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Child Psychology Blogs

Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Saturday, March 16, 2019

When Arguments for Alternative Psychotherapies Cite Chemotherapy

Alternative psychotherapies (APs) are psychological treatments that are unconventional, are without any systematic empirical evidence about their safety and effectiveness, and in many cases are implausible in terms of psychological theory or established facts about child development. Some APs for children are directly harmful, and in the absence of evidence of their effectiveness we can consider all these treatments to be at least indirectly harmful--  for example, to use up families’ resources that would be better spent in other ways.

One possible harm done by APs for children is the infliction of discomfort either physical or emotional, sometimes with real pain and sometimes with the infliction of serious fear. Holding Therapy/Attachment Therapy, sometimes targeting adopted children and aiming at child obedience, gratitude, and the appearance of love for adopted parents, clearly involves both physical and mental discomfort caused by therapists. Nancy Thomas parenting (NTP), although it is not presented as a therapy by its advocates, is intended to bring about attitude and behavior changes like those that are goals of psychotherapy, and it too includes unpleasant, painful, and frightening experiences like being required to sit without moving for periods of time and having food limited in quantity and variety. Conversion therapy, a form of AP argued by its proponents to change same-sex orientation to heterosexuality, sometimes shares characteristics of holding therapy, and according to those who have experienced it, involves intense and disturbing efforts to change the nature of the treated person, in part through threats of eternal damnation.

Treatments for “parental alienation”, like Family Bridges and High Roads, are APs, as they lack empirical evidence of safety and effectiveness and are implausible as well as being unconventional. Like the other APs just mentioned, they depend on threats and fear to bring about certain changes in behavior. Children and adolescents given these treatments have reported not only distressing experiences during treatment, but also terror and discomfort when taken from their homes or schools or even from a courtroom by youth transport service workers who sometimes use handcuffs to restrain their charges.

How do proponents of APs justify the discomfort and fear experienced by children and adolescents receiving treatment—especially given that these methods are without evidence of effectiveness? An argument given by practitioners of Holding Therapy for many years has been that the treatment was analogous to chemotherapy for a child with cancer. Of course chemotherapy is painful, frightening, and distressing, but without it your child will die. The parallel suggested by these practitioners is that Holding Therapy is painful, frightening, and distressing, but without it your child will… perhaps not die, but become a serial killer (if male) or a prostitute (if female; these fates are apparently considered comparable), or will kill you, or will go to prison for some or all of the above. This, of course, is thorough abuse of an analogy, because although many children with untreated cancer do die, and although chemotherapy has been demonstrated to prevent many of those possible deaths, the same does not hold for Holding Therapy for treatment of childhood mental illness, antisocial behavior, or dissatisfaction of adoptive parents. First, although many serial killers have been shown to have had disturbed childhoods, it has not been shown that that childhood behavioral disturbances in general are of necessity followed by serial killing in later life. Second, it has certainly not been shown that children who receive Holding Therapy or other APs become less likely to have serious problems later—in fact, one might well predict that such children become even more likely to have emotional disturbances because of the resemblance of some AP techniques to other adverse childhood experiences.

Discussion of “parental alienation” treatments is beginning to focus on the distress and discomfort experienced by children and adolescents who undergo them. Advocates of these treatments argue that the untreated outcomes would be so bad that the discomfort is completely worth the benefits achieved. They claim, on the basis of very little evidence, that mental illness will result if a child is alienated from a parent and has no contact with that person. They argue also, without evidence, that children and adolescents who avoid one parent already have cognitive problems and disordered critical thinking.

I have yet to see practitioners of “parental alienation” treatments bring up the very faulty chemotherapy analogy as advocates of other APs have done, but no doubt someone will bring it up soon.

Judge Richard Dollinger Brings Common Sense to Parental Alienation Arguments

In a document posted at, the Rochester, New York judge Richard Dollinger brought some common sense to the issue of parental alienation (PA).

 PA advocates generally claim that when children of a divorced family are reluctant to have contact with one of the parents, their behavior is evidence that the preferred parent has “brainwashed” them to dislike the nonpreferred parent, that this treatment has caused or will cause mental illness in the children, that the preferred parent is thus guilty of child abuse, and that a complete custody change plus special PA treatment should be ordered. In a number of cases, judges have accepted this argument—often when no expert had testified about the serious problems of the PA concept and the lack of evidence for safety and effectiveness of the proposed treatments.
In the case about which Judge Dollinger opined, the experts testifying that PA was present and custody change was required were three well-known PA advocates, Amy Baker, Linda Gottlieb, and Robert Evans. As commonly occurs in these cases, they had not interviewed the three daughters of the divorced family, but based their arguments largely on their discussions with the father, who was claiming PA and asking that the girls be ordered to live with him and his girlfriend (the girls’ former nanny).

