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Concerned About Unconventional Mental Health Interventions?

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

Thursday, September 9, 2021

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 18th 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.  

Friday, August 20, 2021

A New Book on Allegations of Parental Alienation for Parents and Professionals

 

A new book questioning claims about parental alienation is about to be published. Here are the citation and the Table of Contents.

Mercer, J., & Drew, M. (2022, in production). Challenging Parental Alienation. Milton Park, OXON: Routledge.

Table of Contents

Foreword

Chapter 1        Introduction to Parental Alienation Concepts and Practices

Jean Mercer and Margaret Drew

Part 1:

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”

Part 2:

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

Part 3:

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 Label 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

 

Thursday, August 19, 2021

When Parental Alienation Proponents Argue Biological Causes

 

It’s common nowadays for popular writers to claim biological or even specific genetic reasons for concerning behaviors. Any issues remotely connected to attachment are likely to get this highly speculative biological post hoc explanation. Until recently, though, I had not seen many proponents of the parental alienation (PA) belief system appeal to biological factors.

But I have seen this now, and not just from Craig Childress.

Linda Gottlieb, a rising PA proponent and increasingly frequent expert witness in PA cases, has now adopted biological arguments. She outlines these in her document Gottlieb, L. (n.d.) , Turning Points for Families: A Therapeutic Vacation. http://parentalalienationexpert.weebly.com/uploads/2/2/5/4/22545256/09-29-2016_treatment_protocol_for_sever_alieantion_2016_treatment_protocol_for_cases_of_severe_parental_rejection.pdf.

Gottlieb’s position is that it is “instinctive” for children to be attached to their parents. In making this claim, she ignores decades of discussion of the role of instinct in animal and human life. Many years ago, the term instinct was used to describe situations in which an individual’s behavior was completely controlled by inherited biological factors; he or she had not learned how to do something, and also could not learn how to refrain from doing it. In 1955, the renowned student of comparative animal behavior Frank Beach predicted accurately that the term instinct would soon disappear from discussion in the mainstream of psychology (Beach, F. (1955). The descent of instinct. Psychological Review, 62, 401-410.) Beach argued that the evidence pointed to the conclusion that all behaviors developed through a combination of genetically-regulated nervous system functions AND individual experiences. Accumulated evidence showed that behaviors did not develop solely as instincts (inherited behavior patterns shared by all members of a species).

More sophisticated discussions of human behavior patterns led to replacing the idea of instinct with two explanatory concepts. One was that human development in some areas was a matter of experience-dependent plasticity; the nervous system was “plastic” or malleable and changed (learned) as a result of experience. The second idea, the one more relevant to the concept of instinct, was called experience-expectant plasticity. This term applied to situations where experience could have a powerful effect, but was by far the most powerful at a particular period of life and might have little effect earlier or later. Experience-expectant plasticity is exemplified by emotional attachment to familiar people and also by the learning not just of a concept of language but of a specific language—both events that begin in the second half of the first  year for human beings. These two concepts (experience-expectant and experience-dependent plasticity) have taken the place of the old idea of instinct.

Nevertheless, we see Gottlieb in her document claiming that attachment to a parent is not only instinctual but permanent and invulnerable to normal experience. In making this statement, she ignores not only the changes that have occurred among psychologists in use of the term instinct, but also the fact that the toddler’s attachment behavior and motivation modulate with maturation and experience so that adolescents feel and behave very differently toward parents. She also ignores the fact that in cases of adoption or other changes, even toddlers lose their attachment for one person and develop it for a new caregiver.

But these points are irrelevant to Gottlieb, as she uses instinct as a rhetorical device. Rather than pursuing an argument about causes of a child’s avoidance of one parent, she wants to be able to claim that an avoiding child must have experienced some powerful malicious actions on the part of the preferred parent, because otherwise the “instinctive” love for the avoided parent could not have been undone. (To support this argument, she states, incorrectly , that children who are abused maintain their attachment to caregivers. This is only true of toddlers and not of the older children and adolescents who are usually the subjects of PA cases.)

If a child’s love for a parent were actually instinctual in the old-fashioned , all-biological sense, it would by definition be invulnerable to experience. If it is vulnerable to experience of any kind, it is not instinctual, but a characteristic that develops through a combination of experience-expectant and of experience-dependent plasticity. The real purpose of Gottlieb’s “instinct” argument would seem to be to imply scientific support for claims about PA. Curiously, Gottlieb, like other PA proponents, acknowledges that not all cases where a child avoids a parent are matters of alienation—a child might learn to avoid an abusive parent.

 But wait, what about the argument that abused children still want to be with the abusive parent? Can this work both ways? It seems that according to Gottlieb’s views about abused children, those who are abused should not avoid the abusive parent, but instead want even more to be with that person. Only those who were not abused (but something else happened, like persuasion by the preferred parent) can want to avoid one parent. Thus avoiding a parent becomes proof that the child was NOT abused, doesn’t it? And how convenient this is for a parent who wants to allege that the ex-spouse or the child is lying about abuse.

If someone wants to use scientific concepts for persuasive argument, it would pay to keep up with the science. Otherwise someone is likely to come along and point out a few errors.