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Concerned About Unconventional Mental Health Interventions?

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

Sunday, June 26, 2022

How Vague Is Your Vagus?

 

Over a lot of years of professional life, I have seen some concepts become popularized, reinterpreted, and generalized beyond all meaning or expectation. One of these concepts was attachment, a rather technical term to begin with but now the explanation of all sorts of problems in self-help discussions. Another is parental alienation, once a term applied to a rare occurrence in divorced families, now a weapon brandished regularly in family courts.

In my pessimistic way, I have been wondering what would be the next wave of misinterpretation—the next concept that will be made the explanation for too much and the foundation of treatments without any basis in evidence. And I think I have found the latest thing: the vagus nerve.

Of course, there really is a vagus nerve. It’s the tenth of the 12 cranial nerves and helps to regulate the heartbeat as well as having other similar functions. Some decades ago, Steven Porges created “polyvagal theory” (PVT), a psychological approach that based emotional and other human functioning on vagus nerve activity. PVT makes a number of assumptions about the evolution of the human nervous system and posits that when threat is felt, human beings revert to an evolutionarily older type of brain function. This is reflected  in vagal activity as known through measurement of an aspect of the heartbeat. Grossman and Taylor in 2007 criticized this view thoroughly, noting both misunderstandings of the evolutionary background and the functioning of the nervous system.

As so often happens when simplistic approaches to the human nervous system are popularized, the claims of PVT soon morphed into treatment plans. The assumption was that if the vagus nerve underlies emotional functioning, anything that affects the activity of the vagus can also influence emotional functioning. In the parental alienation treatment program Transitioning Families, for example, therapists ask clients to “map the autonomic nervous system” by imagining a ladder and climbing it until they reach a place of safety at the top, where a comfortable state of vagal activity is thought to be. Deep breathing is also used, as it is thought be this group of therapists that it stimulates the vagus to reach a calm state. There is no empirical evidence that the vagus is influenced in this way or that there are emotional benefits to the practice.

On her website, one Dr. Arielle Schwartz advises similar techniques that are directed toward affecting vagal activity with the goal od improving mood and functioning. She says, “The vagus nerve passes though by [sic] the vocal cords and the inner ear and the vibrations of humming is a free and easy way to influence your nervous system states”. In addition to humming, she recommends diaphragmatic or “belly” breathing and slowing of the breath, which she proposes as a way to stimulate the vagus nerve.

Schwartz also suggests the Valsalva maneuver, a way of attempting to breathe out even though mouth and nose are closed , as a way to increase pressure in the chest cavity and vagal tone. She believes that the “diving reflex” can be stimulated by splashing your face with cold water, putting a bag of ice on your face, or holding lukewarm water in your mouth. She does not describe how these practices are supposed to affect the vagus nerve, but the reflex does slow heartrate and oxygen use.

Some readers will recognize the breathing and humming techniques as part of yoga and similar practices. They are not directly harmful and may be enjoyable. Indirect harms are possible if an individual puts resources of time and money into methods with neither empirical or theoretical evidence of benefit.

The Valsalva maneuver can be used to treat a too-rapid heartbeat. It should not be used by people with high blood pressure or risk of a stroke. Triggering the diving reflex can be problematic for people with heart problems or a slow heartbeat. As was the case for breathing and humming, indirect harms may come from expenditure of resources for methods that may have no real effect beyond a few minutes.

PVT methods seem to be appearing on the Internet as the newest of the new. However, I remember reading a newspaper medical advice column when I was a young teenager in the mid-1950s.—it spoke of “belly breathing” and advocated the same sorts of techniques as PVT approaches, similarly without supportive empirical evidence. The PVT-related concept of the “enteric brain” and its functions has been posed for decades by the Meridian Institute of Virginia Beach; this institute is associated with the writings of Edgar Cayce, the American “clairvoyant”.

There seems to be no end to the ways people can suggest simple solutions to complex mental health problems. The popularization of PVT seems to be the most recent of these, but it won’t be the last.

 

Monday, March 28, 2022

Identification by Listicle: Parental Alienation and Those Five Factors

 

Author after author has pointed out that as yet there is no established way of identifying cases in which a child rejects one parent because of persuasion by the other parent (parental alienation, by definition). No one has shown a valid and reliable method of discriminating those cases from others in which various different events may be the cause of the child’s resistance or refusal to have contact with one parent (not parental alienation, by definition).

Nevertheless, proponents assert that they have a method for identifying PA cases. This method involves their five factor model, as put forward by William Bernet and others. But is that model anything more than a listicle with other listicles embedded in it? Certainly it has never been shown to be valid and reliable by empirical work—but it could be that such work will appear in the future. Meanwhile, let’s look at the factors and consider how they are applied. I draw this list of factors from Bradley Freeman’s chapter in the 2020 PA book edited by Lorandos and Bernet.

