An excellent article has recently been published on the scientific underpinnings of our understanding of parental alienation.

 Parental alienation as a mental condition is indeed founded on scientific research. In addition, there is a wealth of accumulated clinical knowledge of parental alienation in real-life, high-conflict cases. In this article, my goal is to discuss lessons learned from my experiences as an expert in alienation cases.

To provide context, I have been involved in at least 100 parental alienation cases over the years. I have been court-appointed to evaluate both parents in some of these cases. In others, I have been retained by a targeted or rejected parent to serve as an expert advocate on their behalf. Currently, I am retained in cases in 10 states and in Canada and England.

As a clinician, I can tell you that parental alienation is real, toxic, and potentially life changing. Of course, there are varying degrees of parental alienation, ranging from mild to moderate to severe.

 Mild to moderate alienation means the child is partially rejecting the targeted parent. In severe alienation, the parent is being totally rejected.

Estrangement is very different from alienation.

 Estrangement means the child is rejecting the targeted parent due to a legitimate concern about that parent, such as substance abuse or physical altercations or major mental illness. It is important for a mental health expert not to confuse estrangement with parental alienation. They are totally different situations and conditions.

We know that children who are immersed in the middle of a high-conflict separation, divorce, or postdivorce are at much higher risk for psychiatric symptoms, such as anxiety, depression, behavior problems, substance abuse, and more. This is true for children in childhood and later in adulthood.

 This is exactly what I have encountered clinically in my work.

Parental alienation manifests itself in a wide variety of behaviors, maneuvers, and strategies by the offending parent aimed at having the child reject the other parent. Bad-mouthing, interfering with visitation time, interfering with phone calls, cutting off family members, and false allegations of abuse are a few of the common alienating behaviors. A list of 17 frequent alienating strategies has been described in the literature.

False allegations of abuse are weapons that alienating parents use to gain leverage in their court proceedings. Filing criminal charges intensifies the weaponization even more. Such false allegations are hard to disprove, and offending parents use that fact to their advantage. Fortunately, investigations by child protective services often produce a “not indicated” or “unsubstantiated” finding, which helps to show the falseness of the allegations. Here is an important rule of thumb: multiple false allegations of abuse during a divorce proceeding are a huge red flag for parental alienation.

Attorneys involved in parental alienation cases often make the situations worse, not better.

 Winning is their top priority. The alienating parent’s attorney often turns a blind eye or even encourages the destructive behavior to “win” their case. The child’s attorney—the GAL—often has no mental health training and takes what the child says at face value, thus enabling the parental alienation. The rejected parent’s attorney may understand the dynamics but their hands are tied by the roadblocks imposed by the alienating parent’s attorney and the GAL. Passivity and defeatism may set in. Thus, it is often true that the attorneys in parental alienation cases do little to uncover and correct the pathological dynamic.

We know there is a certain treatment template that works in parental alienation cases.

 The alienating parent needs individual therapy that focuses exclusively on ceasing the alienating behavior. At the same time, the alienated child and the rejected parent must have reunification therapy to repair their relationship. If the child’s alienation is severe—meaning total rejection of the parent—the child must be removed from contact with the alienating parent, at least for a while, so that reunification therapy can take hold and be sustained.

Treatment of parental alienation can be successful if all involved in the case—attorneys, mediators, coordinators, experts, and judges—support the template offered above. Parental alienation in a child can be corrected. It is not a hopeless situation. But roadblocks to treatment must be recognized and combated.

Mental health experts are an invaluable asset in parental alienation cases, especially if the expert is knowledgeable and experienced in such dynamics. In my opinion, all high-conflict divorces that involve child custody matters should have a mental health expert in some capacity. Without an expert, these cases can become convoluted, twisted, and confusing very quickly.

As William Bernet, MD, and I have written, winning in a parental alienation case is much different than in all other family-law cases.

 Winning should be defined in terms of exposing and correcting parental alienation in the child. The correction of parental alienation is in the child’s best interest in each and every case. Ignoring it or accepting it as fait accompli is both ethically and professionally unacceptable and harms the child in the short-term and long-term.

Steven Miller, MD, recently passed away. He was an important contributor to our understanding of parental alienation cases.

