Treatment of Parental Alienation: Guidelines for Mental Health and Legal Practitioners

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Case Vignette

“John” is a 12-year-old boy whose parents are divorced. He is an only child. His parents have 50-50 shared custody of him. John has become aligned with his mother and is rejecting his father. He is being subjected to alienating behaviors by his mother, who is extremely unhappy about the shared custody arrangement with her ex-husband, whom she sees as ungrateful and abandoning. John’s mother wants to obtain primary custody of her son at any cost and views herself as his only parental protector.

Six months after his parents’ divorce, John began refusing visits with his father and stopped communicating with him altogether. He was totally cut off from his father and did not see him for over 2 years, claiming he was “a loser.” Prior to the divorce, John and his father had a close, loving relationship.

At a postdivorce hearing, the judge ordered “family therapy” to address John’s entrenched refusal to see his father. Family therapy went poorly. After several months of sporadic and unproductive sessions with John and both of his parents, the family therapist felt helpless and hopeless about their lack of progress. Cancellations, back-and-forth recriminations, and denial of responsibility punctuated the family therapy. John’s total refusal to have a relationship with his father was solidified rather than repaired.

What Is Parental Alienation?

This clinical vignette highlights a case of severe parental alienation (PA) in a young boy. The purpose of this paper is to answer 2 critical questions: What is PA and how is it a unique condition? Is there a roadmap for the effective treatment of PA? The answer to both questions has special relevance to mental health and legal practitioners who strive to protect and help children who can be embedded in destructive PA dynamics.

PA is a pathological process in which one parent undermines and sabotages a child’s relationship with the other parent, usually during separation, divorce, or postdivorce.^1,2 Most cases of PA end up in an adversarial and contentious legal proceeding. In fact, almost all cases of PA require court intervention, since the parties themselves are typically unable to agree on a positive course of action, even considering the child’s best interest. After all, each parent wants “to win,” which clouds their conceptualization of the case and hinders a genuine effort to resolve this toxic family dynamic.³

Children naturally want to love both of their parents freely and equally, so their alignment with a favored parent is a huge red flag for PA.⁴ The alienating parent engages in the process willfully and with purpose; it is not accidental or unintentional. While the alienating parent may come across as calm, cool, and collected, their demeanor belies the nefarious intent in the ongoing alienation process.⁵ The goal is to subvert and sever the child’s relationship with the targeted parent, who is falsely described as unloving, unworthy, and dangerous.

Research shows that children and teenagers are highly suggestible and can be swayed, cajoled, pressured, bribed, bullied, coached, and indoctrinated by a parent.^6,7 It is easy to see how a child or teenager can become aligned with one parent against the other. When this misalignment occurs, the child’s perceptions and beliefs cannot be taken at face value about either parent. An alienated child’s thinking about both parents is inaccurate, distorted, and tainted. Indeed, the favored parent is seen as “all good,” and the rejected parent is viewed as “all bad.” Alienated children and teenagers do not know what is in their best interest—all they know is that they must remain aligned with the favored parent.⁸

Alienated children exhibit long-term psychiatric consequences from this pathological family process.^9,10 Anxiety, depression, behavior problems, underachievement in school, substance abuse, eating disorders, behavior problems, and more are common. Alienated children become alienators themselves in future adult relationships. PA is not an innocuous, inconsequential condition. Rather, it is toxic, unhealthy, and destructive for the child, not to mention highly unsettling and anguishing for the rejected parent who is also a victim.¹¹

Alienating parents engage in some of 17 behavioral strategies to accomplish their mission.¹² These strategies range from badmouthing to limiting parenting time to interfering with communication to portraying the targeted parent as dangerous. Research shows that the actual number of alienating behaviors used by a parent is less important than their frequency and intensity.¹³ Alienating behaviors have a cumulative effect on children over time.

Lodging false allegations of abuse is a particularly poisonous strategy by an alienating parent. Its intent is to show how dangerous the targeted parent is. Research shows that about 48% of PA cases involve at least 1 false allegation of abuse.¹⁴ False allegations of abuse are used as weapons by alienating parents, and their alienated children become unwitting or witting participants in the PA process.

