Parental alienation (PA) profoundly affects both children and alienated parents. Children of PA are at increased risk for future trust and relationship issues, depression, and substance abuse. For a rejected parent, the pain is excruciating. This article discusses PA from two points of view. The first part relates an account of PA from the perspective of a parent who is also a physician. The second part, by an expert in forensic child psychiatry, explains how the tragedy of PA can be prevented and treated.
“Loss”: Experiencing parental alienation (PMK)
PA impacts people from all walks of life. Dr Jones (name and identity changed) shared his journey with me, and I think this case serves as a good illustration of this devastating condition that damages thousands of families every year.
Like many young professionals, Dr Jones found work-life balance challenging. When his children were little, he loved his time with them. He played Barbies on the floor with his daughter. He played catch for hours with his sons. They often went to the park together, just the three of them. He deferred much of the household responsibilities to their mom. She made the doctor appointments and arranged for dance lessons and play dates. He assumed this unspoken arrangement was natural.
By the time the children reached middle school, things began to change. The marriage was struggling, but he tried to “hang in there for the kids.” They went everywhere with their mother. Dr Jones didn’t notice it at first, but he began having less and less alone time with them. There was always some reason, some excuse. Insidiously, the process of PA was taking hold.
Several years passed before Dr Jones and his wife eventually separated. Dr Jones was ready to be the parent he knew he was without the overbearing presence of his ex, and so he naively set out to re-establish his relationship with his children. But things did not go well. His visitation time was challenged. The children became distant. After a while, they simply refused to go with him. He tried the available channels: mediation, family counseling, and court motions and hearings, with no success. He underestimated the power of PA, an adversary that accepts no compromise.
The concept of PA had been described in the legal and mental health literature for many years, but the phenomenon was given a name in 1985 by Dr Richard Gardner, a child psychiatrist.1 Gardner’s methods were criticized, and controversy has surrounded this topic ever since. Dr Jones tried to learn all he could about PA. He read the literature and took an online class. Everything he read seemed to be spot on. The attitudes and behaviors his children manifested matched the descriptions by Gardner and others. Suddenly, nothing he could do or say was “OK.” When he carefully asked them why things had changed, they strongly responded it was their idea and had nothing to do with their mother. But they could give no specifics.
Dr Jones turned to counselors, highly trained and compassionate professionals in family dynamics. He was told, “You did nothing wrong, but you can’t change what happened. You need to accept it.” Words that are hard for a physician to hear, hard for a father to hear. He sought answers from his pastor. And he prayed. “Like water, my life drains away, all my bones grow soft. My heart has become like wax, it melts away within me.”2
Thanks to the efforts of a growing number of dedicated mental health and behavioral clinician-scientists, PA is gaining acceptance as a recognized disorder. It has been proposed as a search term in ICD-11 (QE52.0 Caregiver-child relationship problem). The concept of PA is described in DSM-5, if not listed as a formal diagnosis. The American Academy of Child and Adolescent Psychiatry3 and the American Academy of Pediatrics4 have both included discussion of PA in society guidelines.
In the years since Dr Jones and his wife split, not a single Father’s Day card. Not a single birthday call. No Christmas anything. Graduations were watched from afar as an uninvited guest. Many milestones—award ceremonies, proms, college visits—were missed. Small moments were missed, as well—having lunch, sharing stories, just spending time together.
Dr Jones finds it difficult to relate to peers, men so proud of their children’s achievements. Conversation, small talk becomes uncomfortable. How does one fit into a community and a society in which we are often defined by our families? How does one deal with the shame?
Another haunting aspect of PA involves a parent’s concern for the welfare of his children. The literature on adult children of PA is not exactly encouraging.5 They don’t always “eventually come around,” as good-intentioned people often say. Dr Jones wonders, will he ever see his children again? Will they be able to form trusting, loving relationships? Will they be OK?
Dr Jones learned of the Parental Alienation Study Group (PASG), an organization dedicated to developing and promoting research on the causes, evaluation, prevention, and treatment of PA. Among other academic activities, an international conference is held annually, bringing together mental health professionals, lawyers, social workers, and alienated parents to further the understanding of this destructive condition. These efforts give hope to parents like Dr Jones around the world. And with hope and understanding comes some degree of acceptance.
PA crosses gender and socioeconomic lines. It is not known if physicians are at increased risk for PA. However, immersion in the practice of clinical medicine can make doctors emotionally unavailable and unaware. The balance between professional and personal life is a precarious one. Increasing awareness of PA for parents and all persons involved in high-conflict divorce is the first step toward prevention.
Preventable and treatable (WB)
The tragedy is that PA occurs at all. Some writers have compared PA to an unexpected, premature death. For the rejected parent, it is like the death of their child. For the child, it is comparable to the early death of their parent, except it is complicated by the child’s painful, guilty knowledge that they contributed to the loss of their parent. That is, the child colluded with the indoctrination from the preferred parent and actively rejected the alienated parent—without any good reason.
PA is a mental condition in which a child—usually one whose parents are engaged in a high-conflict separation or divorce—allies strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification. Note that in PA, the child’s rejection of the alienated parent is without a good reason. We follow the convention of most writers, who use estrangement to refer to warranted rejection of a parent and alienation to refer to unwarranted rejection.
The identification or diagnosis of PA is based on the Five-Factor Model.6,7 If the following factors are present, it is highly likely that the family is experiencing PA:
Factor One: the child actively avoids, resists, or refuses a relationship with a parent.
Factor Two: presence of a prior positive relationship between the child and the now rejected parent.
Factor Three: absence of abuse or neglect or seriously deficient parenting on the part of the now rejected parent.
Factor Four: use of multiple alienating behaviors by the favored parent.
Factor Five: exhibition of many or all of the eight behavioral manifestations of alienation by the child. (See Table).
Dr Koszyk is a gastroenterologist in Bloomington, IL. He reports no conflicts of interest concerning the subject matter of this article. Dr Bernet is Professor Emeritus, Department of Psychiatry, Vanderbilt University School of Medicine in Nashville, TN. He receives royalties for books published by Charles C Thomas Publisher. He was the founder and first president of the Parental Alienation Study Group.
1. Gardner RA. Recent trends in divorce and custody litigation. Academy Forum. 1985;29:3-7.
2. Psalm 22:15. The New American Bible. 1987. Iowa Falls, IA: Catholic World Press.
3. American Academy of Child and Adolescent Psychiatry. Practice parameters for child custody evaluations. J Am Acad Child Adoles Psychiatry. 1997;36(10 Suppl):57S–68S.
4. Cohen GJ, Weitzman CC, AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Section on Developmental and Behavioral Pediatrics. Helping children and families deal with divorce and separation. Pediatrics. 2016;138:1–8.
5. Baker AJL. Adult Children of Parental Alienation Syndrome: Breaking the Ties That Bind. New York, NY: WW Norton; 2007.
6. Bernet W. Introduction to parental alienation. In: Lorandos D, Bernet W, eds. Parental Alienation- Science and Law. Springfield, Illinois: Charles C Thomas; 2020.
7. Gardner RA. The Parental Alienation Syndrome: A Guide for Mental Health and Legal Professionals. Cresskill, NJ: Creative Therapeutics; 1992.
8. Andre KC, Baker AJL. 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; 2009.
9. Richard D. Non-adversarial resolution: All cases between parents of minor children. In: Lorandos D, Bernet W, eds. Parental Alienation- Science and Law. Springfield, IL: Charles C Thomas; 2020.