Factor One: The child actively avoids, resists, or refuses a relationship with a parent.

Interestingly, at one time the child was described as rejecting contact with a parent. Now we have rejection of a relationship, which is rather different. Along these lines, Steven Miller (the emergency medicine physician and PA expert witness) has said in a presentation that the problem is rejection of a normal relationship with the parent; this, like other aspects of the five factors, is certainly left open to interpretation.

But how is this factor actually used in assigning the PA category to children’s behavior? In one case I am familiar with, a girl asked for contact with her father but he refused on the grounds that he feared she would accuse him of sexual abuse. The father nevertheless sought custody and alleged PA. In another case, a 17-year-old girl who had spent week on and week off with her parents for 8 years asked to change to weekdays at her mother’s, weekends and holidays at her father’s. This led to the father alleging PA on the part of the mother. In a third case, children did not resist visiting their father but behaved very badly (e.g. throwing food at him). Apparently helpless to control the children, he alleged that PA by the mother was the source of this bad behavior.

Factor One is thus, in practice, excessively broadly and vaguely defined and has the potential to be identified in many situations where a supposedly alienated parent is simply not pleased with the child’s attitude or behavior.

Factor Two: Presence of a prior positive relationship between the child and the rejected parent.

Factor Two may be difficult to demonstrate except through the testimony of teachers, neighbors, and distant family members. The reunification therapy Turning Points asks attendees to bring photos and videos from the past that show the child and parent together in positive ways, and these are used to show the child that in the past they liked the parent whom they now reject.  But how many families photograph screaming arguments between parent and child or record one of the other refusing to speak? Any records from the past are likely to be of positive events, however frequent or infrequent they may have been.

Even in intact families, developmental and other changes are often linked with more and with less positive relationships in the course of a child’s life. A parent may be temperamentally well-suited to dealing with a cuddly, dependent baby but less able to care for a negative, tantrum-throwing four-year-old—or vice versa. The period around puberty is for most families a time when earlier pleasant relationships seem to falter, in part because of a child’s negative emotionality and desire for autonomy, as well as for reasons in the parents’ own lives. Divorced families too go through relationship changes of this kind, which may be interpreted as PA by certain proponents but are not necessarily caused by parental persuasion.

In the absence of empirical work  showing that early positive relationships are normally followed by consistently positive later relationships, and that periods of negativity are not developmentally appropriate, PA proponents cannot argue effectively for Factor Two as a reasonable way to demonstrate whether or not parental alienation exists in many cases. In addition, demonstrating that there was an initial positive relationship in a specific case may be difficult or impossible, even with extensive investigation.

Factor Three: Absence of abuse or neglect or seriously deficient parenting on the part of the now rejected parent.

As is generally the case about proof of absence, the absence of abuse, neglect, and seriously deficient parenting is difficult to demonstrate. When allegations of abuse are investigated by child protective services and said to be unfounded, this is by no means evidence that abuse did not occur, but simply shows that there was no clear evidence that it did occur. As Freeman himself point out, there are no clear definitions of seriously deficient parenting. Psychological injury remains vaguely defined in that evidence of such injury might not be apparent for years after an event occurred and the event would commonly be accompanied by other events that might be actual causes of any demonstrable psychological injury.

As Madelyn Milchman has noted, parent-child relationships may be negatively affected by single or repeated events which individually could not be considered abuse or seriously deficient parenting. In one alleged PA case, a father repeatedly tickled a child severely even though she begged him to stop. In another, a 12-year-old girl got her period when at her father’s house and asked him to go out to get her menstrual hygiene supplies; he refused and told her to just use toilet paper. In a third, a father posted signs reading “no parental alienation” in all the rooms of his house. None of these actions could be considered abuse or even seriously deficient parenting, and they did not cause demonstrable harm to the children. Nevertheless, each of these situations could easily have played a role in causing a child’s estrangement, especially in combination with repetitions or other similar actions.

Absence of abuse, neglect, or seriously deficient parenting can thus not be considered the proof that a child’s rejection must be caused by the persuasion of the preferred parent.

Factor Four: Use of multiple alienating behaviors on the part of the preferred parent.

Freeman points out that “it is necessary for the evaluator to identify specific [alienating behaviors] that have apparently caused the symptoms of PA” (2020, p. 68). Here is where an additional listicle enters the picture: PA proponents refer to a list of alienating behaviors established by Amy Baker and colleagues, who interviewed about 40 adults on the ways their parents had behaved one or more decades previously. Baker created a list of alienating behaviors based on the interviewees reported recollections but did not look for objective evidence that might have supported or failed to support her list. Nor did she (or anyone else) investigate whether parents alleged to be alienators  performed these behaviors more or less frequently than others who were not said to be alienators.

It has thus never been clarified empirically whether children who reject a parent are more likely than others to have a parent who carries out behaviors from Baker’s list. An additional problem is that some of the listed behaviors are likely to occur in private and are rarely to be observed by people outside the family, although others may be noticed by close friends or relatives and reported during an investigation.