 He wrote about the counterintuitive nature of parental alienation. The counterintuitive features of parental alienation are at the core of all diagnostic and treatment problems in these cases.

It is unacceptable for a physically or sexually abusive parent to falsely claim that they are the victim of parental alienation. That is a ruse that cannot be condoned or enabled. Parental alienation as an entity is not intended to cover up or hide physical or sexual abuse in a family.

Parental alienation is a diagnosable and treatable mental condition. Detractors who say otherwise are misguided and wrong. The condition is supported by both scientific research and clinical experience. Those of us who work in cases of parental alienation can attest to its toxicity, its confusing presentation, and its ability to be corrected under the right circumstances.

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 Blotcky can be reached at alanblotcky@att.net.

1. Harman JJ, Warshak RA, Lorandos D, Florian MJ. 

Developmental psychology and the scientific status of parental alienation.

2. Koszyk PA, Bernet W. Treatment and prevention of parental alienation. 

https://www.psychiatrictimes.com/view/treatment-and-prevention-parental-alienation

The Five-Factor Model for the diagnosis of parental alienation.

The impact of parental alienating behaviours on the mental health of adults alienated in childhood.

Surviving Parental Alienation. A Journey of Hope and Healing

6. Blotcky AD. False allegations of abuse during divorce: the role of alienating beliefs. 

https://www.psychiatrictimes.com/view/false-allegations-of-abuse-during-divorce-the-role-of-alienating-beliefs

7. Blotcky AD, Bernet W. Winning parental alienation cases: a roadmap for family lawyers. 

. January 12, 2022. Accessed July 25, 2022. 

https://familylawyermagazine.com/articles/winning-parental-alienation-cases/

A roadmap for the treatment of parental alienation.

9. Miller SG. Clinical reasoning and decision-making in cases of child alignment: diagnostic and therapeutic issues. In: Baker AJL, Sauber SR, eds. 

Working With Alienated Children and Families: A Clinical Guidebook

. Routledge/Taylor & Francis Group; 2014:8-47.

Articles

Parental alienation: a mental condition is indeed founded on scientific research. 

Lessons Learned From Parental Alienation Cases

 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. To create a better world, he is an advocate for treating mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of

is Clinical Professor and Chair of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences.

is a clinical social worker, a visual storyteller, and a creativity consultant.

If anyone thought that trauma was settling down in the Middle East and the US, this weekend belied that assumption. Though these events otherwise seem separate and are of great social psychiatric concern in their own right, all occurring over the weekend may be more than coincidence. They are:

-After a year of relative “quiet,” rockets were launched from Israel to the Gaza Strip and from the Gaza Strip to Israel.

-The fourth Muslin man to be ambushed and killed in Albuquerque over the past 9 months occurred on Friday.

-Saturday night and Sunday was the Jewish commemoration of Tisha b’Av, an annual fast and study day related to several disasters in Jewish history.

-Saturday August 6th was “Hiroshima Day,” the day in 1945 when the first atomic bomb was dropped on Hiroshima.

In canvassing the members of SPIRIT, who have previously written about such traumas for 

™, there was a great diversity of opinion about whether it was the right time to respond, and what could we say of value, yet still be respectful of the mourning associated with these tragedies.

Then there are also the silent international traumas, such as in Lebanon. Two of our members recently visited Lebanon. Plagued with hunger and a lack of social services, they reported a sense of powerlessness, helplessness, resignation, and psychotic-like “zombies” walking the streets there. It seems that we in psychiatry have to avoid feelings of learned helplessness in reacting to these traumas.

Although hundreds of women dressed in white with their mouths taped shut marched in protest in downtown Chicago on Sunday, the invasion of Ukraine continues, with less attention by the media, psychiatry, and public.

Of course, the powers in the situation are beyond formal mental health, including the survival of countries and people. Oil money and politics are a major influence.

Nevertheless, we in psychiatry know how to sit, listen, and help address the harm we humans do to one another. Our trauma stories can be the source of wisdom, resilience, growth, and transformation. Our children and the continued intergenerational transmission of trauma is at stake. Trauma to children, regardless of whoever is responsible, is a psychiatric and global mental health issue.

