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It's Time to Make History Together: Parental Alienation Relational Problem and DSM-5-TR — Transcript

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0:10Good evening.
0:12I'm Dr. William Burnett. I'm a child
0:14psychiatrist and forensic psychiatrist
0:17in Nashville, Tennessee.
0:19And it's great to see so many people
0:21here this evening
0:22uh at this webinar.
0:24And as usual, we want to thank Elaine
0:27Cobb for organizing this webinar that
0:30happens every month.
0:32So, I have a pretty complicated title,
0:34which is on this first uh title slide,
0:37which says
0:38it's time to make history
0:42together.
0:43Parental alienation relational problem
0:46and DSM-5-TR.
0:50So,
0:52um I'm going to try to explain exactly
0:54what this is all about. And I'm going to
0:56explain what you can do to help me, and
0:59we can all together make history.
1:02So, as you can see on this next slide,
1:05yeah are are the two main components of
1:08what I'm talking about today.
1:09That first of all,
1:11I'm going to be describing
1:13uh
1:14the a diagnostic version of parental
1:17alienation.
1:18And what we're calling it is parental
1:21alienation relational problem or PARP,
1:24and I'll explain why we're using that.
1:27And then uh you can see this is a little
1:30picture of the DSM-5-TR.
1:33And
1:34those are the initials for the
1:36Diagnostic and Statistical Manual of
1:38Mental Disorders, fifth edition, text
1:41revision.
1:43So, most of you probably know in the
1:45next slide that the the actual words
1:49parental alienation are not in DSM,
1:53but the idea, the concept of PARP, p a r
1:57p, is in the DSM already.
2:02And it's there there are three diagnoses
2:05in the DSM
2:06which can be used in a case where
2:09parental alienation is present.
2:12And the first one of these is child
2:14affected by parental relationship
2:16distress. That's a very cumbersome
2:18title, but it's c a p r d.
2:21The second diagnosis that's already in
2:24the DSM is parent-child relational
2:27problem.
2:28And the third one is child psychological
2:31abuse. So, what this means is even now
2:35if a person is doing an evaluation, if a
2:37psychologist or social worker,
2:38psychiatrist is doing an evaluation on a
2:41family and they identify parental
2:44alienation they can use one of these
2:46diagnoses that are already in the DSM.
2:51But, what we would like to do is to have
2:54a more specific diagnosis that
2:56particular that
2:58especially pertains specifically
3:00pertains to parental alienation.
3:03And here's our proposed definition of
3:06PARP,
3:08parental alienation relational problem.
3:11This is the definition that we've been
3:12using for years uh with regard to
3:15parental alienation.
3:18Now, let's read this together.
3:20This category may be used when a child
3:24usually one whose parents are engaged in
3:27a high conflict separation or divorce
3:30allies strongly with one parent and
3:33rejects a relationship with the other
3:35parent without a good reason.
3:39So
3:40uh that's just the one sentence
3:42definition, but in the uh PARP we
3:47explained that there are five criteria.
3:49The diagnosis of PARP usually requires
3:53these five criteria.
3:55And let's run through these together.
3:57The child avoids, resists, or refuses
4:00the relationship with one of the
4:02parents.
4:03There previously in the past was a good
4:07positive relationship between the child
4:09and the parent who is now rejected.
4:12Thirdly, there's an absence of abuse,
4:14neglect, or seriously deficient
4:16parenting on the part of the parent who
4:18is now rejected.
4:21Fourth, there
4:23it's possible to identify multiple
4:25alienating behaviors
4:27on the part of the favored parent. And
4:30finally, the fifth
4:32uh criterion
4:33for the diagnosis of PARP
4:36is the identification of behavioral
4:39signs of alienation by the child.
4:45So, these five criteria were published
4:48only a few months ago
4:50in an article called the five-factor
4:53model for the diagnosis of parental
4:55alienation.
4:56Now,
4:57uh Dr. Amy Baker and I have been talking
5:00about these five factors for several
5:01years, and there have been articles and
5:04and book chapters
5:06uh discussing it for a long time,
5:09but um it was important
5:12that these that this article was
5:14published in an important journal.
5:17The um Journal of the American Academy
5:19of Child and Adolescent Psychiatry.
5:22So, that was only a few months ago. And
5:24in fact, that's part of the reason why
5:26we're now ready to present uh this idea
5:30that PARP should be included
5:34in the DSM.
5:35Because there have been a number of
5:37important publications in the last year
5:39or so.
5:41So, I want to show you several ways that
5:43we've been uh promoting this idea.
5:46And the first one
5:49uh is I want to show you uh the website.
5:52Uh we're going to uh
5:54go to the uh
5:56we have a dedicated website which is
5:58www.parp
6:03-dsm.info.
6:06And later
6:07uh
6:08when you have a chance, you can go to
6:09this website. And we're going to go to
6:11it right now. And on the website, we're
6:14going to scroll down a little bit to a
6:17video.
6:19So, we have a really neat video
6:21uh that you can uh we're going to show
6:23right now. But also, you can see it
6:26yourself if you go to the website. And
6:27this video was made by a colleague of
6:29ours, Larry De Marco, who's an attorney
6:33in Pennsylvania near Philadelphia.
6:36And he is uh his office is called the
6:39law center.
6:41So, Larry has made a number of videos.
6:43And
6:44let's look at this one. This is a kind
6:45of a neat
6:46overview of what happens um
6:50in in with regard to PARP and the DSM.
6:54This video proposes that parental
6:55alienation be considered a relational
6:57problem in the chapter of the Diagnostic
6:59and Statistical Manual of Mental
7:01Disorders, which is called Other
7:02Conditions That May Be a Focus of
7:04Clinical Attention.
7:06This is the proposed wording for
7:08Parental Alienation Relational Problem.
7:12This category may be used when a child
7:15usually one whose parents are engaged in
7:17a high-conflict separation or divorce
7:20allies strongly with one parent and
7:23rejects a relationship with the other
7:25parent without good reason.
7:29The diagnosis of Parental Relational
7:31Problem usually requires five criteria.
7:36One.
7:37The child avoids, resists, or refuses a
7:40relationship with a parent.
7:43Two,
7:45the presence of a prior positive
7:47relationship between the child and the
7:49now rejected parent.
7:52Three,
7:53the absence of abuse or neglect or
7:56seriously deficient parenting on the
7:58part of the now rejected parent.
8:02Four,
8:03the use of multiple alienating behaviors
8:06by the favored parent.
8:08And five, manifestations of behavioral
8:11signs of alienation by the child.
8:14These five criteria are called the
8:17five-factor model for the diagnosis of
8:19parental alienation.
8:22The justifications for the proposed
8:24addition.
8:26For the child, it's painful to be caught
8:28in the battleground between their
8:30parents.
8:31For the alienated parent, it's
8:33humiliating, traumatic, and extremely
8:36frustrating to be irrationally rejected
8:39by a child with whom he previously had
8:42an enjoyable, loving relationship.
8:46Mental health practitioners, legal
8:48professionals, both attorneys and
8:51judges,
8:52and alienated parents have all described
8:55the relentless progression of parental
8:57alienation from a mild level of
8:59intensity when it's reversible to a
9:02severe level when it's almost
9:05intractable.
9:06Adopting a formal definition for
9:09parental alienation will greatly
9:11increase the chances of its early
9:13detection.
9:14And more intensive research will
9:17hopefully lead to prevention of this
9:19painful mental condition.
9:22Historical context for this proposal.
9:26Although the actual words parental
9:29alienation weren't included in the
9:31DSM-5,
9:33the concept of parental alienation was
9:35included in three different diagnoses in
9:38the chapter on other conditions.
9:41Each of these diagnoses paraphrase the
9:44meaning of parental alienation in their
9:47respective definitions.
9:49First, child affected by parental
9:51relationship distress.
9:54Negative effects of parental
9:55relationship discord on a child in the
9:57family. For example, high levels of
10:00conflict, distress, or disparagement.
10:04Two,
10:05parent-child relational problem.
10:09Negative attributions of the other's
10:11intentions or hostility toward the other
10:14and unwarranted feelings of
10:16estrangement.
10:18Three,
10:19child psychological abuse.
10:22That is harming or abandoning people or
10:25things that the child cares about.
10:27The great majority of practitioners who
10:29are familiar with parental alienation
10:31agree on the basic principles of the
10:33theory.
10:35There may be disagreements on how to
10:37distinguish mild, moderate, and severe
10:39levels of parental alienation. There may
10:42be disagreements regarding the
10:43interventions for these levels of
10:45severity, but these disagreements aren't
10:48essential for the inclusion of parental
10:50alienation in the DSM-5.
10:53In fact, many conditions are included in
10:56the DSM for which there's a disagreement
10:59regarding treatment.
11:02The magnitude of the proposed addition.
11:05Jennifer Harman and her colleagues
11:07recently published a comprehensive
11:09review of the parental alienation
11:11literature.
