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Concerned About Unconventional Mental Health Interventions?

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

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.

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