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Concerned About Unconventional Mental Health Interventions?

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

Thursday, October 12, 2023

What's the context for "alienating behaviors"? (Baselines and all that)

 

It would seem quite likely that some parents do sometimes do or say things that can be considered "alienating behaviors”—actions that might make children tend to dislike or avoid the co-parent. Amy Baker, William Bernet, and others have discussed lists of such behaviors, which can range from a simple eyeroll to a deliberate statement that “your mother is an evil woman and does not love you”. Some authors, like Bill Eddy, have even suggested that “alienating behaviors” can be unconscious on the part of the parent who performs them and can have impacts (on the brain, no less) even though a child does not consciously notice them. The certainty with which some authors write about “alienating behaviors” has led to the belief that these actions are readily observed and that it is known that they are damaging to children—the natural conclusion being that children must be separated from “alienating” parents.

It's not all so simple, though, even if we accept for the sake of argument the claim that children are harmed by a parent’s “alienating behaviors”. There are so many things still unknown about these actions. What is the context in which they occur—what are the associated events that we must understand before any conclusions can be drawn about these lists of behaviors? What standards of comparison apply here? 

The situation is rather like the one in which people ask about the effectiveness of a vaccine. The number of people who get sick or die (from any cause) after being vaccinated is only one small piece of information. People do, of course, get sick and die for a lot of reasons. We need to know how often people get sick and die if unvaccinated, and compare that frequency to the frequency after vaccination. (Knowing this gives us a baseline to which we can compare the effects of the vaccine.) If the numbers are the same—or if the vaccinated people do worse—we may have to conclude that the vaccination is ineffective or even harmful. In addition, our conclusion may be different if the types of illness are different in the two groups, or if we see that people of different ages have different outcomes. And, we especially need to know whether different kinds of people got the vaccination than went without. All of these points form the context within which we decide whether a vaccine is helpful or not.

What, then, is the context within which we need to look at “alienating behaviors”?  It’s possible to make a list of possible context items—but it’s critical to realize that we do not in fact know anything about the frequency of any of the events we can consider as “alienating behaviors”, or the contexts in which they occur, so we presently cannot know whether it's in any way useful to use about such behaviors in decision-making. 

1.      Baseline measures and standards of comparison 

How often do functional, happily-married parents display actions that could be considered “alienating behaviors”? How often does an annoyed mother or father say, to or in the presence of children, “your Dad (or Mom) is late again”, or “your Dad (or Mom) just can’t manage money”, or “your Dad (or Mom) chose this movie and now changed their mind”, or “you better go and wake your Dad (or Mom) because they are supposed to take you to soccer today”. How often do these happily married parents perform eyerolls or other gestures to express displeasure at their partner? (For comparison, how many husbands and wives, asked if they ever considered divorce, reply, “never, but often homicide”?) Nobody knows!

These questions are important because (if answered) they would establish a baseline or standard of comparison that would provide the context for knowing whether a divorcing parent was indeed displaying an unusual number of “alienating behaviors”, or was behaving in much the same way as any married parent.

2.      Looking at frequencies of types of behaviors that could include “alienating behaviors”

“Alienating behaviors” generally involve negative statements or actions directed by one divorcing parent toward the other. A more general form of this type of behavior could include negative statements or actions directed toward various other people, not just the co-parent. If a mother has many negative things to say about her own mother, her sister and brother, neighbors, and her children themselves, should her negative remarks about her children’s father be considered to be “alienating behaviors”? In this context of negative remarks, it seems unlikely that negative remarks about the father should carry the same weight that they would in a case where most of the mother’s other statements were positive.

Some people who have many negative things to say will also make many positive statements. A mother or father could be highly reactive and have a lot to say about everyone they meet, and speak freely to the children about their opinions. If a father, for example, both praises the neighbor for his nice yard and complains vociferously that the man parks in an inconvenient place, this is a different matter than saying only negative things. Yet a practice of counting or listing “alienating behaviors” would ignore context and give the two sets of negative statements equal weight.

3.      Cultural issues

Both negative and positive responses to other people are to some extent determined by cultural standards. Some groups deliberately say negative things about beloved people so as not to attract bad luck. Others believe that “Praise to the face is open disgrace”. Some make a game of mutual insults. Children acculturated in any of those groups would probably respond differently to “alienating behaviors” than others—and they might well be more accustomed to observing “alienating behaviors”. Little as is known about “alienating behaviors” in any case, but even less is known outside the middle-class Anglo cultural context. Establishing a baseline or standard of comparison is thus especially difficult for families where one or both parents are minorities or immigrants or members of small, culturally unique groups.

