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Concerned About Unconventional Mental Health Interventions?

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

Saturday, July 16, 2022

Did You Peer At My Article? Facts About Peer Review

 

Go into any family court where social science is being put in evidence,  and you will hear peer review referenced. “Are the papers on your CV in [portentuous pause…] peer reviewed journals?” “You are aware, are you not, that the work you are criticizing was [pause] peer reviewed?” It sounds as if peer review is an assay for gold content rather than what it is—part of the process by which articles are accepted for publications in professional journals.

What is peer review and how is it done? Is it a guarantee that a published article is accurate? This post will attempt to answer all those questions.

When an author submits a paper to be considered for publication in a professional journal, an editor is usually the first person to look at the submission. The editor may decide quickly that a submitted paper is not acceptable for the journal. This might be because the topic is not of much interest to the journal’s usual readers/ There can be many other reasons too. I have had papers rejected because, in one case, the information in the paper was derived from journalistic sources, in another case, because my paper commented on another paper that had been published some time previously, and in a recent case, because the editor was afraid of a lawsuit against the journal if the paper was published there.

If the editor does not quickly reject a paper, he or she will seek peer reviewers who will give opinions about the paper and suggestions for improvements. The reviewers may be members of the editorial board or authors who have published work on similar topics. They receive an anonymous version of the article and their names are also kept secret from the article author. It is not necessarily easy to find two or three reviewers for a paper. Reviewing can be a lot of work, and most people qualified to review an article are also busy with other professional work. (An academic book editor recently mentioned to me that book publishers are having a terrible time getting reviewers for books in development, too.)

Some journals ask authors to suggest some reviewers and even to state whether there are any people they do not want to review their work. I have no idea how those suggestions are actually used.

When reviewers have been found they receive the anonymous manuscript to read. (Authors are even asked to hide citations of their own work by using the word Author instead of their names, but it seems likely that reviewers can sometimes guess whose work they are reading—and some authors can probably guess who their reviewers are.) They reviewers often also receive a list of questions that they should answer as part of their review. These questions, and the focus of the review, are different for different journals. For example, psychology journals are concerned about research design and statistical analysis, whereas journals focused on family law are more likely to focus on legal and practice issues.

Reviewers are often asked to return their completed reviews within a month. When I am a reviewer I usually manage in that time frame, but not everyone does. Between the search for reviewers and the actual review process, peer review may take a year or more. I recently withdrew an article submitted to a journal when it had been a year without any reviews or decisions.

When the reviews have been submitted, an editor will go through them and decide first whether the article should be rejected or accepted as it stands (not common). If the editor decides, as is more usual, to accept the paper if revisions are made in line with the reviewers’ recommendations, he or she may simply send the decision and the reviews to the author, or may summarize the reviewers’ concerns. The editor may add his or her own suggestions for revisions. One of the points the author is asked to make is a list of the weaknesses of the research or reasoning on which the paper is based. The author is given a time limit for resubmitting the revised paper.

If and when the revised paper is resubmitted, the author is also asked to submit a point by point description of the ways the reviewers’ suggestions have been complied with. An editor will review the resubmitted material and decide whether to accept the paper at that point, or to send for another round of reviews, or to reject.

So, these are the steps involved in peer review. They involve many steps and opportunities for human error. Articles may be peer reviewed and yet contain problems that are only noticed later. They may also be correct on the points considered by the reviewers but include misinformation about material that the reviewers did not understand or attend to. Corrections on those points may not occur for years, or ever—or they may be brought up by readers who complain or write rebuttal papers that may or may not be published.

When serious errors are apparent in a published paper, the journal may retract the paper. Depending on when retraction occurs, the paper may not appear at all or may appear with a stamp saying “retracted” on it. Unfortunately, the nature of the Internet is that once such a paper has been posted, it never goes away, and most readers will not know it has been retracted. The retracted paper may even be cited in new papers by other authors. An article by Jeffrey Brainard in Science (1 July 2022) describes unsuccessful efforts to get journal editors to flag citations of now-retracted papers.

The upshot of all this is that peer review is the best thing we’ve got for assuring the accuracy of published articles. It requires great efforts from many people—but it is far from perfect. The best thing readers can do to insure accurate understanding is to be educated, or educate themselves, on the basic issues found in journal articles they want to read and use. In addition, when peer-reviewed articles are used in court, it is critical to remember that research findings are stated in probabilities, not in the simple terms used in law everywhere except Scotland (where “not proven” is an option). Applying the conclusions of journal articles to single cases is a challenge that requires us to think hard even when we would rather have the answer handed to us.

 

Monday, July 11, 2022

Can We Regulate or Ban Potentially Harmful Psychological Treatments?

 

If a psychosocial treatment is powerful enough to change someone’s thoughts, feelings, and behavior for the better, we need to be aware that it would also be possible for the treatment to change matters for the worse. Psychological treatments, like medical practices, can have the potential for harm to the recipient. When the person being treated is a child or adolescent, it’s quite possible that harm to the client can be accompanied by harm to some or all of the rest of the family.

Unlike medical scenarios, where severe physical harm or death can result from some treatments, psychological treatments do not generally cause immediate and visible harm. The harm done by some psychological treatments may be delayed, as would be the case in later family dysfunction or suicidal thinking and actions. The harm may even be indirect, as in the wasting of time and resources a family needs for a range of expenditures like dance lessons for another child or home remodeling to give children their own rooms. The use of potentially harmful, ineffective treatments also delays or makes impossible other treatments that are safe and effective for children and families.

