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Treatment Considerations with Children Diagnosed with PAS
THE FLORIDA BAR JOURNAL, APRIL 2006 VOLUME 80, NO 4 by Dr. Robert A. Evans Frequently in cases in which parental alienation syndrome (PAS) has been determined, courts become concerned with ordering the appropriate mental health treatment for the children involved. There is an abundance of confusion regarding such solutions, and this article will draw upon the available research that addresses this issue and provide suggestions as to treatment interventions. Parental Alienation Syndrome Dr. Richard A. Gardner observed, in the conduct of numerous custody evaluations of children, that divorcing families shared common characteristics which he designated parental alienation syndrome,1 in which one parent, an alienating parent, alienates the child or children from a targeted parent. The alienating parent applies, both consciously and subconsciously, brainwashing and programming techniques in an attempt to alienate the child from the other parent. In the process, the alienating parent commonly denigrates the other parent in front of the child and to other significant adults in the targeted parent’s life. An important distinction of PAS from the term “parent alienation” is that the child also contributes to the denigration process of the targeted parent.2 The children commonly echo the alienating parent in their complaints regarding the targeted parent. Specific symptoms of PAS3 are: Campaign of denigration: denigration of the targeted parent completely, especially in the presence of the alienating parent. The children express profound hatred for the targeted parent. Weak rationalizations for the denigration: The children base their justification for their alienation on rationalizations that are completely irrational, and ludicrous (for example, “he takes me to Disney World too much”). These children are unable to provide more compelling reasons for their rejection.4 Lack of ambivalence: Denigrating statements are often made with a complete lack of ambivalence by the child. That is, there are no mixed feelings with these children; the targeted parent is all “bad” and the alienating parent is all “good.” The “Independent Thinker” phenomenon: The child proudly professes that his or her rejection of the targeted parent is their own doing. They will deny any contributions from the alienating parent, who supports the child in their proclamations. The alienating parent reinforces this contention by making statements such as, “I can’t force her to see her dad, if she does not want to.” Reflexive support of the alienating parent: The child automatically takes the position of the alienating parent; even the alienating parent may not present the argument as forcefully as the supporting child. Absence of guilt: A PAS child typically has no guilt or remorse over the exploitation of the targeted parent. There is frequently a complete absence of gratitude for gifts, support of any kind, or any involvement by the targeted parent in their lives. This lack of guilt cannot be attributed solely to the child’s cognitive immaturity, but is related to the brainwashing and programming by the alienating parent.5 Presence of borrowed scenarios: The child’s presentation carries a rehearsed quality. They use language and expressions that are clearly not their own. Their verbalizations appear to be coached and rehearsed, and the only source of the borrowed scenarios appears to be the alienating parent.6 Animosity toward the extended family of the alienated parent:The targeted parent’s extended family (e.g., aunts, uncles, cousins, grandparents) is included in the animosity. These individuals are also perceived as having negative qualities or using inappropriate actions since they are associated with the targeted parent. Any attempt by the extended family to counter the denigration of the targeted parent is viewed by the child as an attack on his or her beliefs.7 Gardner emphasized the psychopathology of the alienating parent. Additionally, this syndrome causes professionals to recognize that children have to cope with intense conflict in divorce situations and to deal with the rejected parent’s parenting skills, which typically are not at their highest level. Whatever the etiology of the child’s divorce-related psychological conditions that require treatment, improvement usually necessitates both a legal and therapeutic intervention. Gardner made a very important contribution to the field of family law with the development of the PAS by alerting the legal community that a possible reason for a child rejecting a parent is due to overt or covert manipulation by another parent. He provided specific recommendations about the combination of legal and therapeutic interventions. Of significance was the need for a court order for continued contact between parents and children in mild and some moderate levels of PAS. His underlying message was that problems between parents and children should be addressed and not avoided by terminating any relationships. The exceptions are in