Continuing on with last week’s topic, we at PsychLaw have found that there are two ways to think about the severity of the symptoms or behaviors that are manifested in cases of PA. First, one can consider the level of symptoms manifested by the child who is the victim of PA. The child’s symptoms can be classified as mild, moderate, or severe, depending on the intensity of the child’s refusal to see the target or alienated parent. See Text Box 3 for the definitions of mild, moderate, and severe PA. Second, one can consider the level of alienating behaviors manifested by the parent who is inducing PA in the child. See Text Box 4 for descriptions of mild, moderate, and severe degrees of alienating behaviors. The activities and attitudes of the preferred or alienating parent have also been called “naïve,” “active,” and “obsessed,” respectively (Darnall, 1998, pp 18-22).
It is important to keep in mind that the diagnosis of PA is based on the symptoms and behaviors manifested by the child and the severity of PA is based on the intensity of the symptoms and behaviors manifested by the child. Although generally a child who is subjected to more severe degrees of a parent’s alienating behaviors is likely to manifest a more severe level of PA, that is not always the case. It is possible for a parent who is moderately alienating to induce only a mild degree of PA in a child, for example, if the child previously enjoyed an unusually strong bond with the target parent. On the other hand, it is possible for a parent who is moderately alienating to induce a severe degree of PA in a child, for example, if the child was already somewhat fearful and insecure.
Experienced clinicians have proposed a number of treatments or interventions for PA. As is true for most psychiatric disorders, the appropriate treatment depends on the severity of the condition. See Text Box 3 for the definitions of mild, moderate, and severe PA and a brief explanation of the interventions to consider for each level of severity. While the choice of treatment depends primarily on the level of symptoms in the child, it may also depend on the intensity of the indoctrination and the attitude of the alienating parent. The various treatment approaches tailored to the specific intensity of the PA are described in detail in Chapter 3 (mild PA), Chapter 4 (moderate PA), and Chapter 5 (severe PA).
If PA is so severe that the relationship between the child and the target parent has been totally interrupted for an extended period of time and is characterized by intense anger, fear, frustration, and mutual distrust, a higher level of intervention is called for. This is often called “reunification therapy.” To be successful, reunification therapy is likely to require court sanctions in order to stabilize the relationship between the child and target parent from the ongoing malicious behavior of the alienating parent. Reunification therapy is defined later in this chapter and discussed in detail in Chapter 7.
Prevention and early intervention of PA is also very important. Katherine Andre and Amy Baker (2009) published a prevention approach called I Don’t Want to Choose: How Middle School Kids Can Avoid Choosing One Parent over the Other. It is a structured program for group discussions with children of divorced parents, which can be implemented by school counselors. Early intervention refers to identifying children and families who are at risk for developing PA and who are manifesting some signs and symptoms of that disorder. For example, it is likely that very early cases of PA come to the attention of therapists in private practice and mental health centers who work with children of parents who are headed toward divorce. We at PsychLaw.net believe that as PA becomes better understood by front-line clinicians, they will be able to intervene with parent counseling and psychoeducation at a time when the condition is mild and more treatable. For a list of references click here.
Andre, K., & Baker, A. J. L. (2009). I don’t want to choose: How middle school kids can avoid choosing one parent over the other. New York: The Vincent J. Fontana Center for Child Protection.
Darnall, D. (1998). Divorce casualties: Protecting your children from parental alienation. Lanham, MD: Taylor Publishing Co.