 

Can unanswered questions about any of these “alienating behaviors” issues be answered, in the future? This might be possible with a great deal of hard work. However, the work would have to involve actual observation of behavior. It is not sufficient to infer that there must have been “alienating behaviors” just because a child is avoiding one parent. As of right now: if there are no established baselines or standards of comparison, it is not possible to argue credibly that a parent’s actions are “alienating”, whether or not they match items on the behavior list presented by Baker, Bernet, and others..

  

 

Friday, August 4, 2023

Parental Alienation, The Tower of Psychobabble, and the ":Straw Woman"

 

             

Karen Woodall, a UK proponent of the parental alienation (PA) construct, has outdone herself in her 29/7/23 blog post (https://karenwoodall.blog/2023/07/29/the-experience-of-induced-psychological-splitting-in-children-experiencing-parental-divorce-or-separation/). She presents an attack on what she believes feminism to be, as if it were a statement relevant to the evidence about PA. Feminism (as defined by Woodall) is criticized, and via the usual PA method of abuse of analogies, Woodall concludes that she has given a powerful argument in support of the PA belief system. Has she managed this? Well, let’s look at some details.

First, let’s examine Woodall’s critical method. It’s a familiar one—claiming that an opponent’s views are not only wrong but distorted by their own emotional aberrations, which are easily identified and named, and which prove that the opponent’s argument is dead wrong. Anyone who has seen first-year university students at play will recognize this technique. Having learned a list of terms describing psychopathology, students trot these out in all disagreements and consider them to be quite telling tactics that successfully make opponents furiously annoyed. The fact that the terms also serve to darken counsel is ignored, as actual constructive discussion is not the goal. The PSYCH 101 method is also common among proponents of controversial experimental treatments; I saw this years ago during the behind-the-scenes fight about Holding Therapy, when anyone who opposed the use of this dangerous treatment was instantly said to be suffering from Reactive Attachment Disorder.

But Woodall does not seem to understand that using this diagnosis-as-evidence approach just makes more competent opponents roll their eyes with boredom and vicarious embarrassment. She seriously and apparently shamelessly points to her antagonists in the PA discussion as showing “denial”, “splitting”, “primitive defenses”—as if these statements, even if true, had anything to do with evidence for or against PA. By using this approach, of course, she is ignoring the requirement that practitioners of psychotherapy have some contact with people before they offer a diagnosis. But beyond that, she ignores the idea that the accuracy of a statement should be assessed by observation and measurements of events, not by the characteristics of the speaker. The reasoning problem Woodall displays here is ad hominem—or ad feminam – argument; the stress is on irrelevant material about the opponent that has no purpose in serious discussion other than to irk the opponent.

For a second issue, let’s have a look at Woodall’s attempt to attack feminism, or what she apparently thinks feminism is. It’s perfectly true that feminism is an ideology—that is, it’s a statement of values that does not necessarily include any description of the ways in which those values should be applied. It’s my impression that Woodall does not understand the values of feminism. Feminism simply states that girls and women are as much human beings as boys and men are, and that all human beings deserve equal dignity and respect from society. Woodall’s claim that feminism “splits” humans into good women and bad men is simply untrue.  Woodall, I think, has feminist values confused with a matriarchalist approach in which women’s needs and wishes dominate those of all other people. This is parallel, of course, to a patriarchalist approach, in which men’s wishes have priority over those of women, girls, and even boys. It’s very easy for people with an authoritarian bent to mistake the values of feminism for those of matriarchalism, as authoritarian thinking always assumes that someone must be owner and someone else be slave.

But let’s suppose that Woodall could in some way demonstrate that feminist values are all wrong. What would be the conclusion to draw from that?   Woodall’s blog post seems to suggest that there is some connection between the facts about feminism and the facts about PA—but there isn’t. Woodall is setting up feminism as a “straw woman”. She seems to believe that if she can make readers think badly of feminism, they will also think that she has proved bad things about opposition to PA ideas.

Now, there’s a lot more that needs to be said about Woodall’s arguments. Painful as it is, we need to have a look at the Tower of Psychobabble she has constructed in this blog post and elsewhere. An interesting place to start is with her citation of Melanie Klein. Klein, a British psychoanalyst of the 1940s (give or take), was deeply committed to the idea that observation of children’s behavior was of no use to efforts to understand emotional development; instead, the appropriate technique was to consider the fantasy operations of the infant psyche as they could be thought of by analytically-trained adults. Such thinking yielded the idea that the mother’s breast could be thought by infants to be either completely good or completely bad, in a process described as splitting which could occur later in development as well. Klein and her followers were strongly opposed to the thinking of John Bowlby, who used observations of child behavior to develop the concept of attachment and a plethora of empirical research on early emotional development. Citing Klein allows Woodall to name a famous historical name but in fact Kleinian ideas have not received any empirical support that connects them with PA. (The Bernet work that appeals to “splitting” as an explanation is highly questionable.)