Critics of the PA belief system have expressed concern that if a child rejects one parent, it is too easy to assume that the preferred parent’s actions are the cause of the rejection. It is certainly true that quite ordinary statements or actions can be interpreted as alienating behaviors. At the height of the COVID pandemic, a major PA proponent told me that it was alienating behavior when a mother told her 14-year-old that he could go to visit his father but would have to quarantine for 14 days when he came home (at this time, people were told to quarantine after travel or other exposures outside the home). A mother’s failure to tell her children daily about their father’s goodness and importance can be considered alienating behavior.

The alienating behaviors that are the subject of Factor Four thus remain ill-defined and seriously under-researched, and do not provide useful evidence for decisions in cases of alleged PA.

Factor Five: Exhibition of many of the eight behavioral manifestations .of alienation by the child.

A listicle conveying behaviors that he considered diagnostic of PA was published by Richard Gardner decades ago and has been used by PA proponents ever since. Once again, there has been no empirical work to show how often these behaviors occur in children alleged to show PA and how often they occur in other children. Without empirical evidence, it would be a mistake to assume that some behaviors occur exclusively, or much more frequently, in children alleged to have PA.

Absence of guilt about an action, for example, can and does occur in both children and adults when they feel justified in the behavior, even though it may cause discomfort and harm to another person. A child or adolescent who is told that a parent is unhappy because of their rejection may reminisce about the parent’s remembered offenses (of commission or omission) and think, “it serves her right if she’s upset.” Older children and adolescents can certainly understand that in some situations, whatever they may have done, they are not to blame and are not expected to experience guilt. Failing to experience guilt when distress seems to be deserved is by no means a predictor of a lack of empathy or the capacity for remorse.

The decision that a child’s rationale for rejecting a parent may be “frivolous” or “absurd” cannot be made objectively or out of context, as the reason for the rejection is a matter of the child’s own perceptions. These may be childish and egocentric or based on na├»ve worldviews, but they are real and require responses for the best outcome. Indeed, to claim that childish rationales are most characteristic of children alleged to have PA is not logical unless it can be shown that other children of the same age are less inclined to give childish reasons for issues like staying home from school or starting a fight with their brothers. Children who give childish reasons for any issue may be more likely to give such reasons for rejecting a parent than those who rarely give childish reasons for anything.

Young adolescents are especially likely to say they are “independent thinkers” about every issue as they fight for autonomy. Unless it is shown empirically that children in PA cases are more likely than others to display this belief, it makes no sense to say that being an  “independent thinker” is symptomatic of PA.

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Examining these various PA listicles, it becomes plain that we have no data-driven reasons to accept them as providing a way to identify PA in children. If PA proponents want to support their claim that they can identify PA – and treat children to restore good relationships—they will need to get to work and provide good information from well-designed and well-implemented research. To date, this has not happened. But the listicle approach is not sufficient to justify upending people’s lives.

Friday, March 25, 2022

Bishop Wilberforce Rides Again; or, Parental Alienation Advocates Admit a Problem

 

If you look at academia.edu, you will find a lengthy document entitled “Statement of the Global Action for Research Integrity in Parental Alienation”, by Alejandro Mendoza Amaro and William Bernet—the latter, of course, a major figure among advocates of the parental alienation belief system in the United States and elsewhere. The Statement appears to be a cri de coeur conveying the authors’ distress that parental alienation principles and practices have been roundly criticized by organizations like the American Professional Society on Abuse of Children (APSAC). To the further discomfort of Mendoza and Bernet, many individual authors have also critiqued parental alienation (PA) publications and have concluded that there is only a small amount of empirical research on this subject, and that small amount is poorly designed and implemented.

A fruitful response to these critical remarks about PA would have been to carry out new and properly designed research (and, no, the recent efforts of Jennifer Harman to test outcomes for a reunification therapy are not properly designed). But this is not what has been done by PA advocates. Instead, in this Statement, they label materials published by opponents to PA as fraudulent and defamatory. They demand retractions of commentaries discussing the problems of PA research and offering alternative hypotheses for cases in which children resist or refuse contact with one of their divorced parents. But they do not state exactly which publications they mean, or where their faults lie.

The Statement contends that opposing publications have “severe errors such as falsification of data, adulteration of original sources, and defamation “ (p. 17). These would indeed be reasons for complaint to academic or medical institutions with which authors were affiliated, as well as to journals that published the papers. Investigations showing that these things had occurred would lead to serious professional discipline and retraction of papers. But the Statement says this did not happen—they were ignored.

