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.

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.

 

Two of These Things Belong Together: Evidence Based Treatment, Evidence Based Practice, Evidence Informed Intervention

 

Yes, although all these things in my title have the word “evidence” in their names, one is different from the others. The differences hinge on what people mean by evidence and its implications, and this is a real question, not a version of asking what “is” is.

Under different circumstances, “evidence” can be what my neighbor tells me happened on our street, or some material that a judge decided to accept in court over the protests of one party to a suit. It can also be information that has been collected according to the rules set by a group of scientists whose work is relevant to the topic.

Since the 1990s, medical specialists and psychologists have focused a good deal of energy on creating evidence based medicine and evidence based psychological treatments. They have used the term evidence based treatments (EBTs; sometimes called empirically-supported treatments, ESTs) to describe medical or psychological interventions that have been shown to be safe and effective through information collected according to established research rules. EBTs are treatments that have been shown to be effective in treating particular conditions by at least two studies that use randomized controlled trials or clinical controlled trials. At least one study needs to be done by independent researchers, not people involved in the method itself. There are a number of other requirements for these studies, for example that the people evaluating the outcome of a treatment should be “blind” to (unaware of) which clients received the treatment and which did not. Readers can find further descriptions of the rules of research at www.effectivechildtherapy.org , a website sponsored by Division 53 (Clinical Child Psychology) of the American Psychological Association.

Although this point is not always made clear, it is also generally considered that EBTs will not be potentially harmful treatments (PHTs). It’s well understood in medicine that a powerfully effective treatment may have unwanted adverse side effects, and such treatments have to  be chosen with the understanding that there is a risk/benefit ratio to be considered. Psychologists have only fairly recently begun to consider that a psychological treatment can have adverse effects as well as—or even instead of—beneficial ones. There is still too little known about adverse events of psychotherapies to make it easy to calculate risks and benefits of treatments, but a treatment with a known potential for harm would presumably not be considered an EBT at this point.

EBTs are the ones that “just don’t belong here” out of the.group of three in my title. How are evidence based practice (EBP) and evidence informed intervention (EEI) different from EBTs? Why is it important to consider the differences?

To answer the last question first: although psychologists and other mental health professionals have been encouraged to strive to use EBTs by their national professional organizations, they do not always do so. One very practical reason is that the research has not been done to provide a clear evidence basis for all psychosocial treatments. In fact, if people did not use treatments that are currently without a clear evidence basis, no data could be collected to show whether or not those treatments are demonstrably safe and effective. (However, when such treatments are used, it should be made clear that they are experimental treatments whose effectiveness has not been decided.)

A second practical reason for failure to use EBTs is that such treatments require very specific training. They are “manualized”—that is, there are prescribed ways of handling the events and timing of treatment. People trained to carry out EBTs must go through an extensive program that makes sure that their use of the treatment method is very close to the intervention whose outcome was tested empirically. Such training can be expensive in terms of time and other resources and is not available to every mental health practitioner.

But there are other reasons for failure to use EBTs, as well as the practical points. Mental health professionals may in many cases be people who feel that they know how to help others psychologically, that their personalities and compassion are as or more important than the precise methods they use. Like physicians who may prescribe a medication “off-label”, mental health professionals may feel that they have the authority and the responsibility to alter the way therapy is done, to personalize it in ways that they feel work for themselves and for their clients.

EBPs and EEIs are the results of this last reason, as well as of the scarcity of EBT resources. In both of these approaches (EBP or EEI), the idea is that a practitioner looks to the best available empirical research on therapies and chooses treatment from those, while also considering a client’s preferences and the therapist’s own experience, or “practice wisdom”.  There are, however, some flaws in  this approach. The first is that the best available research may not be at EBT level.   For example, none of the various parental alienation treatments have evidence at the EBT level, though there is published outcome research with weaker designs and implementation. To use the EBP language, this is the best available evidence—yet it is not at the level psychologists are encouraged to use, nor are these interventions apparently presented as experimental in nature. (On the contrary, PA advocates insist that they are supported by evidence adequate for admissibility in family courts, rather than acknowledging the level of evidence available.)

It is quite understandable that practitioners choose the EBP approach when there are no EBTs available for use. But—when there are EBTs, as there are in many situations involving children’s mood or behavior, there are fewer reasons to bring in “practice wisdom” and client preferences.