Judge Dollinger described various actions of the parents as foolish, intemperate, immature, boorish, and charged with a “win at all costs” spirit. However, he did not find these behaviors, or the attitudes of the girls, unusual among divorcing families. In addition, he did not find any evidence that the girls had been influenced to avoid their father, that they have actually avoided their father or that their father’s authority has been lessened. He noted that according to the father, the girls “ are often sullen when they come to his home, and that they do not immediately warm up to him when they arrive for visitation; although they eventually overcome their cooler .disposition and then warmly embrace him after time with him. Like many teenagers, they are not always in accord with the father's direction. He claims that the once close relationship between the nanny and the daughters has been altered since she became his girlfriend. Unsurprisingly, [Judge Dollinger continued] in the father's testimony he never suggests that the change might have something to do with his own conduct and the change of the nanny's role (from nanny to his girlfriend).” In addition, the judge noted, the  ”characterization that the children's undisputed consistent access to their father was nonetheless evidence of being "somewhat alienated" strongly suggests that this expert had no actual proof that the children are alienated from their father”. Consequently, Judge Dollinger did not order a custody change, PA treatment for the girls, or financial obligations of mother to father.

 Advocates of  PA appear to have overgeneralized from a rare although genuine family problem to common, even healthy, reactions of parents and children to changes in family structure. They have assumed that negative views of a former spouse, expressed for good legal or therapeutic reasons and not in the presence of children, should be accepted as evidence that the children are being manipulated by the preferred parent. Notably, they claim that PA is present even in cases where children do not resist or refuse visitation with a parent, and appear to base this claim largely on ordinary adolescent behaviors or preferences which would not be seen as “symptoms” in any intact family.

It will be a step in the right direction if other judges follow Judge Dollinger’s lead in demanding real evidence for claims of PA rather than accepting the unsubstantiated statements of PA advocates.

Wednesday, March 6, 2019

Childress Is Cross, Or, Don't Say "Ain't" When I Say "Is"

Craig Childress has kindly written my blog post for me today. I give his letter to me, below—it may differ from the original in bold-face parts and in paragraphing and does not bear the signature on the original. In this letter, Childress appears to be referencing my testimony in the Sahar vs Sahar custody case for which I described the judge’s decision and remarks about Childress’s testimony a few days ago.

