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Dr Linda Nielsen is an expert on father-daughter relationships in the context of divorce and best custody practices. All mental health professionals who are involved in divorce and child custody cases will profit from her expertise. Her knowledge is perfect for inclusion in my Forensic Practice column. – Alan D. Blotcky, PhD

What is it about fathers’ relationships with their daughters that leaves them more damaged than fathers’ relationships with their sons after the parents break up? More important still, how can custody laws, parenting plans, and mental health and family court professionals help protect or strengthen the father-daughter bond?

Divorce Damage: Daughters Take the Greater Hit

One of the most serious, long-lasting consequences of divorce is its negative impact on sons’ and daughters’ relationships with their fathers. This is not groundbreaking news. The research has been acknowledging this fact for decades. This damage often lasts well into the children’s adult lives, sometimes leading to such serious meltdowns that the relationship is never fully repaired. Hopefully, most mental health and family court professionals and custody law policymakers are already aware that divorced fathers’ relationships with their children are at risk.

What might come as a surprise, though, is that this father “wound” is generally worse for daughters than for sons after the parents’ breakup.

 Compared to sons, daughters are more likely to say their relationship with their dad has become distant, strained, superficial, or altogether broken. Daughters also have a greater longing for more time with their dads, feel more ignored and rejected, and are more dissatisfied with their relationship with their dad 

. In fact, it is more common for divorced fathers and sons to rebuild or strengthen their bond after the son becomes an adult than for this to happen with daughters. Even as adults, daughters are more apt to say there is still a lot of tension and conflict with their dads—much of which stems from what happened after the parents separated. In other words, the deterioration in father-daughter relationships is not only more common, but harder to repair.

The other downside for daughters is that this father wound has such a far-reaching impact on so many aspects of their lives. In married families or divorced families, the quality of the father-daughter relationship has 

impact than the mother-daughter relationship on the daughter’s romantic relationships with men, her sexual behavior as a teenager or young adult, her future divorce rate, her career choices, and her resilience in dealing with stress and adversity. The bottom line is that maximizing fathering time after the parents separate is in many ways more important for daughters than for sons.


Why do daughters usually pay a greater price than sons in their relationships with their dads? What is going on? The answer lies in 3 general areas: the nature of mother-daughter relationships before the divorce, maternal enmeshment and role reversals, and our society’s false beliefs about fathers and daughters.

 In most intact families, sons and daughters are closer to their mothers than to their fathers. This does not mean the children and their fathers love one another less. It simply means children and their moms usually share more personal information with each other, spend more one-on-one time together, and feel more comfortable talking about intimate things. Mothers and daughters are the most likely dyad in the family to have that kind of communication and closeness. This means that, when parents are separating, the stage is already set for the mother to share more personal information with her daughter than with her son. Unfortunately, mothers sometimes share damaging information about the marriage or divorce with the children—usually with their daughter, not their son. Consequently, the daughter is more apt than the son to pull away from her dad and side with her mom against him.


 In extreme cases, the mother becomes so needy and dependent that she turns the child into her adult confidant, advisor, and emotional caretaker—a damaging situation known as role reversal, parentification, or emotional incest. Role reversals may also go hand-in-hand with another unhealthy situation known as enmeshment, in which children no longer feel free to be separate entities from their mother. The 2 become “1,” which means the child feels obliged to share the same feelings, values, and judgements as the mother. When the mother’s judgements and feelings toward the child’s father are negative, an enmeshed child is the least emotionally equipped to question or reject her negative beliefs. Unfortunately for daughters, mothers tend to become enmeshed and to reverse roles more with them than with their sons. So, again, the father-daughter relationship pays the greater price.


 When a mother become enmeshed or reverses roles with 1 of her children, she is less likely to welcome or support any of the children’s bonds with their father. Whether unknowingly or intentionally, her behavior closes the metaphorical gate between the father and child—a damaging situation known as “maternal gatekeeping.” In extreme cases, the mother might carry things a step further by not only closing the gate, but by doing things that alienate the children from their dad. If the mother succeeds, alienated children no longer want any contact with their father. The research on gatekeeping and alienation is extensive. Both the American Psychological Association and the American Bar Association have acknowledged parental alienation as a form of child abuse.

 Although gatekeeping and alienation undermine sons’ relationships with their dads, daughters may be at greater risk because they tend to have closer or more enmeshed relationships with their mothers.