Interestingly, Woodall drags attachment into her discussion, as well as Kleinian concepts. She does this by citing the egregious Craig Childress and his self-published claims about the role of attachment in PA. Childress, like many who have incomplete mastery of attachment theory, believes that the “attachment system” is easily manipulated and that a child far past toddler age can have a switch flipped to make them feel attachment to a parent they have been avoiding. The flipping is done by exposing the child to a treatment called High Road to Reunification, as carried out by the high-school graduate Dorcy Pruter. This treatment has never been tested and is in fact an experimental treatment (as defined by Kaminsky and Clausen in 2017); it has apparently often included transportation of children to the venue by youth transport service workers. Childress nevertheless has claimed 100% success of the treatment—a most unlikely outcome. (Woodall seems unaware of the downside of citing Childress and may not know that he has been disciplined by two state psychology boards.) In her blog post, Woodall shows her commitment to the view that PA is an attachment issue by her reference to “attachment healing” as facilitated by the treatment she uses.

There is much more to say about statements and implications in this blog post. One is that Woodall assumes that “splitting” can be and has been measured, so that she feels safe in saying that children in PA cases show this tendency. Another is that Woodall suggests that if there were “splitting”, it would have to be caused by the influence of the preferred parent rather than by any of a myriad other factors in divorcing families. Woodall also implies that any suggestion that fathers commit more domestic violence than mothers is based on “splitting” the parents into good women and bad men, whereas in reality statistics show that men are more inclined to DV than women are, though no one has claimed that women never display violence; not all population differences can be attributed to “splitting” even by proponents of this psychological construct. Finally, Woodall suggests, without a clear statement, that a parent who is alleged to have alienated a child is in fact an abuser from whom the child must be removed and protected—a proof by assertion borrowed from the U.S. PA proponent Jennifer Harman.

To sum up this too-lengthy critique of Woodall’s thinking, then: an ignorant attack on feminism, however it is bolstered by borrowings from psychoanalytic thought and attachment theory, does not constitute evidence that supports the PA belief system. If Woodall or other PA advocates want to show that their identification of PA is accurate or their treatments safe and effective, they need to do this the old-fashioned way, by empirical outcome research.

 

Saturday, July 16, 2022

Did You Peer At My Article? Facts About Peer Review

 

Go into any family court where social science is being put in evidence,  and you will hear peer review referenced. “Are the papers on your CV in [portentuous pause…] peer reviewed journals?” “You are aware, are you not, that the work you are criticizing was [pause] peer reviewed?” It sounds as if peer review is an assay for gold content rather than what it is—part of the process by which articles are accepted for publications in professional journals.

What is peer review and how is it done? Is it a guarantee that a published article is accurate? This post will attempt to answer all those questions.

When an author submits a paper to be considered for publication in a professional journal, an editor is usually the first person to look at the submission. The editor may decide quickly that a submitted paper is not acceptable for the journal. This might be because the topic is not of much interest to the journal’s usual readers/ There can be many other reasons too. I have had papers rejected because, in one case, the information in the paper was derived from journalistic sources, in another case, because my paper commented on another paper that had been published some time previously, and in a recent case, because the editor was afraid of a lawsuit against the journal if the paper was published there.

If the editor does not quickly reject a paper, he or she will seek peer reviewers who will give opinions about the paper and suggestions for improvements. The reviewers may be members of the editorial board or authors who have published work on similar topics. They receive an anonymous version of the article and their names are also kept secret from the article author. It is not necessarily easy to find two or three reviewers for a paper. Reviewing can be a lot of work, and most people qualified to review an article are also busy with other professional work. (An academic book editor recently mentioned to me that book publishers are having a terrible time getting reviewers for books in development, too.)

Some journals ask authors to suggest some reviewers and even to state whether there are any people they do not want to review their work. I have no idea how those suggestions are actually used.

When reviewers have been found they receive the anonymous manuscript to read. (Authors are even asked to hide citations of their own work by using the word Author instead of their names, but it seems likely that reviewers can sometimes guess whose work they are reading—and some authors can probably guess who their reviewers are.) They reviewers often also receive a list of questions that they should answer as part of their review. These questions, and the focus of the review, are different for different journals. For example, psychology journals are concerned about research design and statistical analysis, whereas journals focused on family law are more likely to focus on legal and practice issues.

Reviewers are often asked to return their completed reviews within a month. When I am a reviewer I usually manage in that time frame, but not everyone does. Between the search for reviewers and the actual review process, peer review may take a year or more. I recently withdrew an article submitted to a journal when it had been a year without any reviews or decisions.