C. A. CHILDRESS, Psy.D. LICENSED CLINICAL PSYCHOLOGIST, PSY 18857 219 N. INDIAN HILL BLVD., STE. 201 • CLAREMONT, CA 91711 • (909) 821-5398 3/5/19
 To: Dr. Jean Mercer
 Re: Possible Ethics Violations
 I am providing you with this letter pursuant to my professional responsibilities under Standard 1.04 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.
,1.04 Informal Resolution of Ethical Violations When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. Additionally, I am also concerned that this attempt at informal resolution of these professional concerns may be inadequate to provide patient protection, which may then activate my obligations under Standard 1.05 of the APA ethics.
1.05 Reporting Ethical Violations If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations, or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities. Pursuant to my obligations to the involved client, I am currently preparing a written review of your testimony in a matter in California for the involved client.
 Of concern are: 1. Possible Violation of California State Law: In California, the term “psychologist” is a legally protected term and only licensed psychologists may use the term “psychologist” in referring to their professional standing. You are not licensed in the state of California or any state, and your background and training would not qualify you for licensure. To hold yourself out in your testimony to the court as a “psychologist,” either directly or by implication to the court, or as “an expert in the field of psychology” would likely be in violation of California state law. California Business and Professions Code BPC § 2902 (c) A person represents himself or herself to be a psychologist when the person holds himself or herself out to the public by any title or description of services incorporating the words “psychology,” “psychological,” “psychologist,” “psychology consultation,” “psychology consultant,” “psychometry,” “psychometrics” or “psychometrist,” “psychotherapy,” “psychotherapist,” “psychoanalysis, or 2 “psychoanalyst,” or when the person holds himself or herself out to be trained, experienced, or an expert in the field of psychology. California Business and Professions Code BPC § 2903 (a) No person may engage in the practice of psychology, or represent himself or herself to be a psychologist, without a license granted under this chapter, except as otherwise provided in this chapter. The practice of psychology is defined as rendering or offering to render to individuals, groups, organizations, or the public any psychological service involving the application of psychological principles, methods, and procedures of understanding, predicting, and influencing behavior, such as the principles pertaining to learning, perception, motivation, emotions, and interpersonal relationships; and the methods and procedures of interviewing, counseling, psychotherapy, behavior modification, and hypnosis; and of constructing, administering, and interpreting tests of mental abilities, aptitudes, interests, attitudes, personality characteristics, emotions, and motivations. Note that BPC § 2902(c) explicitly identifies “the person holds himself or herself out to be trained, experienced, or expert in the field of psychology” (emphasis added) as being prohibited without a license under BPC § 2903(a). Of concern is that representing yourself to the court as a “psychologist” and rendering testimony as a supposed “expert in the field of psychology” was a fraudulent misrepresentation of your qualifications to the court and was in violation of California state law.
2. Possible Violation of Standard 2.01a of the APA Ethics Code: An additional area of prominent professional concern is the apparent violation of Standard 2.01a of the APA ethics code.
 2.01 Boundaries of Competence (a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. You have no background education, training, nor experience in the domains of clinical psychology, nor in the assessment, diagnosis, or treatment of pathology. Rendering an opinion on issues of clinical psychology and the assessment, diagnosis, and treatment of pathology is beyond your boundary of competence based on your “education, training, supervised experience, consultation, study, or professional experience.” Of prominent concern is that much of your testimony about the assessment, diagnosis, and treatment of pathology in clinical psychology is factually incorrect, revealing stunning ignorance regarding the practice of clinical psychology (practice beyond the boundary of competence).
 3. Possible Violation of Standard 3.04 of the APA Ethics Code To the extent that your possibly fraudulent and ignorant testimony, in violation of California laws and Standards of practice in professional psychology swayed the court to 3 disregard a confirmed DSM-5 diagnosis made by a licensed clinical psychologist (licensed in the state of California) your testimony likely caused significant harm to the client family in violation of Standard 3.04 of the APA ethics code.
 3.04 Avoiding Harm (a) Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.
 Pursuant to Standard 1.04 of the APA ethics code, I am making you aware of my concerns regarding unprofessional conduct that violates both California state law and Standards of practice in professional psychology. Pursuant to Standard 1.05 of the APA ethics code, I will be providing the client with a report reviewing your testimony regarding its factual errors and my concerns regarding possible violations of California state law, BPC § 2902(c); BPC § 2903(a), and Standards 2.01a and 3.04 of the APA ethics code.
Craig Childress, Psy.D. Clinical Psychologist, PSY 18857

I did not, of course, violate any of the standards of the ethics code, as can be clearly seen in the official transcript of my testimony. I made special efforts to state that I am not a clinical psychologist or qualified to testify about aspects of a particular case, but am an academic psychologist (yes, there are such people) who has spent years studying alternative therapies with the potential for harm to children and adolescents. I commented on the incongruence of Childress’s approach to visitation resistance or refusal with attachment theory as it has developed from the time of John Bowlby. (Incidentally, Childress might like to mull over the fact that Bowlby initially claimed that children formed attachments only to one caregiver, and that one was normally the mother.) I discussed the opinions of current leading attachment researchers and theorists about the lack of predictable connections between early attachment patterns and later personality or mental health status, including a recent article that denied associations between disorganized attachment and adult characteristics. I also described research methods used in establishing diagnostic methods and evaluating the effectiveness and safety of any treatment method, and pointed out that Childress’s claims were not based on research evidence. Childress himself has said that in doing a Psy.D. degree he traded training in research for clinical training, so perhaps he is not aware of the issues about which I testified.

My goal in testifying in this and similar cases was to prevent the harm to children and adolescents that may result from the use of untested diagnostic and therapeutic methods.

Of course, I trust that Childress's letter has no relation to the fact that he and I are both to testify by phone in a Hawaii trial next month. If there were any connection, that might be naughty witness tampering, so I am sure there isn't one.

Sunday, March 3, 2019

Judge Considers Childress's Parental Alienation Treatment Drastic and Potentially Damaging

In a recent decision in a California custody case (Sahar vs Sahar, Yolo County), Judge Daniel Maguire rejected the opinions of Craig Childress, an advocate of the parental alienation (PA) treatment High Roads. Childress had been hired by the father in this case to make recommendations about treatment of two teenagers who were resisting or refusing visitation with their father following the parents’ divorce.

Childress argued that the mother in the case was  manipulating the children’s attitudes and causing them to be alienated from their father. Childress had no direct evidence that this was the case, nor had he evaluated the mother, but he opined that the mother was acting to alienate the children because she was suffering from a personality disorder caused by her childhood disorganized attachment status. An independent evaluator did not find that the mother had a personality disorder, and personality disorders are not thought to result from childhood attachment status by well-known attachment researchers. (N.B. I also testified as an expert in this case, commenting on Childress’s purported attachment explanation and the lack of evidence for his various claims.)

