplicable
absence…
Ugly stress
occurs when the infant has missed out on the opportunity
for repeated experiences of repair, as in situations of emotional neglect, and’ thus
cannot handle any sort of bigger stressful event.” (Tronick & Gold, 2020, p. 134)
From Tronick & Gold:
“Children
growing up with insufficient experiences of
mismatch and repair are at a disadvantage for developing coping mechanisms to
regulate their physiological behavioral and emotional reactions. We use the term
regulatory scaffolding
to describe the developmental process by which resilience
grows out of the interactive repair of the micro-stresses that happen during short
lived, rapidly occurring mismatches. The
caregiver provides “good-enough”
scaffolding to give the child the experience of overcoming a challenge, ensuring
there is neither too long a period to repair nor too close a match with no room for
repair.” (Tronick & Gold, 2020, p. 135)
Risk Assessment for Child Abuse
Diagnosis guides treatment. The treatment for cancer is different than the treatment for
diabetes. Is there child abuse by the targeted parent or is there child abuse by the allied
parent?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
Standards of Professional Practice
There is no such thing as
“parental alienation” – “alienation” – “alienating behaviours” –
there is no defined pathology in clinical psychology of “parental alienation.” It is a made
up thing.
“parental alienation” = unicorns; they are both mythical things that do not exist.
The use of the construct of “parental alienation” (“alienation”)
in a professional
capacity is substantially beneath professional standards of practice in clinical
psychology and is in violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict are:
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•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
Competence Concerns
Prominent questions are present that the authors of This Guidance is not competent in
the necessary knowledge of real things, real pathology, needed for the pathology in the
family courts.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
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•
•
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality
for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Assessments of children should focus on their cognitive, educational, emotional, social, and
behavioural development, and comment on any matters of concern. They should comment
upon any harm which the children may have suffered in respect of their psychological,
intellectual, educational, emotional, social, and behavioural development and assess what
the cause of such harm may be and advise on the support services (including therapeutic
support) which should be put in place to assist the child.
Risk Assessment for Child Abuse
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In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
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•
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Assessments of adults should focus on a parent’s psychological functioning/personality and
prognosis and any appropriate treatment/support required. A
parent’s
ability to prioritise the
child(ren)’s
needs above their own, their understanding, insight and acknowledgement of any
findings made by the court and the concerns raised by professionals, their ability to make
changes in her own behaviours and support the child(ren), their capacity to engage in work
to secure a favourable outcome for the child(ren) including any recommended therapeutic
intervention or any other necessary intervention or support.
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
71
yes
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•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
72
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the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Conflict of interest
The Family Justice Council (FJC)/British Psychological Society (BPS) guidance for Psychologist
expert witnesses (2023) emphasises the importance of the expert being alert to potential
conflicts of interest. In particular it notes that:
"The expert
witness’s
overriding duty is to the Court and to be impartial in their evidence; the
impartiality of expert witnesses is essential to their evidence; if the psychologist has a view
that is controversial as between experts or that might be derived from partiality, she or he
must declare the extent of that interest. This is particularly relevant when a psychologist
expert recommends an intervention or therapy that they or an associate would benefit
financially from delivering. Whilst this may be experienced as helpful and facilitative to the
court, this would be a clear conflict of interest and threat to the independence of their expert
evidence."1
Diagnosis in Healthcare
The National Academy of Sciences describes the diagnostic process in a paper on
Improving Diagnosis in Healthcare
(2015),
From Improving Diagnosis:
“The
working diagnosis may be either a list of
potential diagnoses (a differential diagnosis) or a single potential diagnosis.
Typically, clinicians will consider more than one diagnostic hypothesis or
possibility as an explanation of the patient’s symptoms and
will refine this list as
further information is obtained in the diagnostic process.” (National Academy of
Sciences, 2015)
From Improving Diagnosis:
“As the diagnostic process proceeds, a fairly broad
list of potential diagnoses may be narrowed into fewer potential options, a
process referred to as diagnostic modification and refinement (Kassirer et al.,
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2010). As the list becomes narrowed to one or two possibilities, diagnostic
refinement of the working diagnosis becomes diagnostic verification, in which
the lead diagnosis is checked for its adequacy in explaining the signs and
symptoms, its coherency with the patient’s context (physiology, risk factors), and
whether a single diagnosis is appropriate.” (National Academy of Sciences, 2015)
From Improving Diagnosis:
“Throughout the diagnostic process, there is an
ongoing assessment of whether sufficient information has been collected. If the
diagnostic team members are not satisfied that the necessary information has
been collected to explain the patient’s health
problem, or that the information
available is not consistent with a diagnosis, then the process of information
gathering, information integration and interpretation, and developing a working
diagnosis continues.” (National Academy of Sciences, 2015)
From Improving Diagnosis:
“In addition, the provision of treatment can also
inform and refine a working diagnosis, which is indicated by the feedback loop
from treatment into the information-gathering step of the diagnostic process.
