Transcript THE MISDIAGNOSIS OF PARENTAL ALIENATION SYNDROME

THE MISDIAGNOSIS OF
PARENTAL ALIENATION
SYNDROME
Barry Brody, Ph.D., L.M.F.T.
9495 Sunset Drive, Suite B-295
Miami, Florida 33173
(305) 595-1770
Email: [email protected]
2003 Annual Conference
Florida Association for Marriage and Family
Therapy
May 25, 2003
AGENDA
1. What Is Pas? (9:00A.M.-9:50A.M.)
History and Background
Baseline Data and Criteria
2. How To Diagnose PAS(10A.M.-10:50A.M.)
Legal Context
Causes of Misdiagnosis
Collateral Issues
3. Solutions (11:00A.M.-11:50A.M.)
Treatment Parameters
Court Interventions
“…it must be understood that all mental health
professionals are not aware of nor know how to
treat the PAS phenomenon. In fact, when a
mental health professional unfamiliar with PAS is
called upon to make a recommendation about
custody, access, or related issues, he or she
potentially can do more harm than good.”
Bone and Walsh (1999)
“Many professionals with lots of
experience do not fully understand
Dr. Gardner’s work. This is
probably because they have never
really taken the time to read his
books.”
Dr. Barry Bricklin
“With increasing recognition of PAS, it is
predictable that it will be misdiagnosed,
overdiagnosed, and utilized improperly. This
is true of just about any psychiatric
disturbance, and as a fact, of any medicine.
With increasing knowledge and experience we
should be able to delineate these various
complications regarding correct diagnosis. In
short, not all campaigns of denigration are the
result of manifestations of PAS and not all
campaigns of denigration are manifestations
of abuse. Life is just not that simple.”
Dr. Richard Gardner (2001)
“If you are looking for truth and
justice don’t go into a courtroom”
A.S. Brody, Esquire
Fatherly advice offered to his son
History and Background
1. Legal Developments:
a. Replacement of tender-years
presumption with the best-interests-ofthe-child presumption (gender-blind).
b. Replacement of sole custody with
joint custody preference.
History and Background
2.
Mental Health Developments:
a. 1980-Surviving The Breakup-Wallerstein & Kelly.
b. 1985-Recent Trends in Divorce and Custody LitigationGardner.
c. 1987-The Parental Alienation Syndrome and the
Differentiation Between Fabricated and Genuine Child Sex
Abuse-Gardner.
d. 1992-The Parental Alienation Syndrome: A Guide for Mental
Health and Legal Professionals-Gardner.
e. 1998-The Parental Alienation Syndrome, 2nd EditionGardner.
f. 2002-Publication of PAS Table-Diagnosis of The Three
Levels of PAS Alienators-Gardner.
g. Gender Shift
PAS Definitions
1. “Although this syndrome certainly existed in the past, it is occurring
with such frequency at this point that it deserves a special name.
The term I prefer to use is parental alienation syndrome. I have
introduced this term to refer to a disturbance in which children are
obsessed with depreciation and criticism of a parent—denigration
that is unjustified and/or exaggerated. The notion that such children
are merely ‘brainwashed’ is narrow. The term brainwashing implies
that one parent is systematically and consciously programming the
child to denigrate the other parent. The concept of the parental
alienation syndrome includes the brainwashing component but is
much more inclusive. It includes not only conscious but
subconscious and unconscious factors within the parent that
contribute to the child’s alienation. Furthermore (and this is
extremely important), it includes factors that arise within the child—
independent of the parental contributions—that contribute to the
development of the syndrome.” Gardner, 1985.
PAS Definitions
2. “The parental alienation syndrome (PAS) is a childhood
disorder that arises almost exclusively in the context of
child-custody disputes. Its primary manifestation is the
child’s campaign of denigration against a good, loving
parent—a campaign that has no justification. It results
from the combination of a programming (brainwashing)
parent’s indoctrinations and the child’s own contributions
to the vilification of the target parent. When true parental
abuse and/or neglect is present, the child’s animosity
may be justified and so the parental alienation syndrome
explanation for the child’s hostility is not applicable.”
Gardner, 2002.
