Ira Turkat AAML

The following article is reproduced under the fair use exemptions for educational, scholarship and research purposes pursuant to 17 U.S.C. 107.

From the Journal of the American Academy of Matrimonial Lawyers:

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Parental Alienation Syndrome

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Parental Alienation Syndrome:

A Review of Critical Issues

Ira Turkat*

I. Introduction

Attorneys who litigate child custody cases are accustomed to

hearing clients charge that their children are being turned against

them by the other parent. 1 Allegations of this sort elicit a com-

plex array of questions, consequences, and emotions. The most

important consideration in these circumstances is that when an

allegation of this kind is raised it does not bode well for the chil-

dren involved. 2

If the allegation of manipulation against the other parent is

false, then one parent seriously misinterprets certain familial be-

havior or is lying about the actions of the other parent. Neither

exemplifies the kind of role modeling to which children should

be exposed.

* Dr. Turkat is a psychologist in Venice, Florida, and is Courtesy Clinical

Associate Professor in the Department of Psychiatry at the University of Flor-

ida College of Medicine.

See Stanley S. Clawar & Brynne V. Rivlin, Children Held Hostage:

Dealing with Programmed and Brainwashed Children (1991); Kenneth Byrne,

Brainwashing in Custody Cases: The Parental Alienation Syndrome , 4 A USTL .

F AM . L. 1 (1989); Michael R. Walsh & J. Michael Bone, Parental Alienation

Syndrome: An Age-Old Custody Problem , 71 F LA . B.J. 93 (1997).

At a minimum, this indicates the existence of significant conflict be-

tween the parents, and there is ample scientific evidence that interparental con-

flict can be harmful to the children involved. Paul Amato & Alan Booth, The

Legacy of Parents’ Marital Discord: Consequences for Children’s Marital Qual-

ity , 81 J. P ERS . S OC . P SYCHOL . 627 (2001); Paul Amato & Bruce Keith, Parental

Divorce and the Well-Being of Children: A Meta-Analysis , 110 P SYCHOL . B ULL .

26 (1991); Katherine M. Kitzmann & Robert E. Emery, Child and Family Cop-

ing One Year After Mediated and Litigated Child Custody Disputes , 8 J. F AM .

P SYCHOL . 150 (1994); Anita K. Lampel, Children’s Alignment With Parents in

Highly Conflicted Custody Cases , 34 F AM . & C ONCILIATION . C TS . R EV . 229

(1996).

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132 Journal of the American Academy of Matrimonial Lawyers

When the allegation of alienation is true and deserved , 3 then

one parent has behaved in a way that hurts the children; if proper

warnings are not given, these minors would be inadequately pro-

tected. An example of a parent deserving alienation would be

one with a repeated history of physically abusing his or her chil-

dren in an unpredictable manner that has failed to respond ap-

propriately to numerous professional attempts to control the

destructive behaviors.

If the allegation that one parent is turning the children

against the other parent is true but the alienation is unjustified,

this too is harmful to the children. It is this special category of

abuse 4 that will be the focus of the present paper.

In light of the seriousness of unjustly turning a child against

his or her own parent, it is appropriate for the judiciary to look to

mental health professions for guidance. Unfortunately, for many

years the problem of unjust alienation received inadequate atten-

tion in the psychological literature. 5 This began to change in

1985 when the American Academy of Psychoanalysis published

an article by Dr. Richard Gardner, a psychiatrist from Columbia

University, who identified an abnormality termed Parental Alien-

ation Syndrome , defined as follows:

The parental alienation syndrome (PAS) is a disorder that arises pri-

marily in the context of child-custody disputes. Its primary manifesta-

tion is the child’s campaign of denigration against the parent, a

campaign that has no justification. The disorder results from the com-

bination of indoctrinations by the alienating parent and the child’s

own contributions to the vilification of the alienated parent. 6

Over the years, this description has given rise to a literature

consisting of over 100 professional articles and books on PAS

Naturally, there may be debate about what qualifies as deserved , but

for the purpose of this manuscript, the author is referring to harmful behaviors

that all observers would agree on categorizing as deserved .

See Richard A. Gardner, Differentiating Between the Parental Aliena-

tion Syndrome and Bona Fide Abuse-Neglect , 27 A M . J. F AM . T HERAPY 97

(1999).

See Ira Daniel Turkat, Child Visitation Interference in Divorce , 14

C LINICAL P SYCHOL . R EV . 737 (1994).

See Richard A. Gardner, Recent Trends in Divorce and Custody Litiga-

tion , 29 A CAD . F. 3 (1985).

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that offers clinical characterizations, theoretical formulations,

and considerable controversy. 7

The present article will analyze some of the key features of

this literature. 8 To begin, the author will lay a foundation for

understanding PAS by reviewing its definitional criteria, its pos-

tulated pathogenesis, and its subtypes. Next, PAS’ placement in

psychiatric classification, including its relationship to official di-

agnostic categories of psychopathology, will be delineated. The

article then reviews the state of the research literature on PAS.

In particular, specific indicators for evaluating the progress of

any clinical field of science will be provided and then applied to

the psychological literature on PAS. This evaluation will reveal

strengths and weaknesses in the current PAS literature. Specific

obstacles to performing scientific investigations of PAS will be

identified and suggestions for improving the sophistication of the

literature will be presented. Finally, recommendations for judges

managing PAS cases will be offered, and several problems that

confront the judiciary and trial attorneys when dealing with PAS

cases will be discussed. Various deficiencies that mental health

professionals bring to this controversial area will be identified as

well.

II. Parental Alienation Syndrome

In a nutshell, PAS occurs when one parent campaigns suc-

cessfully to manipulate his or her children to despise the other

parent despite the absence of legitimate reasons for the children

to harbor such animosity. The effort to poison the relationship 9

between the offspring and the targeted parent may be extensive

and at times, relentless. The hostility may include “hints” of sex-

See Richard A. Gardner, Parental Alienation Syndrome: Sixteen Years

Later , 45 A CAD . F. 10 (2001).

A comprehensive review of the literature on Parental Alienation Syn-

drome is beyond the scope of the present manuscript. See , e.g ., Deirdre Con-

way Rand, The Spectrum of Parental Alienation Syndrome (Part I) , 15 A M . J.

F ORENSIC P SYCHOL . 23 (1997); Deirdre Conway Rand, The Spectrum of Paren-

tal Alienation Syndrome (Part II) , 15 A M . J. F ORENSIC P SYCHOL . 39 (1997).

See Ira Daniel Turkat, Relationship Poisoning in Custody and Access

Disputes , 13 A M . J. F AM . L. 101 (1999).

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134 Journal of the American Academy of Matrimonial Lawyers

ual impropriety 10 and in some cases, false allegations 11 of physi-

cal and/or sexual abuse. 12 Bad faith relocation attempts may

surface as well. 13

According to Gardner, 14 the disorder appears most often in

the context of child custody litigation but it is certainly not re-

stricted to this population. 15 Gardner has articulated eight spe-

cific criteria for the diagnosis of PAS. 16

A. Campaign of Denigration

The parent targeted for alienation from his or her children is

the recipient of ongoing animosity from both the parent institut-

ing the alienation and their mutual offspring. The message of

denigration may come in the form of direct and indirect criti-

cisms, sarcasm, distorted communications, and/or other modes of

interpersonal attack. 17

B. Inadequate Rationale for the Denigration

When queried, the manipulated children offer weak, frivo-

lous, or even absurd rationalizations for their hatred of the

targeted parent. 18 This may be associated with visitation refusal,

whereby the minors claim experiencing negative emotional reac-

tions to the alienated parent that are of questionable validity. 19

See Glenn F. Cartwright, Expanding the Parameters of Parental Aliena-

tion Syndrome , 21 A M . J. F AM . T HERAPY 205 (1993).

See Kenneth H. Waldron & David E. Joanis, Understanding and Col-

laboratively Treating Parental Alienation Syndrome , 10 A M . J. F AM . L. 121

(1996).

While allegations of sexual abuse and/or physical abuse arise in certain

PAS cases, a review is beyond the scope of the present manuscript.