When the reviews have been submitted, an editor will go through them and decide first whether the article should be rejected or accepted as it stands (not common). If the editor decides, as is more usual, to accept the paper if revisions are made in line with the reviewers’ recommendations, he or she may simply send the decision and the reviews to the author, or may summarize the reviewers’ concerns. The editor may add his or her own suggestions for revisions. One of the points the author is asked to make is a list of the weaknesses of the research or reasoning on which the paper is based. The author is given a time limit for resubmitting the revised paper.

If and when the revised paper is resubmitted, the author is also asked to submit a point by point description of the ways the reviewers’ suggestions have been complied with. An editor will review the resubmitted material and decide whether to accept the paper at that point, or to send for another round of reviews, or to reject.

So, these are the steps involved in peer review. They involve many steps and opportunities for human error. Articles may be peer reviewed and yet contain problems that are only noticed later. They may also be correct on the points considered by the reviewers but include misinformation about material that the reviewers did not understand or attend to. Corrections on those points may not occur for years, or ever—or they may be brought up by readers who complain or write rebuttal papers that may or may not be published.

When serious errors are apparent in a published paper, the journal may retract the paper. Depending on when retraction occurs, the paper may not appear at all or may appear with a stamp saying “retracted” on it. Unfortunately, the nature of the Internet is that once such a paper has been posted, it never goes away, and most readers will not know it has been retracted. The retracted paper may even be cited in new papers by other authors. An article by Jeffrey Brainard in Science (1 July 2022) describes unsuccessful efforts to get journal editors to flag citations of now-retracted papers.

The upshot of all this is that peer review is the best thing we’ve got for assuring the accuracy of published articles. It requires great efforts from many people—but it is far from perfect. The best thing readers can do to insure accurate understanding is to be educated, or educate themselves, on the basic issues found in journal articles they want to read and use. In addition, when peer-reviewed articles are used in court, it is critical to remember that research findings are stated in probabilities, not in the simple terms used in law everywhere except Scotland (where “not proven” is an option). Applying the conclusions of journal articles to single cases is a challenge that requires us to think hard even when we would rather have the answer handed to us.

 

Monday, July 11, 2022

Can We Regulate or Ban Potentially Harmful Psychological Treatments?

 

If a psychosocial treatment is powerful enough to change someone’s thoughts, feelings, and behavior for the better, we need to be aware that it would also be possible for the treatment to change matters for the worse. Psychological treatments, like medical practices, can have the potential for harm to the recipient. When the person being treated is a child or adolescent, it’s quite possible that harm to the client can be accompanied by harm to some or all of the rest of the family.

Unlike medical scenarios, where severe physical harm or death can result from some treatments, psychological treatments do not generally cause immediate and visible harm. The harm done by some psychological treatments may be delayed, as would be the case in later family dysfunction or suicidal thinking and actions. The harm may even be indirect, as in the wasting of time and resources a family needs for a range of expenditures like dance lessons for another child or home remodeling to give children their own rooms. The use of potentially harmful, ineffective treatments also delays or makes impossible other treatments that are safe and effective for children and families.

An example of a potentially harmful treatment is Critical Incident Stress Debriefing, CISD, an approach to preventing trauma responses in people exposed to disasters. When CISD was used following 9/11, it became apparent that people who did not receive CISD treatment did better in terms of trauma symptoms than those who did receive it. Psychologists and other mental health professionals were advised not to use CISD, but the Internet continues to carry positive messages and encouragement to use CISD.  

It is not illegal to use CISD, and as the treatment is used primarily for adults, there has never been real pressure for legal prohibition. When children or adolescents are harmed by psychosocial treatments, it is much more likely that there will be pressure to regulate those treatments by legislation that prohibits their use with minors.  But even those regulatory bills are not always passed, or if they are passed do not always speak to the real issues.

In 2001, the state of Colorado passed Candace’s Law, which prohibited active physical restraint as a therapy. This law was instigated by the death of a 10-year-old girl, Candace Newmaker, by suffocation during a psychotherapy purporting to cause her to become emotionally attached to her adoptive mother. The therapists believed that they could accomplish this goal by “rebirthing” treatment, ordinarily a brief, silly but harmless procedure. Candace was wrapped tightly in a sheet and told that she must struggle to get out and be “reborn”, while helpers pressed rhythmically on her body in mimicry of uterine contractions. The child was not able to comply and was asphyxiated. The therapists directing the procedure were convinced that Candace had to be forced into compliance and ignored her pleas that she could not breathe. The Colorado legislation was pushed through because of public horror at the event as well as because of a small number of activists pressing for passage, but some Colorado therapists continued to support “rebirthing” and other methods involving physical restraint. Adoption organizations supported the legislation because many of the children involved in these treatments were adopted.