The Need To Correctly Diagnose
PAS
• Time
• Effects of PAS
Cast of Characters (The Spin
Zone)
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Mother
Father
Step-parent
Children
Attorneys
Judge
Guardian Ad Litem
Child Advocate/DCF
Mental Health Professionals (Treating/Evaluator)
“Don’t do something. Stand there!”
Dr. Richard Gardner (1996)
“I cannot emphasize strongly enough that
evaluators should never lose sight of the
crucial medical dictum: diagnosis before
treatment.”
Dr. Richard Gardner (1998)
“…it is important that a proper diagnostic
evaluation be conducted in order to ascertain
specifically in which category the child’s
symptoms lie: mild, moderate or severe. Each
type warrants a very different approach. Failure
to make this discrimination may result in
grievious results, with significant psychological
trauma to all concerned parties.”
Dr. Richard Gardner (1998)
“Accordingly, a proper PAS evaluation rests
on the foundation of a solid and thorough
child-custody assessment.”
Dr. Richard Gardner (1998)
PAS Diagnostic Considerations
• Generally Court-Ordered
• Forensic versus Clinical Context
• Guidelines for Conducting Child Custody
Evaluations
• No Standard Psychological Tests for PAS
• Subjective Evaluator Bias Increased by
Utilizing Specified PAS Diagnostic
Protocol (Interviews and Observations)
PAS Evaluation Parameters
(PAS Diagnostic Protocol)
• Grandma’s Criteria=Stronger-Healthier
Psychological Bond
• Blank Screen Approach
• Only Utilize Interview Format
• Initial Interview with Both Parents
• Individual Interviews with Each Parent
• Individual Interview with Child
• Joint Interviews-Parent and Child
• Family Interview
The Ideal Evaluator
(based on Turkat, 1993)
1.Significant training in the area of child development, with particular understanding of the
stages of development, and how they interact with the positive and negative
attributes of each parent.
2. Significant training in psychopathology, with particular understanding of the factors that
promote the development of mental disorders.
3. Special expertise in the areas of personality and personality disorder.
4. Top-notch diagnostic skill.
5. Many years of experience as a practicing clinician.
6. Be able to document having accomplished a significant number of decisions that
reflect an unbiased record.
7. Make it clear to the Court that his or her tests, interpretations, and recommendations
are potentially subject to error, and give some indication to the Court regarding the
range and degree of possible error involved.
8. Significant training in the areas of attachment theory and object-relations.
9. Significant training in the area of evaluator bias, with specific focus on procedures
utilized to minimize bias.
10. Significant training in the area of Parental Alienation Syndrome.
11. Supervised experience in conducting PAS evaluations.
12. Personal therapy.
Common PAS Diagnostic Errors
(Warshak)
1. Misunderstanding of PAS Definition
three essential elements:
persistent rejection or denigration
response is unjustified
partial result of alienating parent
Common PAS Diagnostic Errors
(Warshak)
2. Five Differentiating Factors in PAS Kids
hostility and/or rejection is:
temporary/short-lived vs. chronic
occasional vs. frequent
occurs only in certain situations
coexists with expressions of love
is directed at both parents
Common PAS Diagnostic Errors
(Warshak)
3. Child resists becoming alienated
4. Child alienated not due to favored
parent’s influence- “child-driven
alienation”
5. “Undiagnosed PAS”/False NegativeBone and Walsh
Potential Causes of Misdiagnosis
of PAS
Procedural Variables
1. Context of PAS Evaluations
inappropriate assessment methods
subjective bias
2. Unintentional Evaluator Errors
technical
knowledge-based
Personal Variables
1. Bias
2. Validators
3. The Non-Existence of PAS
4. MHP’s Attitudes and PAS
Sample Court Order
ORDER GRANTING MOTION FOR PSYCHOLOGICAL
EVALUATION OF MINOR CHILD
THIS CAUSE came on Former Husband’s Motion for
Psychological Evaluation and the Court having heard
argument of counsel and being otherwise advised in the
premises, it is hereby
ORDERED AND ADJUDGED that the Court grants Former
Husband’s Motion for Psychological Evaluation and
orders a psychological evaluation be conducted upon the
parties’ minor child for the purpose of determining
whether there is any psychological evidence of parental
alienation.