Evidence informed interventions (EEIs) use the same preference and wisdom factors as EBP. But they also argue that the quantitative studies used in EBT work cannot give information from the patient’s perspective, for which they consider qualitative and mixed methods research to be most important. These types of research are expensive in time and resources and thus often use small numbers of participants, making it difficult to be sure about results and also making it hard for other researchers to replicate. A recent book on custody and parenting coordination, “Evidence-informed interventions for court-involved families” (edited by Lyn Greenberg, Barbara Fidler, and Michael Saini), presses the EEI approach rather than encouraging more stringent research designs.

According to an Australian source (facs.nsw.gov.au) an EEI approach means using research evidence (level not stated), lived experience and client voice, and professional expertise in mking treatment decisions. The nature of the research evidence is not mentioned (and I have to wonder whether there can be experience that is not “lived”?), nor is there any discussion of the proportions of these sources practitioners should use in their decision-making. EEI proponents, in my opinion, see psychotherapy as an art rather than a science and believe that family events in particular are too complex to be approached effectively on the basis of EBT-level outcome research. I cannot say that they are necessarily quite mistaken in this view, but I would say that art should not be presented as ”evidence” in the scientific sense.

Advocates of EBP and EEI have on their side the practical facts I mentioned earlier—that EBTs are not always available , and that if only currently-known EBTs are used, we can never have any more EBTs identified. Given that these issues are important, however, there would appear to be no reason to withhold from courts and clients the fact that EBP/EEIs should be identified as “experimental” for the simple reason that they are not EBTs. The failure of proponents of these non-evidence-based treatments to identify their methods appropriately leads me to question their reasons for stressing preferences and experience over evidence. An attendee at a conference recently posed for me the question: isn’t it important to provide some treatment when there is a problem? I think it is not—unless it has been demonstrated that the treatment is safe and effective. Otherwise, is the practitioner simply deciding to use a treatment because he or she can do so and wants to do something, perhaps has even told the client or a court that he or she can help?

These are tangled webs, I am afraid, and I do not claim to know why people choose EBP/EEI and fail to say this is what they are doing. What I do know is that the word “evidence” in EBT, EBP, and EEI should not be taken to have the same meaning at all times.

 

 

 

 

Challenging Parental Alienation: A New Book for Professionals and Parents

 

There is a good deal of published material about “parental alienation” (PA). Unfortunately, when parents are confronted with allegations that they have made a child reject the other parent, it can be very hard for them to find the professional journals that publish this kind of material. The books that parents could find in the library or buy are almost all by PA proponents who try to support allegations that a parent has caused a child’s reluctance for contact with the other parent.

Well, TA-DA! The first book arguing against PA principles and practices is to come out on Dec. 3, 2021! Here is the reference info:

Mercer, J., & Drew, M. (Eds.) (2022). Challenging Parental Alienation. Milton Park, UK: Routledge.

I wish I could tell you the price, but I don’t know what it is; it’s the publishers that set this, not authors or editors. But, if it turns out to be too pricey for you, you could ask your public library to buy it.

Pre-publication orders can be placed at https://www.routledge.com/Challenging-Parental-Alienation-New-Directions-Professionals-and-Parents/Mercer-Drew/p/book/9780367559762

This edited book has chapters by a number of lawyers and of psychologists and others involved in the family courts. Especially notable is that chapters deal not only with PA in the United States, but with family court and domestic violence issues in Canada, Australia, and the United Kingdom. And, we are proud that the book includes material written by a young woman who went through a PA treatment and by a mother who experienced psychotherapy based on PA assumptions.

Here is the Table of Contents, with authors’ names for each chapter:

 

Table of Contents

Chapter 1  Introduction to Parental Alienation Concepts and Practices

                       Jean Mercer and Margaret Drew

Section One  

When a Child Avoids a Parent: Understanding the Problem

Chapter 2   History of the Parental Alienation Belief System  

                       Julie Doughty and Margaret Drew

Chapter 3   The International Expansion of the Parental Alienation Belief System Through the

UK and Australian Experiences  

                       Julie  Doughty  and Zoe Rathus

Chapter 4   Experiences of Parental Alienation Interventions 

                       Adrienne Barnett, Arianna Riley, and “Katherine”

Section Two

When a Child Avoids a Parent: Identifying and Treating Problems

Chapter 5   Evaluations for the Courts in Child Custody Cases:   An Attorney’s Perspective