11:12The authors identified more than 1,000
11:15articles and books that pertained
11:16primarily to parental alienation theory.
11:20Excluding the material that contained no
11:21data,
11:23they ultimately reviewed in detail 207
11:27empirical research studies.
11:30The following graph demonstrates how
11:32qualitative and quantitative research
11:34regarding parental alienation theory has
11:36increased over time.
11:39More than 100 books have been published
11:41regarding parental alienation, most of
11:43them written by psychiatrists,
11:45psychologists, and other mental health
11:48professionals. Some were written by
11:50alienated parents or formerly alienated
11:52children describing their lived
11:54experiences.
11:56Peer-reviewed publications regarding
11:58parental alienation have appeared in the
12:00professional literature in more than 50
12:02countries.
12:03There's a worldwide need for inclusion
12:05of parental alienation in the DSM-5.
12:09Practitioners and researchers in many
12:11countries will benefit from standardized
12:13definitions and diagnostic criteria for
12:16this mental condition.
12:18If practitioners identify and understand
12:20parental alienation, they will be able
12:23to help children and families who are
12:25struggling with this mental condition.
12:28There's a great deal of qualitative
12:30research regarding alienating behaviors,
12:33which is factor four of the five factor
12:35model, and the behavioral manifestations
12:38of parental alienation, which is factor
12:40five of the five factor model.
12:43The acceptability of the concept of
12:45parental alienation can be addressed in
12:47four ways.
12:49One,
12:50large professional organizations have
12:52accepted the general concept of parental
12:54alienation.
12:55The large professional organizations
12:57that accept parental alienation include
13:00the American Academy of Child and
13:02Adolescent Psychiatry, the AACAP,
13:06the Association of Family and
13:07Conciliation Courts, the AFCC,
13:12the American Academy of Matrimonial
13:14Lawyers, the AAML,
13:16and the American Academy of Pediatrics,
13:19the AAP.
13:21Many professional organizations have
13:23accepted papers and symposiums regarding
13:26parental alienation at conferences for
13:29mental health and legal professionals.
13:33Two,
13:34major textbooks and reference books have
13:37published information regarding parental
13:39alienation.
13:40For instance,
13:42the comprehensive textbook of
13:43psychiatry,
13:45the encyclopedia of forensic science,
13:47and the encyclopedia of clinical
13:49psychology.
13:51Three,
13:52a great majority of practitioners have
13:54accepted the general concept of parental
13:56alienation and the definitions of
13:59specific components of parental
14:00alienation theory.
14:03In one study, researchers surveyed
14:05mental health professionals. They rated
14:07the importance of 21 factors in shaping
14:10custody recommendations.
14:12One of the factors was related to
14:14parental alienation, which was ranked as
14:16the second highest ranking factor.
14:19That clearly indicated endorsement of
14:21the concept.
14:23In another study, the researchers asked
14:25custody evaluators their opinions of
14:28definitions related to alienation and
14:30estrangement.
14:31About 90% of the participants agreed on
14:34these definitions, including the
14:35definition of a five-factor model to the
14:37diagnosis of parental alienation.
14:41There are several DSM-5 TR diagnosis
14:44that may be confused with parental
14:46alienation in some circumstances,
14:49although these conditions can be
14:50distinguished in a careful clinical
14:52evaluation.
14:54One, child affected by parental
14:56alienation distress.
14:58Two, parent-child relational problem.
15:02Three, child psychological abuse.
15:04And four, delusional symptoms in the
15:07context of relationship with an
15:08individual with prominent delusions.
15:12Several psychological tests have been
15:14found to reliably distinguish alienated
15:17from non-alienated children. Some of
15:19these instruments were developed
15:21specifically this task.
15:24Others were older, established
15:25psychological tests that were newly
15:28applied to cases involving parental
15:30alienation.
15:31The following are listed in
15:33chronological order.
15:35Baker, Burt, Carr, and Albertson Kelly
15:38in 2012.
15:41The Baker Alienation Questionnaire or
15:43BAQ is intended to identify alienated
15:47children using a paper and pencil
15:49measure that's short, easy to
15:51administer, and easy to score
15:53objectively.
15:55The authors found that the BAQ
15:57discriminated between alienated and
16:00non-alienated children at an 87.5%
16:04accuracy rate.
16:06In the table, you can see that the BAQ
16:09gave correct results in 35 out of 40
16:13cases.
16:15The Rowlands Parental Alienation Scale
16:17or RPAS was administered to 592 parents
16:21along with measures of convergent and
16:23discriminant validity.
16:25The RPAS consists of six factors.
16:30One, campaign of denigration toward the
16:32alienated parent. Two, independent
16:35thinker phenomenon. Three, reflexive
16:37support of the favored parent. Four,
16:40presence of borrowed scenarios. Five,
16:43spread of animosity to extended family
16:46of rejected parent. And six, lack of
16:49positive affect toward the rejected
16:50parent.
16:52Parents who reported either that a court
16:54evaluation or court findings had
16:56confirmed the presence of parental
16:58alienation scored significantly higher
17:01on all six RPAS factors as well as on
17:05the overall RPAS score.
17:09Brunet et al. 2018 and 2020.
17:14The Parental Acceptance and Rejection
17:16questionnaire or PARQ park was
17:20administered to 45 severely alienated
17:23children and 71 non-alienated children
17:26in Canada.
17:27It was found that severely alienated
17:29children engage in extreme level of
17:32splitting.
17:33That is perceive the favored parent in
17:36very positive terms and the rejected
17:39parent in exclusively negative terms.
17:42The park gap the difference between the
17:45child's park for the mother and park for
17:47the father scores was 99%
17:51accurate in distinguishing alienated
17:53from non-alienated children.
17:56In the graph, you can see the park
17:59distinguished the alienated children in
18:01red from the non-alienated children in
18:04blue.
18:06Black and Godfrey, 2018.
18:09The Ben Anthony Family Relations Test or
18:13BART
18:15was administered to 16 alienated
18:17children and 17 non-alienated children
18:20in the United Kingdom.
18:22Children in the alienated group
18:24expressed almost exclusively negative
18:26feelings toward the rejected parent
18:28while expressing almost exclusively
18:30positive feelings toward the preferred
18:32parent.
18:34These highly significant results are
18:36summarized in this table.
18:39An unusual feature of this topic is the
18:41extreme amount of misinformation that's
18:43been created by critics of parental
18:45alienation theory over the years.
18:48This information, which was expressed in
18:50various forms, has been methodically
18:52clarified and refuted by proponents of
18:54parental alienation theory in book
18:57chapters and in peer-reviewed journals.
19:00Nonetheless, the proponents of false
19:02information continue to make inaccurate
19:06and inflammatory claims about the topic.
19:10Critics of parental alienation theory
19:12are likely to protest vigorously to this
19:14proposal.
19:16We urge DSM personnel to consider the
19:18writings of parental alienation critics
19:20in a careful and somewhat skeptical
19:22manner and to distinguish factual
19:25material from the false information and
19:28misinformation that may be found there.
19:32Conclusion.
19:34In the United States, there are hundreds
19:36of thousands of children and families
19:38that have experienced parental
19:39alienation.
19:41It's our belief that most of these cases
19:43of parental alienation go undetected and
19:46untreated simply because the serious
19:49mental condition is not well known among
19:52psychiatrists, psychologists, social
19:55workers, and other mental health
19:57professionals and because of the
19:59misinformation that's been disseminated
20:01about it.
20:03In some instances, the process of
20:05alienation is even encouraged by naive
20:08and poorly informed therapists and
20:10lawyers.
20:12This unfortunate state of affairs will
20:14continue until parental alienation is
20:16recognized by leading mental health
20:18organizations and then filter down to
20:21the frontline practitioners.
20:23The most direct method for accomplishing
20:25that goal is for a parental alienation
20:27to be accepted as a relational problem
20:30in the DSM-5-TR,
20:32which will lead to educational programs
20:34for graduate students and trainees as
20:37well as continuing education for
20:40practicing mental health and legal
20:43professionals.
20:45The parental alienation relational
20:47problem in DSM-5 proposal was developed
20:50by Dr. William Burnett and Dr. Amy J. L.
20:54Baker. For additional information,
20:57including the complete proposal
20:59document, visit www.parp-dsm.info.
21:08Go to the description portion of this
21:09video for the complete proposal and to
21:12learn more about the Law Center, the
21:14producer of this video.
21:17So, I hope you enjoyed the video.
21:20Um
21:23If you If you want more information
21:25about all this,
21:27you should go back to the website.
21:29And on the website, you can read the
21:31entire proposal
21:33that we will be submitting in a few
21:34weeks to uh the DSM.
21:37And also, there are a number of
21:39appendices that you can look at. And
21:41also, the list of endorsers.
21:43We now have about 2,000 more than 2,000
21:46people and organizations have endorsed
21:48this proposal.