some moderate and virtually all severe cases of PAS. In PAS, an alienating parent is unable to tolerate separation from the child, and thus, programs and uses the child to meet his or her own emotional needs. The alienating parent is considered emotionally disturbed, keeping the child from a relationship with a potentially healthier, targeted parent. After all, isn’t it the primary role of a parent to foster a relationship with the other parent? Only dysfunctional parents believe a child should terminate such a relationship. This framework of looking for a disturbed versus a healthier parent seems to be in concert with the adversarial court contest over custody. Often there are charges of abuse by one side and countercharges of PAS by the other side, which then must be examined in a social investigation or child custody evaluation. Parents who have suffered the terrible hurt of having a child grow distant from them seize upon the theory of PAS and feel vindicated if an evaluator can determine that the child has been alienated. The PAS cases that end up in therapists’ offices after a court hearing usually do not have one parent who is much more psychologically healthy than the other. Usually, these are families that would have ended up in treatment because of the child’s disturbances, regardless of the parents’ divorce. From a “family systems” perspective, the blame for PAS lies less within the psychopathology of one parent than it does with the usually very high conflict between both parents and their psychopathology. Such families are not easy to help and may very likely return to court with or without therapeutic interventions. It maybe helpful for judges, attorneys, and therapists to increase their understanding about these families and move away from a blame-based formulation, realizing that treatment requires commitment over time for substantial results. There are a number of different reasons that a child might reject one parent in a divorced family, and a number of ways to help those families are available. PAS does fit many of these cases. Whether is PAS is indicated or not, it is essential that courts order continued contact with both parents. In severe PAS cases, however, courts need to terminate the relationship between the alienating parent and the child, and give exclusive, sole custody to the targeted parent without any contact with the alienating parent. This exclusive custody needs to remain in effect until the relationship with the targeted parent is reestablished and the alienating parent is “rehabilitated” in the sense that he or she recognizes the consequences of their behavior. Maintaining the relationship with an alienating parent and child only creates a formula for failure in reestablishing the targeted parent and the child. The alienating parent does not automatically discontinue their programming tactics. There are some non-PAS cases, however, in which there are other reasons for estrangement between parent and child which need different therapeutic interventions. Most notably these cases involve abuse. Variations of PAS The presence of PAS is determined mainly by the extent to which a child is consciously or unconsciously being programmed by the alienating parent to reject the targeted parent. Gardner recommended legal and therapeutic interventions based on the degree of severity of the case. That is, whether it is at the mild, moderate, or severe level of parental alienation. The determination of the degree of PAS depends mainly on the evaluation of the psychopathology of the alienating parent. For mild parental alienation cases, Gardner suggested that court-ordered visitation is the only intervention necessary. Such orders reassure the alienating parent, as well as the child, of the stability of their relationship – their relationship will not be jeopardized or threatened by the targeted parent. The order for visitation will alleviate the child’s guilt. After all, the child is now “ordered” to reside with one parent (e.g., the alienating parent), thus removing the child’s obligation to choose a parent. Hence, there can be no guilt or fear of leaving one parent for a visit, nor any hesitation to visit the other. Court orders also have a side benefit typically to decrease the conflict between the parents. In mild cases, the alienating parent is assumed not to have any severe emotional problems. The vast majority of cases, however, fall in the moderate PAS category, in which it is assumed that the alienating parent gives verbal and nonverbal cues to the child to encourage acting out angrily against the targeted parent or to be afraid of that parent. It is recommended, under these circumstances, that a combination of court orders for visitation as well as counseling or psychotherapy be issued. The therapy in these cases is not designed to increase parents’ insight, but rather to structure their behavior around visitation. Therapy also tries to help the targeted parent become more “tough-skinned” or resilient about the child’s rejection, reprogramming the child, and confronting the alienation tactics of the alienating