This also illustrates the need for clinicians to diagnose health problems that may
arise during treatment.” (National Academy of Sciences, 2015)
From Improving Diagnosis in Health Care: “Clinicians
may refer to or consult
with other clinicians (formally or informally) to seek additional expertise about a
patient’s health problem. The consult may help to confirm or reject the working
diagnosis or may provide information on potential treatment options. If a
patient’s health problem is outside a clinician’s area of expertise, he or she
can
refer the patient to a clinician who holds more suitable expertise. Clinicians can
also recommend that the patient seek a second opinion from another clinician to
verify their impressions of an uncertain diagnosis or if they believe that this
would be
helpful to the patient.”
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
yes
no
74
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psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality
for the patient's beliefs or behavior?”
75
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From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the
oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
The President of the Family
Division’s
Memorandum on the use of experts in the family court
(October 2021) emphasises the rigorous approach to be taken by the family courts in
admitting expert evidence and the need for a reliable body of knowledge or experience to
underpin the expert’s evidence.
Standards of Professional Practice
There is no such thing as “parental alienation” – “alienation” – “alienating behaviours” –
there is
no defined pathology in clinical psychology of “parental alienation.” It is a made
up thing.
“parental alienation” = unicorns; they are both mythical things that do not exist.
The use of the construct of “parental alienation” (“alienation”)
in a professional
capacity is substantially beneath professional standards of practice in clinical
psychology and is in violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict are:
•
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
DSM-5 diagnostic system - American Psychiatric Association
Diagnosis in Healthcare
The National Academy of Sciences describes the diagnostic process in a paper on
Improving Diagnosis in Healthcare
(2015),
From Improving Diagnosis:
“The working diagnosis may be either a list of
potential diagnoses (a differential diagnosis) or a single potential diagnosis.
Typically, clinicians will consider more than one diagnostic hypothesis or
possibility as an explanation of the patient’s symptoms and will refine this list as
further information is obtained in the diagnostic process.” (National Academy of
Sciences, 2015)
From Improving Diagnosis:
“As the diagnostic process proceeds, a fairly broad
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list of potential diagnoses may be narrowed into fewer potential options, a
process referred to as diagnostic modification and refinement (Kassirer et al.,
2010). As the list becomes narrowed to one or two possibilities, diagnostic
refinement of the working diagnosis becomes diagnostic verification, in which
the lead diagnosis is checked for its adequacy in explaining the signs and
symptoms, its coherency with the patient’s context
(physiology, risk factors), and
whether a single diagnosis is appropriate.” (National Academy of Sciences, 2015)
From Improving Diagnosis:
“Throughout the diagnostic process, there is an
ongoing assessment of whether sufficient information has been collected. If the
diagnostic team members are not satisfied that the necessary information has
been collected to explain the patient’s health problem, or that the information
available is not consistent with a diagnosis, then the process of information
gathering, information integration and interpretation, and developing a working
diagnosis continues.” (National Academy of Sciences, 2015)
From Improving Diagnosis:
“In addition, the provision of treatment can also
inform and refine a working diagnosis, which is indicated by the feedback loop
from treatment into the information-gathering step of the diagnostic process.
This also illustrates the need for clinicians to diagnose health problems that may
arise during treatment.” (National Academy of Sciences, 2015)
From
Improving Diagnosis in Health Care: “Clinicians
may refer to or consult
with other clinicians (formally or informally) to seek additional expertise about a
patient’s health problem. The consult may help to confirm or reject the working
diagnosis or may provide information on potential treatment options. If a
patient’s health problem is outside a clinician’s area of expertise, he or she can
refer the patient to a clinician who holds more suitable expertise. Clinicians can
also recommend that the patient seek a second opinion from another clinician to
verify their impressions of an uncertain diagnosis or if they believe that this
would be helpful to the patient.”