There are 8 central characteristics of an alienated child vis-à-vis the rejected parent.² These include (1) a campaign of anger and negativity toward the targeted parent, (2) weak, frivolous, and absurd rationalizations for the child’s rejection of the parent, (3) lack of ambivalence regarding both the favored and rejected parents, (4) absence of guilt for their rude, accusatory, and hurtful treatment of the rejected parent, (5) independent thinker phenomenon, whereby the child professes that the decision to cut off the rejected parent is theirs alone, (6) the presence of borrowed words and scenarios from the favored parent, (7) reflexive support for the favored parent in all instances, and (8) rejection of the targeted parent’s extended family. Some but not all 8 characteristics need to be present for a diagnosis.

The 5-Factor Model (also called the Baker Model) is used for the identification or diagnosis of PA.¹⁵ The 5 factors include (1) contact resistance or refusal, (2) a prior good relationship between the child and rejected parent, (3) the absence of abuse or neglect by the rejected parent, (4) several alienating behaviors by the favored parent, and (5) several of the behavioral characteristics of an alienated child. Usually, all 5 factors must be present for PA to be diagnosed, but there are occasional exceptions to that general statement. For example, Factor 2 might be absent if the mother took possession of the child during infancy and refused to let the father participate in feeding, bathing, and cuddling the child; thus, the father never had a good relationship with the child in the first place. Factor 3 might be absent if some form of domestic violence took place many years ago before the parents fully reconciled. But subsequently, the previous victim of domestic violence resurrects that old grievance and convinces the child that the previously abusive parent remains violent and dangerous.

There are differing degrees of severity of PA in a child: mild, moderate, and severe.¹⁶ Mild PA means that the child resists contact with the rejected parent but enjoys a relationship with that parent once parenting time is underway. Moderate PA means that the child strongly resists contact and is predominantly oppositional during parenting time with the rejected parent. Severe PA means that the child is completely cut off from the rejected parent, refuses all visits, and does not communicate in any way. In cases of severe PA, the alienating parent is obsessed with the goal of interrupting the child’s relationship with the targeted parent.

The words “parental alienation” are not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). However, the concept of PA is included in mental conditions such as “parent-child relational problem” and “child affected by parental relationship distress.” A clinician can use these diagnostic categories to identify children who are experiencing PA. PA is not controversial among experienced mental health and legal practitioners. It can—and should—be diagnosed when its specific criteria are met. Otherwise, the diagnosis should not be made.

Not all instances of contact refusal by a child are due to PA.¹² Sometimes the child has a legitimate and reasonable explanation for rejecting a parent, such as physical abuse, sexual abuse, substance abuse, neglect, defective parenting, and others. When a child rejects a parent for a legitimate reason, this is called estrangement. But when a child is aligned with 1 parent against the other parent for a weak, frivolous, or fabricated reason, PA must be considered. If the additional criteria are met, an appropriate intervention should be launched as soon as possible. Anger about a divorce, vindictiveness toward an ex-spouse, fear of being alone, or a desire to relocate to another state are not legitimate reasons to turn a child against the other parent.

Common parent-child disagreements do not constitute a legitimate reason to cut off a parent. Arguments about rules, food, hobbies, school, sports, dating, and other similar matters are not a legitimate reason to disrupt a parent-child relationship. In fact, working through and resolving disagreements with a parent contributes to the development of maturity, empathy, and good decision-making in the child.¹⁷

PA must not be used by an abusive parent as an excuse or a cover. That would be a cynical and dishonest maneuver by an abusive parent. The fact that this misuse of PA theory occurs on occasion does not undermine the validity of PA as a real clinical entity. It just means that all practitioners—both mental health and legal—need to make sure that an accurate diagnosis is based on specific criteria and a wealth of real-time information.

It is important to recognize that there are critics of PA theory and practice. For the most part, critics are lawyers and mental health professionals who have a particular ideology and agenda. They cannot fathom the idea that both men and women can be victims of domestic violence and PA. They are convinced that abusive men game the legal system to maintain their abusive behavior, thus undercutting the validity of PA as a diagnosable condition. Cutting-edge research clearly shows that both women and men can be perpetrators of domestic violence and PA.¹⁸ And that PA is a form of domestic violence, especially when it is severe.¹⁹

Traditional Family Therapy Is Often Unhelpful

As with other psychiatric disorders, PA can be treated successfully. The science of PA plainly shows that traditional family therapy is not the treatment of choice, especially in severe cases.²⁰ Traditional family therapy fails because the parties involved—the alienating parent, the alienated child, and the rejected parent—are at cross purposes with one another in a powerful and entrenched way. Their intentions and goals are vastly different. The alienating parent strives to maintain the status quo of rejection of the targeted parent by his or her child; the alienated child is aligned with the favored parent and is a witting participant in the alienation process; the rejected parent cannot fix the situation because his or her hands are tied by the alienation stranglehold.