Notably, however, the authors of the Statement do not say to whom they complained or what they complained about, except that in one case they complained to the American Psychological Association about a passage they considered defamatory, and the passage was deleted. By failing to state the particular papers they find problematic, of course, Mendoza and Bernet themselves avoid complaints of defamation. With respect to the claimed falsification of data, they manage to convey to some readers which authors they are accusing, because only three or four articles opposing PA actually present new data. The authors of those articles may want to think about whether this circuitous communication succeeds in defaming them; it is certainly no joke to be accused of falsifying data.

What I find especially engaging about the Statement is that by making it, Mendoza and Bernet have shown that PA does not meet the Frye standards for admissibility of scientific evidence. The Frye standard, and one part of the Daubert standards, require that a concept be generally accepted in the relevant scientific community. If so many professionals, including journal editors, reviewers, and even the American Psychological Association, have acted to reject PA ideas and methods, this is a clear indication that these concepts are not generally accepted by those who form the relevant scientific community.

What does it all have to do with Bishop Wilberforce? Well, in 1860, T.H. Huxley and Bishop Samuel Wilberforce participated in a debate about evolution, Huxley supporting Darwin’s views and Wilberforce contradicting them. Wilberforce asked a very silly question, and Huxley turned to a companion and said, “The Lord hath delivered him into mine hands.” Huxley and the other supporters of Darwin won that debate. I don’t think I need to say more.

 

Monday, February 21, 2022

The Foster Child Mantra and Parental Alienation

 

When advocates of the parental alienation (PA) belief system discuss their conjectures about children’s attitudes toward parents, they often mention the claim that foster children wish very much to return to their abusive parents. William Bernet and Linda Gottlieb are notable repeaters of this assertion.

Let’s examine this claim under a strong light, and then go on to look at the unstated implications.

If PA advocates were talking about children from about 8 months to 5 years, and if the children had been in foster care for a few days or weeks only, their statement might well be correct. For toddlers and preschoolers, familiarity trumps almost everything else. After some time passes and new caregivers and the foster home become familiar, the children are more likely to avoid parents who not only were abusive but are now unfamiliar. Of course, these young children are not the usual candidates for PA claims or related reunification therapies.

Most children in PA cases are between 9 and 17 years of age, and this is the age group aimed at by reunification therapies. How do children in this age group respond to foster care? It’s true that in many cases they would like to leave their foster homes (especially group homes), and the only place that is usually available to them other than foster care is the home of abusive parents.  Some empirical research (Maaskant, van Rooij, Bos, & Hermanns (2016), Journal of Social Work Practice, Vol. 30, pp. 379-396) has shown foster children as thinking better of the foster parents than of the biological parents, but this does not necessarily mean that the children would prefer to stay in foster care if they had a choice.

It’s important to discriminate between wanting to leave a place (foster home or home of “alienated” parent) and wanting to be somewhere else (bio parents’ home or preferred parent’s home). There are multiple reasons why a child in foster care may want to leave the foster home—just as there are multiple reasons why a child in a PA case might want to avoid one parent.

Here are some reasons for wanting to leave some foster homes:

 

Abuse by foster parents or other children in the home

Unfamiliar food, customs, language

Crowding and lack of privacy

Required contact with authorities who may not be trusted

Pressure to conform to unfamiliar religious practices

Requirement of transferring to unfamiliar school near foster home

Loneliness without familiar friends, siblings, cousins, grandparents

Difficulty in making friends when stigmatized as foster child

 

These reasons for wanting to leave a foster home should not be confused with reasons for wanting to return to the parental home, such as:

Wanting affection and companionship of parents

Feeling concern about the needs of siblings or others living in the home

 

These lists of motives for wanting to leave foster care and/or return to the parental home show that there are multiple reasons why such a move might be desired by foster children. But what is very notable is that children in PA cases do not have most of these motives, if indeed they have any of them. Children alleged to have PA as the cause of rejection of a parent are generally living in comfortable middle-class homes (parents who are not in comfortable circumstances cannot afford PA litigation), have familiar friends and siblings nearby, attend schools where they are known and comfortable, do not experience the stigma associated with foster care, have familiar food and other daily experiences, and are already with the parent they prefer. These children have none of the reasons foster children might have for wanting to see a rejected parent, whether or not that rejection is the result of abuse.

It is clear that the analogy between the foster and PA living situations does not hold. Why, then, do PA proponents bring up the posited desire of foster children for their parents as somehow relevant to the attitudes of children in PA cases?

 

There is a strong but unstated set of implications that PA proponents apparently intend to have drawn from their foster child mantra.  Here is what I believe it is:

 

If foster children still long for their abusive parents, the attachment, love, or need of children for their parents must be of extraordinary strength, even outweighing the wish for survival.

If such attachment, love, or need for parents is not in evidence in PA cases, something horrible must have happened to break the “instinctual” connection (see Gottlieb for statements about this).

The horrible event could not have been physical or psychological abuse by the rejected parent, because (returning to the original claim), such abuse is not enough to change the child’s attachment, love, or need for parents.

Someone other than the rejected parent must thus have done the horrible thing.