See Ira Daniel Turkat, Relocation as a Strategy to Interfere with the

Child-Parent Relationship , 11 A M . J. F AM . L. 39 (1996).

See Gardner, supra note 4.

See Rand, supra note 8.

These criteria have not changed from their original description in 1985

( See Gardner, supra note 6) through current articulations of the disorder by its

originator ( See Gardner, supra note 7).

See Ira Daniel Turkat, Management of Visitation Interference , 36

J UDGES J. 17 (1997).

See Richard A. Gardner, The Parental Alienation Syndrome: A Guide

for Mental Health and Legal Professionals (1992).

See Leona M. Kopetski, Identifying Cases of Parental Alienation Syn-

drome—Part 1 , 27 C OLO . L AW . 61 (1998).

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C. Absence of Ambivalent Feelings

In normal interpersonal relationships it is appropriate to ex-

perience both positive and negative reactions to others. 20 This is

particularly apparent in close relationships. For example, parents

who love their teen-aged daughter may still harbor anger at her

selective temper outbursts. They may adore their little boy, but

cringe at the way he chooses to dress himself. In PAS, the evalu-

ation of the targeted parent lacks appropriate balance. The

alienated parent is seen as “all bad.” 21

D. “Independent” Thinking

A child that is alienated unjustly against a parent is sup-

ported by the alienating parent to claim that the antagonism is a

reflection of the minor’s independent judgment and not due to

the campaign of the alienator. 22 However, this “independent

thinker” 23 may use the exact same verbiage of attack utilized by

the alienating parent. 24

E. Reflexive Support of the Alienating Parent

The child manipulated inexcusably to despise the other par-

ent aligns unconditionally with the parent instituting the aliena-

tion campaign. 25 Gardner compares this alignment to the

“identification-with-the-aggressor-phenomenon,” a maneuver

based on the principle: “If you can’t fight ‘em, join ‘em.” 26

F. Absence of Guilt

Children exploited to unfairly denigrate the targeted parent

fail to display appropriate feelings of guilt about their antagonis-

tic behavior. 27 The alienated parent’s feelings are generally ig-

Drew Westen, The Scientific Legacy of Sigmund Freud: Toward a Psy-

chodynamically Informed Psychological Science , 124 P SYCHOL . B ULL . 333

(1998).

Cartwright, supra note 10.

See Gardner, supra note 18.

Id .

See Cartwright, supra note 10.

See id .

Richard A. Gardner, The Empowerment of Children in the Develop-

ment of Parental Alienation Syndrome , 20 A M . J. F ORENSIC P SYCHOL . 5 (2002).

See G ARDNER , supra note 18.

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nored. The affection, gifts, and/or child support provided by the

targeted parent are often disregarded as well. 28

G. Scenarios Are Borrowed from the Alienator

The child utilizes the alienating parent’s stories and explana-

tions to articulate what is wrong with the targeted parent and as a

rationale for despising the alienated parent. 29 These “borrowed

scenarios” may include topics and words that are way beyond the

conceptual level of functioning and/or knowledge base appropri-

ate to a child of that age (e.g., a five year old complaining that

the alienated parent is “in arrears”). As one expert has ob-

served, “these children express themselves like perfect little pho-

tocopies of the alienating parent.” 30

H. Animosity Is Spread to Others Associated with the Targeted

Parent

The campaign to alienate the victimized parent may extend

to his or her friends, relatives, and others. 31 Like the targeted

parent, these individuals may also be viewed with unwarranted

hostility and treated with contempt. 32

As can be seen in the criteria listed above, PAS is a disorder

involving the active participation of the parent and the child. 33

Gardner has emphasized that while the disorder stems from the

manipulative actions of one parent against another, the contribu-

tions of the child in adopting and carrying out the alienating par-

ent’s campaign are critical to the pathogenesis of PAS. 34

See Richard A. Gardner, Judges Interviewing Children in Custody/Visi-

tation Litigation , 7 N.J. F AM . L. 26 (1985).

See Cartwright, supra note 10.

Cartwright, supra note 10, at 205.

See G ARDNER , supra note 18.

See id.

Richard A. Gardner, The Detrimental Effects on Women of the Gender

Egalitarianism of Child-Custody Dispute Resolution Guidelines , 38 A CAD . F. 10

(1994).

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III. Development of Parental Alienation

Syndrome

Given that PAS develops primarily during a custody battle, 35

it is important to understand how this disorder unfolds. 36 Gard-

ner addresses the pathogenesis of PAS — a process in which one

parent utilizes direct and indirect methods to produce a child

preoccupied with unjustified criticism and hatred of the other

parent. 37 He outlines four primary factors that lead to the un-

folding of Parental Alienation Syndrome: brainwashing, subtle

and unconscious parental programming, factors arising within the

child, and situational factors.

A. Brainwashing

Gardner considers brainwashing to be “conscious acts of

programming the child against the other parent.” 38 For example,

a parent may be accused unfairly of being an “adulterer” or an

“abandoner.” Or, a parent may be accused unjustifiably of pro-

viding inadequate financial support, which may be exaggerated

to mislead the children to believe that terrible things are likely to

happen to them. As another example, when one parent leaves

the other parent, the remaining parent may make erroneous

statements to the children such as, “ we have been abandoned.” 39

The aim of such statements is to convey to the children that the

rejection directed at the remaining parent applies also to the chil-

dren. In addition, minor negative characteristics of the targeted

parent may be significantly exaggerated. For example, a parent

who has an occasional evening martini may be described as an

alcoholic. Sarcastic remarks to the children about the targeted

parent’s behavior are also common, such as, “what a wonderful

generous gesture to actually spend a few dollars and take you to

the movies for a change!”

See Gardner, supra note 4.

The ultimate goal of clinical psychology and psychiatry is to prevent

psychological disorders from occurring in the first place. Understanding the

etiology of an abnormality is necessary if one wishes to be able to prevent its

occurrence.

Richard A. Gardner, Family Evaluation In Child Custody Mediations ,

Arbitration And Litigation (1989).

Id. at 233.

Id .

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B. Subtle and Unconscious Parental Programming

More subtle efforts to program the child against the targeted

parent may include statements about him or her such as, “there

are things I could say about your father (mother) that would

make your hair stand on end, but [I am] not the kind of person

who criticizes a parent to his (her) children.” 40 Clearly, com-

ments of this kind have the potential to generate significant nega-

tive emotion in the child.

Visitation with the targeted parent is often sabotaged with

subtle PAS programming. For example, a child in a PAS environ-

ment becomes attuned to the alienating parent’s desire for the

child to despise the other parent. 41 To secure acceptance, the

child may make statements that suggest an uncertainty about vis-

iting with the targeted parent or a lack of desire to do so; the

alienator may then act in a “neutral” manner by instructing the

child to believe that it is the child’s decision whether or not to

visit with the other parent. This “neutrality maneuver” 42 serves

to further alienate the targeted parent by “passively” discourag-

ing the child from participating in visitation. Under these cir-

cumstances, the child is likely to learn quickly to avoid open

expressions of interest in visiting the “hated” parent.

Another common manipulation is to make the child feel

guilty about visiting with the other parent. At times, the child

might face proclamations like, “how can you leave your poor old

mother (father) !” 43

C. Factors Arising Within the Child

According to Gardner, certain factors arise within the child

that may contribute to the development of PAS. 44 For example,

Gardner points out that the child’s psychological bond with the

custodial parent before the divorce is often stronger than that

with the non-custodial parent. 45 When the parents separate, the

child may fear potential abandonment by the custodial parent,

Id.

See G ARDNER , supra note 18.

See G ARDNER , supra note 37.

Id. at 233.

See id.

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139

and thus be more susceptible to aligning with the custodial par-

ent in the effort of alienation.

Gardner also articulates a variety of psychodynamic hypoth-

eses about what may be occurring unconsciously in the child that

contribute to the genesis of PAS; 46 a review is beyond the scope

of the present article.

