Parent-Child Contact Problems: News You Can Use William Bernet, M.D. william.bernet@vanderbilt.edu AFCC 12th Symposium on Child Custody Evaluations Atlanta, Georgia – November 2016

Definition: “Parental Alienation” A child – usually one whose parents are engaged in a high-conflict separation or divorce – allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification.

Causing PA is Child Maltreatment Alienated Parent Alienating Parent Blame Blame Child

First Topic WHAT HAPPENED WITH THE ATTEMPT TO HAVE PARENTAL ALIENATION INCLUDED IN DSM-5? BREAKING NEWS: The concept of parental alienation is in DSM-5, although the actual words are not.

Published 2010 Edited by William Bernet With 70 contributors

Published 2013

The DSM-5 Task Force said … Parental alienation did not meet the standard definition of a mental disorder, that is … “the requirement that a disorder exists as an internal condition residing within an individual” (letter from D. A. Regier, January 2012). Parental alienation should be considered a relational problem because it involves a problem between the child and one or both parents.

DSM-5 Terminology MENTAL DISORDER = all the common mental illnesses in Section II of DSM-5. MENTAL CONDITION = all the topics in the chapter, “Other Conditions That May Be a Focus of Clinical Attention.” “OTHER CONDITIONS” includes Relational Problems Child Maltreatment Adult Maltreatment etc.

Parental Alienation – a Relational Problem The words, “parental alienation,” are not in DSM-5, but the concept of parental alienation is expressed in three diagnoses in DSM-5 … Child affected by parental relationship distress Parent-child relational problem Child psychological abuse

What is CAPRD? Child affected by parental relationship distress = “This category should be used when the focus of clinical attention is the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the family, including effects on the child’s mental or other medical disorders.”

What is CAPRD? Intimate partner distress (frequent arguing) → anxiety, depression Intimate partner violence (physical abuse) → PTSD Intense loyalty conflict → somatic, psychological symptoms Parental alienation → false beliefs, false memories

Important Differences … IPD vs. IPV CAPRD vs. parent-child relational problem Loyalty conflict vs. parental alienation Alienation vs. estrangement

What about ICD-11? The people who are developing ICD-11 say, “Parental alienation is used as an example in the expanded diagnostic guidelines” for caregiver-child relational problem. See chapter on “Factors Influencing Health Status or Contact with Health Services.”

Why does it matter for parental alienation to be in DSM and ICD? Training programs for mental health professionals will include parental alienation Insurance companies might pay for treatment Acceptance of parental alienation in legal settings

Second Topic IS THERE A WAY (FOR CLINICIANS AND FORENSIC EVALUATORS) TO DISTINGUISH ALIENATION AND ESTRANGEMENT? BREAKING NEWS: A simple psychological questionnaire clearly demonstrates “splitting,” which occurs in alienation, not in estrangement.

What’s the difference? PARENTAL ALIENATION – rejection of a parent without a good reason. PARENTAL ESTRANGEMENT – rejection of a parent for a good reason, such as abuse or neglect.

What’s the difference? ALIENATION – rejection is very strong – defense mechanism of splitting. ESTRANGEMENT – feelings toward rejected parent are ambivalent – no splitting. Results are counterintuitive, but convincing.

Parental Acceptance-Rejection Questionnaire

Parental Acceptance-Rejection Questionnaire PARQ – self-report instrument measures children’s perceptions of parental acceptance and rejection. Most items refer to parental behavior, not attitudes. Lowest possible score = 60 = very positive. Highest possible score = 240 = very negative.

Alienation vs. Estrangement

Conclusion The PARQ is useful for both clinicians and forensic practitioners in evaluating children or divorced parents, when there is a concern about the possible diagnosis of parental alienation. Of course, this research needs to be replicated.

Join Parental Alienation Study Group www.pasg.info