In PA cases, it is a mistake to assume that both parents are contributing equally to the family quagmire.²¹ In truth, the alienating parent is the aggressor, and the rejected parent is the victim who does not deserve their plight. Treatment for each parent is very different, which is why traditional family therapy—where all family members are treated together—will not work in many PA cases.

An alienating parent’s disavowal of responsibility for his or her child’s rejection of the other parent is a major roadblock in the treatment of severe PA.²² This is why traditional family therapy will not work. An alienating parent will not be cooperative, helpful, or an active participant in making meaningful changes in the family dynamics. The alienating parent and the alienated child will fight against change, preferring instead to sabotage the family therapy.

An alienating parent will use failed family therapy as “proof” that the rejected parent is the problem. Why else would a child keep rejecting that parent? The rejected parent appears perplexed and agitated because the family therapy is not helping. In fact, it is making things worse by focusing on the wrong parent and/or the alienated child’s false and misleading beliefs. When traditional family therapy fails, it is precisely because the alienating parent and the alienated child are sabotaging it every step of the way. It is not because the rejected parent is the problem.

Focusing on an alienated child’s perspective and beliefs can take family therapy down the wrong rabbit hole. Allowing an alienated child to complain and rehash concerns about a rejected parent does not move their relationship in a positive direction. Traditional family therapy often attempts to validate the child’s feelings, encourage the child to express grievances, and give the child decision-making choice while advising the rejected parent to listen and apologize. Forcing a rejected parent to apologize for misdeeds not actually committed is further victimization of that parent and highly counterproductive. In many cases, a rejected parent can apologize a hundred times and still no progress will be made in reconnecting with an alienated child. This is exactly what happens in family therapy if PA dynamics are missed or misunderstood.

Traditional family therapy will not work if it means the alienated child remains apart from the rejected parent.²³ Research shows that a marked reduction in alienation only occurs in a child who has extended periods of time with their rejected parent.^4,24 No form of family therapy is effective in resolving PA in children who do not have regular contact with their rejected parent. An alienated child’s contact with a rejected parent should be immediate rather than slow or gradual. A phase-in strategy is not necessary, and it conveys the wrong message that the child’s “concerns” about the rejected parent have merit when, in fact, they do not.^4,25

Not all therapists, even family therapists, are familiar with PA. Unknowledgeable therapists are at a terrible disadvantage when trying to navigate the vicissitudes of PA situations.⁵ Getting supervision on PA from an experienced therapist is critical. In some instances, referring the case to a PA specialist makes the most sense. Unfortunately, an inexperienced family therapist can do more harm than good by trying to treat an unfamiliar condition.

Some family therapists believe that their basic therapeutic skills can be applied to all cases. That notion is false. PA cases are unique and require very specific treatment protocols. Even seasoned family therapists can be misled and confused by PA dynamics and its treatment needs.

PA-Specific Treatments Will Work

A PA-specific treatment plan is called for in these cases.

In mild PA—where the child’s contact reluctance or refusal is limited—a parent’s alienating behavior can be stopped with strong directives from an attorney, judge, parent coordinator, or mental health practitioner. More extensive treatment may not be necessary. This form of PA is the easiest and quickest to resolve. Yet, some cases of mild PA closely resemble moderate PA and require a different treatment plan.

For moderate PA—where the child persistently refuses contact and is mostly oppositional during any parenting time—a multifaceted treatment approach is indicated.²⁰ The alienating parent must have individual therapy or coaching with a seasoned clinician who is skilled in alienation tactics. The singular goal of this therapy is to help the offending parent stop his or her alienating behavior. At the same time, reunification therapy of the alienated child and the rejected parent must focus on repairing and restoring their prior good relationship. This treatment plan will be successful if the alienating parent stops his or her dysfunctional behavior and does not sabotage the reunification process. If the alienating parent does not have individual therapy, the reunification of the alienated child and the rejected parent will fail.