                        Nancy Erickson

Chapter 6   Distinguishing Alienation from Child Abuse and Adverse Parenting  

                        Madelyn  Milchman

Chapter 7    Comparison of Parental  Alienation Treatments and Evidence-Based Treatments for 

                    Children

                        Sarah Trane, Kelly Champion, and Steven Hupp

Chapter 8 Gender Credibility and Culture: The Impact on Women Accused of Alienation  

                         Margaret Drew

Chapter 9     Developmental Changes in Children and Adolescents: Relevance for Parental

                     Alienation Discussions

                         Jean Mercer

Section Three

When a Child Avoids a Parent: Scientific and Legal Analyses

Chapter 10    Parental Alienation Concepts and the Law: An International Perspective   

                             Suzanne Zaccour

Chapter 11    Questioning the Scientific Validity of the Parental Alienation Labels in Abuse

Cases                     

                             Joan Meier

Chapter 12     Parental Alienation, Science, and Pseudoscience  

                            Jean Mercer

 

Chapter 13     Conclusion: Current Issues About Parental Alienation 

                           Jean Mercer and Margaret Drew

 

 

 

Parental Alienation Science Stumbles Along

 

Over the last few years, a major goal of proponents of the parental alienation belief system seems to have been to amass a series of weakly-designed and implemented “scientific investigations” to allow the proponents to argue that there is scientific support for their views. This preference for quantity over quality is understandable, as serious empirical investigations are time-consuming and costly in planning and resources, and family courts are more impressed by hearing about dozens of studies than interested in understanding how meaningful those studies are.

Amy Baker and William Bernet have for some years been the PA principal investigators of note. Their work has featured absent or questionable control groups, retrospective self-report information in many cases, and an insistence on forcing ordinal data into Procrustean parametric analyses.

Now the Colorado psychologist Jennifer Harman is taking the lead in weak studies, whose publication allows her to assert repeatedly that children involved in ambiguously-defined parental alienation cases are victims of family violence. She has recently added to her assertions by declaring that rejected parents are the objects of coercive control by the ex-spouse.

I will briefly describe and comment on two recent Harman publications.

Harman, J., Saunders, L., & Afifi, T. (2021). Evaluation of the Turning Points for Families (TPFF) program for severely alienated children. Journal of Family Therapy, DOI: 10.1111/1467-6427.123666. (Please note, this publication is not the same as American Journal of Family Therapy, which also publishes pro-PA material.)

Harman et al. collected data about TPFF, an intensive program run by the LCSW Linda Gottlieb. Like other PA interventions, TPFF requires that children be court-ordered into the program or that an agreement between the parents be approved by the court. Like other PA treatments, TPFF lasts about 4 days, involves prohibition of contact between child and preferred parent, for at least 90 days, and requires “aftercare” for both parents and child or children, performed by a a PA-approved therapist. TPFF also requires the preferred parent to write a letter to the child acknowledging his or her attempts at alienation. Gottlieb videotapes therapy sessions, and the videotaped material was made available to Harman et al. Gottlieb, incidentally, claims almost 100% success in creating positive relationships between children and previously rejected parents; as this rate of success has been questioned, it was desirable from Gottlieb’s viewpoint to have a positive report from Harman..

Harman was interested in evidence that TPFF was safe for children, as I and other authors have questioned whether this is so. On the grounds that none of the observed 32 children from 15 families ran away or carried out any self-harm during the program, and that Gottlieb states that none of the previously-treated children with whom she keeps in touch have done so, Harman concluded that TPFF was safe for children. She did not report on other possible aspects of harm, for example the PTSD diagnosed in a child following another PA intervention. Harman stated her belief that children who have reported distress and harm from PA interventions were simply still alienated, and would not have made such reports if their alienation had been repaired.

Harman also sought to know whether TPFF was an effective treatment for PA cases. To do so appropriately, of course, she would have needed to compare a group of TPFF-treated children with a matched control group who received no treatment or some other form of treatment. To compare behavior before and after treatment (as of course has also been done by Richard Warshak and other PA proponents) is to beg for confounding of variables so that it is impossible to know whether any changes were actually caused by the intervention.  Reports following Family Bridges experience point to threats from therapists as reasons for behavior change, but it is unknown whether such threats occur during TPFF.