We hope to make further comments in the near future and are always available to help and contribute our knowledge. In the meanwhile, we bear witness to these psychiatric tragedies of war and other violence.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

 is a practicing psychiatrist with Providence Healthcare System in Portland, Oregon. He is the author of 

The Wounded Healer: The Pain and Joy of Caregiving

is clinical professor and chair of psychiatry and behavioral science at the University of North Dakota School of Medicine and Health Sciences. 

 is a professor of psychiatry at Cooper Medical School of Rowan University. He is active in several national and regional organizations and published and presented on international medical graduates, culture, religion, family psychiatry, gender issues, etc. 

 is a doctor working in frontline psychiatry for the National Health Service at South London and Maudsley NHS Foundation Trust in the United Kingdom. 

 serves as Kathleen & John Bricker Chair, Department of Psychiatry, LSUHSC. He also is chairman of the Board of Trustees of the Cobb Research Institute and is the 113th present of the National Medical Association. 

 is a clinical social worker, a visual storyteller, and a creativity consultant.

All these events that occurred over the weekend bear social psychiatric weight. 

SPIRIT (Social Psychiatry Interested in Recovery from International Trauma) Voices Some Current Concerns

August 8 is National CBD Day 2022

Slideshows

In honor of National CBD Day, Psychiatric Times™ shares some recent expert discussions on the pros, cons, and clinical implications of cannabis use in psychiatry.

Laughter Therapy: Good Medicine to Make Your Heart Glad

Psychiatry Comic: Stilts

Richard Berlin, MD, shares his poem, "Skilcraft Visible Man Anatomy Kit, 1960," which was featured in the 2022 August issue of 

heart-shaped plinth, his clear plastic hands

naked, transparent, fifteen-inch-tall model

I can remove to pluck organs for study—

a rack of golden ribs, porous blue lungs,

when I notice the bulge between his legs.

has been writing a poem about his experience of being a doctor every month for the past 24 years in 

in a column called “Poetry of the Times.” He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is

Videos

"Lost in the anatomy of wonder, moments pass before I catch my mother’s smile while she pretends to dust her shelves..."


Skilcraft Visible Man Anatomy Kit, 1960

Perhaps you have heard the phrase “the dog days of summer.” We are in them right now, at least in the Northern Hemisphere. The phrase goes back to Greek and Roman history. It ran from July 24 to August 24, and was thought to be an evil weather time when the sea would boil, wine would turn sour, disease would rise in humans, and dogs would go mad.

The Wizard of Oz and The Walk-Off of the Medical Students

Although the canine connotation connects to astrology, it also is a fitting metaphor for heat and humidity. Dogs do not have a huge supply of sweat glands and often have a thick coat of fur. Both characteristics reduce their ability to regulate their body temperature, and hence the visible panting.

Unfortunately, the myths and metaphors are turning out to be prophetic and realistically true. Our seas are becoming warmer, wine left out could easily turn sour, medical and psychiatric diseases are on the rise in people, and dogs best not be left in cars.

Maybe the “doggone days of summer” would now be more accurate. One of the synonyms for doggone is cursed. That seems to be so, except that we have cursed ourselves by our human behavior that has significantly contributed to this global heating and climate instability.

Right now, we are in a heat dome projected for the rest of August in the United States. Heat records are expected to be broken in the Northeast. Kentucky has had disastrous floods and a projected heat wave to complicate its relief efforts. An uncontrolled and destructive wildfire is burning in Northern California.

If this is not a societal public health crisis, what is? If so, it is both a danger and opportunity, as the Chinese character for crisis suggests. The opportunity is for us in psychiatry to finally treat it as such. Psychiatry as usual no longer suffices. We know what to do to treat climate-related psychiatric conditions, but we have not been anywhere near successful in their prevention. As to adaptation to the climate instability, the lack of success to date in such countries as the USA, Europe, Australia, and India does not bode well for the success of that strategy, especially for the poorer. Recommending adaptation may just be another form of psychological denial.

Doggone it, let’s focus in preventing these doggone days! Try to stay cool this weekend, but heat up your climate activism.