In 2003, the state of Utah attempted to pass legislation banning the use of “holding therapy”, a treatment involving physical restraint that was related to the “rebirthing” that killed Candace Newmaker. (Candace had also been subjected to holding therapy, whose tenets supported the view that she must be forced to comply.) However, the bill banning holding therapy never came to a vote as opponents ran out the clock on the final day of the legislative session. Mental health professionals and activists strongly supported the bill, but it was opposed by practitioners of holding therapy in the state.

In 2015 and later, more than 20 states passed legislation prohibiting psychologists from using conversion therapies with minors. Conversion therapies are psychological treatments intended to alter same-sex orientations to heterosexual orientations; these treatments involve a range of unconventional methods such as mock-fighting while naked or  using practices related to holding therapy. Conversion therapies have been very distressing to a number of participants and have never been shown to be effective. Conversion therapies remain legal when chosen by adults for themselves or when performed with children and adolescents by members of the clergy. State psychological associations argued strongly in favor of the legal ban, as did LGBT organizations that wielded considerable political power.  A bill introduced in the House of Representatives in 2021 prohibited states from using Medicaid funds for conversion therapy, which was defined as attempts to change sexual orientation in return for monetary compensation.

In 2022, the reauthorization of the Violence Against Women Act included a model law, Kayden’s Law, which states must enact if they are to be eligible for any of the funds appropriated under VAWA. Kayden’s Law is directed at the use of so-called “reunification therapies”, treatments that purport to correct the attitudes of children who display “parental alienation” (resistance to or refusal of contact with one of their divorced parents). Among other potential harms, use of these treatments has sometimes placed children in the hands of abusive parents.The treatments are generally done under court orders that prohibit any contact between the child and the preferred parent for 90 days or longer; the treatments are claimed to create a good relationship between the child and the rejected parent.  The model law states that children are not to be separated from the preferred parent for the purpose of encouraging their relationship with the disfavored parent, a provision that would essentially prohibit most reunification therapies.. California has already reported its bill, SB616, out of committee, while in Massachusetts the bill is still in committee. These bills are bound to be opposed and challenged by a number of  lawyers and mental health professionals who are deeply involved with parental alienation cases in spite of the lack of evidence for the safety and effectiveness of reunification therapies. It will also be opposed by many fathers’ rights groups and by organizations like Family Access Fighting for Children’s Rights that promote the use of the treatments. Parents who have been ordered not to contact their children will also be strongly interested in the legislation, but in many cases those parents are already bankrupt because of the expenses of their legal fights for custody of their children. Psychologists and psychiatrists as professional groups have not taken official positions on this legislation.

When potentially harmful psychological treatments are not regulated by professional organizations, what does it take to ban them by legislation? There is a horrible advantage to having a child die in the treatment and become a “crystallized symbol” or “poster child” for opposition to the practice. Even then, however, there will be those who favor the problematic practice and want it to continue, who consider the death to be a pure accident (or, in Candace Newmaker’s case, who suggest that the child died on purpose in order to distress people). When harms are indirect and not immediate, there are plenty of people who will say they are negligible harms. Successful legislation may depend on activism by those with a personal stake in the game, with financial and other resources, and with the capacity to organize for political purposes. These factors have played a critical role in the legislative banning of conversion therapies. Will they exist or be successful with respect to treatments for parental alienation? That remains to be seen. It is clear from the examples given in this post that there is no point waiting for professional groups to take the first strong positions regulating potentially harmful psychological treatments. But it may happen that when legislation is in progress, some professional groups will feel that they must speak out one way or the other.

Sunday, June 26, 2022

How Vague Is Your Vagus?

 

Over a lot of years of professional life, I have seen some concepts become popularized, reinterpreted, and generalized beyond all meaning or expectation. One of these concepts was attachment, a rather technical term to begin with but now the explanation of all sorts of problems in self-help discussions. Another is parental alienation, once a term applied to a rare occurrence in divorced families, now a weapon brandished regularly in family courts.

In my pessimistic way, I have been wondering what would be the next wave of misinterpretation—the next concept that will be made the explanation for too much and the foundation of treatments without any basis in evidence. And I think I have found the latest thing: the vagus nerve.

Of course, there really is a vagus nerve. It’s the tenth of the 12 cranial nerves and helps to regulate the heartbeat as well as having other similar functions. Some decades ago, Steven Porges created “polyvagal theory” (PVT), a psychological approach that based emotional and other human functioning on vagus nerve activity. PVT makes a number of assumptions about the evolution of the human nervous system and posits that when threat is felt, human beings revert to an evolutionarily older type of brain function. This is reflected  in vagal activity as known through measurement of an aspect of the heartbeat. Grossman and Taylor in 2007 criticized this view thoroughly, noting both misunderstandings of the evolutionary background and the functioning of the nervous system.

