THE MISDIAGNOSIS OF PARENTAL ALIENATION

SYNDROMEBarry Brody, Ph.D., L.M.F.T.

9495 Sunset Drive, Suite B-295Miami, Florida 33173

(305) 595-1770Email: Drbbrody@aol.com

2003 Annual ConferenceFlorida Association for Marriage and Family

TherapyMay 25, 2003

AGENDA

1. What Is Pas? (9:00A.M.-9:50A.M.)History and BackgroundBaseline Data and Criteria

2. How To Diagnose PAS(10A.M.-10:50A.M.) Legal ContextCauses of MisdiagnosisCollateral Issues

3. Solutions (11:00A.M.-11:50A.M.)Treatment ParametersCourt Interventions

“…it must be understood that all mental health professionals are not aware of nor know how to treat the PAS phenomenon. In fact, when a mental health professional unfamiliar with PAS is called upon to make a recommendation about custody, access, or related issues, he or she potentially can do more harm than good.”

Bone and Walsh (1999)

“Many professionals with lots of experience do not fully understand

Dr. Gardner’s work. This is probably because they have never

really taken the time to read his books.”

Dr. Barry Bricklin

“With increasing recognition of PAS, it is predictable that it will be misdiagnosed,

overdiagnosed, and utilized improperly. This is true of just about any psychiatric

disturbance, and as a fact, of any medicine. With increasing knowledge and experience we

should be able to delineate these various complications regarding correct diagnosis. In short, not all campaigns of denigration are the

result of manifestations of PAS and not all campaigns of denigration are manifestations

of abuse. Life is just not that simple.”

Dr. Richard Gardner (2001)

“If you are looking for truth and justice don’t go into a courtroom”

A.S. Brody, Esquire

Fatherly advice offered to his son

History and Background

1. Legal Developments:

a. Replacement of tender-years presumption with the best-interests-

of- the-child presumption (gender-blind).

b. Replacement of sole custody with joint custody preference.

History and Background2. Mental Health Developments:

a. 1980-Surviving The Breakup-Wallerstein & Kelly.b. 1985-Recent Trends in Divorce and Custody

Litigation-Gardner.c. 1987-The Parental Alienation Syndrome and the

Differentiation Between Fabricated and Genuine Child Sex Abuse-Gardner.

d. 1992-The Parental Alienation Syndrome: A Guide for Mental Health and Legal Professionals-Gardner.

e. 1998-The Parental Alienation Syndrome, 2nd Edition-Gardner.

f. 2002-Publication of PAS Table-Diagnosis of The Three Levels of PAS Alienators-Gardner.

g. Gender Shift

PAS Definitions1. “Although this syndrome certainly existed in the past, it is occurring

with such frequency at this point that it deserves a special name. The term I prefer to use is parental alienation syndrome. I have introduced this term to refer to a disturbance in which children are obsessed with depreciation and criticism of a parent—denigration that is unjustified and/or exaggerated. The notion that such children are merely ‘brainwashed’ is narrow. The term brainwashing implies that one parent is systematically and consciously programming the child to denigrate the other parent. The concept of the parental alienation syndrome includes the brainwashing component but is much more inclusive. It includes not only conscious but subconscious and unconscious factors within the parent that contribute to the child’s alienation. Furthermore (and this is extremely important), it includes factors that arise within the child—independent of the parental contributions—that contribute to the development of the syndrome.” Gardner, 1985.

PAS Definitions

2. “The parental alienation syndrome (PAS) is a childhood disorder that arises almost exclusively in the context of child-custody disputes. Its primary manifestation is the child’s campaign of denigration against a good, loving parent—a campaign that has no justification. It results from the combination of a programming (brainwashing) parent’s indoctrinations and the child’s own contributions to the vilification of the target parent. When true parental abuse and/or neglect is present, the child’s animosity may be justified and so the parental alienation syndrome explanation for the child’s hostility is not applicable.” Gardner, 2002.