D. Situational Factors

In addition to brainwashing, subtle and unconscious pro-

gramming, and internal child psychodynamics, Gardner points

out a variety of situational factors that may also facilitate the de-

velopment of PAS. 47 For example, a child who observes a sibling

being punished for openly displaying affection towards the vili-

fied parent will learn quickly not to display such affection either.

Similarly, a child who observes the alienating parent verbally

abuse the targeted parent may self-protectively declare emo-

tional preference for the alienating parent. When these psycho-

logical factors are considered as ongoing, interacting variables in

the daily lives of a child and an alienating parent, it becomes eas-

ier to grasp how a PAS may develop. 48

IV. Types of Parental Alienation Syndrome

With years of experience dealing with cases of PAS since its

original specification, 49 Gardner has come to conclude that the

disorder has different subtypes. 50 These include the mild , moder-

ate , and severe forms of PAS. Each requires consideration ac-

cording to the eight specific criteria for diagnosing PAS, 51 and

are presented in Table 1.

See id.

See Cartwright, supra note 10.

See Gardner, supra note 6.

Richard A. Gardner, Legal and Psychotherapeutic Approaches to the

Three Types of Parental Alienation Syndrome Families: When Psychiatry and the

Law Join Forces , 28 C T . R EV . 14 (1991); Richard A. Gardner, Family Therapy of

the Moderate Type of Parental Alienation Syndrome , 27 A M . J. F AM . T HERAPY

195 (1999).

See id.

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TABLE 1

Gardner’s Differential Diagnosis of the Three

Types of Parental Alienation Syndrome

Primary Symptomatic

Mild

Moderate

Severe

Manifestation

Campaign of

Minimal

Moderate

Formidable

denigration

Weak frivolous, or

Minimal

Moderate

Multiple absurd

absurd rationalizations

rationalizations

for the deprecation

Lack of ambivalence

Normal

No ambivalence

ambivalence

Independent-thinker

Usually absent

Present

phenomenon

Reflexive support of

Minimal

Present

the alienating parent in

the parental conflict

Absence of guilt

Normal guilt

Minimal to no

No guilt

guilt

Borrowed scenarios

Minimal

Present

Spread of the

Minimal

Present

Formidable,

animosity to the

often fanatic

extended family of the

hated parent

Transitional difficulties

Usually absent

Moderate

Formidable, or

at the time of visitation

visit not possible

Behavior during

Good

Intermittently

No visit, or

visitation

antagonistic

destructive and

and

continually

provocative

behavior

Bonding with the

Strong, healthy

Strong, mildly

Severely

alienator

to moderately

pathological,

pathological

often paranoid

bonding

Bonding with the

Strong, healthy, Strong,

Strong, healthy,

alienated parent

or minimally

healthy, or

or minimally

pathological

minimally

pathological

Parental Alienation Syndrome , by Richard A. Gardner in A MERI-

CAN J OURNAL OF F AMILY T HERAPY . Reproduced by permission

of Taylor & Francis, Inc., http://www.routledge-ny.com

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As can be seen in Table 1, Gardner has provided a compari-

son between the three versions of PAS on the eight criteria listed

above and on a handful of other behavioral indicators (e.g., tran-

sitional difficulties at the time of visitation). Further, Gardner

has advocated different therapeutic approaches based on the

type of PAS encountered. 52

One of the major benefits of specifying three versions of

PAS is that the dimensionality of abnormality is recognized. In

other words, the severity of a particular case of PAS can be

viewed on a continuum and the implication is that such a differ-

entiation offers the potential for a more sophisticated under-

standing of the presenting aberrant behavior. In Table 1,

Gardner illustrates this by pointing out differences in the nature

of the psychopathology seen in the different PAS subtypes (e.g.,

the campaign of denigration is minimal in the mild type yet for-

midable in the severe type) and consequently, differential recom-

mendations for management are advocated (e.g., Gardner

suggests that only in severe PAS cases should a change in custody

be considered). 53

Unfortunately, Gardner’s specification of the three PAS

types also creates certain problems. Researchers have noted the

absence of a clear specification of how many of the eight PAS

symptoms are required to make a PAS diagnosis. 54 It is also un-

clear as to which of the eight criteria must be present to diagnose

PAS. 55 If one examines the criteria listed in Table 1, it appears

that the mild case of PAS does not require the presence of a con-

siderable number of the eight symptoms listed for diagnosis, and

other symptoms only need to be minimally present. With such

flexibility in the diagnostic process, the room for professional dis-

agreement increases. 56

See Gardner, supra note 50 (discussing the therapeutic approaches rec-

ommended by Gardner for the three types of PAS).

Id.

See K. Daniel O’Leary & Kirstin C. Moerk, Divorce , Children and the

Courts: Evaluating the Use of the Parent Alienation Syndrome in Custody Dis-

putes , 7 E XPERT E VIDENCE 127 (1999).

See Richard A. Warshak, Current Controversies Regarding Parental

Alienation Syndrome , 19 AM. J. F ORENSIC P SYCHOL . 29 (2001).

See J. Michael Bone & Michael R. Walsh, Parental Alienation Syn-

drome: How to Detect It and What to Do About It , 73 F LA . B.J. 44 (1999).

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An additional consideration is that there appears to be diag-

nostic overlap across the three subtypes. Table 1 indicates that

the criterion involving reflexive support of the alienating parent

is “minimal” in the mild type and “present” in the moderate and

severe types. 57 Since “minimal” indicates that the behavior is

present, Gardner’s description here does not optimally segregate

the three subtypes. The literature establishes that diagnostic

overlap can pose significant problems 58 when trying to differenti-

ate psychiatric entities, and when investigating relationships be-

tween pertinent variables. 59 In brief, while Gardner offered the

three types of PAS to facilitate diagnostic and therapeutic consid-

erations, 60 he may have inadvertently created other problems.

V. Parental Alienation Versus Parental

Alienation Syndrome

Science does not proceed without a useful classification sys-

tem. 61 Taxonomies permit scientists to communicate clearly

about the phenomena they investigate. 62 Differentiating one

phenomenon from another is integral to advancing scientific

knowledge. 63 In the mental health professions, phenomena are

distinguished from one another using the classification system

known as psychiatric diagnosis. 64 Failure to adequately differen-

tiate between distinct psychiatric entities inhibits the growth of

See Gardner, supra note 50.

See Thomas A. Widiger & Tracie Shea, Differentiation of Axis I and II

Disorders , 100 J. A BNORMAL P SYCHOL . 399 (1991).

The problem of diagnostic overlap is not unique to PAS, and in some

cases, diagnostic overlap may be appropriate. For example, a person with aller-

gies may present with sneezing as a symptom; so may an individual suffering

from a cold.

See Gardner, supra note 50.

See K ENNETH D. B AILEY , T YPOLOGIES AND T AXONOMIES : A N I NTRO-

DUCTION TO C LASSIFICATION T ECHNIQUES (1994).

See id.

See Ira Daniel Turkat & Stephen A. Maisto, Functions of and Differ-

ences Between Psychiatric Diagnosis and Case Formulation , 6 B EHAV . T HERA-

PIST 184 (1983).

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knowledge of mental disorders at the scientific level 65 and com-

petent service provision at the clinical level. 66

A. PAS as a Subset of Parental Alienation

Gardner considers the classification of PAS to be a subset of

the broader rubric of Parental Alienation (PA). 67 According to

Gardner, PA refers to a child who has been alienated from a par-

ent, whether it is justified or not. 68 Examples include alienation

due to parental abandonment, aversive interpersonal qualities of

a parent (e.g., alcoholism), parental verbal abuse, and PAS.

Gardner believes that a wide variety of symptoms may be seen in

PA, whereas in PAS one should see behaviors indicative of the

eight criteria previously described. Given Gardner’s conceptual-

ization that PAS is but one example of PA, and that other exam-

ples of PA (e.g., alienating a child from a sexually abusive parent)

may be incompatible with the definition of PAS (which requires

the alienation to be unjustified), it seems appropriate to follow

Gardner’s recommendation 69 that professionals not use the

terms PA and PAS interchangeably.