21:50And
21:51um you can see the list actually on the
21:53website. And also, there are links on
21:56the website
21:58so that if you're interested,
22:00if you think this is a good idea,
22:02you can uh sign in and add your name
22:06and your location.
22:08And we will add you to the list of
22:09endorsers for this project.
22:12So, once again, I want to thank Larry
22:14DeMarco who made
22:15this video and uh the Law Center.
22:19So, um
22:21this is one approach. In other words,
22:22this video is an informal sort of folksy
22:25uh way to present this topic. And I
22:28think it it's the kind of thing that the
22:29general public can understand. It's It's
22:32pretty succinct. It gives an overview.
22:35It hits the main points.
22:37But we we of course have used other
22:39uh approaches, too. And just recently,
22:42uh I did something at the
22:45uh annual meeting of the American
22:47Academy of Child and Adolescent
22:49Psychiatry and that we had a booth, you
22:51know, in a big convention, they have an
22:53exhibit hall.
22:55And they have uh
22:57uh booths by various organizations.
23:00And
23:01um
23:03the um
23:05what we did, um my organization, PASG,
23:09Parental Alienation Study Group, we
23:11rented a booth and we arranged uh to
23:15have this poster. As you can see, uh the
23:18poster itself gives the the definition
23:21that we're proposing
23:22for the uh the diagnosis of PARP, and it
23:26also gives the name of the website.
23:28And it there's even a what's called a
23:30QR, quick response, that people walking
23:33by or coming to the to the
23:36um
23:38uh to the booth can simply hold up their
23:41phone and it will take them to the the
23:44way to uh log in
23:46their endorsement. So, I guess my idea
23:49here is that
23:51um
23:53we uh we we have different approaches.
23:56You know, we have an approach that's
23:57more suitable for the general public. We
23:59have an approach that perhaps is more
24:01suitable for
24:02uh psychiatrists and other mental health
24:04professionals, and so on. So, we hope to
24:07reach a lot of people. And in fact, I
24:09really appreciate this opportunity right
24:11now to reach you all
24:13uh with regard to this campaign.
24:17So, I really appreciate it that a number
24:18of people in the audience have posed
24:20questions. And we're going to go through
24:22several,
24:24and I hope to be able to answer some of
24:26them. I don't think I'm able to do
24:29all of them, but I I can do some of
24:31them. And here's a Let's Let's
24:33read this next question.
24:35Uh let's read this together.
24:39Uh that's on the slide.
24:41What is the diagnosis being used by
24:44trained psychologists
24:49Here, let me look at this try to get
24:53by trained psychologists
24:56that are doing custody evaluations
24:58currently.
25:00When getting mine done, they said they
25:02could not mention the word parental
25:04alienation
25:05in my reports because it is unrecognized
25:08and not in the DSM.
25:10And there are other terms for it that
25:13were acceptable and mean the same thing.
25:15Well, of course, that's exactly what
25:16we're trying to address. We're trying to
25:18get parental alienation in the DSM so
25:20that in the future, when people do
25:22evaluations, they will be able to uh
25:25actually use that term.
25:29But, the answer to their question was
25:32actually in the video that I just showed
25:34you.
25:34That there are three different
25:35diagnoses, as mentioned in the video,
25:38that uh even now
25:40an evaluator can use if if they have a
25:43case involving parental alienation.
25:46And those three diagnoses are
25:49child affected by parental relationship
25:52distress, or CPRD,
25:56parent-child relational problem,
25:58and child psychological abuse.
26:02So, here's another question.
26:04Let's read this together.
26:07It starts out in a provocative way.
26:10So, what is the psycho-alienator
26:13diagnosed with?
26:16It is far more important to diagnose the
26:19root of the problem.
26:21These children need protection from a
26:23mentally unstable parent who's causing
26:25their child's psychosis. So, that this
26:28this actually raises a good point, which
26:30is that
26:32the the the diagnosis of PA actually
26:35pertains to the child, but there are
26:37ways to diagnose the perp- the
26:39perpetrator.
26:40And
26:41there are a number of different
26:42diagnoses, but
26:44when you're doing an evaluation, it
26:46depends on who is the focus of the
26:49evaluation.
26:51And I have on this slide if the focus of
26:55clinical attention is on the child
26:58and the child's relationship with the
27:00with the targeted or rejected parent,
27:02then the diagnosis should be PARP,
27:05parental alienation relational problem.
27:08But if the focus of the evaluation
27:12or the focus of clinical attention is on
27:14the alienating parent then there are
27:17there are several diagnoses that might
27:19be appropriate. One is child
27:20psychological abuse, which is already in
27:23DSM.
27:24Or if the person has personality
27:27disorder, for instance, some some
27:29parents have narcissistic personality
27:31disorder, that would be the diagnosis.
27:34Or in in some really severe cases where
27:36the person actually is
27:38psychotic or delusional, there's a
27:40diagnosis in the DSM specifically for
27:42that.
27:44So,
27:45uh
27:47I think
27:48uh
27:50the the the the DSM is pretty flexible
27:53as to applying different diagnoses for
27:55different purposes, but we think it'll
27:57be even better
27:58when PARP is included.
28:00So, here's another question.
28:03On the next slide,
28:05is there any way you can include
28:07grandparent alienation in the request to
28:10DSM-5 personnel
28:12along with parental alienation?
28:15I'm a PhD candidate in depth psychology
28:19and I would love to see you make history
28:21in escorting in not only parent
28:24alienation into the DSM-5, but also
28:27grandparent alienation. So, that's a
28:29great suggestion. We do allude to that
28:32in the proposal. We do mention that it's
28:35not just parents, but grandparents and
28:37other people
28:38who are rejected, but um
28:42I think we can expand on that
28:44and uh going to that a little bit more
28:46explicit. So, thank you
28:48for whoever made that suggestion and and
28:50to remind us to do that.
28:52Um that's great.
28:54So, on the next slide is another
28:55question.
28:57I would like to know if there is any
29:00literature or research that helps
29:02formulate the diagnosis of parental
29:04alienation prior to divorce.
29:08And what tools are needed to establish
29:11the diagnosis early?
29:14So, that's good to try to figure that
29:16out. And what we have done um
29:20we've created levels of parental
29:22alienation. And typically they're called
29:24mild, moderate, and severe.
29:27And sometimes
29:30um the person who asked the question is
29:32right. Sometimes the alienation starts
29:35even before the people split up, the
29:39parents split up, or or the divorce
29:41occurs. And sometimes it starts at
29:44birth.
29:45That the uh one parent, and I guess that
29:47would typically be the mother, might be
29:49so protective of the child
29:53that she uh totally takes control of the
29:56child even at birth
29:58um
30:00to the exclusion of the other parent.
30:01And obviously this is prior to any
30:03divorce if the divorce happens.
30:06So,
30:07um incidentally
30:11um when that happens, that's actually an
30:13exception. This is a nuance to the
30:16five-factor model. And as you recall,
30:18the second factor was that prior to the
30:22onset of alienation, the parent had a
30:24good relationship with the child.
30:26But suppose it it's like in the
30:29situation that I just described. Suppose
30:31the parent took control of the child
30:34even at birth and never let the other
30:36parent have any relationship at all.
30:39Well, I think that might still be a case
30:41of parental alienation, perhaps even
30:42severe, as time goes on.
30:45But but it doesn't fulfill um the second
30:48criterion. So, that's In other words,
30:50the the five-factor model, the five
30:53factors usually stand up, but
30:55occasionally there are exceptions to
30:58some of these factors in in very
31:00specific situations.
31:04So, what we hope
31:07uh that
31:08uh
31:09making people more aware of the
31:11diagnosis of PARP, that it will in fact
31:14mean
31:15that uh
31:16practitioners will identify it earlier
31:19rather than later. And of course,
31:22um that's the whole idea of early
31:24intervention is you pick up conditions
31:26or you pick up problems when they're
31:28mild, when they're relatively easy
31:31to make an adjustment or make a
31:33correction,
31:34rather than later.
31:39So, thank you for that question.
31:41There's one more question I want to talk
31:43about right now.
31:45Is there a timeline of PA symptoms in
31:49children that can be used to diagnose
31:51deterioration over time,
31:53going from initial PA symptoms to being
31:56completely alienated from a parent,
31:58and a parallel timeline um showing what
32:02therapy is needed at each stage? So,
32:04this is a kind of a continuation of the
32:07of the question that we were just
32:08discussing.
32:09Well, let me run through this.
32:11And this has to do with mild, moderate,
32:13and severe levels of alienation.
32:16And and there are in fact different
32:18interventions
32:19for each one.
32:21So, what is mild?
32:23Mild alienation, the child says, let's
32:26say it's the daddy who is the alienated
32:29parent. The child says, I don't want to
32:32go see daddy in a mild case, but the
32:34child goes,
32:36and he's fine.
32:38They get along, they have a good time.