In severe PA cases—where the alienated child is completely cut off from the rejected parent—a different treatment protocol is indicated.²⁰ In these cases, the alienated child must be removed from the care of the alienating parent, placed with the rejected parent, and have no contact with the alienating parent for an extended period of time, perhaps 90 days or more. Simultaneously, the alienating parent must have individual therapy or coaching and the alienated child and rejected parent must have reunification therapy. Once significant improvement is seen, the alienating parent can begin to have supervised visits with the child. A standard visitation schedule may be a reasonable goal if progress is maintained and PA behaviors have remitted.

In moderate and severe cases, the 2 therapists—the individual therapist and the reunification therapist—must be free to communicate and compare notes on a regular basis. Ideally, both therapists need to assure that all parties are making significant progress. Sometimes it is wise to have a parent coordinator assigned to a case who can combine the inputs and recommendations from the 2 therapists.

In severe cases, the notion that an alienated child should not be removed from their favored parent is false and harmful.²⁵ PA does not spontaneously disappear without clear, focused interventions.

Reunification therapy is a hybrid of family therapy that focuses on the reconnection and repair of a broken parent-child relationship. It is often utilized with an alienated child and his or her rejected parent. But if the alienating parent has not stopped his or her harmful behaviors, reunification therapy will be stalled and sabotaged.⁵ This is a rule of thumb that cannot be ignored or circumvented. Ordering reunification therapy alone is the most common mistake made by judges. It is a mistake because it is ineffective if PA dynamics are not understood and addressed.

Family Bridges and other workshop experiences can be helpful in reuniting alienated children and their rejected parents.²⁶ Even when they are helpful, continued reunification therapy will be needed to consolidate and further boost their improvement.

Overall, PA-specific treatments are grounded in scientific research and accumulated clinical knowledge. These treatments are effective; PA can be overcome.

Attorneys, Judges, and Mental Health Practitioners Must Help

It is vital for all mental health and legal practitioners to understand the condition of PA and its effective treatment. Traditional family therapy will not work in many cases. Reunification therapy alone will not work. We know that PA-specific treatments can be successful.

Mental health practitioners must become familiar with PA pathology and skilled in its treatment. Treating alienated children and their parents without the requisite knowledge base can be deleterious.

As Blotcky and Bernet have written, “winning” a PA case is different than other cases.³ Treating and resolving PA is always in the child’s best interest. Attorneys who represent alienating parents must have the wisdom and courage to confront PA when they see it. To do otherwise is to enable and condone a pathological family condition that is damaging to children.

Court intervention by judges is often required in PA cases. Ordering the correct treatment is the key to turning around these fraught family situations. Ordering an incorrect treatment can impede the resolution of PA and make things more convoluted and intransigent. Because of their ultimate decision-making role, judges must understand and appreciate the toxicity of PA, and make its remedy a top priority.

A Return to our Case Vignette

A different intervention plan was instituted by the judge once family therapy failed in its quest to restore John’s relationship with his father. In accordance with the recommendations of a PA expert, John’s custody was transferred from his mother to his father, John’s mother was ordered to have individual therapy, and John and his father were ordered to have reunification therapy. In addition, John and his mother were to have no contact for 90 days. This intervention plan was considered temporary rather than permanent.

Four months later, John’s mother had not made significant progress in her thinking and behavior regarding her son. In contrast, John and his father had repaired and restored their relationship completely. John was doing well academically, had many friends, and was playing both basketball and baseball at school. Ultimately, John’s father was given permanent primary custody of his son. John’s mother was limited to supervised visits for a period of 6 months, and then a standard visitation schedule was gradually established.

Key Clinical Points

1. PA is a complex and toxic family dynamic that is present in some families during separation, divorce, and postdivorce. PA is a diagnosable condition based on specific criteria that are rooted in both scientific research and accumulated clinical experience.
2. PA in a child can be mild, moderate, or severe. PA-specific treatment can be successful. Different severities of PA require different treatment protocols. Traditional family therapy is contraindicated in most cases. Reunification therapy alone often does not work.
3. Mental health and legal practitioners can make sure the correct treatment approach is taken in a PA case. Attorneys, judges, and mental health practitioners hold the key to remedying PA in families.

Dr Blotcky is a clinical and forensic psychologist in private practice in Birmingham, Alabama. He is also clinical associate professor in the Department of Psychology at the University of Alabama at Birmingham.Dr Bernet is professor emeritus from Vanderbilt University School of Medicine in Nashville, Tennessee. He is founder and first president of the Parental Alienation Study Group.

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