‘Thank you for sharing this, Karen. From the perspective of an adult alienated child, I will say your words are completely accurate. No amount of therapy for me or my alienated mother would have changed my father’s behavior or the circumstances. And my father would have had to cooperate and participate in years of intense therapy in order to change his ways. As long as I was under the influence of my father, no therapist in the world would have been able to get me to let down my defenses. In fact, I repressed my love for my mother as a way to survive emotionally, in my father’s care, and therefore became consciously unaware of my own feelings. From my child perspective, no one was as powerful as my father, and until he was removed from my life, I would live according to his wishes. And it’s worth noting that I was the least brainwashed : my sister actively rejected and “hated” our mother. I simply remained numb and neutral, obediently going along w/ our father’s plan.’  From A Mother Erased

On Saturday I wrote about the perils of therapy in alienation cases and about the way in which it is often recommended but rarely (if ever) seen to have any real impact without strong legal compulsions for behavioural change.  I decided that, in the climate of needing to educate and inform, that rather than a shooting from the hip style approach, this topic deserves a serious piece, in which the evidence is clearly laid out.  I was further encouraged to rewrite this by the comment left on the previous piece which is shown above, words from an adult who was alienated as a child from her mother and who is now herself alienated from her children. Evidence indeed that this is a transgenerational problem and that this is not something that we could or should simply avoid or walk away from. For too long now the issue of loss of a child after family separation has blighted people’s lives around the world and it is not the case that there is nothing that can be done about it. Much can be done, even in the most complex of family situations but what can be done is not therapy in any of its straightforward meanings.

I am a member of the International Parental Alienation Studies Group which is organised by  William Bernet M.D who is professor Emeritus at Vanderbilt University. He is a Psychiatrist who has written widely on the issue of parental alienation and who is co-editor of the Handbook for Mental Health and Legal Professionals (2013).  Professor Bernet has additionally co-ordinated the extensive bibiliography on research into parental alienation which is available to the public.  This database of information, contains the wealth of research into the existence and impact of parental alienation on children and their families and is a valuable resource for anyone working in this field or simply wishing to further understand the issues.  It is from this database, as well as my own research, which reveals a rich existence of peer reviewed articles and studies, that the evidence that therapy in its standard forms is unhelpful in cases of parental alienation, can be found.

I entered the term ‘therapy’ into the database this morning to see what it produced and found thirty nine research articles listed, some of which explain the ways in which the clinical picture found in alienation interlocks with different models of therapy. Anyone interested can do the same.  Additionally, I reviewed the evidence from The Handbook for Mental Health and Legal Professionals (2013) and found a whole chapter written by Richard Sauber devoted to the way in which therapy should interlock with the legal system in order to be effective. In his tables (pages 194-195) he shows the difference between ordinary forms of psychotherapy and court ordered work. In my experience this is the core of the issue which we in the UK have to get to grips with in order to routinely be able to intervene successfully in any intervention for parental alienation with the word therapy attached to it, Currently, as therapy cannot be ordered by the court in the UK, we have a variable range of approaches to supporting families in these circumstances, most of which involve parents consenting to therapy in its standard form.

Sauber outlines, in his chapter of the same book (page 194), the difference between court ordered therapy and standard forms. He discusses the way in which the role of forensic court appointed therapist must follow twin track requirements of the court guidelines and the ethical guidelines of their profession. This is indeed a complex matter and one which at least one of the governing bodies of counselling and psychotherapy in the UK have not yet recognised, although the HCPC, the governing body for Psychologists and Independent Social Workers has, offering a layer of protection for members acting as expert witnesses*.

Anyone therefore, who is acting as a therapist in parental alienation cases, is going to be challenged by the reality of what is required in the role if it is going to bring about successful outcomes for children. Perhaps this is why so many people offer standard forms of therapy and believe that if that doesn’t work it is because parents are simply beyond help. A popular and regularly recommended forms of therapy are family therapy, particularly systemic, however as shown by Woodall (2016) this approach is clearly not going to work where there is a necessary need to change the power dynamic and hold parent’s responsible for their behaviours. Anyone who has done even the smallest amount of research into the area, reading or citing work by the most recent authors  Gottlieb (2012), Fidler, Bala and Saini (2012),  (Baker and Sauber (2013)  Lorandos, Bernet and Sauber (2013), has to be aware that therapy in its standard forms is contraindicated in alienation cases.  So why does therapy continue to be recommended?