32:40That once the child gets out of mommy's
32:43household and down the street in the
32:44car,
32:45uh he's fine. So, even though he had
32:47said, "I don't want to go see Daddy." In
32:50fact, he's fine once he gets there. So,
32:53that's mild.
32:54And what do you do about that? So, that
32:56can come to the attention of both
32:58therapists or psychologists or a judge,
33:00even.
33:01And and so, in those cases, the parents
33:03are simply admonished. The judge tells
33:06the parents, "Hey, look. It looks like
33:08there's a problem happening here.
33:10We want both of you to shape up and we
33:12want both of you to do what whatever you
33:14can to encourage
33:16the the child to have a good
33:18relationship with both parents."
33:20And and uh
33:23you know, uh
33:25don't do anything to
33:28uh discourage the child from going on
33:30parenting time with the other parent.
33:32So, that's that's a mild situation. And
33:34usually, that kind of admonishment
33:37is enough to uh correct that situation
33:41when it is mild.
33:45So, a typical moderate alienation,
33:48the uh the child says, "I don't want to
33:50go see Daddy."
33:52And the child goes, but is difficult.
33:55During most of the parenting time, the
33:57child is negative, doesn't want to
33:59participate, doesn't want to have meals,
34:01stays in the room in their bedroom,
34:04perhaps gets on the phone with the uh
34:06mother if it's the the mother is back,
34:09the alienating preferred parent.
34:11And uh
34:14and is negative most of the time.
34:15Although,
34:16in moderate cases, there may be moments
34:19like after a day or so, the child might
34:20soften up
34:22and and communicate and even uh have a
34:25good time at uh for part of the time
34:28with
34:29with the rejected parent. So, in
34:31moderate cases, the child is mostly
34:33negative, but there may be moments when
34:36things are going okay.
34:40And so, those cases
34:43uh there are treatment programs for
34:45those cases.
34:47And typically, they involve everybody
34:50that the child is still living with one
34:52parent and having parenting time with
34:54the second parent.
34:56Both parents need to have coaches. I
34:58like to call them coaches rather than
35:00therapists because the coaches are very
35:04active. They basically tell the parent,
35:06"Do this. Do this. Don't do this."
35:09There usually needs to have some sort of
35:11therapy or family therapy involved with
35:13the children.
35:15And there usually needs to have a
35:17parenting coordinator.
35:20That's a person who meets with both
35:22parents together
35:23and uh helps them communicate regarding
35:26the child.
35:27And then, the parenting coordinator is
35:30in charge of this whole process with all
35:32these different therapists.
35:34Also, there's no confidentiality in this
35:37type of therapy, but all the therapists
35:39have to communicate with each other, and
35:41they all have to be on the same page.
35:44This type of therapy for moderate cases
35:46of alienation almost always has to be
35:49ordered by a court, or else people won't
35:51participate. And also,
35:54uh there has to be a way for the
35:56parenting coordinator to report back to
35:58the court as to progress.
36:01So, that's what happens in moderate
36:03cases.
36:05So, in severe cases, uh there almost
36:07always has been a severe level of
36:10alienating behavior
36:12on the part of the favored parent. And
36:14there's a severe rejection
36:17uh there's a persistent rejection
36:19of the targeted parent. And by
36:22persistent, I mean that the child
36:24refuses to go at all to see that parent,
36:27or if the child goes, the child is
36:29negative during the entire parenting
36:31time.
36:33Um the child won't come out in the room,
36:36their bedroom.
36:37They won't have meals. They They won't
36:39watch TV with the parent or anything
36:41like that.
36:43So,
36:44we consider
36:47um severe cases of parental alienation
36:50where both the
36:52symptoms in the preferred parent and the
36:55symptoms in the child are severe
36:57and pervasive, we consider that to be
37:00child psychological abuse.
37:03And in severe cases like that, we
37:05recommend the child needs to re- be
37:07removed
37:09from that household at least for a
37:11while. Meaning, the child needs to be
37:14removed from the favored parent or the
37:16alienated parent at least for a while.
37:19And then there has to be some work uh
37:22between the child and the rejected
37:24parent so that they they can live
37:27together.
37:28Um
37:29but that's the the I'm sure there are
37:31details to to these programs, but this
37:33is an overview of how to do that.
37:38So, I've I've given you the definition
37:40that we're proposing
37:42for PARP
37:44in DSM, and I've answered a few of these
37:47questions. We're going to have some more
37:48questions later.
37:50But what I want to do now is go over the
37:53actual arguments that can be used.
37:57In other words, on the next slide,
38:00we have
38:01uh
38:02three um of the main arguments that are
38:04used in our proposal. There's actually
38:08there's a there's a series of things
38:10that if you're making the proposal to
38:11the DSM,
38:13uh they tell us
38:15um what they want. There's a series of
38:18um
38:20uh types of information that they want
38:23uh from people who are proposing changes
38:25in the DSM. So, I'm going to tell you
38:27about three of them.
38:29And let's uh let's take a look at this
38:31little list.
38:33Uh first of all, parental alienation
38:35theory is recognized all over the world.
38:40Secondly, what I'm going to summarize
38:42for you
38:44is there's an enormous amount of on
38:47qualitative and quantitative research
38:51uh regarding PARP.
38:54And thirdly, this is something that's
38:56interesting that uh the DSM requires, is
39:00it possible to tell the difference
39:01between PARP and other mental disorders
39:05that might be somewhat similar.
39:10In other words, if you're going to have
39:11something in a book of diagnosis, you
39:13have to be able to distinguish this
39:14diagnosis from all the others.
39:19So, here take a look at this next kind
39:21of heading slide. There's these two
39:23little children
39:25in a picture and and uh what I want to
39:28talk about initially here is that
39:30parental alienation theory
39:32has been observed all over the world.
39:37And in the next slide
39:38is this really impressive list of
39:40countries.
39:42Uh I think there are 50 countries now.
39:44And we've been collecting uh literature
39:47regarding parental alienation for a
39:48number of years.
39:50And we have gradually uh collected
39:53uh
39:54this is litter this is material from the
39:56professional literature
39:58of all of these countries. And by that I
40:01mean I'm not talking about newspaper
40:03articles or blogs on the internet or
40:06magazine stories. I'm talking about
40:08um journals intended for attorneys or
40:12psychologists or psychiatrists or other
40:14mental health professions.
40:16So, it is pretty amazing
40:18that the same phenomena
40:21of parental alienation has been
40:22described in South America,
40:25in Africa,
40:27uh obviously in many countries in
40:29Europe, in Asia, and Australia, and so
40:32on.
40:34So, um
40:36that's that's a point that we make to
40:39the people at DSM that that this
40:42this isn't a rare unknown phenomenon.
40:46This is well known and has been
40:48described in many, many countries.
40:52So, that's the first topic. It's well
40:54known in many countries.
40:56The second topic, um
40:58is you can see this picture of this
40:59little boy and girl again.
41:01And this is I want to summarize that
41:04there is an abundant amount of empirical
41:07research.
41:12So, that's one of the requirements to
41:14get something in the DSM.
41:16And I want to make sure you're aware of
41:18a really important article that was also
41:20published only a few months ago.
41:23It's called Developmental Psychology and
41:26the Scientific Status of Parental
41:29Alienation.
41:30So, this is a huge study that was done
41:32by Jennifer Harman, Richard Warshak,
41:36uh Demosthenes Lorandos, and some other
41:39people,
41:40in which they pulled together
41:42uh hundreds
41:44of research articles that pertain to
41:47alienation.
41:48Now,
41:49I mentioned that there are articles from
41:51all over these different countries. Most
41:53of these articles are descriptive.
41:56In other words, they don't involve
41:58uh
41:59numbers. They don't involve quantitative
42:01research. But even that, most of the
42:04hundreds of them
42:05are descriptive of this phenomenon.
42:08But what Harman and her colleagues did,
42:10out of those thousand There's more than
42:12a thousand
42:13that that they found 213 articles
42:17that
42:18describe actual quantitative research.
42:22Uh where somebody has studied
42:25a specific aspect of alienation
42:28in a quantitative statistical manner.
42:31And I'm going to give you some examples
42:32of that in a few minutes.
42:35But in this next slide is an overview
42:38of uh
42:40how this research has occurred as uh
42:44over I guess 30 years or so.
42:47And the the head of this slide says
42:51it says enormous qualitative
42:52quantitative research, but it shows this
42:55graph. And as you can see
42:57uh
42:59it starts
43:00maybe 30 years ago, and then the the
43:02number it shows the number
43:04of qualitative and quantitative studies
43:07that have been published.
43:08And one of the
43:09the most notable things is that when
43:12when a new topic is being uh written
43:15about most of the articles are
43:17qualitative. Meaning they're simply
43:20descriptive, like all those articles
43:22from those countries I mentioned.
43:24But as time goes on there are more and
43:26more quantitative research studies
43:29regarding that topic, and that's exactly
43:31what has happened
43:32with regard to parental alienation.
43:37Now, I want to mention
43:39uh
43:41some specific research about the
43:43four-factor model and the five-factor.
