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Child Psychology Blogs

Concerned About Unconventional Mental Health Interventions?

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

Thursday, February 28, 2019

Parental Alienation and Recovered Memory: Some Parallels

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

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

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

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

Wednesday, February 20, 2019

Parental Alienation in the Context of Alternative Psychotherapies

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

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

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

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

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

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

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