B. Classificatory Issues Involving the Mild Version of PAS

The nosologic differentiation between alienation entities be-

comes a bit more cumbersome when one considers Gardner’s

description of the three PAS subtypes. 70 If in the mild version, a

PAS diagnosis can be made with a considerable number of PAS

criteria not being met, does it become problematic to call it a

See W. John Livesley, Marsha L. Schroeder, Douglas N. Jackson &

Kerry L. Jang, Categorical Distinctions in the Study of Personality Disorder Im-

plications for Classification , 103 J. A BNORMAL P SYCHOL . 6 (1994).

See , e.g. , Carole Jenny, Kent P. Hymel, Alene Ritzen, Steven E. Rei-

nert, & Thomas C. Hay, Analysis of Missed Cases of Abusive Head Trauma , 281

JAMA 621 (1999); Gerhard Jordan & Dan J. Stein, Mental Disorders Due to a

General Medical Condition , 41 P SYCHOSOMATICS 370 (2000).

Richard A. Gardner, Parental Alienation Syndrome vs. Parental Aliena-

tion: Which Diagnosis Should Evaluators Use in Child-Custody Disputes? 30

A M . J. F AM . T HERAPY 93 (2002).

Id.

Gardner, supra note 50.

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case of PAS? 71 If so, what should it be called? Furthermore,

Gardner reports that mild cases of PAS usually do not require

psychiatric intervention. 72 If true, is a “mild” case of PAS actu-

ally representing a disorder requiring a psychiatric diagnosis?

Other psychopathological conditions may shed some light

on the subject. For example, the scheme of personality disorders

— one of the most common psychiatric diagnoses, 73 recognizes

normal personality types and abnormal personality types. 74 One

can, for example, distinguish between a “normal” paranoid per-

sonality and a paranoid personality disorder. 75 A normal individ-

ual

may

demonstrate

paranoid

personality

traits

suspiciousness and distrust; however, it is only when these traits

are enduring and cause significant problems on an ongoing basis,

are they likely to be representative of a personality disorder. 76

Does such a distinction seem useful for understanding the dimen-

sionality of PAS? Like the personality disorders, does PAS lie on

a continuum of normal to abnormal? Does a mild case of PAS

seem directly analogous to the non-disorder paranoid

personality?

Using the paranoid personality versus paranoid personality

disorder distinction as an example, if one chooses to call a mild

case of PAS “PA” instead of calling it “PAS,” that would prove

problematic since PAS is considered to be a subset of PA. 77

Given that PA includes both justified and unjustified alienation,

calling a mild PAS case “PA” would not communicate if the

Not all psychiatric diagnostic categories require that every symptom be

present to make a diagnosis; Gardner should not be held to a higher standard.

However, when introducing a new disorder, there is less room for diagnostic

uncertainty if the number of criteria that must be met is specified clearly.

Richard A. Gardner, Recommendations for Dealing with Parents Who

Induce a Parental Alienation Syndrome in Their Children , 28 J. D IVORCE &

R EMARRIAGE 1 (1998).

Michael R. Leibowitz, Michael H. Stone & Ira Daniel Turkat, Treat-

ment of Personality Disorders , 5 A M . P SYCHIATRIC A SS ’ N A NNUAL R EV . 356

(1986).

See D IFFERENTIATING N ORMAL AND A BNORMAL P ERSONALITY (Ste-

phen Strack & Maurice Lorr eds., 1994).

See Ira Daniel Turkat & David Banks, Paranoid Personality and Its Dis-

order , 9 J. P SYCHOPATHOLOGY B EHAV . 295 (1987).

See I RA D ANIEL T URKAT , T HE P ERSONALITY D ISORDERS : A P SYCHO-

LOGICAL A PPROACH TO C LINICAL M ANAGEMENT (1990).

See Gardner, supra note 67.

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alienation was deserved or unjustified. This is a critical point be-

cause PAS, by definition, means that the alienation is

unjustified. 78

Carrying the paranoid personality versus paranoid personal-

ity disorder example a step further, a more serious problem with

calling a mild case of PAS “PA” is that turning a child unjustifi-

ably against a parent is not normal. 79 Even in the mild version of

PAS, the child is taught unjustifiably to disrespect and act out

against the targeted parent; 80 behavior of this kind is certainly

abnormal.

As long as unjustified alienation is the hallmark of PAS, a

normal version is unlikely to emerge because unjustified aliena-

tion is not normal. Relatedly, even the mild version of PAS rep-

resents abusive behavior.

C. PA and PAS Relationship Configurations

Since the term PA can be misused (and has been 81 ) to imply

a “normal” version of PAS (like the paranoid personality is to

the paranoid personality disorder) or a “less worrisome” version,

misapplication may be reduced if PA and PAS are viewed as dis-

tinct entities and not as a subset of the other. This, of course,

would require a shift in Gardner’s current view that PAS is a sub-

set of PA; however, it might facilitate his goal of not having these

terms used interchangeably. Perhaps a larger subset of “prob-

lematic interparental behaviors” could encompass categories

such as PA, PAS, and other related phenomena such as Divorce

Related Malicious Parent Syndrome, 82 domestic violence, 83 and

Shared Parenting Dysfunction. 84 O’Leary and Moerk suggest

that PAS could be viewed as a subset of emotionally abusive be-

haviors; 85 PA could thus be placed in a different categorization.

See Gardner, supra note 6.

See Warshak, supra note 55.

See Gardner, supra note 67.

See id.

See Ira Daniel Turkat, Divorce Related Malicious Parent Syndrome , 14

J. F AM . V IOLENCE 95 (1999).

See Lenore E. Walker, Psychology and Domestic Violence Around the

World , 54 A M . P SYCHOL . 21 (1999).

See Ira Daniel Turkat, Shared Parenting Dysfunction , 30 A M . J. F AM .

T HERAPY 385 (2002).

O’Leary, supra note 54.

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Another possible viewpoint on the dimensionality issue is to

consider PA and PAS on a continuum, where one end of the pole

represents appropriate alienation (e.g., a parent warns a child

about the other parent that has sexually abused the child) and

inappropriate alienation (e.g., PAS). Or, justified alienation and

unjustified alienation might serve as functional anchors on such a

continuum. While potentially useful conceptually, endpoints of

this kind would still require some accommodation regarding: (1)

PA as a broader rubric, and (2) the fact that PAS is never normal.

At a minimum, a clear specification of what the threshold is to

differentiate justified from unjustified alienation (or appropriate

from inappropriate alienation) would be essential.

D. Diagnostic Convenience

A final point to be raised is a practical one: humans natu-

rally use shortcuts when they can. Thus, when discussing a case

of PAS, it is not surprising that some would use the term “Paren-

tal Alienation” in lieu of the formal “Parental Alienation Syn-

drome.” The misuse of diagnostic terms is not unique to PAS.

For example, not too long ago, the label “borderline” was used

inappropriately so frequently in the field of mental heath that the

term seemed to represent a “wastebasket” diagnosis. 86 Reckless

use of the word “borderline” made it difficult to know if one was

referring to a personality disorder, a psychosis, a mood disorder,

a degree of psychopathology or some other entity, such as a

“heterogenic hodgepodge.” 87 Misuse of diagnostic terms creates

chaos among psychiatric researchers and clinicians. 88

Whether one is talking about Borderline Personality Disor-

der or PAS, a shortcut is not an adequate excuse for diagnostic

sloppiness by a mental health professional. A clinician should

not use the label PA when diagnosing a potential case of PAS.

However, it may be unrealistic for psychologists and psychiatrists

See I RA D ANIEL T URKAT & R OBERT A. L EVIN , F ORMULATION OF P ER-

SONALITY D ISORDERS , C OMPREHENSIVE H ANDBOOK OF P SYCHOPATHOLOGY

495 (Henry E. Adams & Patricia B. Sutker eds., 1984).

Thomas A. Widiger, Allen Frances, Robert L. Spitzer, & Janet B.W.

Williams, The DSM-IIIR Personality Disorders: An Overview , 144 A M . J. P SY-

CHIATRY 786 (1988).

See T URKAT & L EVIN , supra note 86.