43:46So, I've already told you the five
43:48factors. Well, the four-factor model is
43:50exactly the same thing except it doesn't
43:52have that very first factor, which is
43:55uh the child rejects one of the parents.
43:58So
44:00years ago, Dr. Baker started writing
44:03articles and uh publishing material
44:06about the four factors, but as time went
44:09on, we thought it would be a good idea
44:10to add factor one, and she agreed. So,
44:13so now we have her four factors plus the
44:16the first factor, which is
44:21a basic principle that the child is
44:22rejecting one of the parents, and that's
44:24why we now have five factor model.
44:26But both of these factors, both of these
44:29models have been studied in quantitative
44:32research.
44:33For instance,
44:35in the research study on the four factor
44:37model,
44:38uh Dr. Baker gave a vignettes
44:42to a number of mental health
44:44professionals.
44:45And then the the vignettes varied as to
44:48whether or not four factors were present
44:51or absent or so on.
44:55And she found
44:56uh
44:57systematic agreement. That is, that if
45:00all four factors were present, that the
45:03evaluator said this is a case of
45:05alienation. If no factor or only one
45:08factor was present, then the evaluator
45:10said no, this is not a case of
45:12alienation in this vignette.
45:16So,
45:19the what does that mean? Statistically,
45:20that means that there was a high level
45:22of reliability
45:25in this research project regarding the
45:28four factor model.
45:30Well,
45:31last year, and another colleague, Steven
45:34Morrison,
45:35uh did a similar study using our five
45:39factors.
45:40And so he presented a series of
45:42vignettes
45:43with five factors to a number
45:46of um
45:47practitioners.
45:49And he had them rate whether or not
45:51um
45:54alienation was present.
45:56And as you can see, there's some
45:57statistics in this next slide.
46:00It says six vignettes were presented
46:04and they provided responses for each of
46:06the five criteria and then
46:09there are ways to measure
46:11uh whether or not the evaluators agree.
46:14And there was a very high agreement
46:16among the evaluators
46:18as to
46:20the presence of uh
46:23parental alienation
46:24in these vignettes.
46:29So,
46:30I'm getting I'm
46:31giving you these examples
46:34of how research can be done on parental
46:37alienation theory.
46:42And in the next topic
46:44I I want to continue this
46:46and explain that there are objective
46:49tests for alienation.
46:51So, this comes up sometimes when people
46:53criticize parental alienation theory.
46:55They say, "Oh, well, it's all just
46:57subjective. It's just up to the
46:59evaluator to figure this out."
47:01Well, actually
47:03what we're presenting to the DSM
47:06is that there are several objective
47:08tests
47:10for parental alienation. And uh the
47:12first one is this test
47:14developed by Dr. Amy Baker and published
47:17in 2012.
47:19And the name of her article was
47:21Differentiating Alienated from
47:24Non-Alienated Children: A Pilot Study.
47:27So, that's the whole point of this type
47:29of research is can you give a little a
47:31fairly simple test
47:33to a child, a little questionnaire
47:36and
47:38is it possible to to to score the test
47:41and that that would help you tell, help
47:44the evaluator tell whether the child is
47:46alienated or not? Now, I I need to warn
47:49you, nobody is going to suggest using
47:52only
47:53a a simple test to make that uh
47:56decision. That this these tests that are
47:59used are really only one part of a
48:02comprehensive evaluation.
48:04But here, just let me tell you about Dr.
48:06Baker's test, which was eventually
48:08called the BAQ, the Baker Alienation
48:12Questionnaire.
48:13So, it is it's
48:15what she did, she had a number of
48:16children who were referred for
48:19uh therapy
48:21in a clinic, and these are all children
48:23whose parents were divorced.
48:26And some of the children were there
48:28because they needed to have
48:30reunification because they were
48:32uh
48:34separated from a parent,
48:36or they they simply needed
48:39uh counseling, but not reunification
48:42therapy. So,
48:43the implication is that the children who
48:45needed re- re- reunification therapy
48:48presumably had uh alienation,
48:51and the other children did not.
48:53So, Dr. Baker administered this
48:56paper-pencil test.
48:58Uh there are only a few questions, there
48:59are 14 questions. Some of them are
49:01objective, for instance, the question
49:02was, "Do you enjoy spending time with
49:05your mother or father?"
49:06And the answer is yes or no. And so,
49:09that's that's easy to score, that's an
49:11objective scoring of that particular
49:14question. Some of them are more
49:16complicated, like the one of the
49:18questions was, "What are some things you
49:20don't like about your mother or that you
49:22don't like about your father?"
49:26In any case, on the next slide, you can
49:28see the results.
49:31And that
49:32the children who were alienated
49:35uh that it that is uh let me say it
49:37again. The children who were in
49:38reunification therapy scored as as they
49:42were alienated, scored on this little
49:44questionnaire in the in the uh range of
49:48a of being alienated.
49:50While the children who were not involved
49:52them, with reunification therapy, did
49:54not score that way. So, what it boils
49:57down to is this fairly simple test was
50:01pretty successful. It was 87 and 1/2%
50:04successful in distinguishing the
50:07alienated from the non-alienated
50:10children.
50:11So, I'm just trying to give you some
50:12example
50:13of
50:14tests that can be used to distinguish
50:17alienation
50:19from other situations. And that's the
50:21kind of thing you have to have
50:24to
50:25add something to the DSM.
50:28So, I realize some of this is a little
50:29bit technical, but I hope it I hope it's
50:31of interest to y'all. And I hope that
50:34I hope that you
50:36will also feel that it would be good for
50:38this part to be included in and I hope
50:41that you will go to the website and
50:44endorse it so that we can add your name
50:46to the list of endorsers.
50:48Well, here I want to tell you a couple
50:50more of these tests. And this is the
50:51research that I did with my colleagues
50:54that was published in the Journal of
50:56Forensic Sciences a few years ago.
51:02And we used a different question.
51:05We used uh it was called the PARQ,
51:09the Parental Acceptance Question, the
51:11the Parental Acceptance Rejection
51:14Questionnaire.
51:16And in the next slide, you can see the
51:18participants in this project. Um
51:22and usually you have to put this kind of
51:24information when you publish a paper.
51:27But we had several categories of
51:29children. We had categories of children
51:30from an intact family
51:33uh whose parents were divorced,
51:35a situation where one of the parents was
51:38absent.
51:39And then we had children who were
51:41alienated from their father and
51:43alienated from their mother. So, in
51:45general,
51:47we had some children who were alienated
51:49from their parent and other children who
51:51were not alienated.
51:54And then we we gave them this
51:55questionnaire the questionnaire the
51:57PARENTAL ALIENATION QUESTIONNAIRE and
51:58here are a couple of examples
52:00of
52:01of what's on this.
52:03For instance, some of the
52:06um
52:07some of the questions are positive.
52:10Like this one says, "My father says nice
52:13things about me." So, that's a positive
52:16statement about father.
52:18And some of them are negative like my
52:20father does not really love me.
52:22And it and it takes about 20 25 minutes
52:24for the child to
52:27um
52:28to respond
52:30to this questionnaire. Now, it's done on
52:31a computer
52:33just to make sure that it's done
52:34systematically.
52:36Um
52:37and and then it's also scored by a
52:39computer.
52:40But in any case, the next slide showed
52:43our results. And that we found that
52:47alienated children engage in splitting.
52:50Now, that's been described for 30 years.
52:53There's nothing new about the idea that
52:55alienated children engage in splitting,
52:58which means that they say one parent is
53:00all good and the other parent is all
53:02evil.
53:03So, there's nothing new with that.
53:06But this is the first time this research
53:09that my colleagues and I did was the
53:11first time that the splitting was
53:13measured
53:14in a quantitative manner.
53:16And if you look at this slide that says
53:18splitting occurs in alienated children,
53:21on the right-hand side,
53:23you see
53:25um and if what this means is that if the
53:29children were alienated from their
53:30father, they had extremely negative
53:33views of their father and extremely
53:35positive views of their mother.
53:37And likewise, the reverse, if they were
53:39alienated from their mother,
53:41they had extremely negative views of
53:43their mother and extremely positive
53:45views of their father.
53:47So, that is a very striking result from
53:51this research.
53:54And
53:56we had a name for this called the gap.
53:59In other words, when one parent is very,
54:01very high and the other parent is very,
54:03very low, we said that can be measured
54:05and that's the gap.
54:07And in the next slide
54:09uh talks about the PARQ
54:13and how the PARQ distinguished alienated
54:15from non-alienated children.
54:17And
54:18um
54:20we don't need to get into all the
54:21details, but basically
54:23on the right-hand side, the children
54:26in red all have very, very, very high
54:29numbers
54:31for this gap score.
54:33And then on the left side, the children
54:36had
54:37low numbers.
54:39And this test, the PARQ,
54:42was had an astounding result. It was 99%
54:46successful or 99% accurate in
54:50distinguishing alienated from
54:51non-alienated children.