Childress proposed that the court reverse past custody decisions and place the resistant teenagers entirely in their father’s custody. He also recommended an untested form of treatment called High Roads, practiced by his colleague, the life coach Dorcy Pruter. When cross-examined by the minors’ counsel, Childress declined to answer some questions on the grounds that his professional license would be affected.

Judge Maguire’s decision in this case was that the teenagers should remain in their mother’s physical custody, but should have three meals a month with their father, each child having one meal alone with the father. They are not prohibited from talking about past circumstances but advised to do this in a constructive way rather than “relitigating” matters. This is seen as a step toward better relationships and a minimum rather than a maximum contact time. The mother is asked to encourage this but not required to force the children physically to attend meals with their father.

Judge Maguire commented on Childress’s testimony. The minors’ counsel had challenged Childress’s appearance on Kelly/Frye grounds, as Childress’s views are not generally accepted in the professional community. However, Judge Maguire stated that under California law Childress was giving an opinion, not employing a “new technique or method” or “novel method of proof”.. The decision should not then be taken to mean that the judge believed that Childress’s views were in fact shared by the professional community (my comment, not part of the decision—JM) or were found persuasive by the court.

Judge Maguire noted that Childress’s diagnosis was presented ipse dixit, as proof by assertion and without evidence. In addition, the judge stated that the proposed treatment appeared “drastic and potentially damaging”. In a footnote, Judge Maguire stated that “The court makes no finding as to whether or not Dr. Childress violated the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, the court does not rely on his testimony”.

This decision should be noted by other courts, by parents of whom parental alienation has been alleged, and by the lawyers representing those parents,

Friday, March 1, 2019

Talkin' Family Hierarchy (Blues)

The idea of a family hierarchy, a form of organization in which members have different amounts of power and authority to make decisions, is far from unreasonable. Groups do tend to work more efficiently when there is clear leadership, even though they may be more creative and effective in other ways when every member has equal say. And, of course, families characteristically are made up of people of a variety of ages and levels of competence, so there are generally a small number of members who have more ability and more authority to make decisions for the group.

 However, families are also different from other organizations in that members who have little competence may also have more important needs than those who are more competent, so good decisions are often made in the interest of the weakest members rather than just according to the wishes of the strongest. In some ways, the youngest and most vulnerable members of a family have more “power” than the older ones, as the older ones recognize the importance of protecting and nurturing the young. An additional difference between family hierarchies and other groups’ hierarchical organizations is that the family organization is dynamic—it changes as individuals develop and their needs and abilities change. A parent who exercised much power in the family may lose that status with age, and a younger person entering adulthood can and often does attain greater authority in the family group. (Those changes can be even more obvious in times of rapid technological change, where younger people may have mastered skills that older people do not have, or may be less when families have money or political power that is managed by elders and sometimes passes to younger adults only at the death of the older.)

These comments about family hierarchy refer to the actual observable (and ever-changing) organization of families and of the relationships among family members. But there is more to family hierarchy than just the ways families work: family hierarchy is a concept that overlaps considerably with ideological positions. For some families, and especially for their senior members, hierarchy and power differentials within the family represent right ways of life. Such power differentials are not expected to change as family members develop, as the structure rather than the function of the hierarchical organization is cherished. Alterations in the hierarchy may symbolize religious issues, as obedience to parents may be equated with obedience to God; a disobedient child may be seen as moving toward eternal damnation, and parents who allow their children to disobey may themselves be seen as failing in their religious duty. Beyond specific religious belief, too, the family hierarchy may represent the authoritarian organization of the community so valued by certain political groups, and power attained by younger members of a family may appear to be a frightening reminder of chaotic revolutionary movements.

Whatever the reasons for the ideological commitment to an unchangeable family hierarchy, those committed to this kind of hierarchy may use it as an essential touchstone for evaluation of families and individuals. For example, the German “family therapist” Bert Hellinger has claimed that in cases where an older family member has sexually molested a younger one, the younger person should apologize to the abuser for his or her own role in the breaking of the hierarchy through criticism or complaints about an older family member. (Hellinger is known for his work with Jirina Prekopova, a Czech psychologist who had proposed that autistic children can be helped only if their mothers are submissive to the fathers, thereby establishing a strong hierarchy.) In the United States and Britain, practitioners of holding therapy have claimed that children’s emotional attachment depends on their experience of powerlessness with respect to adults. Children in that form of treatment are to call adults names connoting authority like “Mom Sally” or “Dad Brian”. Proponents of parental alienation (PA) have made similar arguments. Richard Warshak, for example, considers it inappropriate for children to address their parents by first names, a breaking of the hierarchy that he feels is best maintained by using names that indicate special importance, power, and status such as Mom or Dad. According to sworn testimony, the PA proponent Craig Childress scolded children for their rejection of their father, which was  related to his violence against their mother, and stated that they should not break the hierarchy by criticizing the father’s actions.