parent. In severe cases of PAS, Gardner recommended a change in residence or primary custody.8 While apparently a drastic recommendation, given the child’s professed attachment to the alienating parent and fear of the targeted parent, there are significant justifications to warrant such a change. Typically, in severe cases, the alienating parent has severe psychopathology which affects other parenting aspects. For example, the alienating parent may be chronically suicidal and the child skips school to stay home with that parent partly out of fear that parent will take his or her life while at school. By staying home the child protects the parent. Sometimes the alienating parent has rigid, paranoid thinking that severely limits the child’s ability to differentiate and mature in other aspects of life. The paranoid thinking leads to choices of with whom the child may play and when. The paranoia may be projected onto the targeted parent who is perceived to be a threat to the alienating parent and ultimately the child. This delusional thinking is transmitted to the child who develops a shared delusion toward the targeted parent. The ordered change in custody assumes that the targeted parent is more emotionally healthy than the alienating parent. In the classic PAS scenario, a hated, or targeted, parent and an alienating, or loved, parent are involved with each other. Typically, one parent has left a depressed, low-functioning, alienating parent who over-identifies with their parenting role (mother/father role). For the child to be susceptible to alienation, the child usually feels abandoned by the departed parent, who may have left precipitously. The child may feel abandoned because of the alienating parent’s statements, such as he or she “left us.” One child told this writer, “He divorced us.” The child clings to the lower-functioning, alienating parent and may be caught in what Gardner called a “folly a deux” against the departed parent as a way of bolstering the alienating parent so that he or she can continue to care for the child. In cases where the alienating parent is the father and the target is the mother, the child, usually a male, identifies with the father who is contemptuous of the mother’s weakness. The father, narcissistic and successful, looks down on others he may perceive as not as successful as he. The mother has usually committed the abandonment (e.g., pursued a career, left to care for an ailing parent, etc.), thereby subjecting the child to emotional stress by feeling overburdened in taking care of her. The mother may have behaved in a way that the child labels as morally wrong (usually with help from the father). A Systems View of PAS The vast majority of PAS cases that attempt therapy are categorized at the moderate level. One of the difficulties in these cases is that the targeted parent, being a human being, usually contributes directly to the problems in the parent-child relationship. The targeted parent’s shortcomings contribute to the ongoing parental conflict with the alienating parent. Very often, the targeted parent has, or develops, a distant, rigid style which is seen by the child as authoritarian. Males, growing up in 21st century America, are still not educated on emotions, feelings, and communication skills and naturally fall prey to this scenario. The style of the targeted parent contrasts with the indulgent, clinging style of the alienating parent. This combination of parenting styles is often seen in intact families as well as families who have children with severe emotional problems. Family therapy in intact families is usually aimed at bringing the father into a closer relationship with the child and increasing their affection. It is also aimed at helping the mother find an identity outside of the parent role to help with her parenting. The same therapy techniques apply in PAS cases. Both parents usually need help with their parenting skills. Conflict between the parents is probably the main contributor to moderate PAS. Johnson and Campbell, in their book Impasses of Divorce,9 note that children around the age of nine usually ally with one parent in high conflict cases. This behavior is a common survival strategy because conflict takes great ego strength to remain neutral. Divorced couples usually force friends to choose between them, and even therapists find it difficult to maintain emotional ties to both divorced parents. In family therapy for PAS cases, the neutral family therapist assists the child in keeping contact with both sides and performs conjoint work with the parents in order to reduce situational conflict. Conflict often escalates outside of the immediate family to include attorneys and therapists. Johnson and Campbell maintain that therapists, especially individual child therapists, can unwittingly become part of the system, thus, sustaining the syndrome. Very few therapists and mediators are knowledgeable about PAS. Most therapists are originally trained in individual models of psychotherapy in which understanding and venting of feelings are the main therapeutic techniques. Often therapists only