 Our society’s sexist beliefs and negative stereotypes about fathers and daughters also contribute to the greater rift between them after parents separate. Whether the parents are married or separated, many of our traditional beliefs about fathers’ roles and their impact on children work against father-daughter relationships in ways they do not work against fathers and sons. Even now there are family court professionals and mental health workers who believe that mothers and mothering time are more essential than fathers and fathering time—especially for infants and other very young children. The idea that sons need, want, and benefit more from their fathers than daughters do is alive and well. Supposedly mothers and daughters have a “special” and more important bond that fathers and daughters cannot and should not have, want, or strive for. After all, “everyone knows” a son needs his dad more than he needs his mom and a daughter needs her mom more than she needs her dad. Sexist ideas like these can contribute to custody plans aimed at keeping fathers more closely connected to their sons than to their daughters. There is only 1 problem with these beliefs: They are false. They have no scientific foundation.


So how can family court and mental health professionals and policymakers who create our custody laws help father-daughter relationships survive and thrive after parents separate? First and foremost, custody laws need to be revised so that children are given equal or nearly equal parenting time with both parents, except in situations where a parent is abusive, negligent, or otherwise unfit to be safe. For the 10% of parents who end up having to resolve their custody issues in court, judges, mediators, and lawyers need to work toward the goal of giving children the gift of equal parenting time.


Why would children benefit if we were to change our custody laws? How do we know that living more equally in both parents’ homes with shared physical custody is in children’s best interests? Because more than 60 studies have told us so.

 Over the past 4 decades, 60 studies have been conducted in more than 14 countries to address the question: Do children have better outcomes when they live with 1 parent (almost always the mother) and have visitation time with their other parent (almost always the father) than when they live 35% to 50% time (shared physical custody, shared parenting) with both parents year-round? Children in the shared parenting families had better outcomes on 

measure of well-being in 34 studies, better outcomes on most measures in 20 studies, and equal outcomes in 6 studies. In other words, shared-parenting kids had better outcomes overall regarding depression, anxiety, school behavior, delinquency, self-esteem, relationships with peers. Most important of all, they had better relationships with both parents, stepparents, and grandparents.

These results held true even in studies that considered the parents’ levels of conflict and their incomes

Even in high-conflict families and even when family incomes were factored in before comparing the children’s outcomes, shared parenting benefited the children

 It appears that the damage done by parents’ high conflict is offset by having a stronger relationship with both parents in the shared parenting arrangement. In other words, when parents are not getting along and coparenting conflict is high, children who live with only 1 parent are more handicapped than those who live with both parents.


It is extremely important to realize that children under the age of 5, including infants, also benefit from shared parenting custody plans. Although there are only 5 studies that have addressed this question, infants, toddlers, and 4-year-olds are as well off and generally better in shared parenting when it comes to emotional, behavioral, and social development. In fact, 110 international experts on child development, early childhood attachment, and children of divorce reached a consensus on this point: Baby girls and baby boys, just like older boys and girls, benefit from shared parenting.

Given the many benefits of shared physical custody, the bad news for sons and daughters is that 80% of our nation’s children live almost exclusively or exclusively with their mother after the parents separate. Given the way custody laws are written and interpreted, children’s time with their fathers is generally confined to 20% to 25% of the parenting time until the children turn 18. Although 21 states were considering making changes to their custody laws back in 2017, only Kentucky, Arkansas, and Arizona have passed shared parenting laws that allow each parent to have equal parenting time.

 This is especially troubling news for daughters, given the greater fragility of their bond with their fathers after their parents stop living together.


Regardless of the existing custody laws in their states, when working with parents who are trying to negotiate a custody plan, professionals should emphasize and repeatedly remind them of these 3 conclusions from the research. First, children benefit most when they continue to live with each parent at least 35% of the time, even when the parents do not get along well as coparents. Second, the father-daughter relationship has a major impact on daughters—not only in the short term, but years later as an adult. Third, daughters are at greater risk than sons of ending up with father “wounds”—preventable wounds that are related to the custody plan, enmeshment, role reversals, gatekeeping, and parental alienation.


Finally, professionals who influence custody plans must be able to recognize signs and the consequences of maternal gatekeeping, enmeshment, role reversals, and parental alienation— unhealthy situations that more commonly hurt daughters’ than sons’ relationships with their dads. Extensive checklists of these behaviors are provided and explained elsewhere.

 Byraising awareness, mental health and family court professionals can help protect and strengthen father-daughter relationships. Likewise, state legislators and the voters who elect them can make more of an effort to revise custody laws in ways that give children equal living time with both parents.

 is a professor of education at Wake Forest University in Winston-Salem, North Carolina. She is an internationally recognized expert on father-daughter relationships and shared physical custody parenting for separated parents. Her research has appeared in such outlets as 

. More information about her research, blogs, books, and courses is available 

Father-Daughter Relationships: Contemporary Research and Issues

Parent-Child Reunification: A Guide to Legal and Forensic Strategies

Statement on parental alienation syndrome

Joint versus sole physical custody: children’s outcomes independent of parent–child relationships, income, and conflict in 60 studies

Social science and parenting plans for young children: a consensus report

More than 20 states in 2017 considered laws to promote shared custody

. December 12, 2017. Accessed November 15, 2021.