Like some other PA proponents, Harman asked her staff to evaluate child behaviors on a Likert scale, rating behaviors from 1 to 5. Again like other PA proponents, Harman took these evaluative data and performed a statistical analysis which would only have been acceptable if the measurement method met certain criteria which were not met. The conclusion that TPFF is an effective treatment thus remains open to question.

There are many concerns about the basic data as well as about the data analysis. The videotapes evaluated by Harman’s students were made by Gottlieb and certainly in her presence (it is not clear whether other people than parent and child were in the room at the time). This is far from an independent set of data, as Gottlieb’s presence signaled to both parents and children what behaviors were desired, and indeed necessary to bring the program to an end. The correct method would have been to have the recording done by a person who was not aware of the purpose of TPFF and who observed  parent and child without Gottlieb being present. Without wishing to stress that videorecordings can be cherry-picked, I would also note that the recordings should have stayed in the possession of the neutral recorder until handed over for analysis.

The research report by Harman, Saunders, and Afifi thus adds to the collection of weak studies of PA interventions, but in fact does not allow any clear conclusions about the safety or effectiveness of TPFF.

A second recent publication by Harman is this:

Harman, J., Maniotes, C, & Grubb, C. (2021). Power dynamics in families affected by parental alienation. Personal Relationship. (this journal is unfamiliar to me and the pdf I downloaded did not contain any DOI information.)

In this study, Harman and her colleagues approached special interest social media groups like Facebook divorce or parental alienation groups. They provided a survey and asked for emails from people who would be willing to be interviewed, and interviewed 50 fathers and 29 mothers about their experiences with their ex-spouses and children following divorce. The point of the study was to examine how these experiences fit the concept of coercive control and how power dynamics were related to parental alienation—interestingly, the very features that protective parents have been attributing to parents now rejected by their children. Harman et al. appear to have collected information closely related to parental alienation concepts, for example, that “in some cases the adultification [of children] took the form of allowing the children to decide whether they wanted to have their parenting time with the targeted [sic] parent or by sharing inappropriate information with the children”, statements frequently found in discussions by PA proponents.

It would seem that reviewers or others must have queried Harman’s personal commitment to PA ideas and her ability to be objective on the topic. Harman stated that “the first author contends that her experience as an alienated step-parent provides a unique perspective to the study and has helped to gain the trust and confidence of the parents that were interviewed, as many were afraid or concerned about their experiences not being believed.” She noted also that the second and third authors were included because they did not  have PA experience and could provide “more objective interpretation of the data”.

There are a number of concerning issues here. The first is that interviewees were sought from organized groups who were likely already to share certain views of post-divorce events, particularly views of parental alienation as they felt it had negatively affected their lives”.  This is a matter not so much of preaching to the choir but of being preached to by a choir that has memorized the hymns for the season. Members of social media groups are likely to share beliefs both before they join (this is why they join), and afterwards, when they have thoroughly informed each other of their opinions and experiences. One would imagine that anyone who planned to use regression methods would want to include a number of “nonbelievers” to show a comparison to a different power dynamic among them, but this did not happen.

That Harman thought her personal experiences would set interviewees at ease is worrisome, as it suggest that she told the interviewees about her own life, thus introducing various types of bias in the forms of the wish to please her,  social conformity to the standards she supplied about views of post-divorce relationships, and increased memory and reporting of events that could be interpreted as PA. Harman’s statement that the second and third authors would be more objective in interpretation of data seems to be an acknowledgment that she herself would not be objective—although it is difficult to know how one can be subjective in reporting statistical results.

Once again, Harman and her colleagues have added yet another questionable study to the trove already provided in courts of law as “evidence” to support PA concepts regarding identification and treatment of a posited disorder.

 

 

Talkin' Pseudoscience/Parental Alienation (Blues)

 

In recent months, I have come across the use of the term “pseudoscience” several times in advocacy for and against the parental alienation belief system. One blog post declared (but did not provide a rationale for the view) that parental alienation (PA) beliefs are pseudoscience. A little earlier, William Bernet, a well-known proponent of PA, declared in a journal article that critics of PA are pseudoscientists. The PA proponents Linda Gottlieb and Steven Miller have taken Bernet’s position in print and in testimony.

This conflict has quickly descended to the mutual finger-pointing, tit-for-tat, “I know you are but what am I?” level. “Pseudoscience” is not just an insulting term; it has a real meaning, which I will talk about here.