Collateral Issues
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DSM-IV
Syndrome
PA vs. PAS
Abuse vs. PAS
Legal Process Therapy Trauma
Reliability
Recognition in Court
Recognition in the Mental Health Community
“My experience has been that the vast
majority of therapists have contributed
formidably to the pathological
empowerment of PAS children.”
Dr. Richard Gardner (2002)
“One of the most surprising and discouraging findings in
this survey was that in 15 families in which a parent was
successfully alienated, the alienation was supported by a
therapist on the basis that the child should not be
separated from a ‘symbiotic relationship’ (with the
alienating parent), even though the ‘symbiosis’
proceeded far beyond the time when such a parent-child
relationship could even be remotely considered. It was
as though the therapists had joined the delusion that the
child could not survive if separated from the symbiotic
parent.”
Dr. Deidre Rand (1997)
Treatment Parameters
1. Court-ordered with Specific Sanctions
2. Personality Characteristics of Therapist
authoritarian vs. passive
knowledge of PAS
One Therapist for Whole Family
Non-Traditional Confidentiality
Threat Therapy
3. Increased Frequency of Visits
4. Use of Videotape
5. Child’s Need for Dictatorial Approach
Mild PAS Cases
Treatment: None usually indicated
“attempted PAS” ? (Bone and Walsh)
collateral issues re:divorce
Legal: Court Order that Alienating Parent
Will Be Awarded Primary Custody
Moderate PAS Cases
(Plan A)
Treatment: By Court-Ordered PAS Therapist
Legal: Court Order that Alienating Parent
Will be Awarded Primary Custody
Court-Appointment of PAS therapist
Specified Court Sanctions
Moderate PAS Cases
(Plan B)
Treatment: By Court-Ordered PAS Therapist
Legal: Court Order that Primary Custody
Transferred to Alienated Parent
Court-Appointment of PAS therapist
Extremely Restricted and Monitored
Visitation by Alienating Parent
Severe PAS Cases
Treatment: Monitoring of Transitional-site
Program by Court-Ordered PAS Therapist
Legal: Court Order that Primary Custody
Transferred to Alienated Parent
Court-Ordered Transitional-site Program
Transitional Site Program
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2.
3 Levels (based on restricted access)
a. home of relative/friend
b. shelter
c. hospital or detention center
6 Phases
a. no contact with alienating parent, visit by alienated parent
on site
b. visit by child at alienated parent’s home
c. discharge to alienated parent’s home
d. monitored telephone and mail contact with alienating parent
e. visits by alienating parent in alienated parent’s home
f. Visits to alienating parent’s home
“It is out opinion that one of the most powerful tools the
courts have is the threat and implementation of
environmental modification. Of the approximately four
hundred cases we have seen where the courts have
increased the contact with the target parent (and in half
of these, over the objection of the children), there has
been positive change in 90 percent of the relationships
between the child and the target parent, including the
elimination or reduction of many social-psychological,
education, and physical problems that the child
presented prior to the modification.”
Clawar and Rivlin (1991)
“The predictable reluctance of the court to take action in all
of the aforementioned areas is one of the important
reasons why the PAS is such a widespread disorder.”
Dr. Richard Gardner (2001)
“Lawyers who work within the adversary system, although
they are doing what they were taught to do in law school,
that is zealously support their clients, are playing an
active role in promulgating and entrenching the PAS.”
Dr. Richard Gardner (2002)
Court Interventions
1. Sets Foundation for Therapy
2. Appoint Therapists with Knowledge of
PAS
3. Implement Sanctions for Alienating
Parent
4. Appoint Guardians with Knowledge of
PAS
“Whether or not one chooses to use Gardner’s terminology,
the problems posed by these cases to families,
professionals and the courts are very real. Reluctance
to consider Parental Alienation Syndrome by name,
along with the diagnostic and interventions it entails,
tends to contribute to the perpetuation of the problem in
a variety of ways. Like any other label, that of PAS has
the potential to be misapplied and misused. Whether or
not it is the appropriate diagnosis in a given instance
must be determined based on facts of the case,
corroborated historical evidence and data from multiple
sources. An appropriate diagnosis of PAS, including
level of severity as Gardner recommends, can make the
difference between allowing a case to go beyond the
point of no return or intervening effectively before it is too
late.”
Dr. Deidre Rand (1997)