7. Austin W, Fieldstone L, Kline Pruett M. 

Bench book for assessing parental gatekeeping in parenting disputes: understanding the dynamics of gate closing and opening for the best interests of children

After parents break up, why is the father-daughter relationship typically more damaged than the father-son relationship?

Fathers and Daughters: Custody Plans and Other Steps to Protect Their Relationships

Parental alienation is a mental state in which a child—usually one whose parents are engaged in a high-conflict separation or divorce—allies strongly with 1 parent (the offending, but favored parent) and rejects a relationship with the other parent (the alienated parent) without legitimate reason.

 This condition occurs in the context of a maladaptive family dynamic involving at least 3 individuals: the alienating parent, who intentionally and purposefully manipulates the child to reject the other parent; the child, who experiences parental alienation; and the rejected, alienated parent. A variety of tactics and maneuvers are used by alienating parents to achieve their goal, ranging from bad-mouthing and disruption of visitation time to false allegations of abuse and criminal charges.

Research indicates that parental alienation is present in 11% to 15% of divorce cases. It has also been found that 20% to 25% of parents engage in alienating behavior as long as 6 years after divorce. Alienating parents can be either mothers or fathers.

Parental alienation is poorly understood by many mental health professionals, not to mention attorneys, guardians ad litem, and judges. It is a confusing and vexing problem because many of its features and dynamics are hidden behind the scenes, ferociously denied, and counterintuitive from what one would expect.

Because of its counterintuitive nature, many false assumptions are made by professionals who are involved in cases of parental alienation. Much can be learned from recognizing and understanding these false assumptions, both in terms of diagnosis and treatment. This is especially important since early diagnosis and intervention are predictive of better outcomes for the child.

What follows is a description of many false assumptions that are made routinely in alienation cases. Richard Warshak, PhD,

 have written about fallacies and fundamental attribution error in these cases, and 1 of us has written about misinformation in alienation theory.

 The following concepts serve as the foundation for our fuller understanding of the role of false assumptions in parental alienation cases.

. When we think intuitively, our decisions tend to feel “right,” regardless of whether they are or not. To accurately understand parental alienation, a clinician must have an advanced understanding of the typical dynamics in these cases. Relying on intuition can lead to major mistakes right from the get-go. For example, just because a parent seems healthy or believable, does not make it so.

 It is a common fallacy that both parents are equally responsible for high conflict during a separation or divorce. It is always important to consider the possibility that 1 parent may be the aggressor, while the other parent is the victim. In most cases, both parents are not equally responsible for the ongoing conflict. It can be a major blunder to assume so.

Outward demeanors are indicative of truth. 

Alienating parents typically present as calm, verbal, and convincing. In contrast, alienated or rejected parents usually present as agitated, angry, and afraid; they are victims.

 In many cases, the alienating parent appears to be healthier and more believable—but that is a manipulation and a distraction from their intentionally alienating behavior. The rejected parent appears more psychologically disturbed, and so it is assumed that he or she is the one engaging in problematic behavior. Outward demeanors can be quite deceiving and must be considered cautiously in diagnostic decision-making.

 The intrapsychic defense of projection is often seen in cases of alienation. In essence, the alienating parent accuses the rejected parent of being the aggressor. If you fall for the offending parent’s distortion and misperception, poor diagnostic decisions will be made, and the case can quickly go haywire. Projection can lead to the wrong person being identified as the alienating parent.

Children’s denials and “truths” are gospel. 

Simply believing a child’s denial of alienation by a parent can be a recipe for disaster. Children are not usually aware of the maneuvers employed by the offending parent to turn them against the rejected parent. Plus, such children are frequently enmeshed with the offending parent and will defend that parent to the bitter end. Independent thinker phenomenon is often seen, whereby alienated children assert that their rejection of a parent is solely their idea and decision—not due to the offending parent’s influence. So just listening to a child’s denials can be a serious error that will undermine good decision-making in a case. There is a body of literature that tells us that children and teenagers do not know what is in their own best interest.

 This is especially true when they are the unwitting participants in alienation by a parent.

Alienation does not involve total rejection. 

Children naturally want to love both of their parents without interruption or impediment. A child does not totally reject a parent unless there is an alienating influence in the mix. This is true even for abusive parents. Indeed, children who have been verbally, physically, or sexually abused by a parent experience profound ambivalence because they still love the parent. They are upset and in turmoil by the fact that they cannot have a continued relationship despite the well-established abuse.

 As such, total rejection by a child is much more indicative of alienation. And to use a child’s rejection of a parent as corroboration or validation of the rejected parent’s badness can be flat-out wrong.