The only possible culprit is the preferred parent or that person’s relatives or other proxies.

Thus, QED, the preferred parent is guilty of a form of abuse so terrible that it alters the basic nature of the child and the needs that have developed in the course of evolution. The child is now a monster who has a lost an intrinsic human quality, and must be carefully rehabilitated and protected from contact with the soul-destroying preferred parent.

 

If this line of reasoning is not what PA proponents want us to follow, I wish they would say so. Otherwise, I do not see why they repeat the unfounded and irrelevant statement about foster children wanting their abusive parents.

 

 

 

 

Monday, January 3, 2022

Parental Alienation Webinar: Miller Talks and Talks

 

On Jan. 2, 2022, the organization Family Access Fighting for Children’s Right presented one of a series of webinars related to the parental alienation belief system. The Jan. 2 webinar was a presentation by Dr. Steven Miller, the emergency medicine physician, with the following title: “How Should Alienated Parents and their Attorneys Respond to False and Misleading Criticisms of Alienation Science?” Readers will note that Miller’s title did not suggest that he would address accurate criticisms of the parental alienation belief system, and indeed he did not do so.

I will summarize as well as I can some of the content of Miller’s talk, but I should note to begin with that he rather flatteringly called me out by name as a critic of PA concepts and practices. There are quite a number of other psychologists, psychiatrists, social workers, and other professionals who have taken positions similar to mine. Perhaps Miller wanted to do me a favor by making my opposition more generally known.

Miller’s rather turgid and rambling presentation went on for two hours and in most points resembled the testimony I have heard him give in court. The apparent organizing principle of the presentation was to stress critical thinking errors and fallacious logic that Miller feels PA opponents have used and misused. Oddly, it appeared that in pointing to various fallacies used by PA opponents, Miller was falling into the same problematic paths. I will give some examples of assertions Miller made and when it seems necessary I will note logical errors.

1.    1.   Miller stated that PA opponents say that there is no such thing as parental alienation. I have never seen this statement, that PA does not exist, made by any of the people I know to have discussed this topic. In the thirteen chapters of Challenging Parental Alienation (Routledge, 2022), not a single author says that PA does not exist, although all of them express concern about the overuse and weaponization of this term in family courts. One chapter in that book discusses at length how to rule out other possible causes of a child’s rejection of a parent until only PA is left, thus showing that the author considers PA to be a possibility.

Miller noted in the webinar the deceptive reasoning involved when one attributes to others positions that they have never taken. In the course of my decades of study of alternative psychologies and psychotherapies, I have seen this kind of attribution used frequently, and it is no surprise to see it used by PA proponents. Attributing a denial of PA to PA opponents like myself is a clever ploy because parents and others who are involved with PA allegations are likely to interpret the statement that someone denies the existence of PA as a hostile denial of anger and distress surrounding family conflict—this understandably makes them angry at the person who is said to have denied their troubles.  

2.     2.  Miller played the M.D card frequently and implied (at least) that PA is a medical problem that can be identified only by specialists, who are likely to be physicians. One of his efforts along this line involved attempting to reason by analogy from medical concerns to PA and vice-versa. (I will omit the detour into affirming the consequent he took in this process, because the abuse of analogies is more obvious.)

I, and other authors, have noted that identifying alienating behavior on the part of a preferred parent is regrettably often done by inference rather than direct observation. A child shows some or all of the “ eight manifestations” of PA, and it is inferred that the preferred parent has caused these manifestations by persuading the child to reject the other parent. PA proponents regularly say they do not do this, but their published work does not describe the methods that they use to establish that alienating behavior has occurred; I would think this would be a topic of interest to them, as such would make possible investigations of cases where a parent did  his or her best to alienate a child, but the child continued to do well with both parents.

Miller has said, and said in the webinar, that if this reasoning were followed (that inference should not be used in this way, I think he means), no medical test would be possible. An electrocardiogram could not be accepted as a way to identify a heart attack, for instance, and this test IS accepted, therefore examination of the eight PA manifestations should also be accepted as a way to identify PA.

However, EKG use and PA identification from “manifestations” are quite different things:

Heart functioning depends on electrical activity in the heart muscle and elsewhere.

When a heart attack occurs, the electrical activity is disrupted.

An external measure, the EKG, evaluates the internal electrical activity and allows symptoms like pain to be interpreted as resulting from a heart attack with its electrical disruption, or from some other cause in which electrical functioning remains normal.

Because the mechanism of heart functioning is known to involve electrical activity, treatments that alter electrical activity can be put to work to restore good functioning.

However, a child’s rejection of a parent can occur for many reasons, not solely because a preferred parent has persuaded the child. Unlike heart electrical activity, rejection of a parent can depend on multiple factors.

Measures of any of the possible causes of child rejection are ambiguous and difficult to carry out, unlike the EKG measure. The “eight manifestations” describe the child’s behavior, not the reasons for it.