Certainly there are families for whom long-term maintenance of a hierarchy of authority is a basic goal, whether because of religious or of broader political beliefs, or as part of a “therapeutic” approach. As long as no one gets hurt, there is no reason why they should not manage their lives in this way, although they may find that adolescents are forced to break with a family whose support they still need, rather than forego and foreclose their own development. For most families, however, the effort to maintain an unchanging family hierarchy is a waste of time as well as potentially damaging to relationships.  In the ordinary course of events, parents who have given up their own sleep or dinner in order to fulfill the needs of infants will come to say that older children can wait a bit or manage their own needs while the parents sleep or eat. Parents who sympathized with the anger or frustration of the tantruming toddler begin to feel justified in demanding some peace and quiet. And parents, who decided what music lessons or sports participation a third-grader should have, come to realize that the interests and abilities of a teenager ought to shape decisions about schooling and career preparation. 

That families have hierarchies of power and authority is clear, and is important to their effective functioning. But the idea that the structure rather than the function of hierarchy must be preserved is a mistake. People change, so family hierarchies change, and attempting to keep relationships the same forever is a mistake, however understandable may be the wish of some family members that time stand still.  

Thursday, February 28, 2019

Parental Alienation and Recovered Memory: Some Parallels

In the 1990s, the United States and other countries saw much excitement about the idea of recovered memories (RM) and associated psychological treatments. The basic idea of RM was that memories of traumatic childhood experiences can become unavailable to conscious experience in one of several ways, but can continue through unconscious influence to make the victim unhappy or unable to function normally. RM therapists said they could help people recover their lost memories of traumatic events, after which they would feel better, and if possible confront those responsible for their trauma. Following RM treatments, some individuals believed they could identify people who had harmed them; the people were often their parents, the harms were often sexual in nature, and the identification was often followed by confrontation and estrangement from the parents who denied that any such things had happened. In some case, victims reported their recovered memories to the police, and arrests sometimes followed. In some cases the arrested parents offered confessions and were convicted, saying they had no memory of the events but they were now convinced that they must have done these things. Courts accepted these arguments and the principle that when experiences were too traumatic, people could not remember them, and that the absence of memory for many years was proof that a recovered memory was valid evidence of something that had happened. Over time and with systematic research, however, it became evident that “recovering” a memory with the help of a therapist was not evidence that the memory was correct, because the experience of memory is easily constructed under the right circumstances and may well not reflect a person’s actual history. Claims of RM are still present today, but courts demand much more evidence of past wrongdoing than sometimes was required during the RM heyday.

In the later ‘90s, and after the beginning of the present century, similar excitement began to occur about the idea of parental alienation (PA) and the treatments purporting to treat it. The basic idea of PA is that following divorce, some children resist or refuse contact with one of their parents and have a strong preference  for the other parent. When this situation occurs in the absence of  any “good reason” named by the child, or of substantiated physical or sexual abuse by the nonpreferred parent, proponents of this idea say that PA is present and has been caused by actions (also called PA) of the preferred parent, who has somehow manipulated or exploited the child in order to cause rejection of the nonpreferred parent. Family courts have sometimes accepted this argument and in spite of the denials of child and preferred parent have followed the recommendations for a custody reversal and orders against contact of the child with the preferred parent, as well as PA treatments for the child and PA-themed counseling for the preferred parent. A group of lawyers and mental health professionals continues to argue for the PA position, although opposition to that position is increasing in professional circles.