Estrangement and alienation are the same thing

. When children resist contact with a parent for legitimate reasons, this is called estrangement, not alienation. Estrangement is very different than alienation; it is important not to confuse them. For example, it would make sense for a child to be estranged from a parent if that parent engages in substance abuse during the child’s visits. Estrangement can be corrected if the parent is willing to make the necessary changes. Alienation, in contrast, tends to be camouflaged, insidious, and recalcitrant.

Alienating behavior is relatively harmless and will not impact the child’s long-term mental health. 

Engaging persistently in alienating behavior is child psychological abuse. It is a mistake to deny it or rationalize it away. According to DSM-5, child psychological abuse is nonaccidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child. In light of this, parental alienation is considered a psychiatric emergency, especially in moderate to severe cases. Minimizing the severity of the problem does a terrible disservice to the child. Unfortunately, it enables the abusive behavior to continue unchecked.

Since persistent alienating behavior constitutes child psychological abuse, the top priority should be to protect the child from further abuse. Until this is accomplished, no form of psychotherapy will be effective. In other words, protecting the child from further abuse must be the first step before psychotherapy of any kind is started. This mistake is common. In many court cases, it is erroneously assumed that psychotherapy can fix the problem when, in fact, little or nothing can be accomplished because the alienating behavior is ongoing.

Removing the child from the home is harmful. 

There is no credible evidence that removing an alienated child from the home of the offending parent causes a significant risk of psychological harm. The opposite is true. In almost all severe and some moderate cases of parental alienation, the risks of not protecting the child are far greater than the risks of protecting the child. Removal of the child from the offending parent’s care may be necessary, at least temporarily. Children and teenagers may fuss about it, but they will comply with, and benefit from, such an intervention.

Reunification therapy can start at any time and is easy. 

Reunification therapy cannot be successful unless the alienating behavior by the offending parent is stopped. Otherwise, progress will be impeded by the continued alienation, and everyone will be perplexed as to why significant gains are not being made. The reunification therapy itself may not be the issue at all. Its progress may be stalled by the omnipresence of alienating behavior by the 1 parent.

Reunification therapy is difficult and complex. It requires a knowledgeable and seasoned therapist. The therapist must be directive and assertive, not passive, lethargic, or naïve. An inexperienced or unknowledgeable therapist can make things worse. Such therapists can begin to feel overwhelmed, frustrated, and disappointed. A negative expectation for improvement can take over and become a complicating and limiting factor.

There are no interventions for alienation situations. 

Active interventions for parental alienation are available and they do work. The interventions must be aimed at (1) stopping the alienation by the offending parent, (2) clarifying and resolving the alienation in the child, and (3) repairing the child-rejected parent relationship. More traditional psychotherapies that do not target these specific areas are doomed to fail. The right therapy at the right time is critical.

Children’s school performance is the best guide. 

Just because a child is doing well in school or other activities does not mean they are doing well psychologically or emotionally. This is a common misconception. Focusing on school grades can miss the larger issues at hand.

The truly guilty party will confess eventually. 

No matter how much pressure is applied, the severely alienating parent will never admit to their intentionally harmful behavior. There is never a 

 moment. Do not be misguided or misled by this parent’s persistent denials, as they are disingenuous and untruthful.

Alienating behavior always results in alienation. 

Not all children who have an alienating parent become alienated. However, even if the child is not alienated does not mean the parent’s alienating behavior is harmless. The negative consequences of alienating behavior tend to be cumulative over time. In addition, the child might become alienated if the damaging behavior does not cease.

All cases of parental alienation are fraught with complexities and difficulties. None are easy or straightforward. False assumptions are pitfalls to be understood and avoided in these cases. Missteps anywhere along the way can result in misdiagnosis, miscalculations, and ill-fated interventions.

Early diagnosis and intervention are important in alienation cases. The offending parent’s behavior must be stopped as soon as possible. All professionals—from mental health experts to attorneys to judges—must understand this principle. It is unacceptable to turn a blind eye. By doing so, complicity with the offending parent will be established and the child’s mental health will be rendered unimportant.

Professionals want to help children and their parents when they are embroiled in high conflict and escalating acrimony. But falling for any of these false assumptions can take a case down a dangerous path. And, in every instance, a child’s psychological wellbeing and mental health are at stake.

is a clinical and forensic psychologist in private practice in Birmingham, Alabama. He is also a clinical associate professor in the Department of Psychology, University of Alabama at Birmingham. He is a member of the Parental Alienation Study Group.

is professor emeritus, Department of Psychiatry, Vanderbilt University School of Medicine in Nashville, Tennessee. He was the founder and first president of the Parental Alienation Study Group.