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to expect professionals that do not provide mental health ser-

vices to be as rigid about the diagnostic distinctions.

In light of the above, Gardner’s articulation of a mild, mod-

erate, and severe form of PAS is useful, and his admonition

about not interchanging the terms PA and PAS seems appropri-

ate. Unfortunately, the lack of a threshold requirement for diag-

nosing PAS and other related concerns may perpetuate the kind

of terminological confusion that Gardner would like others to

avoid. 89

VI. Parental Alienation Syndrome and the DSM-

The standard for making psychiatric diagnoses is the Ameri-

can Psychiatric Association’s Fourth Edition of the Diagnostic

and Statistical Manual of Mental Disorders (DSM-IV). 90 The

DSM-IV does not specifically list PAS. 91 This has been used by

some to argue that PAS is not a psychiatric syndrome. 92 Those

who make this argument are violating the dictums of the DSM-

IV.

First, the introduction to DSM-IV states, “It is important

that DSM-IV not be applied mechanically by untrained individu-

als. The specific diagnostic criteria included in DSM-IV are

meant to serve as guidelines to be informed by clinical judgment

and are not meant to be used in a cookbook fashion.” 93 Thus,

the DSM-IV warns that non-mental health professionals should

not be making judgments about what is and is not a mental disor-

der; attorneys would seem to represent one group to which this

admonition likely applies. Furthermore, mental health profes-

sionals are required to exercise their own clinical judgment in

making diagnoses, and are instructed not to rely on the DSM-IV

guidelines in a mechanical or cookbook fashion. 94 As noted in

See Gardner, supra note 67.

A M . P SYCHIATRIC A SS ’ N , D IAGNOSTIC AND S TATISTICAL M ANUAL OF

M ENTAL D ISORDERS (4th ed. 1994). In 2000, a text revision of the DSM-IV was

published, known as DSM-IV-TR; it has no significant impact on the discussion

provided in the present manuscript.

Id.

See Gardner, supra note 67.

A M . P SYCHIATRIC A SS ’ N , supra note 90, at xxiii.

See id.

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the DSM-IV, “the exercise of clinical judgment may justify giving

a certain diagnosis to an individual even though the clinical pres-

entation falls just short of meeting the full criteria for the diagno-

sis as long as the symptoms that are present are persistent and

severe.” 95

Second, the DSM-IV states explicitly that there are mental

disorders that have not been included in the diagnostic manual:

“Because of the diversity of clinical presentations, it is impossible

for the diagnostic nomenclature to cover every possible situa-

tion.” 96 To remedy this problem, the DSM-IV provides a diag-

nostic entity called, “Not Otherwise Specified.” 97 Four different

clinical presentations merit a Not Otherwise Specified (NOS) di-

agnosis. 98 One of these is: “The presentation conforms to a

symptom pattern that has not been included in the DSM-IV.” 99

The NOS diagnostic label is utilized according to the type of dis-

order seen, such as an Anxiety Disorder NOS, a Sexual Disorder

NOS or other problem that may be encountered. 100

In addition to NOS disorders, the DSM-IV describes the

Unspecified Mental Disorder:

There are several circumstances in which it may be appropriate to as-

sign this code: 1) for a specific mental disorder not included in the

DSM-IV classification, 2) when none of the available Not Otherwise

Specified categories is appropriate, or 3) when it is judged that a nonp-

sychotic mental disorder is present but there is not enough informa-

tion available to diagnose one of the categories provided in the

Classification. 101

Clearly, PAS meets the criteria for listing as a DSM-IV NOS

mental disorder or Unspecified Mental Disorder (UMD). The

symptom pattern seen in PAS was identified specifically over fif-

teen years ago, 102 and since then has been independently utilized

clinically by many other mental health practitioners; 103 this sug-

Id. Thus, Gardner’s specification of a mild version of PAS is not in-

compatible with the concepts of diagnosis utilized by the DSM-IV.

A M . P SYCHIATRIC A SS ’ N , supra note 90, at 4.

Id.

See id.

Id.

100

See id.

101

A M . P SYCHIATRIC A SS ’ N , supra note 90, at 687.

102

See Gardner, supra note 6.

103

See Gardner, supra note 7.

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gests that PAS appears to be a recognizable symptom complex at

the clinical level. In fact, the Chairman of the DSM-III 104 and

the DSM-IIIR 105 (the predecessors to the DSM-IV), Dr. Robert

Spitzer, endorsed Gardner’s use of the term syndrome to de-

scribe PAS. 106 Without question, Spitzer is one of the preemi-

nent researchers in the area of psychiatric diagnosis, 107 and has

published extensively on what does and does not qualify as a psy-

chiatric syndrome. 108 In essence, PAS is a DSM-IV mental disor-

der: it is diagnosable under rubrics of psychiatric abnormality 109

such as NOS or UMD. 110

VII. Parental Alienation Syndrome and DSM-V

Gardner would like to see PAS listed specifically as a disor-

der in the DSM-V 111 under its own diagnostic label (i.e., not

under NOS or some other diagnostic entity). The DSM-V is

years away. 112

To evaluate the potential of PAS being listed as a discrete

diagnostic category in the DSM-V (or a later DSM edition), one

needs to appreciate the process that enables a disorder to be spe-

104

A M . P SYCHIATRIC A SS ’ N , D IAGNOSTIC AND S TATISTICAL M ANUAL OF

M ENTAL D ISORDERS (3d ed. 1980).

105

A M . P SYCHIATRIC A SS ’ N , D IAGNOSTIC AND S TATISTICAL M ANUAL OF

M ENTAL D ISORDERS (3d ed. rev. 1987).

106

See Gardner, supra note 7.

107

See Turkat, supra note 76.

108

See Randall D. Marshall, Robert L. Spitzer, & Michael R. Leibowitz,

Review and Critique of the New DSM-IV Diagnosis of Acute Stress Disorder ,

156 A M . J. P SYCHIATRY 1677 (1999).

109

The above discussion does not preclude the possibility of utilizing

DSM-IV diagnoses other than NOS or UMD when clinical circumstances dic-

tate. An example might be an Adjustment Disorder. Gardner provides a vari-

ety of other possibilities. See R ICHARD A. G ARDNER , T HE P ARENTAL

A LIENATION S YNDROME (2d ed. 1998).

110

While other disorders not labeled as PAS in DSM-IV might be appro-

priate diagnostically for a particular PAS case, the present author’s point is that

the DSM-IV accommodates PAS merely by utilizing the NOS or UMD noso-

logic entities.

111

Richard A. Gardner, Denial of the Parental Alienation Syndrome Also

Harms Women , 30 A M . J. F AM . T HERAPY 191 (2001).

112

See Michael B. First & Harold Alan Pincus, The DSM-IV Text Revi-

sion: Rationale and Potential Impact on Clinical Practice , 53 P SYCHIATRIC S ERV .

288 (2002).

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cifically listed. This process has been summarized in the DSM-

IV. 113

Over one-thousand individuals helped prepare the DSM-IV.

Thirteen work groups were created with liaisons to over sixty

professional organizations interested in the content of the diag-

nostic manual. The National Institute of Mental Health spon-

sored twelve field trials encompassing over seventy research sites

with more than 6,000 subjects participating. Significant research

data were collected, but it was group consensus that led to ulti-

mate decisions about which disorders were to be listed and how

the diagnostic criteria were to be specified. 114 Thus, while certain

scientific evidence is required for a disorder’s listing in the diag-

nostic manual, other issues impact the final product. 115

An important consideration in the development and refine-

ment of the nomenclature was the DSM-IV Task Force’s position

on new disorders: “We decided that, in general, new diagnoses

should be included in the system only after research has estab-

lished that they should be included.” 116

Because the literature on PAS was quite limited at the time

that DSM-IV was under development, Gardner did not submit

PAS for inclusion in the DSM-IV. 117 Given the DSM-IV require-

ment that new disorders be included in the diagnostic manual

only after an appropriate research base has been established,

Gardner believes that sufficient literature now exists to support

the inclusion of PAS in DSM-V, and he intends to submit PAS

for proper consideration. 118 The present author is unaware of

any information as to whether PAS will in fact be listed as a spe-

cific disorder in the DSM-V.