54:53So, it's that kind of research that I
54:55think will help us
54:57get this into the DSM.
55:01So, there's one more test
55:03for children I want to tell you about
55:05by our colleagues in the United Kingdom,
55:08Black and Godfrey.
55:12And they used a different test with a
55:15different group of children in a
55:16different country and they had the same
55:18results.
55:19They used a test called the
55:21B A F R T, stands for the Bene-Anthony
55:27Family Relations Test.
55:30So,
55:32I don't want to go into all the details,
55:33but this test involved asking the
55:35children
55:37their opinion
55:39uh about various family members
55:41and uh other people that they might um
55:46have have close contact with.
55:49And in the next slide is the results.
55:52It says the Bernay Anthony Family
55:54Relations Test distinguishes alienated
55:57from non-alienated children.
55:59And just I'll tell you what these
56:01numbers mean.
56:02It It means that if
56:05uh
56:07when the children were asked about the
56:09preferred parent or the favored parent
56:12they gave very, very positive
56:15opinions.
56:17And when they were asked about the
56:19targeted parent, they gave very, very
56:21negative opinions.
56:22So, that's the same kind of result
56:25that's consistent with splitting. It's
56:27the same kind of result
56:29um but with using a different test.
56:32So, I've just given you the Baker Test
56:35the PARENTAL ALIENATION and now this
56:37Bernay Anthony Test. And all these
56:39pertain to children. And all of these
56:41All three of these
56:42are are questionnaires
56:45or testing procedures that are used with
56:47the children.
56:49And now I want to tell you about one
56:50more way to distinguish alienated from
56:52non-alienated children.
56:54And this has to do with a questionnaire
56:56that's given to the parents.
56:58And this is also pretty well known.
57:01Uh the name of the
57:02paper was called Parental Alienation a
57:05measurement tool
57:07by Gina Rowland, a psychologist.
57:11And Dr. Rowland developed this scale
57:15called the Rowland Parental Alienation
57:18Scale, RPAS. And it was administered to
57:21a very large number of parents.
57:24And
57:25um
57:27the scale had a number of different
57:30questions on it, but it was eventually
57:32reduced down to these six questions.
57:36Does your child engage in a campaign of
57:39denigration toward the alienated parent?
57:44Does your child manifest the independent
57:46thinker phenomenon?
57:50And so on. Another one was, does your
57:53child
57:54manifest
57:55the presence of borrowed scenarios? So,
57:57these are the same eight
57:59um
58:01questions that are actually part of the
58:02five-factor model. In other words, the
58:05five-factor model, factor five, are
58:08certain behaviors of children,
58:10and these are
58:11the the
58:12those behaviors in factor five are the
58:15same as these
58:17factors that are in the Rowland's
58:19questionnaire. So, that's good. In other
58:21words, there's a huge amount of
58:22consistency there.
58:24So, what did they find? What did Dr.
58:27Rowland find?
58:28Her conclusion was the following,
58:31that if the parent
58:34uh
58:34was known to have been an alienated an
58:37alienated parent,
58:39you know, in other words,
58:41if
58:43if a court made that decision
58:45or a court evaluator made that
58:48conclusion
58:50and confirmed the presence of parental
58:52alienation,
58:53those parents scored higher on all six
58:56of these factors
58:58than
58:59uh situations where alienation was not
59:03present. In other words, they had
59:06cases determined by a court
59:09to involve alienation and other cases
59:12that it was absent. And the cases that
59:15involved alienation scored higher on
59:18this test than the others.
59:23So, here, I have a couple more
59:25questions
59:26um posed by audience members
59:29that I want to take a look at.
59:37So, um,
59:40let's read this together.
59:45The diagnosis of parental alienation is
59:48just as accurate
59:50as an x-ray
59:51for a broken bone.
59:55And what leg
59:57does the DSM-5 have to stand on
1:00:00to refuse its inclusion?
1:00:04It's sort of a mixed metaphor here, but
1:00:07we're talking about
1:00:10having a broken bone, and then we're
1:00:12talking about what leg does
1:00:15the DSM have? So, that's a good
1:00:17question.
1:00:18So, the the the question here is
1:00:21if we submit this proposal,
1:00:23what opposition
1:00:27will be considered? And I think there
1:00:29will be opposition that we have to think
1:00:31about.
1:00:32But, here are the things that um,
1:00:36have been mentioned to me
1:00:37as might be
1:00:39something that the DSM people would be
1:00:41concerned about.
1:00:44First of all,
1:00:45the American Psychiatric Association is,
1:00:48of course, a very large professional
1:00:50body. And the American Psychological
1:00:52Association is even larger.
1:00:55I mean, there are thousands of people
1:00:57who belong to these organizations.
1:01:00And big organizations
1:01:04frequently
1:01:05do not want to take on
1:01:07issues that are really controversial.
1:01:15And we know that this issue of parental
1:01:17alienation will be controversial. And in
1:01:19fact,
1:01:21when
1:01:22um,
1:01:23parental alienation proposed when the
1:01:26DSM-5 first came out
1:01:28in 2013
1:01:31that there were hundreds
1:01:33of comments on both sides of the
1:01:35question.
1:01:36I I think the DSM people said that they
1:01:39received more comments regarding
1:01:40parental alienation than any other topic
1:01:43that was being considered at that time.
1:01:46So, that's one of the reasons why I
1:01:48wanted to get a lot of endorse So, in
1:01:50other words
1:01:51uh I think I mentioned we already have
1:01:53more than 2,000
1:01:55uh individuals
1:01:57and organizations
1:01:59who
1:02:00uh are supporting this. And by
1:02:02individuals, I mean practitioners, but
1:02:04also parents and grandparents. That if
1:02:07if you if you do sign up to be an
1:02:09endorser you you have to indicate are
1:02:11you a practitioner
1:02:12or are you a uh
1:02:15family or child advocate?
1:02:17And if you're a parent or a grandparent
1:02:20you should check off that you're a
1:02:21family or child advocate.
1:02:24I mean, that's the category that we
1:02:25would put you in.
1:02:27And uh
1:02:30we're anticipating that once DSM
1:02:34um
1:02:35starts looking at this one of the things
1:02:37they do is they send it out for public
1:02:40comment. And so, they will actually
1:02:42invite
1:02:44on their own people to sign in and say
1:02:47what they think about this proposal.
1:02:50And I'm I'm hoping that many of you will
1:02:52do will also comment directly to the
1:02:55DSM, but I'm sure that there will be
1:02:57opponents who will send in their
1:03:00comments at that time.
1:03:02So, anyway
1:03:04uh I think that's something we have to
1:03:06be concerned about because these
1:03:08organizations don't like to be in the
1:03:10center of a controversy
1:03:12because
1:03:13the even within the organization
1:03:16there are different opinions about what
1:03:18to do about a particular topic.
1:03:22And then the second concern is what's
1:03:25always raised by the people who
1:03:28criticize parental alienation theory.
1:03:31That they are concerned
1:03:33that a parental alienation diagnosis
1:03:37would be used by fathers
1:03:40who are abusive of their children
1:03:43as a way to escape responsibility. In
1:03:45other words,
1:03:46if there's a child who's back and forth
1:03:48between mom and dad,
1:03:50the child doesn't want to go see dad
1:03:52anymore,
1:03:54and the mother says, "Oh, the child
1:03:55doesn't want to go see dad because he's
1:03:57abusive."
1:03:58And then the dad will say, "No, the the
1:04:01children don't want to come see me
1:04:03because they've been indoctrinated by
1:04:05their mother."
1:04:06And so
1:04:07you can see, and this is probably the
1:04:10most common objection
1:04:11to parental alienation, is the idea that
1:04:14it might be abused
1:04:17by some parents to escape responsibility
1:04:21for abusing their children.
1:04:25Um
1:04:26obviously, we don't want it to be used
1:04:28in that way.
1:04:30We want it to be diagnosed correctly.
1:04:33Uh we think that if the criteria
1:04:36for parental alienation are in the DSM,
1:04:40that it will mean
1:04:42that hopefully they'll be applied
1:04:44correctly and hopefully people will be
1:04:46diagnosed correctly
1:04:48rather than
1:04:50uh in some incorrect manner.
1:04:54So, another one of possibilities is
1:04:56they'll say that there's not enough
1:04:58research. Well,
1:05:00I think that's not really much of a
1:05:04of a criticism because I don't think
1:05:06it's true. I think there there are
1:05:08hundreds of published research
1:05:10um articles on this topic.
1:05:13And I'm but I'm concerned that the DSM
1:05:17people might be very picky and will say,
1:05:20"Oh, only a handful of these really are
1:05:22relevant to what we're concerned about."
1:05:24or something like that.
1:05:28So, those are some criticisms
1:05:30that I'm concerned might come up
1:05:33when we submit this to the DSM.
1:05:36So, let's look at the next question
1:05:37posed by one of you.