. Springfield, Illinois: Charles C Thomas Publisher Ltd. 2020.

Current controversies regarding parental alienation syndrome

3. 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

. New York, New York: Routledge. 2013:8-46.

Recurrent misinformation regarding parental alienation theory

Payoffs and pitfalls of listening to children

6. Baker AJL, Creegan A, Quinones A, et al. 

Foster children’s views of their birth parents: a review of the literature

Ten parental alienation fallacies that compromise decisions in court and in therapy

Here’s how to avoid false assumptions in cases of parental alienation to ensure better outcomes for children.

Avoiding the Pitfalls of False Assumptions in Parental Alienation Cases

As a clinical and forensic psychologist, I have been involved in hundreds of cases of divorce and child custody. The topic of false allegations of abuse is a complicated and thorny one that deserves much attention. In particular, there needs to be a focus on the alienating beliefs that often underly and compel false allegations.

False allegations of abuse are an all-too-common phenomenon during divorce and child custody proceedings. One parent fabricates a false allegation against the other parent to gain leverage in court and to undermine the parent-child relationship going forward. The frequency of false allegations in custody cases is not fully understood, with estimates ranging from 2% to 35% of all cases involving children.

 Whatever the percentage, attorneys, judges, and mental health experts all know firsthand that it is a vexing problem in court cases. And nothing can disrupt, sidetrack, or impede a case more than an allegation of abuse that eventually proves to be false.

Parents never admit to their conniving and harmful behavior during a legal action. As such, proving an allegation is false can be extremely challenging. Why? Because a false allegation is hatched in the mind of the offending parent, who then enlists the help of their child to unwittingly carry out the plot. The intent is to harm the other parent, but to do so as if the offending parent is the real victim. Parents know that an allegation of abuse has the potential to help them win their case, which is their ultimate goal. Unfortunately, being honest and fair is not always a virtue in a contentious child custody case.

Detecting a false allegation is critical because judges can be swayed by the accusation, even if it is not substantiated by the evidence. More often than not, custody decisions go in favor of the accusing parent.

 So, uncovering and exposing a false allegation is vital in making sure the offending parent is not rewarded for his or her destructive behavior.

The surest way to prove a false allegation of abuse is to uncover the alienating belief system of the offending parent. Alienating beliefs often underlie a parent’s decision to fabricate a false allegation against the other parent. With careful interviewing and psychological testing, these beliefs can be brought to the surface. A mental health professional is best suited to address this clinical problem. It takes patience and a probing attitude by the clinician to elicit alienating beliefs that are being hidden from view by the offending parent. Sentence Completion Series is one psychological instrument that will elicit thoughts, feelings, actions, intentions, and motivations. In interviewing, hypothetical questions, a focus on nonverbal cues, and exploration of apparent discrepancies can be productive.

Here are 7 common alienating beliefs that occur in false allegations:

1. “I am afraid our child will love you more than me and will want to live with you.”

3. “If you don’t want me, you don’t get our child, either.”

4. “I want to exact revenge on you, and what better way than to deprive you of your child?”

5. “I don’t want my child to be anything like you.”

6. “I’ve been the real parent in this family, not you.”

7. “I don’t want my child to love their new stepparent because I might be pushed out.”

There are important implications to consider in cases of false allegations of abuse. First, the desire to alienate the child from the other parent is at the core of most false allegations of abuse. And, when a parent makes multiple false allegations during a legal proceeding, you can bet that alienating beliefs are in play. Yet, it is important to note that not all false allegations are due to alienating motives. Sometimes, for example, a parent may over-interpret a comment or report from a child, thereby jumping to an erroneous conclusion. Rather than clarifying the benign situation, the parent makes what proves to be a false allegation. Other examples exist where alienation is not a major component in a false allegation.

Second, a child needs to love both parents without impediment or interruption. Being caught in a loyalty fight is damaging, as a child’s long-term adjustment is dependent upon having a close relationship with both parents. Anything short of that is unacceptable. A false allegation of abuse can go a long way to disrupt a child’s relationship with the accused parent. Loving that parent may become strained or even impossible going forward. Thus, a false allegation against a parent can have a tragically negative impact on the child.

Third, offending parents tend to view their children as possessions to be controlled and manipulated. They see them as extensions of themselves. That is not parental love, but rather, narcissistic self-absorption. It is the offending parent’s hostile needs and motivations that are the real problem in these cases, not the rejected, victimized parent. Offending parents lodge false allegations against the other parent to meet their own needs, not their child’s. Teaching a child to be a victim under false pretenses can set the stage for a lifetime of victimhood for the child.