113

See A M . P SYCHIATRIC A SS ’ N , supra note 90.

114

See id.

115

See Robert L. Spitzer, DSM-III and the Politics-Science Dichotomy

Syndrome: A Response to Thomas E. Schacht’s “DSM-III and the Politics of

Truth , ” 40 A M . P SYCHOL . 522 (1985).

116

A M . P SYCHIATRIC A SS ’ N , supra note 90, at XX.

117

Gardner, supra note 111.

118

Id.

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VIII. Research on Parental Alienation Syndrome

To evaluate the research literature on PAS, it will first be

necessary to discuss the nature of scientific investigation. 119 This

is particularly important because some have stated that PAS

lacks an adequate scientific basis; 120 this conflicts with Gardner’s

view that there is now a sufficient PAS literature to support its

inclusion in official diagnostic nomenclature. 121 In the absence

of professional consensus on this issue, controversy ensues. 122 By

exploring the nature of scientific investigation, one can then con-

sider the literature specific to PAS with greater sophistication

and thereby make an informed judgment about the state of that

literature.

A. The Nature of Research in Applied Fields

Scientific research in applied fields such as medicine and

psychology usually follows a relatively straightforward progres-

sion. 123 First, a practitioner notices a condition that has little sci-

entific information about it or devises a novel idea about how to

evaluate or treat a more commonly encountered problem. The

practitioner engages in some preliminary investigation 124 of what

has been observed, and then describes it in the professional liter-

ature. 125 Other practitioners subsequently learn of the origina-

119

The author’s presentation of the nature of scientific investigation is de-

liberately simplistic; a more comprehensive coverage is beyond the scope of this

manuscript, and not necessary for present purposes.

120

See Lewis Zirogiannis, Evidentiary Issues with Parental Alienation Syn-

drome , 39 F AM . C T . R EV . 334 (2001).

121

Gardner, supra note 111.

122

See e.g. , Kathleen Coulborn Faller, The Parental Alienation Syndrome:

What Is It and What Data Support It? 3 C HILD M ALTREATMENT 100 (1998);

Richard A. Gardner, The Parental Alienation Syndrome: What Is It and What

Data Support It?: Comment 3 C HILD M ALTREATREATMENT 309 (1998); Richard

A. Gardner, Response to Kelly/Johnston Article , 17 S PEAK O UT FOR C HILD . 5

(2002); Joan B. Kelly & Janet R. Johnston, A Reformulation of Parental Aliena-

tion Syndrome , 39 F AM . C T . R EV . 249 (2001).

123

See Ira Daniel Turkat, Issues in the Relationship Between Assessment

and Treatment , 10 J. P SYCHOPATHOLOGY B EHAV . 185 (1988).

124

Such investigation could be purely theoretical.

125

This may include the descriptive case study, the case theory report, the

case theory investigation, the case treatment report and/or the case treatment

investigation. See I RA D ANIEL T URKAT , supra note 76.

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tor’s report(s) and begin their own explorations in their

respective offices. Exploratory permutations begin to appear.

As multiple reports converge in the literature, eventually a more

controlled scientific investigation is initiated. If the results are

positive, other controlled experiments are initiated. When a sub-

stantial body of scientific evidence has accrued, the meaning of

this evidence is reviewed with an eye toward professional con-

sensus about the hypothesis under examination. 126

The above description details how clinical science progresses

from initial ideas. 127 If we were to consider the state of scientific

knowledge about a particular phenomenon on a continuum, at

one end of the continuum would be the untested hypothesis of a

cause-effect relationship and at the other end would be the thor-

oughly tested hypothesis . To get from one end to the other, a

series of research steps must be taken.

1. Investigative Procedures

The tools of research progression can be briefly summarized.

First, uncontrolled observations of the phenomena of interest are

collected. For example, a physician reports his or her observa-

tions of an unusual case. Or, a psychologist describes a case

study of an existing disorder where a new theory emerged and

led to development of a novel treatment approach. 128 Next, con-

trolled observations of the phenomenon are undertaken. For ex-

ample, a psychologist gives a group of patients two psychological

tests and determines statistically the relationship between the

test scores.

Both controlled and uncontrolled observations permit the

investigation of hypothesized relationships between certain vari-

ables, but neither allow a scientific statement about cause and

effect. Once multiple controlled and uncontrolled observations

126

See , e.g. , James C. Ballenger, Jonathan R. T. Davidson, Yves Lecrubier,

David J. Nutt, Thomas D. Borkovec, Karl Rickels, Dan J. Stein, & Hans-Urlich

Wittchen, Consensus Statement on Generalized Anxiety Disorder from the Inter-

national Consensus Group on Depression and Anxiety , 62 J. C LINICAL P SYCHIA-

TRY 53 (2001); Thomas Ollendick & Ronald J. Prinz, Editors’ Comment:

International Consensus Statement on Attention Deficit Hyperactivity Disorder

(ADHD) , 5 C LINICAL C HILD F AM . P SYCHOL . R EV . 87 (2002).

127

See T URKAT , supra note 76.

128

See id.

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are reported in the literature, and a hypothesis about the relation

between two or more variables remains plausible, experiments

are performed. In contrast to observations (controlled or uncon-

trolled), experiments are designed to manipulate conditions so

that a cause-effect relationship can be determined scientifically.

An example of a cause-effect relationship might be that certain

parental behavior causes a child to detest the other parent

unjustly.

In an experiment, tightly controlled conditions are imposed

to allow strict comparisons while one or more variables are

manipulated. For example, 150 anxiety patients are randomly as-

signed 129 to one of five groups to evaluate the effectiveness of a

new medicine: group one receives no medication, 130 group two

receives a sugar pill (placebo), 131 group three receives a small

dose of the medicine, group four receives a moderate dose of the

medication, and group five receives a large medicinal dose. 132 In

addition, in each of the groups that receive a pill, half of the pa-

tients are told that the medication they are taking has been

shown to be only mildly effective, whereas the other half of pa-

tients in each group are told that the medication they are taking

has been shown to be highly effective. 133 In every other aspect of

the study, each patient is treated exactly the same. As a result,

statements can be made about cause and effect because actual

conditions representing the hypothesized relationships have been

manipulated and compared while all other conditions have been

held constant.

129

This is done to improve the likelihood that there is no difference be-

tween the subjects in the groups before experimental conditions are manipu-

lated. In this way, any differences between the groups that emerge at the end of

the experiment are more likely to be due to the experimenter’s manipulations

and not some characteristic difference that set the groups apart before the ex-

perimental conditions were manipulated.

130

This is done to compare the manipulation of no treatment versus the

other treatment groups.

131

This is done to compare the manipulation of taking a pill that should

have no therapeutic value versus one that should have some therapeutic value.

132

This is done to compare the differential effectiveness of dose levels.

133

This is done to compare the effect of manipulating the patients’ expec-

tancies about the effectiveness of the medicine they are taking.

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2. Inquiry Advancements

When studies are published — whether observational (un-

controlled or controlled) or experimental — limitations from

previously published work are usually addressed and overcome

by instituting ever increasing refinements to seek a greater speci-

fication of knowledge about the hypothesis of interest. In other

words, the “bar should rise” with each generation of reports in

the literature on a particular topic. For example, early investiga-

tions of a treatment for AIDS began with one patient and then

two. Eventually, the treatment was given to one group of pa-

tients and not another. Later, the treatment was compared to

other treatments, and subsequent permutations of the treatment

were applied to those individuals with certain AIDS characteris-

tics (e.g., number of years suffering from the disease) and com-

pared to those patients with other AIDS characteristics (e.g.,

number of years receiving a particular medication).

In sum, a simple understanding of the progression and qual-

ity of scientific information can be ascertained by observing the

tools used in research: uncontrolled observations followed by

controlled observations and then experiments. While observa-

tions are highly useful, only properly designed experiments per-

mit statements about cause-effect relationships.