I would suggest, as a definition of pseudoscience, the following: pseudoscience is the claim that certain ideas have been supported by empirical data collected and analyzed by methods approved by members of the most closely related scientific discipline—when no such data collection and analysis have actually occurred. Please note that I do not say there has been no data collection at all (though that can happen), but simply that the methods used are not the ones agreed upon by members of the appropriate discipline.

To elaborate on this definition, I am going to discuss some hallmarks of pseudoscience as considered in the 2019 Cambridge University Press book Pseudoscience in Child and Adolescent Psychotherapy, edited by Stephen Hupp. The introductory chapter of this book (by Hupp, Mercer, Thyer, and Pignotti) notes a few common characteristics of pseudoscience:

1.   1   It involves exploited expertise, where someone who is a genuine expert in one field provides testimony in an area where he or she lacks training. For example, Steven Miller, a prominent figure in parental alienation discussion, is in fact an emergency medicine physician. Warren Farrell, who has testified about his observations of children in PA cases, is a political scientist who has written about fathers’ rights.

2.   2    There is no research support (as in the claims made by Craig Childress and Dorcy Pruter) , but the promoters of the treatment have financial interests in the treatment.

3.    3   There is inflated research support; “exaggerated claims are made on the basis of poorly designed or conducted research or research published in journals with very low scientific standards”. This is the case with the well-known research reports of Richard Warshak or of Amy Baker, reports which present weakly-designed and implemented research as if it met high standards.

4.    4   An important mechanism of the treatment is implausible based on current scientific knowledge, as is the case with PA claims about brainwashing.

5     Pseudoscience often includes references to established biological or physical concepts that are irrelevant to claims made and appear to have no purpose but obfuscation and a “veneer” of science. Reports about PA methods supposedly associated with polyvagal theory would be included here, although polyvagal theory itself is very much open to similar criticism.

 

Proponents of the PA belief system claim, pseudoscientifically, that they have empirical research evidence for their concepts, even though they have in no case complied with the evidence base standards set in medicine and in psychology over at least 20 years now. In addition, as I have just shown, their claims share hallmarks of pseudoscience. It is for them to correct these failings if they do not wish to be called pseudoscientists. Incidentally, addressing a topic other than PA, the developmental psychologist Lawrence Steinberg recently discussed the pitfalls of claims of cause and effect in outcome studies with nonrandomized or other correlational designs – highly relevant to PA issues (nytimes.com/2021/10/10/opinion/Instagram-facebook-mental-health-study.html).

 

What, then, about the statement that opponents of PA are pseudoscientists? This is absurd on the face of it, because opponents have done only a very few empirical investigations of matters associated with PA, and none of PA itself or of  the proprietary PA interventions. PA opponents on the whole do not offer claims of scientific evidence, so what they do offer is not pseudoscience. Instead, PA opponents have offered commentaries and critiques of PA claims that are designed to show weaknesses of PA concepts and of PA outcome research. If PA proponents paid  attention to these critiques and made serious efforts to develop acceptable empirical work on this topic, there would be benefits for children and parents. Such benefits, however, do not seem to be a major goal of PA advocates.

 

Gottlieb Addresses FAF on Interesting Subject of Cognitive Errors about PA

 

The organization www.familyaccessfightingforchildrensrights.com has been putting on a series of webinars by proponents of the parental alienation (PA) belief system. On Oct. 3, 2021, the speaker was Linda Gottlieb, creator of the Turning Points for Families (TPFF) intensive intervention for children who reject or resist contact with a divorced parent following posited manipulation by the other parent. Gottlieb addressed herself to the subject of “nonspecialists” and “pseudoscientists” and advised parents whose children are resisting contact with them to use her statements to have professionals who disagree with her positions dismissed from the case they bring.

There is, of course, a certain flavor of the schoolyard taunt “I’m rubber, you’re glue” here, as Gottlieb and other PA supporters have been correctly termed pseudoscientists, and the idea of a specialty in this area has been severely questioned as tending to focus on one issue when many should be considered.

Here are some concerning ideas put forward by Gottlieb in the webinar:

1.     1. Gottlieb continues to speak of diagnosis of PA, when it is clear that there is no such diagnostic category in DSM-5 or ICD-11. She does not speak of identification of child or parental behavior, as would be appropriate if there is no established diagnosis of the family situation in question.

