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Concerned About Unconventional Mental Health Interventions?

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

Friday, March 6, 2020

The Fight Over Parental Alienation (PA)

A number of publications in professional journals in the last few years have argued strongly against the idea of parental alienation (PA)--  the belief that when a child of divorced parents avoids contact with one parent, the reason is likely to be that the preferred parent has “brainwashed” the child into this negative attitude. Journal articles have pointed out that PA advocates have given no acceptable scientific evidence to support their views, and in addition the treatments advised by PA proponents may be not only ineffective but harmful.

 Because of this lack of supportive evidence, PA advocates were unable to get their claimed “syndrome” listed in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association when a new edition was published in 2013. The goal of inclusion in DSM-5 was an important one for PA proponents because this would be the key to payment for PA treatments by health insurance companies, who require a DSM code diagnosis.

It seems as if PA advocates and practitioners of PA treatments should recognize that they have been called out, but they are continuing to fight, and the money and power associated with bringing the PA concept into the courtroom are no doubt good enough reasons to do this. There are two fronts on which PA-related conflicts are intense right now.

One area of conflict is the International Classification of Diseases (ICD) produced by the Workd Health Organization. ICD includes both mental and physical disease and provides codes as DSM does, though DSM does this for mental illness only. The eleventh edition of ICD is in preparation. ICD-11 will not include PA as a diagnosis—there is no argument about that. There is, however, conflict over the proposed conclusion of PA as an index term. That means that a person could look up PA in the ICD-11 index, find it, and be directed to a page discussing child-parent relationship problems. This is legitimately seen by opponents of PA beliefs as the camel’s nose under the tent, with indexing of the term suggesting that there is a meaningful concept there, possibly to be followed by a later acceptance of PA as an ICD diagnosis. Comments have proliferated on the WHO website, with most of them arguing that PA should be included. An interesting comment recently was a masterpiece of irrelevant conclusion, arguing in favor of the inclusion of Craig Childress’s views and comparing statements about the lack of evidence for PA to climate science denial (apparently the fact that some denials are incorrect is taken as proof that this, and maybe all, denials must also be incorrect). Interested readers can find this material on the WHO website and can set up an account to read it.

A second area of conflict for PA opponents and proponents has to do with the demonstrated association between allegations of PA against one parent and domestic violence or child abuse by the other parent. It appears that women who charge their husbands with DV or abuse are more likely to have it alleged that they, the women, are interfering with the fathers’ relationships with their children and thus causing PA. This has come to the point where women may be afraid to state that they or their children have been abused because this statement may be taken as evidence that they are “brainwashing” the children and that they are irrationally hostile toward their husbands. In family courts, these arguments may well result in court orders prohibiting a mother to have contact with a child, making complete custody change to the father, and sending the child to a parental alienation treatment at the mother’s expense. Once these events have occurred, the possibility that the mother will regain contact (much less custody) diminish in a number of ways that would be familiar to Franz Kafka.

One belief behind this series of events is that family courts are biased against men and therefore, in all fairness, and to right this wrong, men’s claims and wishes should be given extra consideration. This idea appears to be a myth, and thus any effort to put a judicial thumb on the father’s side of the scale is going to create bias against mothers. The Guardian discusses this issue here:     Biased outcomes are undesirable in all cases, but they are actually dangerous if they lead to custody of children being given to abusers.

The argument thus goes on, but it seems to me that only the anti-PA side is paying any attention to the facts about outcomes.

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