1:05:40It says, "Can you indicate parental
1:05:42alienation be included as a subject
1:05:45required to get psychology graduation?"
1:05:48Well, that's a really that's a really
1:05:50important idea. In fact, that's that's
1:05:52maybe the first reason why we're doing
1:05:55this.
1:05:57Why are we going to all this trouble
1:05:59to have parental alienation
1:06:01included or to have part included in the
1:06:04DSM-5?
1:06:05Is because we think that once that
1:06:08happens more people will teach it.
1:06:13That it will be taught in graduate
1:06:14school
1:06:16to psychology students and social work
1:06:18students.
1:06:20It will be taught taught in residency
1:06:22training for child psychiatrists and and
1:06:24general psychiatrists.
1:06:26It will be taught
1:06:28hopefully to child protection workers.
1:06:30In other words, if
1:06:31if parental alienation is more obviously
1:06:35uh
1:06:36called a form of child abuse
1:06:39uh child protection workers will need to
1:06:41learn about it.
1:06:42And even more important, it will be
1:06:44taught to law students
1:06:47and to judges. You know, judges get lots
1:06:49of training about topics, many many
1:06:52topics, including this topic.
1:06:54And I think that if
1:06:56um
1:06:58if it's in the DSM, the training for
1:07:00judges will be
1:07:01uh more powerful.
1:07:07So, here's
1:07:09uh
1:07:10question posed by
1:07:12somebody in the audience.
1:07:15I'm seeing more cases in which one
1:07:17parent
1:07:19is extremely hostile, verbally abusive,
1:07:22and blaming to the child
1:07:24without physical abuse.
1:07:27And the child resists contact with that
1:07:29parent. How will your proposal address
1:07:33recognizing
1:07:34the difference between such cases of
1:07:36estrangement and caught cases of
1:07:38alienation?
1:07:40So,
1:07:41um
1:07:42that is always
1:07:44uh part of the diagnostic evaluation.
1:07:47And to be able to distinguish
1:07:49estrangement,
1:07:51which is rejection of a parent for a
1:07:52good reason,
1:07:54and alienation, which is rejection for a
1:07:56parent without a good reason.
1:07:58And what this person wrote down here
1:08:01describes estrangement. In other words,
1:08:03the child would have a reason
1:08:06uh to reject a parent who's extremely
1:08:08hostile, verbally abusive,
1:08:11blaming, and so on. Even though there's
1:08:13not physical abuse, this would
1:08:15constitute extremely
1:08:18um
1:08:19poor parenting it
1:08:21to the point where it would uh
1:08:24it would come up under factor three.
1:08:26Factor three of the five-factor model is
1:08:29the absence of abuse, neglect, or highly
1:08:32deficient parenting
1:08:33on the part of the rejecting parent.
1:08:36And I think what's being described here
1:08:37is highly deficient parenting.
1:08:41So, there's another way
1:08:43uh
1:08:44to word factor three,
1:08:47which is something like this.
1:08:49Is the child's rejection
1:08:53of the targeted parent
1:08:55far out of proportion to anything that
1:08:58that parent has done?
1:09:00So,
1:09:01all parents make mistakes. All parents
1:09:04sometimes say the wrong thing or they do
1:09:06the wrong thing.
1:09:08And so, you can see
1:09:10how
1:09:11uh
1:09:12a very, very picky person might say,
1:09:14"Oh, that's
1:09:15enough reason for
1:09:17the child rejection." But it really
1:09:19isn't. And of what's what happens in
1:09:21alienation
1:09:23is the child's rejection is far out of
1:09:25proportion to anything that parent has
1:09:28done.
1:09:30In this case right here,
1:09:32that was um in this question, and that's
1:09:35that seems to be a case of a strange
1:09:36parent. And you can see how the child
1:09:38rejection might make sense
1:09:41if the parent behaves in that way.
1:09:44So, it does not uh qualify for factor
1:09:47three of the five-factor model.
1:09:52Here's another question.
1:09:54Uh
1:09:56if the alienating parent and alienated
1:09:59children do not participate in any
1:10:01therapy
1:10:03or evaluation, how can DSM code be
1:10:06assigned?
1:10:07It has been the biggest challenge, and
1:10:09I'm not sure how to
1:10:11best address it.
1:10:16So, that does come up
1:10:19because sometimes
1:10:21uh even if an evaluation is
1:10:23court-ordered,
1:10:25sometimes the uh
1:10:28favored parent or the alienating parent
1:10:31won't participate in the evaluation
1:10:34and won't bring the children.
1:10:37So, general
1:10:39as a general rule, it's not appropriate
1:10:43for an evaluator to have may have a make
1:10:46a diagnosis
1:10:47of a person that they have not
1:10:49personally interviewed and not
1:10:50personally evaluated. Now, I realize
1:10:53occasionally that does happen.
1:10:55And forensic psychiatrists and
1:10:57psychologists do
1:10:59have opinions about people they have
1:11:01never seen and that happens when the
1:11:04person is deceased.
1:11:06You know, for instance, suppose there is
1:11:09some sort of medical malpractice claim
1:11:12and the forensic psychologist
1:11:15or forensic uh
1:11:17pathologist perhaps
1:11:19uh
1:11:20might have to make
1:11:22a uh conclusion about the patient's
1:11:24diagnosis and obviously the patient's
1:11:26deceased and they're not going to
1:11:28interview that patient.
1:11:30Or occasionally in criminal cases, the
1:11:34prisoner totally refuses to have a
1:11:35conversation
1:11:37with
1:11:38the evaluator.
1:11:39So, the evaluator might still need to
1:11:42express an opinion about the diagnosis.
1:11:45But I think in family law cases, the
1:11:48best way to do it is something like
1:11:49this.
1:11:51That even if the evaluator has not
1:11:53interviewed
1:11:55the uh parent, the alienating parent
1:11:59the evaluator can say something like the
1:12:01following.
1:12:02The activities of the favored parent are
1:12:06consistent
1:12:07with factor four of the five-factor
1:12:11model.
1:12:12In other words, they're
1:12:14they're not actually making a diagnosis,
1:12:16but they are able to say that such and
1:12:18such is consistent
1:12:20with the alienating behaviors that are
1:12:23listed in the five factor in factor
1:12:25four.
1:12:26Or they can make observations about the
1:12:29children's behaviors. They can say the
1:12:31behaviors of the child are consistent
1:12:34with factor five of the five-factor
1:12:37model.
1:12:38So, I think in court, the the evaluator
1:12:40needs to be really, really honest about
1:12:43what he and she has done and what they
1:12:45have who whom they have interviewed and
1:12:47so on.
1:12:49But um
1:12:50and you have to say I haven't really
1:12:52personally interviewed certain people,
1:12:54but you can still say that certain
1:12:57things, I can't make a diagnosis, but
1:12:59that certain things are consistent with
1:13:03uh with that kind of diagnosis.
1:13:08Okay, I think I have
1:13:12I think I have one more question from
1:13:14the audience.
1:13:19Were you
1:13:20or your colleagues
1:13:23include children of all ages,
1:13:27including teenage children and adult
1:13:30children in references about victims of
1:13:33parental alienation?
1:13:36Children can be lost, disregarded,
1:13:38dismissed for a life
1:13:41and left in the control of the
1:13:43alienating person indefinitely and
1:13:45possibly lifelong with possibly
1:13:48life-ending
1:13:49consequences.
1:13:51So,
1:13:53um
1:13:54we do talk about
1:13:56in the proposal, we talk about what are
1:13:59the possible bad effects
1:14:01of adding
1:14:03parental alienation
1:14:05to the DSM. I mean, they actually asked
1:14:08us that. And we will And we say, well, a
1:14:10possible bad effect is that this this
1:14:13diagnosis will be misused
1:14:16by some parents. And of course,
1:14:18we we say that that can be mitigated by
1:14:20having good criteria. And And if there
1:14:23are good criteria, it's going to be
1:14:25harder to misuse the diagnosis.
1:14:28So, that's a possible
1:14:30bad effect
1:14:33um
1:14:34of adding
1:14:36PARP to the DSM. But they also asked,
1:14:40what are the possible bad effects of not
1:14:43adding
1:14:44PARP
1:14:46to the DSM. And we in fact talk about
1:14:49that. We talk about hundreds of
1:14:51thousands of children
1:14:53who have been cut off from parent, who
1:14:55have experienced parent-ectomy.
1:14:58And that's a huge
1:15:00um
1:15:01negative effect of
1:15:03of this condition.
1:15:05And if it's not added
1:15:08uh
1:15:09do those children are less likely to be
1:15:11identified and helped.
1:15:16And
1:15:17we already say something about how it
1:15:19continues into adult life. We will will
1:15:22I think we'll strengthen that
1:15:24based on what this person
1:15:27has um
1:15:30has suggested that we could make that a
1:15:32bit
1:15:33we could make that part of it stronger.