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
yes
no
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(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
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irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
The importance of robust psychological approaches consistent with this memorandum is
highlighted in the FJC/BPS guidance. This includes assessments drawing on a range of
different sources and methods (to combat biases inherent in any single approach) in order to
inform therapeutic recommendations in the opinion given. Recommendations should be
consistent with typical current psychological practice and evidence base and flow from a
rationale based on recognised assessment methodology. This is a marker of a good quality
psychological report. The court should expect a range of options in psychological opinion and
recommendations that are:
•
•
•
Transparent as to the intervention and requisite qualifications needed to effect
desired change.
Interpretable by a wide range of practitioners in the field.
Deliverable by any suitably qualified practitioners.
Standards of Professional Practice
There is no such thing as “parental alienation” – “alienation” – “alienating behaviours” –
there is no defined pathology in clinical psychology of “parental alienation.” It is a made
up thing.
“parental alienation” = unicorns; they are both mythical things that do not exist.
The use of the construct of “parental alienation” (“alienation”)
in a professional
capacity is substantially beneath professional standards of practice in clinical
psychology and is in violation of Standard 2.04 of the APA ethics code.
2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional
knowledge of the discipline.
The established scientific and professional knowledge of the discipline required for
competence with court-involved custody conflict are:
•
•
•
•
•
•
Attachment pathology - Bowlby & others
Family systems therapy - Minuchin & others
Child abuse and complex trauma
–
van der Kolk & others
Personality disorder pathology - Beck & others
Child Development
–
Tronick & others
Psychological control
–
Barber & others
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•
DSM-5 diagnostic system - American Psychiatric Association
Diagnosis in Healthcare
The National Academy of Sciences describes the diagnostic process in a paper on
Improving Diagnosis in Healthcare
(2015),
From Improving Diagnosis:
“The working diagnosis may be either a list of
potential diagnoses (a differential diagnosis) or a single potential diagnosis.
Typically, clinicians will consider more than one diagnostic hypothesis or
possibility as an explanation of the patient’s symptoms and will refine this list as
further information is obtained in the diagnostic process.” (National Academy
of
Sciences, 2015)
From Improving Diagnosis:
“As the diagnostic process proceeds, a fairly broad
list of potential diagnoses may be narrowed into fewer potential options, a
process referred to as diagnostic modification and refinement (Kassirer et al.,
2010). As the list becomes narrowed to one or two possibilities, diagnostic
refinement of the working diagnosis becomes diagnostic verification, in which
the lead diagnosis is checked for its adequacy in explaining the signs and
symptoms, its coherency with
the patient’s context (physiology, risk factors), and
whether a single diagnosis is appropriate.” (National Academy of Sciences, 2015)
From Improving Diagnosis:
“Throughout the diagnostic process, there is an
ongoing assessment of whether sufficient information has been collected. If the
diagnostic team members are not satisfied that the necessary information has
been collected to explain the patient’s health problem, or that the information
available is not consistent with a diagnosis, then the process of information
gathering, information integration and interpretation, and developing a working
diagnosis continues.” (National Academy of Sciences, 2015)
From Improving Diagnosis:
“In addition, the provision of treatment can also
inform and refine a working diagnosis, which is indicated by the feedback loop
from treatment into the information-gathering step of the diagnostic process.
This also illustrates the need for clinicians to diagnose health problems that may
arise during treatment.” (National Academy of
Sciences, 2015)
From Improving Diagnosis in Health Care: “Clinicians
may refer to or consult
with other clinicians (formally or informally) to seek additional expertise about a
patient’s health problem. The consult may help to confirm or reject the working
diagnosis or may provide information on potential treatment options. If a
patient’s health problem is outside a clinician’s area of expertise, he or she can
refer the patient to a clinician who holds more suitable expertise. Clinicians can
also recommend that the patient seek a second opinion from another clinician to
verify their impressions of an uncertain diagnosis or if they believe that this
would be helpful to the patient.”
Risk Assessment for Child Abuse
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
yes
no
80
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pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
Differential Diagnosis
–
Allied Parent:
Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
This Guidance is problematic in development and will be problematic in
implementation. Following the recommendations of this Guidance will lead to un-
diagnosed and un-treated Child Psychological Abuse in the family courts by pathological
81
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parents (narcissistic-borderline-dark personality parents).
The only thing that causes severe attachment pathology is child abuse by one parent or
the other. The diagnostic question to be answered is which parent is abusing the child?