Fourth, vindictiveness is a malignant emotion that causes great pain, sorrow, and unhappiness in any relationship. Being consumed with vindictiveness is profoundly unhealthy. It has nothing to do with love and care for the child. Vindictiveness is common in false allegations of abuse. What is portrayed as protectiveness of the child is actually hostility and destructiveness toward the other parent, with little genuine concern for the child’s best interest.

Fifth, false allegations of abuse must be stopped as soon as possible for the child’s wellbeing. If they are not stopped, the offending parent’s pernicious behavior will gain steam and impact over time. False allegations cannot be condoned in any way. Several courses of action are reasonable: limited parenting time, supervised visits, change of custody, court-ordered therapy, and others. Turning a blind eye to a false allegation of abuse is not an option.

Finally, judges and attorneys need to be educated about the seriousness and deleterious consequences of false allegations of abuse. Mental health experts can help inform, explain, and guide during the legal proceeding or at trial. False allegations and alienation are highly disruptive to the wellbeing and mental health of the child.

It should be reassuring to know that alienating beliefs can be uncovered and exposed. That is the key to unlocking the “proof” of a false allegation. Without exposure, a child custody case can be hijacked by a false allegation, and the child’s wellbeing may be lost in the confusion. After all, a child’s future can be at stake.

This is the first installment in Dr Blotcky’s new column, “Forensic Practice.” Feedback and suggestions for future articles can be sent to 

 is a clinical and forensic psychologist in private practice in Birmingham, Alabama. His specialty is false allegations of abuse and parental alienation. He can be reached at 

Recantation and false allegations of child abuse

The National Children’s Advocacy Center

2. Meier JS, Dickson S, O’Sullivan C, et al. 

Child custody outcomes in cases involving parental alienation and abuse allegations

False statements and the differential diagnosis of abuse allegations

Psychological impact of being wrongfully accused of criminal offences: a systematic literature review

How can mental health experts help identify false allegations and alienation during divorce proceedings?

False Allegations of Abuse During Divorce: The Role of Alienating Beliefs

We are accustomed to hearing the old adages, “You do the crime, you do the time" and “You reap what you sow.” I continue to reflect on these words, especially in the context of individuals who have been incarcerated. 

I serve a diverse patient population, and some of them have come in contact with the criminal justice system. I have heard their narratives of trauma and resilience. I have heard them describe the inhumane treatment they received, and how their experience was the antithesis of “rehabilitation.”

Criminal charges do not equate with treating people like caged lepers. If we truly want to decrease recidivism rates and health disparities for individuals in the carceral system, then perhaps we should not strip people of their humanity. I recommend we build on their strengths and provide them with the resources that will help them flourish when they reenter society.

 by Stanley Andrisse, MBA, PhD. His narrative is palpable. I appreciate his authenticity and transparency. It is never too late for the carceral system to have a facelift.

is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for

With so many stories of trauma associated with the criminal justice system, it is time to reexamine how this population is treated.

Trauma, Resilience, and Justice for Those in the Criminal Justice System

interview with James L. Knoll IV, MD. In the first half of the conversation, Knoll discussed the challenges of treating patients with traits like psychopathy or 

Forensic psychiatrists have emotionally taxing jobs: They spend countless hours studying acts of violence and the individuals who commit them. How could anyone endure this job for more than a few years?

James L. Knoll IV, MD, has survived decades in the field. In this edition of 

, Knoll talks about how he maintains his mental well-being. He also reveals the childhood obsession that set him on his career path, reflects on how forensic psychiatry has changed over time, and looks forward to how it might change for the better in the future.

His childhood fascination with the Jonestown murder-suicide.

How he got interested in forensic psychiatry.

The risk of burnout in forensic psychiatry (or any other psychiatric specialty).

How the arts and other creative endeavors can help psychiatrists stay mentally and physically well.

The tension at the heart of the forensic psychiatrist’s identity: are they primarily treaters of mental illnesses, or expert witnesses?

The new importance of social media for forensic investigations.

Why it’s important not to judge patients—no matter how difficult they may be.

is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the 

 and President-elect of the American Academy of Psychiatry and the Law (2022-23).

Forensic psychiatry is not for everyone, but looking back on his life and illustrious career, James L. Knoll IV, MD, realizes that he was destined to study crime. 

A Forensic Psychiatrist Takes the Stand

Psychiatrists are not strangers to difficult and even potentially dangerous patients, but James L. Knoll IV, MD, has made these populations one of his specialties. With decades of experience in forensic psychiatry, Knoll takes listeners deep into the US criminal justice system, where he treats both inmates suffering from detention-related psychiatric disorders and an especially challenging group that he has dubbed 

How prisons’ strict social hierarchies can contribute to psychiatric illnesses.

The high prevalence of bipolar disorder and schizophrenia in corrections—and their potential causes.

The different challenges of treating patients in prisons vs jails.