see the child with the loved parent and avoid contact with the other parent because of their own fear of conflict. These therapists take children’s statements at face value and do not realize that children of divorce will often say different things depending upon which parent is with the child. Even sophisticated therapists who know about PAS can be drawn into the warring systems. When an evaluator believes that a child is alienated and the child’s therapist is unwilling to meet with the hated parent and is unreceptive to feedback about alienation, it may be necessary to discontinue the child’s therapy. However, if the child is very attached to that therapist, changing the child’s therapist should be done only as a last resort. Because therapists can become part of the warring factions that contribute to PAS, communication and collaboration among therapists in the family is essential. As part of the conflict, often parents will try to block communication between therapists. Court orders allowing communication will facilitate treatment. Innovations in Legal and Therapeutic Interventions What about the role of mediation or parent coordination in PAS? The premise is that help for PAS almost always involves a combination of legal and therapeutic interventions; however the delays caused by the formal court proceedings may contribute to the problem. Early negotiation, intervention, or mediation in these cases can be a powerful tool for attorneys in providing a rapid solution to child estrangement which can evolve into total rejection of one parent by a child. Time is of the essence in dealing with problems that may lead to PAS. If contact is stopped between a parent and a child, a pattern is likely to develop such that it will be difficult to mend the relationship. Even without the assistance and cooperation of an “alienating parent,” the child can develop phobic-type symptoms, showing anxiety about contact with a parent. Phobias are strengthened and maintained by avoidance. Mediation and parental coordination can be used to keep contact between parents and children, to help to select a mutually acceptable therapist who may be able to solve the problems with early intervention, or to quickly select a neutral evaluator. A neutral evaluator is in the best position to determine whether there are substantive reasons for the child’s rejection of one parent or if the child is responding to the other parent’s need to have an ally. Outcomes of Treatment There has been very little research on the success of legal and therapeutic interventions for PAS. However, reports from therapists who are working in the field suggest that there are few relatively quick, miraculous cures. Success in PAS cases should be defined as the rehabilitation of a previously alienated relationship between a parent and child and a continuing relationship with a previously alienating parent. It is often frustrating for parents and therapists when the parents improve in their behavior and the child remains stuck in a rejecting attitude. Sometimes the children who have gone through the wars of divorce must reach a higher level of maturity before they are able to give up their rejecting attitude. The biggest tragedy is that sometimes the rejected parent loses patience and gives up before that change occurs. The damage of PAS can be a life-threatening disorder with dire consequences to children, and ultimately society. In many cases, however, speedy intervention by therapists, attorneys, and the courts can keep smaller problems from escalating into termination of the relationship between parents and children. The more that judges, attorneys, and therapists understand PAS, and how they may unwittingly contribute to the problems through escalation of conflict, the more damage can be prevented. 1 D.C. Rand, The Spectrum of Parental Alienation Syndrome (Part I), 15 Amer. J. of Forensic Psychology, (No. 3, 1997). 2 G.F. Cartwright, Expanding the Parameters of Parental Alienation Syndrome, 21 Amer. J. of Forensic Psychology, (No. 3, 1993); R. A. Gardner, The Parents Book About Divorce (2d ed. 1992). 3 R.A. Gardner, The Parents Book About Divorce (2d ed.1992). 4 R.A. Gardner, The Parental Alienation Syndrome (2d ed.1998). 5 G.F. Cartwright, Expanding the Parameters of Parental Alienation Syndrome, 21 Amer. J. of Forensic Psychology, (No. 3, 1993); R.A. Gardner, The Parents Book About Divorce, Second Ed., (1992). 6 Id. 7 Id. 8 R.A. Gardner, The Parents Book About Divorce, (2d ed. 1992); see also Psychotherapeutic and Legal Approaches to Three Types of Parental Alienation Syndrome Families, in Family Evaluation in Child Custody Mediation, Arbitration, and Litigation, (1989). 9 J.R. Johnston & L.E.G. Campbell, Impasses of Divorce: The Dynamics and Resolution of Family Conflict (1988). Robert A. Evans, Ph.D., is a licensed school psychologist and has a private practice in Altamonte Springs and Safety Harbor. He can be reached through his Web site: www.ACenterForHumanPotential.com. This column is submitted on behalf of the Family Law Section, Jorge M. Cestero, chair, and Charles F. Miller, editor. |