As so often happens when simplistic approaches to the human nervous system are popularized, the claims of PVT soon morphed into treatment plans. The assumption was that if the vagus nerve underlies emotional functioning, anything that affects the activity of the vagus can also influence emotional functioning. In the parental alienation treatment program Transitioning Families, for example, therapists ask clients to “map the autonomic nervous system” by imagining a ladder and climbing it until they reach a place of safety at the top, where a comfortable state of vagal activity is thought to be. Deep breathing is also used, as it is thought be this group of therapists that it stimulates the vagus to reach a calm state. There is no empirical evidence that the vagus is influenced in this way or that there are emotional benefits to the practice.

On her website, one Dr. Arielle Schwartz advises similar techniques that are directed toward affecting vagal activity with the goal od improving mood and functioning. She says, “The vagus nerve passes though by [sic] the vocal cords and the inner ear and the vibrations of humming is a free and easy way to influence your nervous system states”. In addition to humming, she recommends diaphragmatic or “belly” breathing and slowing of the breath, which she proposes as a way to stimulate the vagus nerve.

Schwartz also suggests the Valsalva maneuver, a way of attempting to breathe out even though mouth and nose are closed , as a way to increase pressure in the chest cavity and vagal tone. She believes that the “diving reflex” can be stimulated by splashing your face with cold water, putting a bag of ice on your face, or holding lukewarm water in your mouth. She does not describe how these practices are supposed to affect the vagus nerve, but the reflex does slow heartrate and oxygen use.

Some readers will recognize the breathing and humming techniques as part of yoga and similar practices. They are not directly harmful and may be enjoyable. Indirect harms are possible if an individual puts resources of time and money into methods with neither empirical or theoretical evidence of benefit.

The Valsalva maneuver can be used to treat a too-rapid heartbeat. It should not be used by people with high blood pressure or risk of a stroke. Triggering the diving reflex can be problematic for people with heart problems or a slow heartbeat. As was the case for breathing and humming, indirect harms may come from expenditure of resources for methods that may have no real effect beyond a few minutes.

PVT methods seem to be appearing on the Internet as the newest of the new. However, I remember reading a newspaper medical advice column when I was a young teenager in the mid-1950s.—it spoke of “belly breathing” and advocated the same sorts of techniques as PVT approaches, similarly without supportive empirical evidence. The PVT-related concept of the “enteric brain” and its functions has been posed for decades by the Meridian Institute of Virginia Beach; this institute is associated with the writings of Edgar Cayce, the American “clairvoyant”.

There seems to be no end to the ways people can suggest simple solutions to complex mental health problems. The popularization of PVT seems to be the most recent of these, but it won’t be the last.

 

Monday, March 28, 2022

Identification by Listicle: Parental Alienation and Those Five Factors

 

Author after author has pointed out that as yet there is no established way of identifying cases in which a child rejects one parent because of persuasion by the other parent (parental alienation, by definition). No one has shown a valid and reliable method of discriminating those cases from others in which various different events may be the cause of the child’s resistance or refusal to have contact with one parent (not parental alienation, by definition).

Nevertheless, proponents assert that they have a method for identifying PA cases. This method involves their five factor model, as put forward by William Bernet and others. But is that model anything more than a listicle with other listicles embedded in it? Certainly it has never been shown to be valid and reliable by empirical work—but it could be that such work will appear in the future. Meanwhile, let’s look at the factors and consider how they are applied. I draw this list of factors from Bradley Freeman’s chapter in the 2020 PA book edited by Lorandos and Bernet.

Factor One: The child actively avoids, resists, or refuses a relationship with a parent.

Interestingly, at one time the child was described as rejecting contact with a parent. Now we have rejection of a relationship, which is rather different. Along these lines, Steven Miller (the emergency medicine physician and PA expert witness) has said in a presentation that the problem is rejection of a normal relationship with the parent; this, like other aspects of the five factors, is certainly left open to interpretation.

But how is this factor actually used in assigning the PA category to children’s behavior? In one case I am familiar with, a girl asked for contact with her father but he refused on the grounds that he feared she would accuse him of sexual abuse. The father nevertheless sought custody and alleged PA. In another case, a 17-year-old girl who had spent week on and week off with her parents for 8 years asked to change to weekdays at her mother’s, weekends and holidays at her father’s. This led to the father alleging PA on the part of the mother. In a third case, children did not resist visiting their father but behaved very badly (e.g. throwing food at him). Apparently helpless to control the children, he alleged that PA by the mother was the source of this bad behavior.

Factor One is thus, in practice, excessively broadly and vaguely defined and has the potential to be identified in many situations where a supposedly alienated parent is simply not pleased with the child’s attitude or behavior.

Factor Two: Presence of a prior positive relationship between the child and the rejected parent.