The mechanism by which parental alienating behavior could cause the child to reject one parent has never been described; this is true of all examples of persuasion, where only a few mechanisms (like cognitive dissonance) have been identified.

In the absence of adequate measures and mechanisms, there is no way to discriminate between rejection caused in one way and rejection caused in another way except by observation of parental alienating behavior. There is thus no parallel between identification of PA on the basis of child behavior and the use of an EKG, the latter being effective at discriminating between some causes of symptoms and others.

Because the mechanism of persuading the child to reject a parent is not understood (and would probably be different for children of different ages), there is no obvious treatment method based on a mechanism, and identification of PA is not parallel with use of an EKG or other medical tests.

3.    3.   I will address one other statement made by Miller in the webinar. This is the statement that PA is not necessarily refusal of contact, but is rejection of a normal relationship with a parent without justification.

The definition offered by PA proponents like Miller, Bernet, Lorandos, etc. has always failed to be either operationalized or clearly defined, because of the inclusion of justification as a criterion. Reasons that are or are not “justified” will vary with child age, culture, personality, even religious beliefs. Unless a specific list of reasons deemed to be (or not to be) justified is provided, decisions about justification are clearly subjective (or, to use Miller’s and Gottlib’s locution, “pattern recognition”).

Now, it appears that Miller is adding a second ambiguous term, “normal relationship”. Once again, the age of the child, the culture and other circumstances, individual differences, and so on, all help to determine a range of “normal” relationships. Without clear definitions and examples, this addition to the definition of PA opens the door for identification as PA of anything a parent does not like—a child’s affection, obedience, gratitude, enthusiasm, affinity of personality, for instance. I acknowledge freely that some children’s actions toward a rejected parent are shockingly inappropriate and it is no gift to the child to allow them to go on, but to include the ill-defined term “normal relationship” does not help us deal with these real problems. I am afraid that instead of helping families, speaking vaguely of normal relationships can simply encode parents’ and practitioners’ views about authority and family hierarchy that do not work well in intact families and have the potential to explode conflicted relationships following divorce.

 

That’s all from me, folks. Anyone who wants to see what Miller actually had to say is free to buy the recording from the Family Access website.

 

 

Tuesday, December 7, 2021

Alternative Psychotherapies Include Some Parental Alienation Interventions

 

Since the 1990s, the movement toward evidence-based medicine has been associated with a term for medical practices that are not evidence-based. These are often referred to as complementary and alternative (CAM) methods. Complementary methods are those that are used together with conventional evidence-based treatments; readers can no doubt figure out that alternative medical practices are used on their own. CAM approaches are without clear evidence of safety or effectiveness—if that evidence were present, they would just be medicine, not CAM.

Similar terminology for psychological treatments has lagged. People do not usually speak of complementary and alternative psychotherapies (“CAPs”). One real reason for this is that unconventional psychological treatments are rarely used in a complementary fashion together with conventional treatments. Unconventional treatments are generally put forward as alternatives to conventional therapies. As a result of this situation, I suggested in a book published some years ago (“Alternative Psychotherapies”, Rowman & Littlefield, 2014) that we simply use the term alternative psychotherapies (or therapies, or treatments, or interventions) to describe unconventional treatments that lack clear evidence of safety or effectiveness. Alternative psychotherapies are of particular interest because they can do both direct and indirect harm to clients. We see, for example, that “conversion therapies” intended to change sexual orientation can do direct harm by increasing depression and suicidality, and indirect harm by using up family resources that could be used better in other ways.

Having spent years looking at alternative psychotherapies for children like Attachment Therapy (AKA Holding Therapy), I am interested in what all of these treatments have in common. I notice, certainly, that proprietary treatments for parental alienation (a child’s rejection of one divorced parent in circumstances thought to indicate persuasion by the preferred parent) meet requirements to be called alternative psychotherapies. Interventions like Family Bridges or Turning Points for Families have never presented adequate evidence of effectiveness and have shown little or no concern about safety issues. But Family Bridges and Holding Therapy are vastly different in most ways. Are there points they share as alternative psychotherapies?

 

I am going to describe some characteristics that I think are shared by various alternative psychotherapies, including those directed at parental alienation. Please note, though, that I am taking the opportunity to use this blog as a way to speculate on points that are not yet clear to me. Some of what I mention here does not come from the published work of parental alienation proponents (for example), but from organizations that serve to popularize certain viewpoints. For Attachment Therapy, an example would be radzebra.org. For parental alienation therapies, the organization Family Access—Fighting for Children’s Rights has become very active in the last year or so and is moving from webinars into a subscription television service.

I.                   Proponents of alternative psychotherapies state that conventional treatments exacerbate children’s problems. Such exacerbation may be attributed to the vulnerability of conventional therapists, who believe lying children or allow themselves to be manipulated by children or parents.