The Need To Correctly Diagnose PAS

• Time

• Effects of PAS

Cast of Characters (The Spin Zone)

• Mother• Father• Step-parent• Children• Attorneys• Judge• Guardian Ad Litem• Child Advocate/DCF • Mental Health Professionals (Treating/Evaluator)

“Don’t do something. Stand there!” Dr. Richard Gardner (1996)

“I cannot emphasize strongly enough that evaluators should never lose sight of the crucial medical dictum: diagnosis before treatment.”

Dr. Richard Gardner (1998)

“…it is important that a proper diagnostic evaluation be conducted in order to ascertain specifically in which category the child’s symptoms lie: mild, moderate or severe. Each type warrants a very different approach. Failure to make this discrimination may result in grievious results, with significant psychological trauma to all concerned parties.”

Dr. Richard Gardner (1998)

“Accordingly, a proper PAS evaluation rests on the foundation of a solid and thorough child-custody assessment.”

Dr. Richard Gardner (1998)

PAS Diagnostic Considerations

• Generally Court-Ordered

• Forensic versus Clinical Context

• Guidelines for Conducting Child Custody Evaluations

• No Standard Psychological Tests for PAS

• Subjective Evaluator Bias Increased by Utilizing Specified PAS Diagnostic Protocol (Interviews and Observations)

PAS Evaluation Parameters(PAS Diagnostic Protocol)

• Grandma’s Criteria=Stronger-Healthier Psychological Bond

• Blank Screen Approach• Only Utilize Interview Format• Initial Interview with Both Parents• Individual Interviews with Each Parent• Individual Interview with Child• Joint Interviews-Parent and Child• Family Interview

The Ideal Evaluator(based on Turkat, 1993)

1.Significant training in the area of child development, with particular understanding of the stages of development, and how they interact with the positive and negative attributes of each parent.

2. Significant training in psychopathology, with particular understanding of the factors that promote the development of mental disorders.

3. Special expertise in the areas of personality and personality disorder.4. Top-notch diagnostic skill.5. Many years of experience as a practicing clinician.6. Be able to document having accomplished a significant number of decisions that

reflect an unbiased record.7. Make it clear to the Court that his or her tests, interpretations, and recommendations

are potentially subject to error, and give some indication to the Court regarding the range and degree of possible error involved.

8. Significant training in the areas of attachment theory and object-relations.9. Significant training in the area of evaluator bias, with specific focus on procedures

utilized to minimize bias.10. Significant training in the area of Parental Alienation Syndrome.11. Supervised experience in conducting PAS evaluations.12. Personal therapy.

Common PAS Diagnostic Errors(Warshak)

1. Misunderstanding of PAS Definitionthree essential elements:

persistent rejection or denigration

response is unjustified

partial result of alienating parent

Common PAS Diagnostic Errors(Warshak)

2. Five Differentiating Factors in PAS Kidshostility and/or rejection is:

temporary/short-lived vs. chronic

occasional vs. frequent

occurs only in certain situations

coexists with expressions of love

is directed at both parents

Common PAS Diagnostic Errors(Warshak)

3. Child resists becoming alienated

4. Child alienated not due to favored parent’s influence- “child-driven alienation”

5. “Undiagnosed PAS”/False Negative-Bone and Walsh

Potential Causes of Misdiagnosis of PAS

Procedural Variables1. Context of PAS Evaluations

inappropriate assessment methodssubjective bias

2. Unintentional Evaluator Errorstechnicalknowledge-based

Personal Variables1. Bias2. Validators3. The Non-Existence of PAS4. MHP’s Attitudes and PAS

Sample Court Order

ORDER GRANTING MOTION FOR PSYCHOLOGICAL EVALUATION OF MINOR CHILD

THIS CAUSE came on Former Husband’s Motion for Psychological Evaluation and the Court having heard argument of counsel and being otherwise advised in the premises, it is hereby

ORDERED AND ADJUDGED that the Court grants Former Husband’s Motion for Psychological Evaluation and orders a psychological evaluation be conducted upon the parties’ minor child for the purpose of determining whether there is any psychological evidence of parental alienation.