Are there parallels between these two psychological concepts and their influence in the courts? I believe a number can be presented.
1.      Both RM and PA are possible but not common. There are many reasons why a person may not remember or think about an event for years at a time, including conscious attempts to suppress thoughts about a disturbing experience. New experiences may call the “forgotten” event to mind in a pressing way; these might include having children of the age the victim was at the time of a trauma, or suggestions made by a RM therapist, or renewed contact with someone who was for years not available. It is also distinctly possible that PA can and no doubt does happen—that a parent works on a child’s attitudes and beliefs in order to shape the child’s attitude toward the other parent. (At a low level, such efforts occur in intact, low-conflict families too, as parents and children form shifting alliances that emphasize virtues and faults of each family member.)
2.      RM and PA behaviors and thoughts have possible causes in addition to those stressed by RM and PA proponents. Memories in general are constructed from available information, rather than existing somewhere intact like a non-digital photograph. Memories of all kinds, traumatic and otherwise, are “photoshopped” in the process of recall. Frequent recall and rehearsal of some memories changes them, omitting some features, emphasizing others, and adding or subtracting details that “must have” or “couldn’t have” happened. As for the traumatic aspect of RM, it appears that people do not forget or lose traumatic memories more easily than ordinary memories, and we would expect that because the vividness of an experience strengthens its memory. The idea of repression of memories and consequent emotional distress is not well supported. Sudden RM can thus be caused by factors other than real past experiences of trauma. Similarly, PA, or children’s rejection of a nonpreferred parent, may result from past abuse or domestic violence that has not been substantiated but nevertheless existed, from poor parenting skills on the part of the nonpreferred parent, from conflicts with parents’ new romantic partners or with stepsiblings, with developmental events like puberty, or simply with the child’s wish for a stable home and control of scheduled activities and friend or romantic relationships. Children rejecting a parent may also be responding to the parent’s own rejection or criticism or demands for time together that do not jibe with the child’s increasing need for autonomy and peer contacts.
3.      PA and RM treatments are without an adequate evidence basis. Any treatment that claims to be safe and effective must be supported by research that involves some sort of comparison of the treatment outcomes with the outcomes of receiving no treatment or receiving other known treatments. In order to carry out such studies, the treatment must be standardized (manualized) in such a way that practitioners can follow known standards and perform the treatment in known ways. In addition, research needs to investigate any adverse events that occur during or after the treatment, even if those events do not seem to be caused by the treatment in any obvious way. No evidence of this kind has been presented for RM treatments. Some published reports claim to support PA treatments, but they do not involve treatment comparisons, nor have they explored adverse effects.   PA treatments are not manualized in forms available to independent researchers, and one, Family Bridges, is trademarked, suggesting an identification of the treatment methods as “trade secrets”.
4.      PA and RM treatments are potentially harmful. RM accusations in the past resulted in criminal charges and in some cases imprisonment. The exclusive RM emphasis made it unlikely that persons with emotional disturbances would receive appropriate treatment from practitioners who attributed mental illness to traumatic experiences alone. According to some who received RM treatment, the treatment experience alone was distressing and interfered with normal functioning, as well as causing troubled family relationships for many years, Similar problems exist with respect to PA treatments, not excluding the possibility of imprisonment with which the preferred parent is sometimes threatened. In addition to the effects of the specific treatments themselves, PA treatment is potentially harmful because of the use of youth transport service workers to move children to treatment facilities, sometimes using handcuffs for restraint.
5.      RM and PA advocacy is driven by moral panic and is persuasive to courts for this reason. The RM concept became strong at about the time that other treatments like holding therapy took hold among some parents and mental health professionals, and at  about the same time that claims of “Satanic ritual abuse” became common. These attitudes may be connected with a sense of moral panic elated to the belief that adult mistreatment causes mental illness in children and results in ongoing evil, dangerous behavior by the children. In order to protect ourselves from dangerous children, we must stop adult mistreatment, or punish it if it happened too long ago. For a relatively small number of charismatic Christians, this type of moral panic seems to have been associated with the idea that mental illness is caused by demonic possession, which in turn results from sin, either by the disordered person, or by sins of his or her ancestors—especially sexual sins. Though less obviously associated with religious or quasi-religious beliefs, PA ideas are also connected with moral panic. From its early popularization by Richard Gardner, the PA concept has been accused of pandering to men’s wishes and fighting against equal voices for women, but this concern is blurred by the fact that fathers are sometimes the preferred parents and are alleged to have created PA by nonpreferred mothers. Although this is far from clear, it may be that the real concern in PA comes out of an authoritarian emphasis on family hierarchy and the threats to traditional family structures of having children exercise choices and express criticism of parents. In a world in which women are moving toward equality with men and a weakened hierarchy, both men and women with authoritarian values may be panicked by the idea that control over children could be diminished. These powerful motivating beliefs can help lawyers and clients argue persuasively in courts despite a lack of evidence for their claims.