B. Evaluating the Accumulation of Evidence

With an understanding of the steps and procedures that

characterize the development of knowledge in applied fields such

as psychology and medicine, it is important to examine the level

of progress in evidence accumulation. How can we evaluate the

course of the accumulation of findings on a topic of interest?

What is the natural history of a particular untested hypothesis

that begins to undergo professional scrutiny? For present pur-

poses, the author will attempt to describe several ways to evalu-

ate the progress of knowledge accumulation about a clinical

hypothesis 134 because it has direct implications for evaluating the

PAS literature.

134

The present author served for 15 years as the Associate Editor of the

Journal of Psychopathology and Behavioral Assessment , a scientific and clinical

peer-review journal.

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1. The Availability of Clinical Hypotheses

Most clinical hypotheses never reach the stage of being stud-

ied by those who did not originate the hypothesis. In other

words, mental health professionals frequently come up with unt-

ested ideas about their patients that typically will remain buried

in the clinicians’ offices, as most practitioners rarely publish. 135

Therefore, the mental health professional who publishes his or

her clinical observations and hypotheses is part of an exclusive

group of contributors to the field.

2. The Reaction to New Clinical Hypotheses

Many of the uncontrolled observations offered by practi-

tioners that publish them go unnoticed by others. This may be

due to several factors, such as the amount of information already

available on a particular phenomenon (e.g., a well studied prob-

lem may be less influenced by a new clinical hypothesis), where

the article was published, and the quality of the uncontrolled ob-

servation being offered. An uncontrolled observation of poor

quality usually dies a rapid death in the literature. 136

In contrast, a useful observation is likely to become a topic

of discussion by others. If the uncontrolled observation was not

useful, few would spend time on it, and certainly not for long.

Thus, if an uncontrolled observation begins to receive attention

in the literature from others, that is usually a sign that the idea

has some degree of merit. 137

3. Beyond Uncontrolled Evaluations

Clinical hypotheses that remain exclusively in the domain of

practitioners’ uncontrolled observations limit the potential con-

135

See Colin Barrom, William Shadish & Linda Montgomery, PhDs ,

PsyDs , and Real-World Constraints on Scholarly Activity: Another Look at the

Boulder Model , 19 P ROF . P SYCHOL . 93 (1988).

136

Although this may vary considerably; sometimes, an uncontrolled ob-

servation may go unnoticed for a lengthy period of time; subsequently, its qual-

ity becomes apparent. However, a poor quality observation is unlikely to offer

much utility to others at any time.

137

In science, an idea with merit is one that stimulates research, even if

that idea eventually is rejected by scientific investigation. Naturally, the unt-

ested hypothesis that survives the progression of scientific inquiry is a more

useful contribution.

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156 Journal of the American Academy of Matrimonial Lawyers

tribution of those hypotheses to the field at large. Thus, a signifi-

cant point in the fate of a clinical hypothesis occurs when

controlled observations start to be reported in the literature — it

suggests that knowledge is progressing. Having survived attacks

on the hypothesis at the uncontrolled level, the idea appears to

have sufficient merit to advance to more systematic data

collection.

Next, when a clinical hypothesis becomes the focus of well

controlled scientific experiments, the hypothesis of interest has

made a definite contribution to the field. Clinicians do not have

the resources to perform rigorous scientific experiments; 138

whereas, researchers do. 139 However, the number of researchers

that have the wherewithal to perform controlled scientific experi-

ments is far smaller than the number of practitioners that can

generate untested clinical hypotheses. Given the limited re-

sources, the idea that is studied experimentally has survived the

“cut” in the sense that a determination has been made that it is

worth investing considerable resources to evaluate the idea’s via-

bility. Furthermore, the hypothesis properly studied experimen-

tally has made a contribution no matter what the outcome:

whether confirmed or not, scientific knowledge has developed

about the viability of the idea. A hypothesis that has been re-

jected because of scientific data is a statement of greater knowl-

edge than a hypothesis that has been rejected without the benefit

of scientific inquiry. 140

Finally, when numerous research experiments provide data

on a hypothesis, the field moves toward developing a consen-

sus. 141 Sometimes, that consensus may be that additional scien-

tific data of a particular type is needed to support or reject the

hypothesis; in other cases, confirmatory consensus or outright re-

jection develops from the scientific data. A good example is the

body of literature that has accrued on the Rorschach, a widely

138

See Ira Daniel Turkat & Stephen A. Maisto, Application of the Experi-

mental Method to the Formulation and Modification of Personality Disorders ,

C LINICAL H ANDBOOK O F P SYCHOL . D ISORDERS 503 (David H. Barlow ed.,

1985).

139

See Turkat, supra note 76.

140

A hypothesis, for example, that has been rejected purely for political

reasons.

141

See William J. White, A Communication Model of Conceptual Innova-

tion in Science , 11 C OMMUNICATION T HEORY 290 (2001).

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used psychological test that has been studied in hundreds of in-

vestigations. 142 Despite this, considerable disagreement exists to-

day whether psychologists should use this test. 143

Scientific knowledge about a clinical hypothesis does not

come from a few published reports. Rather, a substantial body

of literature develops over many years to evaluate the utility of

the hypothesis of interest. In many cases, it may take decades to

develop a scientific consensus about a particular clinical

hypothesis.

C. The Nature of Research on Parental Alienation Syndrome

How does PAS fare in regard to the development of scien-

tific knowledge about Gardner’s observations? This question can

now be examined in light of the indicators of scientific knowl-

edge progression just discussed. 144

First, Dr. Richard Gardner has made a substantial contribu-

tion to the clinical literature. He has published numerous articles

and books on PAS that have stimulated many others to further

investigate PAS. 145 Not only has he reported observational infor-

mation 146 on PAS evaluation, treatment, and follow-up, 147 he has

provided considerable theory about the pathogenesis of PAS. 148

Scientific research does not proceed without useful hypothe-

ses. 149 Gardner has provided a wealth of useful hypotheses to

142

See John Hunsley & J. Michael Bailey, The Clinical Utility of the Ror-

schach: Unfulfilled Promises and an Uncertain Future , 11 P SYCHOL . A SSESS-

MENT 266 (1999); Gregory J. Meyer, The Hard Science of Rorschach Research:

What Do We Know and Where Do We Go? 13 P SYCHOL . A SSESSMENT 486

(2001).

143

See id.

144

Considerable research has been conducted on topics that are related to

PAS such as high-conflict divorce and attitude manipulation. However, these

studies were not specifically addressing PAS as defined by Gardner, and thus

are not included in the present discussion.

145

Gardner, supra note 7.

146

Gardner, supra note 6; but see , e.g. , Rand, supra note 8.

147

Richard A. Gardner, Should Courts Order PAS Children to Visit/Reside

with the Alienated Parent? A Follow-up Study , 19 AM. J. F ORENSIC P SYCHOL . 61

(2001).

148

See Gardner, supra note 37.

149

See Turkat, supra note 76.

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the clinical literature. 150 In this regard, he has been an exem-

plary role model compared to other practitioners in the field.

Second, as literature on PAS occurs with increasing regular-

ity, 151 support for the utility of Gardner’s clinical descriptions is

provided. Similar to Gardner’s contributions, the current litera-

ture, which is less than twenty-years old, consists primarily of

clinical case reports, theoretical offerings, and other uncontrolled

observations. As inquiries on PAS have begun to mature, con-

trolled observations are now starting to appear. 152 To date, the

author is not aware of any experiments designed specifically to

evaluate PAS, 153 in which key variables were tightly manipulated

and measured under properly controlled comparison condi-

tions, 154 or any field trials 155 that have been conducted to estab-

lish that PAS can be diagnosed in a reliable 156 and valid 157

manner. Thus, when viewed as a whole, one can conclude that

the current literature on PAS reflects the natural progression one

would expect to find when scientific understanding of a particu-

lar disorder begins to accrue. However, the fact that necessary

scientific investigations have yet to be performed, 158 means that

one cannot state with proper authority that PAS has been re-

jected or accepted by the scientific community.

150

Mary Lund, A Therapist’s View of Parental Alienation Syndrome , 33

F AM . & C ONCILIATION C TS . R EV . 308 (1995).

