Some would have it that all parental alienation involves personality disorder, I disagree. Some children become alienated in situations where there isn’t a whiff of personality disorder in sight and they are just as alienated, just as entitled, arrogant and dismissive of the parent they are ‘choosing’ to reject.  In my experience, relying upon personality disorder as a diagnostic indicator for parental alienation approaches the differentiation of the problem in the wrong direction.  If one relies upon the presence of a personality disorder to arrive at a diagnosis of parental alienation (which is now recognised by the World Health Organisation and is included in the new edition of the International Classification of Diseases (ICD-11) as a synonym or an index term for the specific diagnosis of QE52.0 Caregiver-child Relationship Problem) then the exclusion of many families where children are alienated but where personality is not present in either parent, will occur.  That for me is unacceptable because those families where a child is alienated but personality disorder is not present, face EXACTLY the same outcome as those where it is. The child is still alienated. The rejected parent is still rejected and the aligned parent remains in a position of control and power over the child.

In our work we use a differentiation approach to understand the child’s route into the alienated state of mind.  When we do this work we spend a good deal of time with a family to properly observe and figure out the dynamics.  In our rolling assessment, in which we delivery therapeutic testing as part of our assessment, we start from a place of understanding the counter intuitive nature of parental alienation where all is never as it seems.  This forensic examination, enables us to provoke to the surface, the dynamics of the alienation narrative and work out what is really going on to cause the child to enter into the psychologically split state of mind as a defence mechanism.

As Steve Miller wrote

“Alienating parents tend to present well; targeted parents tend to present poorly. As a rule, alienating parents present with the Four C’s. They are cool, calm, charming, and convincing. That is because effective alienators tend to be master manipulators … In contrast, targeted parents tend to present with the Four A’s. They are anxious, agitated, angry, and afraid. That is because they are trauma victims. They are attempting to manage a horrific family crisis, usually without success, often while being attacked by professionals who fail to recognize the counterintuitive issues. Indeed, non-specialists often get these cases backwards” – Steven G. Miller, M.D., Massachusetts, USA –

and in all of our work we approach a case of a child’s complete rejection of a parent as a red flag which signals the potential presence of parental alienation.  In the first part of our assessment we check that what we are seeing is the unjustified rejection by the child and we do this by looking at the information coming from the child about their relationship with each parent.  The child who is alienated presents with the signs of alienation which are unmistakeable and repeated in startling similarity by different children.  Arrogant entitlement, cruelty without remorse, stark division of feelings into wholly good and wholly bad, a determination that these are their own feelings, tales of the rejected parent’s ‘horrific’ abuse which are actually weak and unbelievable and out of proportion to the child’s reaction, a sense of omnipotence and a belief that they and only they can determine the future are the clear signs seen.  When these signs are seen, we approach the case counter intuitively – knowing that everything which is being presented is likely being shown to us back to front and upside down.

In the UK it is not possible to force someone to have a psychological assessment in the court process and it is very unlikely that any aligned parent would submit to one outside of that. And so the only option we have, if we suspect personality disorder, is to recommend psychological assessment and hope that the Judge will support our request for that.  Given that  parental alienation is also about power and control however, it is often the case that even when we suspect personality disorder, it is not something we can use as a diagnostic indicator with any real reliability and so, when we see a pure case of parental alienation, where we suspect personality disorder, what we have to do in the court process is point to the significant harm being caused by the parent in driving the child into the psychologically split state of mind.  In such circumstances we recommend a transfer of residence and alongside that we offer our residence transfer intervention which supports the integration of the split state of mind in the child.  In the UK we use direct residence transfer and the use of ‘stepping stone’ transfer in which the child is moved to live with foster parents whilst the work is undertaken to restore the integrated state of mind which enables the child to drop the rejecting behaviours.  In all cases we work to restore relational health in the child and an integration of the splitting.

Removing the masks is a key part of our forensic work and it is often not until we have been with a family for some weeks that we see the mask begin to slip.  In static assessment, which is when someone meets the members of the family once and writes up a report on that meeting, masks can be held firmly in place and it can be extremely difficult for practitioners to hang on to their core need to think counter intuitively.  As Steve Miller says, some of the alienating parents I have worked with have been the most plausible, sweet, kind and charming people I have ever met.  They are innocent and seemingly open to scrutiny, they are  compliant and often dependent very quickly and they behave as if butter wouldn’t melt in their mouths.  Whilst rejected parents can often be brittle, aggressive, defensive, angry and seemingly controlling, so desperate are they for someone somewhere to see what is happening to their children.  When faced with this confusing presentation on a one off basis, it is all to easy to slip into the belief that what the children are saying is the truth.  But spend time with these parents and in particular, ask the aligned parent to do what they do not want to do (make the child see the rejected parent for example) and the mask begins to fall quite quickly.

When the mask begins to slip and the evidence begins to unravel it is time to plan the intervention to bring the children into relationship with the rejected parent.  We only do this when we have the full backing of the court and when the legal and mental health interlock is properly and safely achieved.  The legal and mental health interlock is the way that the court recognises the need for the counter intuitive approach in mental health and holds the power dynamic over the alienating parent firmly enough to allow that to be delivered.  A court ordered transfer of residence is one example of the legal and mental health interlock, although even that can be less then secure if, for example, the whole of the professional team around the family is not speaking with one voice.  There is a truism in this work, which is that the legal and mental health interlock is only as strong as the weakest link.  And in cases where someone has been weak in their belief and understanding (social workers for example or unskilled Guardians who don’t really believe in parental alienation) all the forensic work to prepare the intervention can be rapidly undermined and in fact ruined through the sabotage caused by unconscious or sometimes conscious disbelief.

Much occurs in the hidden world of parental alienation which is in reality the hidden face of the family, the shadow side.  All families have a shadow, that place in which all the things which are unwanted and intolerable to the family consciousness are placed.  And in it is in this shadow where the source of the distortion which causes the alienation reaction in children is found.  Whilst on the surface, those who seem the kindest and most charming people are dripping poison into the family system, those who are unaware are going about their business completely unprepared.  When the mask slips and the perpetrator is revealed, people are often astonished at how such manipulation is achieved.

Knowing how to identify the purveyor of the poisoned apple is one of the key skills of an alienation aware practitioner.

Being able to hold one’s nerve, whilst working in the creeping dread of the shadow side of the family for long enough to unmask him/her, is quite another.


Steve G Miller is A Clinical Instructor of Medicine at Harvard Medical School, Dr. Miller is board certified in internal and emergency medicine and has extensive experience in experience in forensic medicine, forensic psychiatry, and psychology.  Steve will talk about the counter intuitive in practice with parental alienation on Day One at the EAPAP Conference on August 30/31 in London.  You can see Steve Miller in discussion about parental alienation here.


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