Collateral Issues

• DSM-IV• Syndrome• PA vs. PAS• Abuse vs. PAS• Legal Process Therapy Trauma• Reliability• Recognition in Court• Recognition in the Mental Health Community

“My experience has been that the vast majority of therapists have contributed formidably to the pathological empowerment of PAS children.”

Dr. Richard Gardner (2002)

“One of the most surprising and discouraging findings in this survey was that in 15 families in which a parent was successfully alienated, the alienation was supported by a therapist on the basis that the child should not be separated from a ‘symbiotic relationship’ (with the alienating parent), even though the ‘symbiosis’ proceeded far beyond the time when such a parent-child relationship could even be remotely considered. It was as though the therapists had joined the delusion that the child could not survive if separated from the symbiotic parent.”

Dr. Deidre Rand (1997)

Treatment Parameters

1. Court-ordered with Specific Sanctions2. Personality Characteristics of Therapist

authoritarian vs. passiveknowledge of PASOne Therapist for Whole FamilyNon-Traditional ConfidentialityThreat Therapy

3. Increased Frequency of Visits4. Use of Videotape5. Child’s Need for Dictatorial Approach

Mild PAS Cases

Treatment: None usually indicated

“attempted PAS” ? (Bone and Walsh)

collateral issues re:divorce

Legal: Court Order that Alienating Parent Will Be Awarded Primary Custody

Moderate PAS Cases(Plan A)

Treatment: By Court-Ordered PAS Therapist

Legal: Court Order that Alienating Parent Will be Awarded Primary Custody

Court-Appointment of PAS therapist

Specified Court Sanctions

Moderate PAS Cases(Plan B)

Treatment: By Court-Ordered PAS Therapist

Legal: Court Order that Primary Custody Transferred to Alienated Parent

Court-Appointment of PAS therapist

Extremely Restricted and Monitored Visitation by Alienating Parent

Severe PAS Cases

Treatment: Monitoring of Transitional-site Program by Court-Ordered PAS Therapist

Legal: Court Order that Primary Custody Transferred to Alienated Parent

Court-Ordered Transitional-site Program

Transitional Site Program

1. 3 Levels (based on restricted access)a. home of relative/friendb. shelterc. hospital or detention center

2. 6 Phasesa. no contact with alienating parent, visit by alienated parent on siteb. visit by child at alienated parent’s homec. discharge to alienated parent’s homed. monitored telephone and mail contact with alienating parente. visits by alienating parent in alienated parent’s homef. Visits to alienating parent’s home

“It is out opinion that one of the most powerful tools the courts have is the threat and implementation of environmental modification. Of the approximately four hundred cases we have seen where the courts have increased the contact with the target parent (and in half of these, over the objection of the children), there has been positive change in 90 percent of the relationships between the child and the target parent, including the elimination or reduction of many social-psychological, education, and physical problems that the child presented prior to the modification.”

Clawar and Rivlin (1991)

“The predictable reluctance of the court to take action in all of the aforementioned areas is one of the important reasons why the PAS is such a widespread disorder.”

Dr. Richard Gardner (2001)

“Lawyers who work within the adversary system, although they are doing what they were taught to do in law school, that is zealously support their clients, are playing an active role in promulgating and entrenching the PAS.”

Dr. Richard Gardner (2002)

Court Interventions

1. Sets Foundation for Therapy

2. Appoint Therapists with Knowledge of PAS

3. Implement Sanctions for Alienating Parent

4. Appoint Guardians with Knowledge of PAS

“Whether or not one chooses to use Gardner’s terminology, the problems posed by these cases to families, professionals and the courts are very real. Reluctance to consider Parental Alienation Syndrome by name, along with the diagnostic and interventions it entails, tends to contribute to the perpetuation of the problem in a variety of ways. Like any other label, that of PAS has the potential to be misapplied and misused. Whether or not it is the appropriate diagnosis in a given instance must be determined based on facts of the case, corroborated historical evidence and data from multiple sources. An appropriate diagnosis of PAS, including level of severity as Gardner recommends, can make the difference between allowing a case to go beyond the point of no return or intervening effectively before it is too late.”

Dr. Deidre Rand (1997)