1:15:35That this is one of the possible bad
1:15:37effects of not including
1:15:41PRP in DSM.
1:15:42That um
1:15:44it affects
1:15:45not only children, but teenagers, adult
1:15:48children.
1:15:49And it it can go on
1:15:51it can go on forever.
1:15:53And it can have very, very
1:15:55sad consequences.
1:16:00It is sad. I mean it in ex- We actually
1:16:02mentioned this in our proposal.
1:16:04That in extreme cases of parental
1:16:06alienation, you know, I talk about mild,
1:16:08moderate, severe. Well, there actually
1:16:10is one step beyond severe,
1:16:13which is extreme.
1:16:15And
1:16:16and we know that there have been cases
1:16:18where people have died
1:16:21uh
1:16:21as a result of parental alienation.
1:16:24Occasionally, the child or teenager
1:16:28uh
1:16:29committed suicide.
1:16:31And occasionally
1:16:33the targeted parent
1:16:35who has experienced enormous
1:16:38frustration
1:16:41um
1:16:42has committed suicide. and I I realize
1:16:44that
1:16:45I should have given you a heads-up that
1:16:47I I might mention something that is
1:16:50painful and I'm sure that it is.
1:16:52But we actually say this in our
1:16:54proposal.
1:16:55And
1:16:57occasionally
1:16:58uh people have been murdered that
1:17:01Uh we know of two cases where the
1:17:03alienated child
1:17:05helped to kill to murder
1:17:08the victim parent, the departed parent.
1:17:11And there have been a number of cases
1:17:13where the alienating parent parent
1:17:16has
1:17:17killed the child in order in order to
1:17:19keep the child away from the
1:17:22uh
1:17:23rejected parent.
1:17:25They they they take the child's life and
1:17:27then
1:17:28frequently kill themselves. So they're
1:17:30it's a murder-suicide. So I mean all
1:17:32this is horrible to think about and I'm
1:17:34sorry
1:17:36to
1:17:36bring this up
1:17:38in this way. But we actually say this
1:17:41in our proposal. We mention
1:17:43that these things sometimes happen
1:17:45in what we call extreme cases
1:17:48of parental alienation and that's part
1:17:51of this discussion of what are the
1:17:53possible bad effects of including it and
1:17:56what are the possible bad effects of not
1:18:01So that's the last question I want to
1:18:03talk about. In the next slide I I want
1:18:05to
1:18:06emphasize that you all can help us. I
1:18:08mean this is a huge project.
1:18:11We started this in July
1:18:14and have had a number of different
1:18:15presentations and
1:18:17um videos and websites and so on.
1:18:21And we are going to submit this
1:18:24uh to the committee. It's called the DSM
1:18:28um
1:18:29five steering committee
1:18:33in November, in only a few weeks from
1:18:35now.
1:18:36And we hope that
1:18:39uh you can endorse our proposal. The way
1:18:41you do it
1:18:43um
1:18:44is you go to that website I mentioned.
1:18:47And
1:18:49there's a mechanism there for endorsing
1:18:51the proposal.
1:18:53So I
1:18:54I I mentioned we already have a couple
1:18:55of thousand people and organizations.
1:18:58If you're a mental health professional,
1:19:01you can indicate that you're a
1:19:02practitioner and you indicate
1:19:04what your degree is in and you indicate
1:19:07whether or not you're affiliated with
1:19:09the university.
1:19:11If you are a
1:19:14parent or a grandparent, you can
1:19:15indicate that you are a child advocate
1:19:18or family advocate.
1:19:20If you are an organization, you actually
1:19:24the you you need to contact
1:19:26uh Dr. Jennifer Harman and she's keeping
1:19:29track of organizations
1:19:31that are interested. But all this it's
1:19:33all explained
1:19:35on the website. So you can help us make
1:19:36history.
1:19:38If you want to see the entire proposal,
1:19:40you can go to the website www.par-dsm.
1:19:47info.
1:19:49And if you want to see the entire
1:19:50proposal, you'll find it there.
1:19:52The appendices are there. And if you
1:19:54want to endorse the proposal, there are
1:19:57links
1:19:58on the website to be able to do that.
1:20:03Uh I'm also really interested in
1:20:05comments. I mean some of the suggestions
1:20:07that were made here
1:20:09uh are are prompting my co-author of the
1:20:12proposal, Dr. Baker and I are doing this
1:20:14together. And I think some of the
1:20:16comments, some of the those questions
1:20:18that were raised by you all
1:20:21um have prompted us to make a few
1:20:24changes in the actual proposal. So we're
1:20:26welcome for that. If you If you do have
1:20:29comments about the proposal
1:20:31or you want to make suggestions, or you
1:20:33want to changes,
1:20:35uh you can contact me.
1:20:38And my email is on this slide.
1:20:41But it's pretty simple. It's
1:20:42william.burnett
1:20:45b e r n e t @vumc.org.
1:20:51And VUMC stands for Vanderbilt
1:20:53University Medical Center. .org o r g
1:20:58So, I worked at Vanderbilt for a long
1:21:00time. I was on the full-time faculty for
1:21:0220 years. And now I've been retired for
1:21:0510 years.
1:21:06So, I I still have an office at
1:21:08Vanderbilt because I'm a professor
1:21:10emeritus. So,
1:21:12uh I actually appreciate the support
1:21:15from Vanderbilt for this project.
1:21:21Finally, in the last slide,
1:21:25it has a little bit of information about
1:21:26the organization. I'm the president of
1:21:29the uh Parental Alienation Study Group.
1:21:33And if you're interested in staying in
1:21:36touch, or you're interested in more
1:21:37information about Parental Alienation,
1:21:40you're uh
1:21:42um you're welcome to
1:21:44uh join the organization. And you you do
1:21:47that, you go to the the PASG website,
1:21:51which is www.pasg.info
1:21:56As you all probably know, there are lots
1:21:58of websites
1:22:00and and organizations and advocacy
1:22:02organizations that are now involved with
1:22:06um Parental Alienation. I think in our
1:22:08proposal, we're being endorsed by 40 or
1:22:1150 advocacy organizations, and we
1:22:14including Family Access, which we
1:22:16really, really appreciate.
1:22:18And these organizations have different
1:22:21missions. Family Access is extremely
1:22:24active
1:22:25in uh communicating uh information about
1:22:29parental alienation in a variety of
1:22:31ways, which they do through this
1:22:33webinar,
1:22:34through a television program,
1:22:36uh through a the web their website and
1:22:40conferences that occur every year. So,
1:22:43uh that's something Family Access is
1:22:46extremely successful at.
1:22:48PASG does other things.
1:22:50We have members who who write articles
1:22:53for journals.
1:22:54We uh put on
1:22:56uh presentations not only at our
1:22:59meeting, but at uh meetings of
1:23:02professional organizations, such as
1:23:04psychiatric organizations
1:23:06and
1:23:07psychology organizations and social work
1:23:10organizations.
1:23:11So, I think it it is useful. You could
1:23:14join a number of different
1:23:16organizations with regard to parental
1:23:19alienation and they they have different
1:23:21uh they have different agendas and they
1:23:23have different missions and they're all
1:23:25helpful.
1:23:26So, anyway, I I hope I have given you
1:23:29some education about PARP
1:23:32and I've given you some of the arguments
1:23:34that we use for why it should be
1:23:36included in DSM-5.
1:23:38And oh, as incidentally, I
1:23:41one question that
1:23:42people ask,
1:23:44the DSM used to only be revised every
1:23:46few years. They would accumulate changes
1:23:49and then in 10 years, they would publish
1:23:51a whole new DSM. They don't do that
1:23:53anymore.
1:23:54They they consider new ideas on an
1:23:58ongoing basis. So, that's why we're
1:24:00submitting our proposal in November.
1:24:04We hope it will be given out for public
1:24:06comment
1:24:08um a few weeks after that
1:24:10and we hope that that it will be
1:24:12considered by the different parts of the
1:24:14American Psychiatric Association and
1:24:16that they will give us a final answer in
1:24:18a few months.
1:24:20We don't have to wait 5 years or 10
1:24:22years for a whole new
1:24:24uh copy of DSM to be published. And what
1:24:27happens when something new is accepted
1:24:29by the DSM, they uh
1:24:33they they make changes in the digital
1:24:36version,
1:24:37which is on the APA website. In other
1:24:40words,
1:24:41the digital version of the DSM-5 is the
1:24:46definitive version
1:24:48of of the DSM, and we hope that we will
1:24:52will be included in that. And then after
1:24:54a few years, they eventually do publish
1:24:56a new hard copy, but we don't have to
1:24:58wait for that for uh
1:25:01PARP for PARP to be included in the
1:25:05digital version.
1:25:07Thank you very much for your attention
1:25:08this evening. I really appreciate it.
1:25:10Let me know personally if you have any
1:25:12questions or comments about our
1:25:13proposal,
1:25:14and uh goodnight, and we wish you the
1:25:17best.

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