Perhaps it is because there are few people in the UK who really understand what is required and even fewer who are willing to undertake the work in the format which is necessary to help children. My view is that this is not because there isn’t the evidence for the what is really needed, there simply isn’t the appetite. Additionally, there may also be a risk averse population of therapists who, keen to ensure that they do not fall foul of the guidelines of their professional governing body, are reluctant to work in ways that are necessary with alienating parents, who are often an extremely adversarial and often litigious cohort of people.

The research evidence shows that the court is an essential part of the therapeutic process (Bala, Fidler and Saini 2012). Families in which parental alienation exists, will only change when there is scrutiny and external motivation. (Drozd as interviewed by Bala, Fidler and Saini 2012).  Thus, any therapeutic intervention which is delivered in such a case, must be constructed within the legal framework it is being delivered in and must be outwardly accountable. This is why the interlocking relationship of the court and the mental health services which support such families is necessary, in this field, one cannot work without the other. Whilst such therapeutic interventions may contain elements of different modalities, cognitive behavioural, dialetical behavioural, psychodynamic and solution focused therapy being only some of the strands of therapeutic approaches which are useful in such cases, all interventions are governed by the court and are different to standard therapy in that they are open to scrutiny and not governed by the same rules of confidentiality (Sullivan and Kelly 2001).

Most recently the issue of ethics and the mental health professional working with parental alienation has been raised by Dr Childress on his blog, where he points out that the core concepts of his reformulation of Gardner’s original concept of parental alienation, would necessarily lead to all mental health professionals who recommend standard therapy for alienation, being seen to transgress the ethical guidelines of the American Psychological Society. Whilst Childress can appear controversial in his approach to the argument, there is something in what he has done in reformulating the concepts and linking those issues seen in alienation cases back to the DSM V.  If, as he argues, all professionals working in this field were properly regulated by the research and an internationally recognised diagnostical framework, standard therapy for such cases would fall out of favour, because the evidence shows that it does not work AND it risks making things worse for children.

In the shadow of such a framework it would automatically be easier to increase the delivery of the interventions which are shown to work, which are combinations of systemic work which is psycho-educational in nature combined with compulsion towards behavioural change via contracting, goal setting and external scrutiny which is provided by the court.(Bala et al 2012). All such cases would be triaged and any in which the child concerned appears to fall back into alienated behaviours would be further assessed via psychological means to determine the presence or not of personality disorder. This strategic approach to evaluating and triaging cases means that those intractable cases which languish for years in court, with a revolving door of professionals, could now be resolved within the twenty six weeks now alloted in the UK for case management time in court.

The UK clearly has a long way to go before it reaches the point where this approach is routinely used in the court process but that should not stop us from highlighting best practice from other jurisdictions and demonstrating wherever possible that using these approaches works.  The closest that the UK can currently come to dealing with families in this combined therapeutic and court based approached is the use of transfer of residence, in which the primary residence of the child is changed and the underlying power dynamic is changed with it.  In the shadow of such action, much can be achieved, with parents often either coming to their senses or at least being willing to participate in therapeutic work. That should not mean however, that consent to participate should remove a case from court, far from it. All cases of therapeutic intervention should remain under the watching eye of the court until the child concerned is shown to be in full recovery from the alienation reaction and can be seen to move freely between parental homes. In some cases it may not be possible for this to happen. Where a parent is shown to have a personality disorder that is not responsive to therapeutic intervention for example, contact between the child and that parent may have to be restricted.