2.     2.  Gottlieb fails to note that there is no established protocol for identifying PA and discriminating PA cases from cases where resistance results from experiences with the rejected parent.

3.    3.   Gottlieb continues to insist that when a child is identified as showing PA, and when the preferred parent is known to have shown parental alienating behaviors, this situation is equivalent to an adverse childhood experience (ACE). ACEs have been shown to correlate with a number of undesirable physical and mental health outcomes, and Gottlieb claims that similar outcomes would result from PA. This is, however, simply proof by assertion, as no empirical work has ever shown any particular outcome, positive or negative, of the child’s experience when PA is claimed to be a factor.

4.      4. Gottlieb’s argument that PA is an ACE leads her to state categorically that where there is PA, the preferred parent’s actions are equivalent to child abuse (CA). The PA=CA equation is repeated throughout the presentations.

5.     5.  Having defined PA as equal to CA, Gottlieb proceeds to state the position that PA is even worse than CA. In order to make this argument, she refers to her own experience with foster children who had been abused and neglected and who nevertheless wanted to visit their parents. Children in PA cases do not want this, by definition, which leads Gottlieb to say that their experiences of manipulation have been so severe as to interfere with the “instinctive” wish for contact with parents, as displayed by the foster children. Gottlieb and other PA proponents have frequently made this argument, and it is time to rebut it.

Let’s consider the differences in the current living situations of these two groups. Children in PA cases are living comfortably in familiar homes, with adults they trust and care for, with access to friends, siblings, supportive school situations, and sports or hobbies they have chosen. Foster children are in unfamiliar settings that may or may not be comfortable, they are supervised by unfamiliar adults who do not necessarily care for them, they may share the foster home with the carer’s children and a number of other foster children and therefore feel a lack of either privacy or friendly intimacy, they may suffer abuse from other children or from the foster parents themselves, they may be mocked at school as foster children or seen as potential problems by teachers, and they may not be able to visit other children in their homes or have any contact with their “home” friends. The food they are given and the religious practices of the foster home may be quire unfamiliar to the children.

Should we be surprised, then, that foster children long for their familiar home setting and even for contact with a parent who may at times have been abusive (but is not being abusive at the time)? And should we be surprised that a child in a PA case does not wish to exchange a familiar, comfortable setting, with pleasant social contacts and familiar activities, for a less familiar, even unknown, situation with a parent who has been rejected for various weaker or stringer reasons? I don’t think we need to enter into ill-informed discussions of instinct to answer these questions.

6.     6.  Gottlieb’s argument that PA=CA is intended to justify prohibition of contact between the child and the preferred parent for 90 days, often increased in further 90 day increments. Defining the preferred parent as a child abuser is the foundation for making these cases equivalent to child protection cases and removing the child from the home.

 

Gottlieb’s lengthy presentation failed to support her claims about PA or the implication that her TPFF intervention is a successful one.

By the way, another PA proponent, Jennifer Harman, who makes claims about PA and CA exactly like Gottlieb’s, has recently published what purports to be an evaluation of TPFF (see Harman, J., Saunders, L., & Afifi, T.[2021]. Evaluation of the Turning Points For Families (TPFF) program for severely alienated children. Journal of Family Therapy.) Regrettably but unsurprisingly, Harman et al report positive outcomes for TPFF while continuing to make the usual design errors of PA supporters. They use a Likert scale but apply parametric statistics, they have no comparison group, and they base their conclusions on videorecordings made by Gottlieb rather than on any independent data source. I might also point out that they define harm to children as limited to self-harm and running away—curiously different from the mental health disorders they attribute to untreated PA experiences.

 

Ill-Judged Encouragement of "Facilitated Communication" by Vermont

 

Janyce Boynton, an activist working to protect nonverbal people and their families from use of the discredited “facilitated communication” (FC) technique, has commented on another blog about events in the state of Vermont. I am reposting these links because I think it is critical for people to know how problematic FC actually is.

Although supporters of FC believe that this method of pointing at letters and words allows nonverbal people to communicate their real thoughts to others, it is unfortunately the case that no systematic evidence supports this claim. Instead, we have seen disastrous effects on families when FC “interpreters” have made accusations that family members had abused their nonverbal relative. Even though those investigations did not show that such abuse had occurred, unsubstantiated or even retracted allegations of abuse cannot be undone and continue to harm families and individuals.