An example of a potentially harmful treatment is Critical Incident Stress Debriefing, CISD, an approach to preventing trauma responses in people exposed to disasters. When CISD was used following 9/11, it became apparent that people who did not receive CISD treatment did better in terms of trauma symptoms than those who did receive it. Psychologists and other mental health professionals were advised not to use CISD, but the Internet continues to carry positive messages and encouragement to use CISD.  

It is not illegal to use CISD, and as the treatment is used primarily for adults, there has never been real pressure for legal prohibition. When children or adolescents are harmed by psychosocial treatments, it is much more likely that there will be pressure to regulate those treatments by legislation that prohibits their use with minors.  But even those regulatory bills are not always passed, or if they are passed do not always speak to the real issues.

In 2001, the state of Colorado passed Candace’s Law, which prohibited active physical restraint as a therapy. This law was instigated by the death of a 10-year-old girl, Candace Newmaker, by suffocation during a psychotherapy purporting to cause her to become emotionally attached to her adoptive mother. The therapists believed that they could accomplish this goal by “rebirthing” treatment, ordinarily a brief, silly but harmless procedure. Candace was wrapped tightly in a sheet and told that she must struggle to get out and be “reborn”, while helpers pressed rhythmically on her body in mimicry of uterine contractions. The child was not able to comply and was asphyxiated. The therapists directing the procedure were convinced that Candace had to be forced into compliance and ignored her pleas that she could not breathe. The Colorado legislation was pushed through because of public horror at the event as well as because of a small number of activists pressing for passage, but some Colorado therapists continued to support “rebirthing” and other methods involving physical restraint. Adoption organizations supported the legislation because many of the children involved in these treatments were adopted.

In 2003, the state of Utah attempted to pass legislation banning the use of “holding therapy”, a treatment involving physical restraint that was related to the “rebirthing” that killed Candace Newmaker. (Candace had also been subjected to holding therapy, whose tenets supported the view that she must be forced to comply.) However, the bill banning holding therapy never came to a vote as opponents ran out the clock on the final day of the legislative session. Mental health professionals and activists strongly supported the bill, but it was opposed by practitioners of holding therapy in the state.

In 2015 and later, more than 20 states passed legislation prohibiting psychologists from using conversion therapies with minors. Conversion therapies are psychological treatments intended to alter same-sex orientations to heterosexual orientations; these treatments involve a range of unconventional methods such as mock-fighting while naked or  using practices related to holding therapy. Conversion therapies have been very distressing to a number of participants and have never been shown to be effective. Conversion therapies remain legal when chosen by adults for themselves or when performed with children and adolescents by members of the clergy. State psychological associations argued strongly in favor of the legal ban, as did LGBT organizations that wielded considerable political power.  A bill introduced in the House of Representatives in 2021 prohibited states from using Medicaid funds for conversion therapy, which was defined as attempts to change sexual orientation in return for monetary compensation.

In 2022, the reauthorization of the Violence Against Women Act included a model law, Kayden’s Law, which states must enact if they are to be eligible for any of the funds appropriated under VAWA. Kayden’s Law is directed at the use of so-called “reunification therapies”, treatments that purport to correct the attitudes of children who display “parental alienation” (resistance to or refusal of contact with one of their divorced parents). Among other potential harms, use of these treatments has sometimes placed children in the hands of abusive parents.The treatments are generally done under court orders that prohibit any contact between the child and the preferred parent for 90 days or longer; the treatments are claimed to create a good relationship between the child and the rejected parent.  The model law states that children are not to be separated from the preferred parent for the purpose of encouraging their relationship with the disfavored parent, a provision that would essentially prohibit most reunification therapies.. California has already reported its bill, SB616, out of committee, while in Massachusetts the bill is still in committee. These bills are bound to be opposed and challenged by a number of  lawyers and mental health professionals who are deeply involved with parental alienation cases in spite of the lack of evidence for the safety and effectiveness of reunification therapies. It will also be opposed by many fathers’ rights groups and by organizations like Family Access Fighting for Children’s Rights that promote the use of the treatments. Parents who have been ordered not to contact their children will also be strongly interested in the legislation, but in many cases those parents are already bankrupt because of the expenses of their legal fights for custody of their children. Psychologists and psychiatrists as professional groups have not taken official positions on this legislation.

When potentially harmful psychological treatments are not regulated by professional organizations, what does it take to ban them by legislation? There is a horrible advantage to having a child die in the treatment and become a “crystallized symbol” or “poster child” for opposition to the practice. Even then, however, there will be those who favor the problematic practice and want it to continue, who consider the death to be a pure accident (or, in Candace Newmaker’s case, who suggest that the child died on purpose in order to distress people). When harms are indirect and not immediate, there are plenty of people who will say they are negligible harms. Successful legislation may depend on activism by those with a personal stake in the game, with financial and other resources, and with the capacity to organize for political purposes. These factors have played a critical role in the legislative banning of conversion therapies. Will they exist or be successful with respect to treatments for parental alienation? That remains to be seen. It is clear from the examples given in this post that there is no point waiting for professional groups to take the first strong positions regulating potentially harmful psychological treatments. But it may happen that when legislation is in progress, some professional groups will feel that they must speak out one way or the other.

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.

                                    *********************************

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.