II.                Proponents of some alternative psychotherapies have argued that children’s experiences of distress during treatment were minimal when compared to the predicted negative outcomes of remaining untreated or treated only by conventional methods.

III.             Proponents of some alternative psychotherapies warn against attention to children’s statements or wishes, on the grounds that mental health problems will be worsened if children are allowed to exercise autonomy; children are also characterized as liars who must be called to account.

IV.             Proponents of alternative psychotherapies predict serious long-term consequences for children who do not receive their recommended treatments. Proponents of Attachment Therapy have long claimed that untreated children will be violent in childhood and will grow up to be serial killers (Ted Bundy has often been cited as an example). In a recent email, Family Access claimed that children who did not receive parental alienation interventions as recommended would be sociopaths in adulthood.

V.                Proponents of alternative psychotherapies may create alternative diagnostic categories and announce them as “not yet” in DSM-5 or ICD-11, implying that these diagnostic manuals will eventually accept the categories.

VI.       Proponents of alternative psychotherapies claim that only people they have trained can carry out their methods, and that extensive conventional training is not needed, or that the treatments are not actually mental health treatments so no licensure is required.

VII.             Proponents of alternative psychotherapies may claim scientific evidence for their methods when in fact there is no evidence that meets the usual standards required for support of psychological treatment.

VIII.          Proponents of alternative psychotherapies may respond to criticism by personal attacks rather than by discussion of evidence or of planned systematic outcome research.

It’s my impression that alternative psychotherapies share these as well as other characteristics. I would be interested in hearing others’ comments about additions to or deletions from this list.

 

NYT Lets “Relinquishment Trauma” Pass

 

Every adoption is simultaneously a triumph or a tragedy for most or even all of the particpnats. The New York Times op-ed by Elizabeth Spiers demonstrates this fact (“I was adopted. I know the trauma it can inflict.” E. Spiers, Dec. 6, 2021, p. A23). Whether there would have been greater tragedy without the adoption of a child is something we can only guess at, and out guesses are different for different individual cases.

Spiers tells her story and describes her own emotions about her childhood and her adult meeting with her biological mother. No one else can possibly know her experiences  and her emotional reactions, and I would not dream of arguing about what she feels. (What would be the point of doing that, anyway? I only bring it up because there will be some people out there who castigate me for what they see as denying lived experience.)

However, there is one part of Spiers’ narrative that is not a description of her experiences and feelings, but a speculation on why she feels as she does. I had hoped that this particular speculation had fallen under its own weight when deployed in the past, and I am shocked to see it printed in the New York Times.

The speculation I refer to is the idea that babies “bond” to their biological mothers during gestation, and as a result they later suffer from “relinquishment trauma” if adopted or fostered. This idea was put forward in the 1990s, not by “researchers” as Spiers suggests, but by authors like Nancy Verrier, whose book “The Primal Wound” has served to distress many adopted individuals and adoptive families. Verrier, and her colleagues at the Association for Pre- and Perinatal Psychology and Health (APPPAH) have held that separation of a child from its biological mother, even on the day of birth, causes an intense and lingering sense of loss and difficulty with social relationships.

This speculation, repeated by Spiers in  her NYT piece, contradicts much that is known about emotional development. It also fails to consider alternative explanations for cases where adopted individuals do suffer from a sense of loss, loneliness, and difficulties with relationships. These facts and the existence of alternative explanations need to be considered before anyone accepts the idea of a “relinquishment trauma” affecting adopted individuals.

Here are some specific points that contradict Spiers’ claims about “relinquishment trauma”, a factor which, if operative, would presumably affect all adopted children:

I.                    The great majority of adopted children do very well.

II.                 When there are problems that can reasonably be associated with adoption these are usually seen in late-adopted children. Much research on this point was done after the closing of the notoriously dreadful Romanian orphanages in the 1990s.

III.              Attachment behaviors, in which infants and toddlers show their preference for familiar people and seek them when distressed or frightened, are not apparent until at least six months after birth. Newborn babies have been shown to recognize the smell of their mothers’ milk, but they do not show fear and distress when cared for by other people, as they will do in later months.

IV.              Feelings of loss and distress in adopted individuals can be explained without appealing to “relinquishment trauma”. Most adopted people will learn at some time that they are adopted and will either learn or imagine the circumstances of the adoption. Those circumstances are never pleasant and may range from the deaths of one or both biological parents to extreme youth or poor health or drug involvement of the biological mother to abandonment of the mother by the father and her own parents. It is possible, though less likely, that the biological mother simply did not want any children or had reason to reject this one as a child conceived through rape or incest.

Learning (or imagining) and processing any of these possibilities can place a serious psychological burden on adopted individuals. Feelings of loss and the need for comfort are likely to follow—especially if adoptees are told that they must be affected by “primal wounds” or “traumas” that are offered as explanations for feelings that have much more evident causes. Mental health professionals who stress “relinquishment trauma” as a reason for adoptees’ psychological distress should consider iatrogenic effects they may be creating. The New York Times opinion editors might also give some thought to this problem.