Factor Two may be difficult to demonstrate except through the testimony of teachers, neighbors, and distant family members. The reunification therapy Turning Points asks attendees to bring photos and videos from the past that show the child and parent together in positive ways, and these are used to show the child that in the past they liked the parent whom they now reject.  But how many families photograph screaming arguments between parent and child or record one of the other refusing to speak? Any records from the past are likely to be of positive events, however frequent or infrequent they may have been.

Even in intact families, developmental and other changes are often linked with more and with less positive relationships in the course of a child’s life. A parent may be temperamentally well-suited to dealing with a cuddly, dependent baby but less able to care for a negative, tantrum-throwing four-year-old—or vice versa. The period around puberty is for most families a time when earlier pleasant relationships seem to falter, in part because of a child’s negative emotionality and desire for autonomy, as well as for reasons in the parents’ own lives. Divorced families too go through relationship changes of this kind, which may be interpreted as PA by certain proponents but are not necessarily caused by parental persuasion.

In the absence of empirical work  showing that early positive relationships are normally followed by consistently positive later relationships, and that periods of negativity are not developmentally appropriate, PA proponents cannot argue effectively for Factor Two as a reasonable way to demonstrate whether or not parental alienation exists in many cases. In addition, demonstrating that there was an initial positive relationship in a specific case may be difficult or impossible, even with extensive investigation.

Factor Three: Absence of abuse or neglect or seriously deficient parenting on the part of the now rejected parent.

As is generally the case about proof of absence, the absence of abuse, neglect, and seriously deficient parenting is difficult to demonstrate. When allegations of abuse are investigated by child protective services and said to be unfounded, this is by no means evidence that abuse did not occur, but simply shows that there was no clear evidence that it did occur. As Freeman himself point out, there are no clear definitions of seriously deficient parenting. Psychological injury remains vaguely defined in that evidence of such injury might not be apparent for years after an event occurred and the event would commonly be accompanied by other events that might be actual causes of any demonstrable psychological injury.

As Madelyn Milchman has noted, parent-child relationships may be negatively affected by single or repeated events which individually could not be considered abuse or seriously deficient parenting. In one alleged PA case, a father repeatedly tickled a child severely even though she begged him to stop. In another, a 12-year-old girl got her period when at her father’s house and asked him to go out to get her menstrual hygiene supplies; he refused and told her to just use toilet paper. In a third, a father posted signs reading “no parental alienation” in all the rooms of his house. None of these actions could be considered abuse or even seriously deficient parenting, and they did not cause demonstrable harm to the children. Nevertheless, each of these situations could easily have played a role in causing a child’s estrangement, especially in combination with repetitions or other similar actions.

Absence of abuse, neglect, or seriously deficient parenting can thus not be considered the proof that a child’s rejection must be caused by the persuasion of the preferred parent.

Factor Four: Use of multiple alienating behaviors on the part of the preferred parent.

Freeman points out that “it is necessary for the evaluator to identify specific [alienating behaviors] that have apparently caused the symptoms of PA” (2020, p. 68). Here is where an additional listicle enters the picture: PA proponents refer to a list of alienating behaviors established by Amy Baker and colleagues, who interviewed about 40 adults on the ways their parents had behaved one or more decades previously. Baker created a list of alienating behaviors based on the interviewees reported recollections but did not look for objective evidence that might have supported or failed to support her list. Nor did she (or anyone else) investigate whether parents alleged to be alienators  performed these behaviors more or less frequently than others who were not said to be alienators.

It has thus never been clarified empirically whether children who reject a parent are more likely than others to have a parent who carries out behaviors from Baker’s list. An additional problem is that some of the listed behaviors are likely to occur in private and are rarely to be observed by people outside the family, although others may be noticed by close friends or relatives and reported during an investigation.

Critics of the PA belief system have expressed concern that if a child rejects one parent, it is too easy to assume that the preferred parent’s actions are the cause of the rejection. It is certainly true that quite ordinary statements or actions can be interpreted as alienating behaviors. At the height of the COVID pandemic, a major PA proponent told me that it was alienating behavior when a mother told her 14-year-old that he could go to visit his father but would have to quarantine for 14 days when he came home (at this time, people were told to quarantine after travel or other exposures outside the home). A mother’s failure to tell her children daily about their father’s goodness and importance can be considered alienating behavior.

The alienating behaviors that are the subject of Factor Four thus remain ill-defined and seriously under-researched, and do not provide useful evidence for decisions in cases of alleged PA.

Factor Five: Exhibition of many of the eight behavioral manifestations .of alienation by the child.

A listicle conveying behaviors that he considered diagnostic of PA was published by Richard Gardner decades ago and has been used by PA proponents ever since. Once again, there has been no empirical work to show how often these behaviors occur in children alleged to show PA and how often they occur in other children. Without empirical evidence, it would be a mistake to assume that some behaviors occur exclusively, or much more frequently, in children alleged to have PA.