RM beliefs and treatments are considerably less powerful than they once were and have less influence in courts. How did this change come about, and can similar methods be used to fight the influence of PA? There seem to have been several factors at work in the diminution of RM influence. One was simply the spread of more factual information, so people were exposed to reports countering “news” about Satanic rituals and the recovery of traumatic memories. Another was the effort made by psychologists and others to examine systematically the nature of memories , yielding much information about how memories are created and recalled. In addition, help for and coordination of these efforts was provided by organizations like the False Memory Syndrome Foundation. These may be the sorts of work we need to combat the increasing influence of PA ideas: serious efforts to spread the facts and counter PA claims, more systematic research exploring the various reasons why children of divorce may avoid one parent and whether it is important for their development that they have relationships with both parents, and the involvement of organizations  like the American Psychological Association and American Professional Society on Abuse of Children to oppose the several hybrid parent-professional groups that advocate extensively for PA views.

Wednesday, February 20, 2019

Parental Alienation in the Context of Alternative Psychotherapies

In some child custody cases, children resist or refuse visitation with one parent and have a strong preference for living with the preferred parent. This observable visitation resistance or refusal (VRR) may occur for a wide range of reasons, including abuse by the non-preferred parent but also reasons like the child’s handling of puberty or the non-preferred parent’s lack of parenting skills or problems in interactions with a parent’s new partner or stepchildren. If there has been no substantiated physical or sexual abuse, however, proponents of the concept of parental alienation (PA) identify the child’s behavior as PA, extrapolate from the behavior that the preferred parent has worked actively to cause alienation (that active work also being called PA), posit that the preferred parent is causing the child to become mentally ill and therefore should be considered an abuser, and advise that custody arrangements should be reversed so that the child is sent to live with the non-preferred parent and barred from contact with the preferred parent.

PA proponents also advise that the child must be given special treatments for the behavior they have defined as mental illness. These treatments, including Family Bridges, High Road, and others which I have described in a recent article in Journal of Child Custody, have much in common in their use of threats and other persuasive efforts, and have never been tested in any way that allows them to be assessed as anything but experimental treatments.

Over the years, parents who have been accused of causing PA in their children have brought into family court their own expert witnesses, clinical psychologists or social workers who have testified that the children were not mentally ill and had good reasons for avoiding one parent. This approach has been successful in some cases, but far from all, and of course many parents accused of PA cannot even afford legal representation, much less the fees of expert witnesses. More recently, experts have begun to challenge the scientific foundations of the whole PA concept as well as of the treatments themselves, and I am one who has done this. Certainly the PA approach is implausible in many ways, incongruent with much that is known about child development, potentially harmful to children, and without an adequate basis in empirical work.

As I am preparing to testify in three PA-related cases in the next month, I have begun to think of PA in a broader context: the context of “fringe” psychotherapies, or, as I called them in a 2014 book, alternative psychotherapies (APs). AP is a polite way to refer to what Singer and Lalich called “crazy therapies” many years ago. APs are implausible, unsupported or weakly supported by evidence, and potentially harmful. As Scott Lilienfeld and his colleagues pointed out in a 2003 book chapter, AP proponents also look to confirm their hypotheses rather than refute them as is normally done in scientific work, they reverse the normal burden of proof to demand that their opponents demonstrate that their claims are not true, they invent obscure language to confuse the issues, and they ignore the nature of boundary conditions in order to expand the number of cases in which their treatments might be applied.

PA fits the criteria for APs as just described. It is implausible that VRR can be identified  without specific empirical evidence as caused by the preferred parent’s actions when there is no substantiated abuse, as a wide range of other explanations are available, and in fact some research has shown that attempts to persuade a child to avoid one of the parents are likely to backfire. PA treatments are only weakly supported by empirical evidence, as all reports on the treatments are limited to before and after studies of a small number of children, yielding no better classification for the evidence than that the treatments are “promising” or “experimental”. PA treatments are potentially harmful in that they may re-expose children to abusers, they are usually associated with disturbing strong-arm tactics including abduction, and  they disrupt children’s lives and may interfere with academic and social development during the adolescent period of rapid developmental change. PA proponents in some cases have reported that their methods are always successful, a rather different situation than is the case for most therapies, suggesting that   they have selected measures or families that are likely to confirm their hypotheses. PA proponents demand that others show that their claims are not true and offer proof by assertion rather than evidence. PA proponents have created a confusing terminology in which PA itself can mean either VRR, the posited behavior of the preferred parent, or both. Advocates of PA have set very wide boundary conditions, excluding only substantiated physical or sexual abuse (and not always those, as some tell children they may not talk about anything that happened in the past), and apply the PA label to cases in which children have quite legitimate reasons for avoiding a parent.