In all cases of severe attachment pathology displayed by the child surrounding court-
involved custody conflict, a proper risk assessment for child abuse needs to be
conducted to the appropriate differential diagnoses for each parent.
The diagnostic assessment for a delusional thought disorder is a Mental Status Exam of
thought and perception as described by Martin (1990),
From Martin:
“Thought and Perception.
The inability to process information
correctly is part of the definition of psychotic thinking. How the patient perceives
and responds to stimuli is therefore a critical psychiatric assessment. Does the
patient harbor realistic concerns, or are these concerns elevated to the level of
irrational fear? Is the patient responding in exaggerated fashion to actual events,
or is there no discernible basis in reality for the patient's beliefs or behavior?”
From Martin:
“Of
all portions of the mental status examination, the evaluation of
a potential thought disorder is one of the most difficult and requires
considerable experience. The primary-care physician will frequently desire
formal psychiatric consultation in patients exhibiting such disorders.”
The rating of the delusional thought disorder can be made using item 11 Unusual
Thought Content of the Brief Psychiatric Rating Scale (BPRS), “one of the oldest, most
widely used scales to measure psychotic symptoms” (Wikipedia: BPRS).
Recommendations for interventions deliverable only by the instructed expert or their
associates are inconsistent with this. It increases the risk of bias, can limit appropriate
oversight of interventions and risks delays as it may create barriers to families accessing
appropriate, timely support local to them.
Pilot Program for the Family Courts
For decision-makers surrounding the family courts, I recommend that a pilot program
for the family courts be initiated with university involvement for evaluation research, to
develop a standardized and agreed upon diagnostic assessment and treatment protocol
of the highest professional quality, reliability, and validity for the differential diagnoses
of concern.
Differential Diagnosis for Targeted Parent:
Targeted Parent Abusive:
Is the targeted parent abusing the
child in some way, thereby creating the child’s attachment
pathology toward that parent?
If yes, identify the DSM-5 Child Abuse diagnosis involved:
•
•
•
•
Child Physical Abuse (V995.54)
Child Sexual Abuse (V995.53)
Child Neglect (V995.52)
Child Psychological Abuse (V995.51)
yes
yes
yes
yes
no
no
no
no
yes
no
Differential Diagnosis
–
Allied Parent:
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Allied Parent Abusive:
Is the allied parent psychologically
abusing the child (DSM-5 V995.51 Child Psychological Abuse) by
creating a shared (induced) persecutory delusion and false
(factitious) attachment pathology in the child for the secondary
gain of manipulating the court’s
decisions regarding child
custody, and to meet the allied parent’s own emotional and
psychological needs?
•
Persecutory Delusion (shared):
Does the allied parent
have a persecutory delusion surrounding the other parent,
and does the child share this persecutory belief (a fixed and
false belief that the child is being malevolently treated in
some way)?
Factitious Attachment Pathology:
Does the child have a
false (factitious) attachment pathology imposed on the child
by the pathogenic parenting of the allied parent (DSM-5
300.19 Factitious Disorder Imposed on Another)?
Spousal Psychological Abuse:
Is the allied parent using the
child’s induced pathology as a weapon of spousal emotional
and psychological abuse of the targeted parent (DSM-5
V995.82 Spouse or Partner Abuse, Psychological)?
Triangulation:
Is the child being triangulated into the
spousal conflict surrounding the divorce?
Cross-generational Coalition:
Is there a cross-
generational coalition of the child with the one parent
against the other parent?
Emotional Cutoff:
Is there an emotional cutoff between
the child and a parent?
Inverted Hierarchy:
Is there an inverted hierarchy in the
family? (Does the child judge the parent’s adequacy as if
the parent was the child and the child was the parent?)
Enmeshment:
Do the parent and child have an enmeshed
relationship?
yes
no
yes
no
•
yes
no
•
yes
no
Family Systems Pathology
•
•
yes
no
yes
no
•
•
yes
no
yes
no
•
yes
no
The court should be extremely cautious when asked to consider assessment and treatment
packages offered by the same or linked providers.
References:
1.
Guidance on the use of Psychologists as Expert Witnesses in the Family Courts in England and
Wales (Standards and Competencies) - June 2023 | BPS
2.
https://www.judiciary.uk/wp-content/uploads/2021/10/PFD-Memo-Experts.pdf
83