Any therapist who is familiar with the research and who has undertaken transfer of residence of a child will be very familiar with the psychological splitting of the child. This psychological coping mechanism, which leads to the phenomenon of the idealised/demonised division of feelings about their parents, causes children a great deal of harm. (Baker &Sauber 2013, Bernet et al 2013, Clawar & Rivlin 1991, Dunne & Hendrick 1994, Gardner 1998, Johnstone 2003, Kelly & Johnstone 2001,  Wallerstein & Kelly (1980) Waldron & Joanis 1996, Warshak 2001). A child who is saying on the surface that they hate their parent and using weak and spurious reasoning for doing so, who is seen to be involved in an overly close relationship with a parent they profess to love beyond measure and who is making proclamations of hatred or simply saying that they have no feelings about the other parent, must routinely be assessed for this phenomenon. Psychological splitting causes children  immense suffering (Baker 2007) and the core concern about parental alienation is in fact not even the relationship that the child loses with a parent (though that is terrible enough) but the psychological impact on their wellbeing over their entire lifetime. (Gottlieb 2012). This is reason enough to intervene and the evidence which is provided by studies undertaken by Amy Baker et al, as well as interviews with adult children who were once alienated and parents who were alienated as children who are now alienated themselves (see above comment), should provide mental health professionals with the impetus to stop this generational march of harm, by providing the right interventions, interlocked in the right way, with the legal system.

The interlocking of the mental health intervention with the legal process is key to the resolution of such cases and there is much that can be done in the UK immediately to bring about this change. It is not that the mechanisms do not exist to make this happen, it is that they are largely unknown and therefore little used.  Similarly, the lack of practitioner awareness, interest or committment amongst those who work in the court arena, in understanding and working with the issue of parental alienation, including how it is better dealt with in other countries, should not prevent us from highlighting wherever we can, the alternatives to the deeply sad and troubling outcomes which have been seen in too many of these cases over too many years.

*Taken From the HCPC standards of acceptance for complaints fact sheet:  Registrants often make decisions using their professional knowledge, skills and experience. Not everyone will agree with these decisions. We will not normally continue with concerns which challenge or second-guess registrants’ decisions unless there is evidence they have acted unprofessionally – for example, they have knowingly made a false statement or acted beyond their scope of practice. Similarly, we will not normally continue with concerns which challenge a registrant acting as an expert witness, unless there is evidence they have acted unprofessionally.

Baker, A. (2007) Adult children of Parental Alienation Syndrome:Breaking the Ties that Bind New York: W W Norton.

Baker, A. and Sauber, R. (2013) Working with Alienated Children and Families New York & London: Routledge

Clawar, S S. & Rivlin,  B V. (1991) Children Held Hostage: Dealing with Brainwashed and children. Chicago: American Bar Association Press.

Dunne, H. & Hendrick, M (1994) The Parental Alienation Syndrome an analysis of sixteen cases, Journal of Divorce and Remarriage 21 (3/4) 21-38

Gardner, R. (1992) The Parental Alienation Syndrome a Guide for Mental Health and Legal Professionals. Cresskill, NJ: Creative Therapeutics inc

Gottleib, L. (2012) The Parental Alienation Syndrome. Illinois: Charles Thomas

Johnstone, J.R.  (2003) Parental Alignements and Rejection : An empirical study of children of divorce. Journal of the American Academy of Psychiatry and Law. 31, 158-70

Kelly & Johnstone (2001)  Rethinking Parental Alienation and Redesigning parent-child access services for children who resist or refuse visitation. Paper Presented at at the International Conference on Supervised Visitation. Munich, Germany.

Sullivan, M.J. & Kelly, J.B. (2001) Legal and psychological management of cases with an alienated child. Family Court Review, 48. 115-134

Waldron, K.H.  & Joanis,D.E. (1996) Understanding and Collaboratively treating Parental Alienation Syndrome, American Journal of Family Law, 10, 121-133

Wallerstein, J.S. & Kelly, J.B. (1980) Surviving the Breakup. How Children and Parents Cope with Divorce. New York: Hyperion.

Warshak, R. (2001) Current Controversies regarding Parental Alienation Syndrome. American journal of Forensic Psychology. 20 (31-52).

Woodall, N. (2016) Why Systemic Family Therapy cannot help in cases of Parental Alienation. Retrieved from http://www.nickwoodall.net, last visted 30.5.2016