1. Important Updates Regarding Parental Alienation
William Bernet, M.D.
American Academy of Child and Adolescent Psychiatry
New York, NY – October 2016

2. Disclosures of Potential Conflicts
Source
Research
Funding
Advisor
Consult
Employee
Speaker
Bureau
Books
In-kind
Stock,
Equity
Honorarium
Charles C Thomas XX
Krieger Publishing
Seminar in
Forensic Sciences

3. 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.

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

5. 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.

6. Published 2010
Edited by
William Bernet
With
70 contributors

7. 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.

8. 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.

9. 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

10. 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.”

12. 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

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

14. 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.”

15. 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

16. 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.

17. 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.

18. 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.

19. Parental Acceptance-Rejection Questionnaire

20. 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.

21. Alienation vs. Estrangement

22. Conclusion of Recent Research
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.

23. Third Topic
IS THERE A TREATMENT FOR SEVERE PAREN- TAL ALIENATION, WHEN THE CHILD HAS A STRONGLY HELD FALSE BELIEF THAT THE REJECTED PARENT IS EVIL OR DANGEROUS? BREAKING NEWS: Causing parental alienation is child psychological abuse. In severe cases, it may be necessary to remove the child from the abusive parent.

24. Levels of Severity of Parental Alienation
MILD PARENTAL ALIENATION: Child resists contact with rejected parent, but enjoys relationship with that parent once parenting time is underway.
MODERATE PARENTAL ALIENATION: Child strongly resists contact and is persistently oppositional during parenting time with rejected parent.
SEVERE PARENTAL ALIENATION: Child persistently and adamantly refuses contact and may hide or run away to avoid being with rejected parent.

25. Clinical Interventions for Parental Alienation
MILD PARENTAL ALIENATION: Court may strongly admonish parents to stop exposing their child to conflict and stop under-mining child’s relationship with the other parent.
MODERATE PARENTAL ALIENATION: Comprehensive ap-proach with preferred parent, rejected parent, and child to change their attitudes and behaviors. In some cases, it is necessary to remove child from the influence of the preferred parent.
SEVERE PARENTAL ALIENATION: It is almost always neces-sary to remove child from the influence of the preferred parent.

26. Interventions for Severe Parental Alienation
Richard Gardner (2001). Should courts order PAS children to visit/ reside with the alienated parent? A follow-up study. American Journal of Forensic Psychology.
Symptoms Reduced or Eliminated
Symptoms Not Reduced
or Eliminated N
Custody Changed or Alienator’s Access Reduced 22
Custody Not Changed or Access Not Reduced 7 70 77 29 99

27. Interventions for Severe Parental Alienation
Richard Warshak (2010). Family Bridges: Using insights from social science to reconnect parents and alienated children. Family Court Review.
“By the conclusion of the workshop, 22 of the 23 children, all of whom were severely alienated at the outset, and had prior failed experiences with counseling, had restored a positive relationship with the rejected parent as evidenced by the children’s own statements, by the observations of the parent and workshop leaders, and by the observations of the aftercare specialist.”

28. Interventions for Severe Parental Alienation
Richard Warshak (2015). Parental alienation: Overview, manage-ment, intervention, and practice tips. Journal of the American Academy of Matrimonial Lawyers.
Larger study of 88 subjects. “At the workshop’s conclusion, 95% of the child participants recovered a positive relationship with the rejected parent. … They complied with the court’s custody decision, and were prepared to return home with their formerly rejected parent….”
NOTE: In both Warshak studies, some children later relapsed, usually because of premature contact with the preferred parent.

29. Interventions for Severe Parental Alienation
Kathleen Reay (2015). Family Reflections: A promising therapeutic program designed to treat severely alienated children and their family system. American Journal of Family Therapy.
“The pilot revealed a 95% success rate (21 of the 22 children) in reestablishing a relationship between the children and their once-rejected parents between the second and third day of the retreat as evidenced by the children’s statements, parents’ statements, and observations of the multidisciplinary team at the retreat.”

30. Join Parental Alienation Study Group www.pasg.info