If PA is an AP, how has it come about that family courts have so often been swayed by PA arguments? Well, this has happened before—courts have been sold on an AP and done a lot of harm by their decisions before the professional community pulled itself together enough to counter the mistaken beliefs. I refer to the recovered memory moral panic of the 1990s, in which bewildered parents were accused of sexual abuse by their now-adult children, who had “recovered” memories of the abuse with the help of therapists who were convinced they were right. Some of the accused people actually confessed to the suggested crimes, stating that they could not remember the events but were convinced that they must have happened if everybody said so. It took a long time for the courts to recognize that recovered memory therapy was an AP and that although in some cases accusations were well-founded, in a great many the memories had been created in the process of the treatment.

In my opinion, we are now seeing a similar moral panic surrounding  PA allegations, fomented by PA advocates who claim to be rescuing children from the harm done by their preferred parents and restoring them to the loving arms of the parents they want to avoid. Facebook groups and other organizations help professionals persuade parents, and parents persuade each other, that a crusade is needed to ensure the needed moral reform. But do courts need to repeat the mistakes of the recovered memory period? I think not, and I have hopes that mental health professionals will step forward to stop the PA approach, as they eventually stepped forward about recovered memory therapies.

Thursday, January 10, 2019

Legal Resident vs Undocumented Resident: Thinking Critically About Who Kills Whom

Ordinarily I avoid on this blog topics that are obviously political in nature—even though anything connected with child care and child welfare is highly value-laden and therefore has strong political implications. However, I can no longer resist commenting on some critical thinking issues about discussions of killings by undocumented migrants.

In the last year or two, there have been several much-discussed events in which a person later discovered to be in the United States illegally has killed another person who was a legal resident of the country. These facts have been used as part of arguments against admitting most immigrants and in favor of draconian measures against undocumented persons already in the U.S.

Is it legitimate to reason from the killings to the positions taken by the people who advocate for much stricter anti-immigration measures? There are actually two ways we can think about this.

The first approach we might make to the making of a connection between killings by undocumented immigrants and severe immigration policies involves the idea of “the canary in the coal mine”. When little information about a danger is available , it can be the case that unusual attention should be paid to a few anecdotes. Although ordinarily psychologists assign little weight to anecdotal information, an important 2010 paper by Dimidjian and Hollon poited out that with respect to adverse events, attention to anecdotes may be the first line of defense. Anecdotes can alert us to potential problems, which can then be given systematic study. In cases where there are serious but rare problems that we would like to prevent, we might never notice such infrequent events without considering anecdotes, as the great preponderance of the information would “wash out” the problems statistically. This does not, of course, imply that we can generalize freely from a small number of anecdotes—it only means that anecdotes can guide our attention to risks that we might not otherwise notice. Without systematic study, even a large number of anecdotes can only give us proof of concept (as I am trying to argue in a paper I am presently working on, which involves about 50 anecdotes).

The second approach involves thinking through all of the possible events and looking at them in terms of the proportion each makes up of the whole set of events of interest. In the case of the migrant=killer argument stated earlier, there are two variables that can be used to categorize events. People may be classified according to their legal status in the United States (i.e., legal resident or undocumented resident). They may also be classified as to their involvement in a murder, either killing or being killed. This sets aside the great majority of the population, who, whatever their residence status, have not killed anyone, nor have they been killed.

Focusing our attention only on the small proportion of people who have killed or been killed, we see that there are four possible categories they may fall into: 1. Legal residents who have killed other legal residents; 2. Legal residents who have  killed undocumented residents; 3. Undocumented residents who have killed other undocumented residents; and 4. Undocumented residents who have killed legal residents. The argument that undocumented residents are killers has been based only on the fourth category, undocumented residents who have killed legal residents. And you can create a table with four categories of interest, each of which needs to have a number filled in if we are going to use them to support any argument. (However, I apparently can't, because every time I try to post what I've done, the lines get scrambled, and I am giving it up.) 


The conclusions we could draw—IF we had the numbers to plug into our table—would have to take account of proportions of people, not of absolute numbers. There are a lot more legal residents than there are undocumented residents, so we would expect more of the killings to be done by legal residents, and we would learn something from this analysis only if we look at the rates (number of killings compared to the total number of killers) for each category.

So what are the possible conclusions that we could draw from the completed table, if we had the numbers to fill it in? We might conclude that legal residents kill other legal residents at a higher rate than we see in the other categories--  or that legal residents are more likely to kill undocumented residents—or that undocumented residents are more likely to kill each other—or, what has recently been claimed, that undocumented residents have a high rate of killing legal residents.

Whatever the outcome and the policy argument it supports, we can’t figure it out until we have all the information required. The existence of a few anecdotes may encourage us to do this work, but until it is done, no conclusion is possible.