Here’s why we need to better prepare for the doggone days of summer. 

The Dog and Doggone Days of Summer

In this episode of The Big Q, Rif El-Mallakh, MD, shares his approach to introducing patients to new medications, from explaining the medication’s mechanism of action to telling patients how the medication can help alleviate their most problematic symptoms.

is the director of the Mood Disorders Research Program at the University of Louisville School of Medicine in Louisville, Kentucky.

What is the first thing you share with your patient when you are about to prescribe a new medication?

How Can This Medication Help?

Many years ago, I wrote in a personal journal a list I called “Things of Value I Would Say in 5 Minutes.” This was my way of getting past my inner censor to arrive at what I felt was truly important.

I have always taught psychiatry trainees that being an effective psychiatrist demands constant work on oneself. Although this internal work may be helpful in other disciplines, in psychiatry, it is essential.

During my last formal seminar with graduating trainees, I began to share my list in the hope that some of these points would resonate. Over the years, my list evolved into this poem.

As the long, paved road to the dirt gives yield—

is an Adjunct Professor of Clinical Psychiatry at the University of Southern California Keck School of Medicine, a Consulting Psychiatrist at the California State University, Long Beach Trauma Recovery Center, and a Distinguished Life Fellow of the American Psychiatric Association.

One psychiatrist shares some words of wisdom for the class of 2022.

Some Words for the Graduates

Often regarded as the greatest of all Greek tragedies, Sophocles’ “Oedipus Rex” dates back at least to 400 BC. Like so much of our great literature, like “The Wizard of Oz” which we discussed in the 

, it predates modern psychiatry in its psychological sophistication. In this case, Freud tried to update and clarify what it meant as far as the inevitable father and son conflicts.

The Stories That We in Psychiatry Have to Tell

In the play, Oedipus unwittingly or unconsciously kills his father and marries his mother, becoming King of Thebes. However, to end a plague, he promises to find the culprit of his father’s death, which turns out to be himself. Upon the revelation, his mother kills herself and then he blinds himself.

Freud felt that the competition of the son with his father for his mother was built into development and was solved best by leaving home and achieving some positive identification with the father. Without too much self-disclosure, it certainly applied to my own development and family.

Though less universally agreed upon nowadays in psychiatry and Freudian-oriented psychotherapy, certainly father and son family conflict is common. Just look at the news that a father was recently sentenced to 7 years in prison after his son played a major role in identifying him as part of the January 6 invasion of our Capitol building.

In the CNN interview of the son—and more briefly his sisters and mother—that I saw on Wednesday, the family conflict was obvious.

 No psychiatric analysis or knowledge is needed. The son conveyed that this was a moral, and not a political, conflict at its basis, and morally he had to identify his father to the FBI. The 2 sisters conveyed more blame on the cultish influence of the prior President, while the mother supported her incarcerated husband as a patriot. The 18-year-old son still hoped to maintain some sort of relationship with his father, but felt the incarceration was well-deserved. Whether any or all of the family have received mental health care seems unknown.

Perhaps this example has some connection to the popular Star Wars movies. Luke Skywalker ends up confronting his father, Darth Vader, who has gone over to the dark side of the force. Instead of killing Luke, his father ends up sacrificing himself in order to try to save his son from the Emperor.

Socially, it seems that we are in a difficult transition of the identification of sons with fathers. The historical role of aggressive, assertive, and domineering no longer fits a society so well as women and daughters are seeking comparable roles in the workplace and politics. Rather, more vulnerability, tenderness, and compassion are needed on the part of boys and men, not the continued attempt by some to keep women down.

How well we resolve this societal conflict will be crucial for our future.

1. Stracqualursi V. Convicted US Capitol rioter’s son says he ‘absolutely’ agrees with father’s sentence. 

https://www.cnn.com/2022/08/02/politics/january-6-rioter-guy-reffitt-son-sentence-cnntv/index.html

The ages-old father son conflict continues—but in a different, modern light. 

Oedipus Rex and the Capitol Crime

H. Steven Moffic, MD, shares his thoughts on the medical student walk out at the University of Michigan. Does this incident have larger implications?

Sometimes patients have to leave in order to feel better upon returning... 