Why inmates with psychiatric illnesses end up in the correctional system for longer than those without psychiatric illnesses.

The role of mental health courts in improving psychiatric care in the correctional system.

The challenges of treating patients who are high in psychopathy or have anti-social personality disorders.

, in which Knoll talks about how he first became interested in forensic psychiatry (at age 10). 

James L. Knoll IV, MD, shares insights from his decades in forensic psychiatry, where he has treated some of the criminal justice system’s most difficult and dangerous patients. 

Treating ‘Morally Objectionable’ Patients

About half of marriages end in divorce, and approximately 6 out of 10 divorces involve children. Even when amicable, a divorce is a difficult situation. However, divorces can be tumultuous, and children often pay the price. One way this is manifested is in false allegations of abuse in child custody cases. Typically, one parent accuses the other parent of physical and/or sexual abuse of their child to gain leverage in their court proceeding. This tactic can be particularly impactful because judges tend to award primary physical custody to the parent who made the allegation, even if the accused parent’s actions are not substantiated. Thus, false allegations can be a powerful weapon to limit or deny custody and/or visitation in a vindictive manner.

Although a strong visceral reaction to an abuse allegation is expected, it can be counterproductive. Similarly, a rushed response can make the situation worse. In contrast, a wait-and-see attitude leaves the door open for a thorough evaluation before a disposition is decided upon.

To be clear: False allegations of abuse are a form of parental alienation. Alienation involves the concerted effort of one parent to undermine the other parent’s relationship with their child. Nothing could be worse than a custody decision that is based on a false allegation. To make matters worse, once a custody decision has been issued, modification of it is burdensome and an uphill challenge.

The clinical evaluation is an important part of proceedings in which allegations have been made. A successful case requires coordinated efforts among the judge, attorneys, and a court-appointed evaluator, who is often a psychiatrist or clinical psychologist.

The approach outlined in this article is based on years of experience with hundreds of cases of abuse allegations, and it consists of sequential steps. The evaluation process is aimed at determining if an allegation of abuse has occurred or not—in other words, whether the allegation has been fabricated by a parent with the intent of sabotaging and harming the other parent.

For obvious reasons, the evaluation must include both parents and the child to understand the entire narrative. All 3 individuals—the accused parent, the accusing parent, and the child—must be a part of the evaluation process. After all, we want our conclusions and recommendations to be based on full and accurate information.

The accused parent is often advised by their attorney not to participate in the evaluation process. This is ill-conceived advice. By doing so, the mental health professional evaluator will be deprived of critical information that can shine a light on the falsity of the claim. Otherwise, all the information will be coming from the accusing parent, whose allegation will hold greater weight if it is not disputed.

It is always a good idea for the child in such a case to be seen for an independent forensic evaluation. This would be in addition to the child’s involvement with the court-appointed evaluator.

If this is the first allegation of abuse, and it occurs during a child custody case, its validity must be questioned. In fact, there is a significant probability that the allegation is false, as it is unlikely that a parent’s first abuse of the child occurs after the child custody case has been initiated. Thus, if a parent does not have a history of abusing the child, it is not likely that the first abuse is occurring during the legal proceeding.

A series of allegations against a parent during a child custody proceeding is also a major red flag. An accusing parent often believes that multiple allegations against the other parent are more convincing to a judge than a single allegation. However, repeated abuse of a child during a circumscribed time period—during a child custody case, for example—is quite improbable.

Detecting a false allegation is easier with the use of a timeline. Marking the major occurrences in a child custody case can show the specific sequence of events. A false allegation of abuse may occur during the custody case, and not before. It may also occur in response to legal action taken by the other parent. For example, if a mother files for full custody of her child, this sets the stage for the father to report a false allegation of abuse against the mother with the hopes that the allegation will derail the mother’s quest. The motive of the false allegation can be detected by examining its place on the timeline of events.

False allegations of abuse often include unwitting help from the children. Children aged between 3 and 7 years can be easily coached by a parent to testify against the other. Because most children want to please their primary parent, they are easily swayed, cajoled, convinced, and brainwashed. It is difficult for children to know the truth once a parent has coached them extensively. False allegations can involve older children and teenagers as well, but their coaching is more easily transparent and adolescents may even admit to it.

There are 5 common beliefs that motivate a parent to lodge a false allegation of abuse against the other parent (

). If any of these beliefs are discovered, the allegation of abuse is likely false. Detecting these beliefs in a parent requires careful interviews over several sessions. A parent will never admit to fabricating a false allegation. The clinician must be skilled to see through the defensiveness, deceitfulness, and/or distractions of an offending parent.