Here is what Janyce Boynton has had to say about the involvement of Vermont with FC:

 

Vermont DAIL's Commitment to a Discredited Technique

https://www.facilitatedcommunication.org/blog/vermont-dails-commitment-to-a-discredited-technique

"New" Vermont Facilitated Guidelines. Really?

https://www.facilitatedcommunication.org/blog/vermont-facilitated-communication-guidelines-really

Vermont Allows Abuse Allegation Disclosures and Interviews Using a Discredited Technique

https://www.facilitatedcommunication.org/blog/vermont-allows-abuse-allegation-disclosures-and-interviews-using-a-discredited-technique

Not on the Levels: Harman Says She Evaluated Turning Points

 

Jennifer Harman, a proponent of the parental alienation belief system, has published an article that reports her attempt to evaluate Linda Gottlieb’s intensive parental alienation treatment, Turning Points for Families (TPFF). For those readers who are interested, the citation is

Harman, J., Saunders, L., & Afifi, T. (2021). Evaluation of the Turning Points for Families (TPFF) program for severely alienated children. Journal of Family Therapy. DOI: 10.1111/1467-6427.

In this post, I will discuss a number of issues of research design and analysis that argue against any conclusion that TPFF is a demonstrably effective treatment for parental alienation (PA). It’s notable that this conclusion, though not exactly reached, was possibly assumed in Harman’s plan, as she notes early in the paper that Gottlieb has provided “evidence-based treatment since 1994. (It is not clear what this means, as Gottlieb has stated that she did not formulate TPFF until 2015.)

My title for this post, “Not on the Levels”, is not a calumny against Harman’s integrity or her appropriate intentions in carrying out this piece of outcome research. I think it is most parsimonious to assume that Harman intended to do this work correctly but made some errors that closely resemble those of other PA proponents like William Bernet and Amy Baker. These errors can be described in terms of “levels” of various kinds – particularly levels of evidence and levels of measurement.

I.                    Levels of evidence

Harman et al. state in their abstract and essential points that they have shown that TPFF is an effective treatment. They have not concerned themselves, or reminded their readers, about the idea that not all outcome studies are equally meaningful. How much credence can be given to an outcome study depends on the way data were collected and the comparisons that were made (if any). (More about this concept is available at www.effectivechildtherapy.org and at www.cebc4cw.org, websites that evaluate outcome research on therapies for children and adolescents.) Reports of the effectiveness of a treatment can be said to be evidence-based when the outcome research has involved randomized controlled trials or careful clinical controlled trials; in both these cases, the word “control” signifies that treated individuals’ outcomes were compared to outcomes for similar individuals who received a different treatment.

Harman’s study did not involve any comparison group. It was essentially a study of events in a single group over a period of time, a level of evidence sometimes described (a bit deceptively) as “promising”. (“Of interest” might be a better description for treatments with these uncontrolled outcome studies.) Just as Harman could not correctly claim that Gottlieb has been doing evidence-based treatment for a long time, she and her colleagues cannot correctly state that this attempt at evaluation has shown the effectiveness of TPFF. In order to reach that conclusion, they would have needed to do similar observations on a matched group of children and parents who did not receive TPFF, and to show differences between the treated and untreated groups.

II.                 Levels of measurement

In 1946, the Harvard psychologist S. Smith Stevens (known to students at the time as “Shitty Smitty” for his rather unlovable personality) published a seminal paper in the journal Science, on the idea of levels of measurement and the kinds of statistical analysis that could be used for each one. The idea here is that we can and do measure events in different ways. If I look at a painting and say that it contains greens, blues, and pinks, I am measuring in a very simple way. If I say that this painting is greener than that one, I am measuring in a somewhat more complex way. And if I say I have counted 92 green one-inch squares in this painting and 95 green one-inch squares in that one, I am at the most complex level of measurement of all. If I can count how many green squares there are in different paintings, I can say, for example, that one painting has twice as many green squares as another one, or I can state the mean number of green squares in a group of paintings. I can’t do that kind of arithmetic if I am simply saying that one is greener than another, and if I can’t do that kind of arithmetic, I can’t use the various important parametric statistics like means, standard deviations, Student’s t, or ANOVA. Instead, I have to use some less refined statistics from a group called nonparametric statistics.

Harman’s statistical analysis falls by the wayside because she has ignored levels of measurement, just as Bernet and Baker have done elsewhere. She has performed what someone has called “quantitative alchemy” by trying to force measurements of what is “greener” (more desirable) into statistical procedures that are meant for measures that can be added, subtracted, multiplied and divided. This does not lead to meaningful conclusions.