Wednesday, November 24, 2021

Parental Alienation and “Science Claimers”, or, “I’m Rubber, You’re Glue”

 

In a webinar (“Parental Alienating Behaviors and Coercive Control: The One and the Same” [sic]) sponsored by the “family access” organization on Nov. 21, Jennifer Harman, the parental alienation proponent, named a number of critics as Science Deniers (her caps). I was one of those who received this label, among whom were Bob Geffner, Joan Meier, Madelyn Milchman, Linda Neilson, and Joy Silberg.  

The statement that we are Science Deniers, as she puts it (with initial caps), is yet one more example of the “reversing” pattern of addressing criticism so characteristic of parental alienation proponents. Like abusers, who respond to accusations with DARVO tactics (deny, attack, reverse victim and offender), the PA group has come to the point of using criticisms they receive as allegations against their critics. You say they don’t understand demand characteristics, they respond that YOU don’t understand demand characteristics. You refer to PA ideas as a belief system, PA proponents refer to your positions as a belief system (Harman actually did this). This reversal is reminiscent of the playground response, “I’m rubber, you’re glue, what you say bounces off me and sticks to you”, or to the kid-witty rejoinder “I know you are, but what am I?”.

 The Science Deniers label is presumably a “reversal” response to the many published and presented criticisms of research work otherwise claimed to support the parental alienation belief system. For a number of years, critics of PA have been pointing out that there is no established way to identify (much less quantify) parental alienation, and that as a result there is no way to compare children’s attitudes before and after a PA intervention like Family Bridges or Turning Points. In addition, when PA proponents have attempted outcome research on the effects of their intervention programs, they have always used designs yielding low levels of evidence, so that their conclusions cannot be given the weight that is assigned to evidence-based treatments like Coping Cat or PCIT.

Nevertheless, Harman and other PA proponents have continued to claim that PA interventions and evaluations meet the Daubert or Frye  standards for admissibility of scientific evidence. As critics contradict this claim, PA proponents like Harman do not argue point by point why their work is adequate, nor do they address the specific criticisms supplied, or attempt to design research that meets higher standards. On the contrary, they simply re-assert that their work is “scientific”, and like Harman a few days ago, declare that anyone who is critical is therefore a Science Denier ( and to be classed with people who do not accept the reality of global warming). Thus, they seem to state, they are rubber and we are glue, and our criticisms of research failings prove that we refuse to take a scientific stance on PA issues.

It seems to me that there is no problem here of anyone “denying science”. The problem is that Harman and her colleagues are Science Claimers. They assert that their views “are science” and therefore anyone who rejects those views is “denying science”.

Harman, as a Science Claimer, said not a word about the nature of the scientific enterprise, about research design, or about any of the reasons why PA evaluation or outcome research should or should not be regarded as meeting scientific criteria. She did not for a moment address the criticisms of PA work that have been widely discussed by psychologist, psychiatrists, social workers, lawyers, and judges. Instead, she spent much of the presentation instructing her audience about professional journals and wowing them with how complicated it is to publish in a peer-reviewed journal. She introduced and contrasted peer-reviewed scientific journals and scholarly journals, asserting that she and other PA proponents have published scientific work in highly-rated journals, and comparing impact factors and other metrics in a way that was probably of little interest to her audience (but did sound important.)

Harman spoke with pride (as indeed she deserves to do) of publishing an article in Psychological Bulletin, a major professional journal with a high impact factor. She denigrated critiques of that article on the grounds that they were late and were published in less prestigious journals. She did not, however, note that her article was not “scientific” in the usual sense, in that it did not report or analyze any new empirical data. Harman’s article was a review or commentary article, discussing other people’s empirical work, just as were the published critiques of the Psychological Bulletin paper. Harman also failed to address any of the criticisms of her article’s claims and conclusions. For example, rather than discussing the criticism that her comparison of parental alienating behaviors to family violence should be considered an analogy, she stated firmly that in her “scientific opinion” the equation of the two was a correct and real one rather than a matter of reasoning by analogy. The two terms, she said, meant the same thing, had the same referent. She equally firmly restated her conviction that abused children protect and do not reject their abusive parents, a common assertion of PA proponents but one that has been critiqued and should be discussed in all its complexity and implications. Although there are both empirical and logical factors that Harman should have addressed if she wanted to support the PA belief system as scientists do, she failed to speak to any such points. She simply acted as a Science Claimer.

Of course, I am using the term Science Claimer only to mirror the term Science Denier. There is already a perfectly good word to describe the act of saying that one has scientific evidence for a position when there is in fact no adequate evidence. This is called pseudoscience. Identifying a set of claims as pseudoscience is not denying science, but clarifying the difference between an evidence-based position and one that is largely speculative but is asserted to be otherwise.