Absence of guilt about an action, for example, can and does occur in both children and adults when they feel justified in the behavior, even though it may cause discomfort and harm to another person. A child or adolescent who is told that a parent is unhappy because of their rejection may reminisce about the parent’s remembered offenses (of commission or omission) and think, “it serves her right if she’s upset.” Older children and adolescents can certainly understand that in some situations, whatever they may have done, they are not to blame and are not expected to experience guilt. Failing to experience guilt when distress seems to be deserved is by no means a predictor of a lack of empathy or the capacity for remorse.

The decision that a child’s rationale for rejecting a parent may be “frivolous” or “absurd” cannot be made objectively or out of context, as the reason for the rejection is a matter of the child’s own perceptions. These may be childish and egocentric or based on na├»ve worldviews, but they are real and require responses for the best outcome. Indeed, to claim that childish rationales are most characteristic of children alleged to have PA is not logical unless it can be shown that other children of the same age are less inclined to give childish reasons for issues like staying home from school or starting a fight with their brothers. Children who give childish reasons for any issue may be more likely to give such reasons for rejecting a parent than those who rarely give childish reasons for anything.

Young adolescents are especially likely to say they are “independent thinkers” about every issue as they fight for autonomy. Unless it is shown empirically that children in PA cases are more likely than others to display this belief, it makes no sense to say that being an  “independent thinker” is symptomatic of PA.

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Examining these various PA listicles, it becomes plain that we have no data-driven reasons to accept them as providing a way to identify PA in children. If PA proponents want to support their claim that they can identify PA – and treat children to restore good relationships—they will need to get to work and provide good information from well-designed and well-implemented research. To date, this has not happened. But the listicle approach is not sufficient to justify upending people’s lives.

Friday, March 25, 2022

Bishop Wilberforce Rides Again; or, Parental Alienation Advocates Admit a Problem

 

If you look at academia.edu, you will find a lengthy document entitled “Statement of the Global Action for Research Integrity in Parental Alienation”, by Alejandro Mendoza Amaro and William Bernet—the latter, of course, a major figure among advocates of the parental alienation belief system in the United States and elsewhere. The Statement appears to be a cri de coeur conveying the authors’ distress that parental alienation principles and practices have been roundly criticized by organizations like the American Professional Society on Abuse of Children (APSAC). To the further discomfort of Mendoza and Bernet, many individual authors have also critiqued parental alienation (PA) publications and have concluded that there is only a small amount of empirical research on this subject, and that small amount is poorly designed and implemented.

A fruitful response to these critical remarks about PA would have been to carry out new and properly designed research (and, no, the recent efforts of Jennifer Harman to test outcomes for a reunification therapy are not properly designed). But this is not what has been done by PA advocates. Instead, in this Statement, they label materials published by opponents to PA as fraudulent and defamatory. They demand retractions of commentaries discussing the problems of PA research and offering alternative hypotheses for cases in which children resist or refuse contact with one of their divorced parents. But they do not state exactly which publications they mean, or where their faults lie.

The Statement contends that opposing publications have “severe errors such as falsification of data, adulteration of original sources, and defamation “ (p. 17). These would indeed be reasons for complaint to academic or medical institutions with which authors were affiliated, as well as to journals that published the papers. Investigations showing that these things had occurred would lead to serious professional discipline and retraction of papers. But the Statement says this did not happen—they were ignored.

Notably, however, the authors of the Statement do not say to whom they complained or what they complained about, except that in one case they complained to the American Psychological Association about a passage they considered defamatory, and the passage was deleted. By failing to state the particular papers they find problematic, of course, Mendoza and Bernet themselves avoid complaints of defamation. With respect to the claimed falsification of data, they manage to convey to some readers which authors they are accusing, because only three or four articles opposing PA actually present new data. The authors of those articles may want to think about whether this circuitous communication succeeds in defaming them; it is certainly no joke to be accused of falsifying data.

What I find especially engaging about the Statement is that by making it, Mendoza and Bernet have shown that PA does not meet the Frye standards for admissibility of scientific evidence. The Frye standard, and one part of the Daubert standards, require that a concept be generally accepted in the relevant scientific community. If so many professionals, including journal editors, reviewers, and even the American Psychological Association, have acted to reject PA ideas and methods, this is a clear indication that these concepts are not generally accepted by those who form the relevant scientific community.

What does it all have to do with Bishop Wilberforce? Well, in 1860, T.H. Huxley and Bishop Samuel Wilberforce participated in a debate about evolution, Huxley supporting Darwin’s views and Wilberforce contradicting them. Wilberforce asked a very silly question, and Huxley turned to a companion and said, “The Lord hath delivered him into mine hands.” Huxley and the other supporters of Darwin won that debate. I don’t think I need to say more.