Harman, Bernet, Baker, and other PA proponents have an unfortunate affection for Likert scales. These are the ubiquitous ways of measuring that ask people to rate an event or statement as “don’t agree at all”, “agree somewhat”, “totally agree”, or some version of that procedure. That is what Harman did in her study: observers of videorecordings rated events they saw on a Likert scale. This scale does not permit any of the arithmetical operations needed for parametric statistics, because it is not reasonable to claim (for instance) that a rating of 5 is 5 times a rating of one. Nevertheless, Harman and her colleagues (including the statistician who sees to have been given authorship for that reason) have gone merrily along and presented means and other parametric statistics as if they are appropriate.

Just for the sake of argument, however, let’s for a moment accept the use of the parametric statistics and look at how the rated behaviors changed over time. I would have assumed that the goal of TPFF was to improve the parent-child relationship quality. Harman et al say “we did not anticipate large changes in relationship quality in a short, 4-day intervention”, and they were apparently right not to anticipate such, as the t for this measure was -0.66, p=0.51. (I would ask, though, if you don’t anticipate a change in 4 days, why design a 4-day intervention?)

As a final point on measurement in this study, it was unclear to me why Harman did not just use a count of events, which could have been analyzed parametrically, and did not present any information about whether the observed behaviors were performed by the child or by the parent. Are any reported changes to be read as changes in the child’s behavior, the parent’s behavior, or both? Perhaps the moral of this story is that there should be a license required to use the SPSS package.

III.              Levels of severity and their implications for research design

Harman et al title their report as involving “severely alienated children”. Yet here is what they say about the children: “The majority of the children who [had] refused to have ay relationship with the alienated parent traveled significant distances across the country and spent several hours or days with them prior to the intervention…a large number of alienated children had transferred custody to the alienated parent for between a week and as long as 44 days after the order had been entered.” In other words, although these children had been said (by someone) to be severely resistant to contact with one parent, they now were not resisting at all even before the TPFF program began.

If it is true that the children were not resistant when they arrived at TPFF,  what confounding variables must we consider as possibly causing this change from the previously reported resistance? Is the court order alone the cause of any changes suggested as resulting from TPFF? Is TPFF to be praised as not having caused the children to become resistant again? Why is it appropriate to use an expensive and disruptive program if the children are already doing what was wanted, and why, in particular, should the preferred parent be ordered to participate in treatment with a TPFF-approved therapist? This would appear to be a good business model but a weak treatment model.

Beyond the issue of levels of severity, of course, there is the much larger issue of how PA is identified to begin with. The only consistency in the various treatment program outcome studies is that a court has decided there is PA present. On what basis that has been done remains unclear. Harman, unfortunately, states that the Parental Acceptance-Rejection Questionnaire, discussed by Bernet and colleagues as a way to discuss “splitting”, is a PA assessment tool! I hope her PA colleagues will talk to her about this point.

IV.              Levels of harm

The possibility that PA treatments can be harmful to children and adolescents, which I as well as other authors have considered, is of much concern to PA proponents. Harman et al, like other PA advocates, remark that my published discussion of this point is based on a small number of cases in which the children claiming harms were still alienated. There has been a gradual increase in the number of anecdotal claims of this kind, with at least one PTSD diagnosis, but I would be the first to acknowledge that they have never been investigated systematically, nor have the reports brought PA proponents to look for adverse effects of their programs. There are a number of lawsuits in the making as some affected children approach their 18^th birthdays, and those will bring out some interesting information.

Anyone treating children and adolescents is bound to have concerns about very serious harms, self-injury, depression, suicidality or completed suicide, or running away and being trafficked or otherwise injured. Harman et al stated that no harms were caused by TPFF, as no children ran away or self-harmed during the intervention or some subsequent period. These measures are important but minimal. It may be that following the expected lawsuits we will see some evidence of harms that proponents of PA interventions will have to consider in the future.

 

Conclusion

On a number of different levels, the outcome research on TPFF reported by Harman et al fails to support the conclusions that TPFF is a safe and effective treatment for children in cases of parental alienation. In addition, the serious flaws of design and analysis in this work suggest that the critiques of Joan Meier’s work, recently presented by PA advocates, may be open to serious question.