Harmful and false beliefs by the accusing parent can also be detected through interviews with the child and the accused parent. Usually, the child or the accused parent will provide critical clues as to the accusing parent’s belief system. Bits and pieces of information will fit together into a detailed narrative that exposes the falseness of the allegation at hand. Remember, the accusing parent generally does not recant nor apologize for their attempts at relationship interference.

Once an allegation of abuse has been declared by a parent, there is a process that should ensue.

First, the judge should appoint a psychiatrist or clinical psychologist to evaluate the child and both parents. This evaluation must include interviews, psychological testing, and a review of collateral data (eg, emails, texts, recordings, pictures, etc). The evaluator should have access to other independent assessments of the allegation, such as Department of Human Resources investigations or a forensic evaluation of the child.

The psychiatrist or clinical psychologist must be experienced in child custody evaluations. Similarly, there should be a wait-and-see attitude about the allegation until the evaluation process has been fully completed. In other words, no assumptions or decisions should be considered until all the facts and information have been collected and assessed. The evaluation by the mental health professional should be aimed at determining the validity of the stated allegation of abuse.

During this time, attorneys should not respond to an allegation of abuse by filing motions for dramatic or extreme action, such as obtaining full custody of the child. However, granting a parent temporary custody until the matter is settled may make sense, especially if the child’s physical safety is of acute concern. Similarly, the attorneys must not try to sabotage the evaluator in order to win their case. The evaluator’s conclusions and recommendations should be given strong weight in the judge’s final decision.

A false allegation of abuse by a parent should be met with firm consequences, such as a fine, supervised parenting time, court-ordered counseling, and/or loss of primary custody. Swift and decisive consequences will dissuade future false allegations of abuse.

The accusing parent may not be appropriate for primary custody. Even shared custody may not be appropriate. A parent’s willingness to fabricate an allegation of abuse against the other parent is a poor prognostic indicator. It is not simply an accident or a mistake. A false allegation is an intentional and purposeful attempt to undermine the child custody proceeding.

Similarly, the false allegation has implications for the future well-being of the child, and a false allegation should be considered a form of parental alienation. This experience, especially if they are asked to take an active role in the allegation, teaches the child to be dishonest, deceitful, manipulative, conflictual, and blaming. Furthermore, the love the child should have for both parents is compromised and potentially destroyed.

A false allegation of abuse is serious, and it must not be tolerated in the court system. Based on the consequences, a false allegation represents a psychiatric emergency. As such, it must be handled and dealt with in a direct and timely manner. A child’s mental health and well-being depend upon it.

is a licensed clinical psychologist in private practice in Birmingham, Alabama. His forensic practice focuses on child custody and alienation cases. He is also a clinical associate professor in the Department of Psychology at the University of Alabama at Birmingham.

False allegations of abuse during a custody battle can seriously harm children. Here's how psychiatrists can separate fact from fiction. 

Child Abuse Allegations: Sorting Out Lies Versus Truths

As with any cutting-edge innovation, digital therapeutics (DTx) have their detractors. This is particularly evident when concerned doctors focus upon 

, such as trauma, in which DTx “might not be able to replace face-to-face therapy.”

 What practical considerations arise when the results of DTx interventions are interpreted in forensic as opposed to other medical settings? Using DTx can have variable results, as we will illustrate in 2 vignettes, both of which are composites of actual legal matters involving DTx. Regardless of the outcome of any individual case, it is important to consider how DTx can help physicians make clinical decisions and improve patient care.

Barriers to Treating Psychiatric Disorders in Forensic Settings

Forensic settings can be free-standing, secure medical facilities, or they can be correctional settings in which individuals accused of criminal offenses are housed while awaiting trial. These patients are being assessed for competency to stand trial, criminal responsibility, or other legally relevant issues. They may be receiving psychiatric treatment in order to become competent, or perhaps they are being retained in a forensic setting so they remain competent and legal proceedings will not be delayed any further.

Individuals who have already been convicted may be retained in forensic settings as well. These services are typically delivered in jail and prison environments, and sometimes draw upon the same resources as those used for pretrial assessment. Patient care may focus upon such issues as serious mental illness, anger management, sexual offender recidivism, and societal reintegration. Forensic services can also be rendered subsequent to release in the context of mental health courts, drug courts, and outpatient commitment.

Serious mental illness is significantly overrepresented in jail and prison populations. A recent 

 of reviews on this topic identified, for example, notably high prevalence rates for psychotic disorders (males, 4%; females, 4%), major depression (males, 10%; females, 14%), alcohol misuse (males, 18-30%; females, 10-24%), and drug misuse (males, 10-48%; females, 30-60%).

of jail and prison treatment practices conducted by the Treatment Advocacy Center concluded that

How can digital therapeutics overcome barriers to psychiatric treatment in forensic settings? 

Forensic Psychiatry