151

See Gardner, supra note 7.

152

See Jeffrey Siegel & Joseph Langford, MMPI-2 Validity Scales and Sus-

pected Parental Alienation Syndrome , 16 A M . J. F ORENSIC P SYCHOL . 5 (1998).

153

In an experiment where PAS was clearly defined, diagnosed, and

measured.

154

See Cartwright, supra note 10, for the proposition that there is an ab-

sence of proper scientific data regarding the effects of PAS on the children

involved.

155

Similar to the DSM field trials.

156

Numerous ways exist to consider the reliability of a diagnosis, but for

present purposes, when different clinicians can independently agree at a high

rate on the presence or absence of a particular disorder in the same group of

patients, the diagnosis is considered to be reliable.

157

Validity of a diagnosis is a complex subject, but here it refers to the

accuracy of this phenomenon as representing a true diagnostic entity. In other

words, what scientific evidence is there that PAS exists? Various types and

methods exist to establish validity; numerous high quality research studies are

required to establish a disorder’s diagnostic validity.

158

See Warshak, supra note 55.

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D. Impediments to Scientific Research on PAS

Why has over a decade of reports in the literature on PAS

failed to produce well controlled scientific investigations?

1. The Pace of Research

As noted above, the progression of scientific knowledge

concerning applied phenomena involves varying degrees of in-

vestigation; many years are required to develop a full body of

pertinent literature. This is true under the best of circumstances.

Conversely, if conditions are not conducive to foster the accumu-

lation of proper scientific data, the body of research literature

grows at an even slower pace.

2. Definitional Requirements

For high quality research to proceed, one must have clear

definitions. 159 Gardner has articulated eight criteria for diagnos-

ing PAS, 160 but how many of these symptoms are needed for a

PAS diagnosis, and which symptoms must be present? 161 With-

out a uniform diagnostic criteria specification, different defini-

tions of PAS could be used which would complicate the

interpretation of data across different research studies.

3. Measurement Requirements

To perform quality research on PAS, one must have a relia-

ble and valid method for its measure. 162 This may take the form

of a standardized questionnaire, structured interview, a rating

scale or some other protocol that has been scientifically evalu-

ated and supported. To date, no instrument in the literature has

appeared that has been scientifically shown to be a reliable and

valid method to assess PAS. 163 This is true not only for differen-

159

See C OMPREHENSIVE H ANDBOOK OF P SYCHOPATHOLOGY (Henry E.

Adams & Patricia B. Sutker eds., 1984).

160

Gardner, supra note 7.

161

See Warshak, supra note 55.

162

See Anthony R. Ciminero, Karen S. Calhoun & Henry E. Adams,

H ANDBOOK OF B EHAV . A SSESSMENT (1977).

163

See O’Leary, supra note 54.

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tiating PAS from other disorders, but also for measuring the level

of PAS symptomatology. 164

The scientific development of a reliable and valid psycholog-

ical measure takes several years, and requires many research

studies. The most widely used clinical assessment instrument in

psychology, the Minnesota Multiphasic Personality Inventory

(MMPI), 165 has fifty-years worth of scientific investigations be-

hind it; despite this, scoring errors continue to occur, 166 and ques-

tions about its usefulness in assessing psychopathology remain. 167

4. Terminological Practices

Even when definitions are clearly specified, terminological

confusion can still occur to hinder research advancement. 168 As

Gardner has noted, some have confused the terms PA and

PAS. 169 The problem is exacerbated when related phenomena

are discussed as evidence for PAS or for some aspects (or deriva-

tive) of PAS. 170 For example, considerable scientific research ex-

ists in the areas of high conflict divorce, 171 intense

indoctrination, 172 and methods of influence. 173 However, these

bodies of research do not specifically categorize subjects accord-

ing to the presence or absence of PAS as defined by Gardner, nor

do they manipulate conditions to produce the set of behaviors

specifically labeled and clustered as PAS. Thus, one cannot prop-

164

The same observation applies to certain diagnostic categories in the

DSM-IV.

165

The current version is the MMPI-2.

166

See David Faust & Gregory Allard, Errors in Scoring Objective Person-

ality Tests , 7 A SSESSMENT 119 (2000).

167

Edward Helmes & John R. Reddon, A Perspective on Developments in

Assessing Psychopathology: A Critical Review of the MMPI and MMPI—2 , 113

P SYCHOL . B ULL . 453 (1993).

168

See Turkat, supra note 86.

169

See Gardner, supra note 67.

170

See Warshak, supra note 55.

171

See Michael E. Lamb, Kathleen Sternberg & Ross A. Thompson, The

Effects of Divorce and Custody Arrangements on Children’s Behavior , Develop-

ment , and Adjustment , 35 F AM . & C ONCILIATION C TS . R EV . 393 (1997).

172

See Robert Baron, Arousal , Capacity , and Intense Indoctrination , 4

P ERSONALITY & S OC . P SYCHOL . R EV . 238 (2000).

173

See Daniel J. O’Keefe & Scott L. Hale, An Odds-Ratio-Based-Meta-

Analysis of Research on the Door-in-the-Face Influence Strategy , 14 C OMMUNI-

CATION R EP . 31 (2001).

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erly utilize studies of this kind as scientific evidence supporting

PAS as a distinct, reliable and valid diagnostic entity. Pointing to

non-PAS research as directly supportive of PAS can muddle the

literature. Similarly, some have attempted to “reformulate”

PAS 174 or couch it within different conceptual frameworks. 175

While useful theoretical models are certainly to be encouraged, it

is important that researchers not confuse the definition of PAS

with that of a reformulation of it. As noted in research on other

types of psychopathology, when investigators use different defi-

nitions while using similar diagnostic labels, the scientific litera-

ture becomes chaotic and the advancement of data based

knowledge is inhibited. 176 Research on topics related to PAS can

be quite useful but can never serve as an adequate substitute for

inquiry specific to PAS.

5. Availability of Research Participants

One of the greatest impediments to scientific studies on PAS

involves the availability of litigants to serve as participants in re-

search investigations. Some psychiatric abnormalities are easier

to study than others. For example, anxiety disorders are com-

mon and individuals regularly seek out treatment for them.

Thus, a shortage of individuals to participate in research on anxi-

ety is rare. 177 On the other hand, researchers interested in PAS

are not as fortunate.

Most subjects in clinical research come from centers that

treat psychiatric disorders (e.g., mental health clinics or hospi-

tals) and/or from university departments of psychology and psy-

chiatry. To the best of the author’s knowledge, there is no

academic center for studying PAS or a well established clinic that

specializes in treating large numbers of the disorder. PAS cases

most often arise out of custody litigation; 178 by and large, courts

are not set up to funnel potential PAS cases into standardized

research protocols.

174

See Kelly, supra note 122.

175

See Joseph Price & Kerry Pioske, Parental Alienation Syndrome: A De-

velopmental Analysis of a Vulnerable Population , 32 J. P SYCHOSOCIAL N URSING

M ENTAL H EALTH S ERV . 9 (1994).

176

See Turkat, supra note 86.

177

Millions of individuals suffer from anxiety.

178

See Gardner, supra note 4.

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Even if courts were to actively participate in forwarding

cases into psychological research projects on PAS, numerous ob-

stacles can arise. In addition to the diagnostic and assessment

issues presented earlier, ethical problems should be considered.

For example, subjects in psychological research participate pri-

marily on a voluntary basis. 179 Individuals who have been ac-

cused of demonstrating PAS, but deny it, are probably not likely

to volunteer to serve as subjects in a PAS experiment. 180

Scientific research also requires a relatively large number of

available subjects. How prevalent is PAS? Gardner has indi-

cated that he sees some PAS symptomatology in about ninety

percent of custody cases that are litigated. 181 That does not

mean, however, that PAS is present in ninety-percent of custody

litigation cases. Given that the number of symptoms required to

diagnose PAS has yet to be determined scientifically, estimating

the prevalence of PAS becomes difficult. 182

Another way to illustrate the difficulty in subject recruit-

ment for research on PAS is to consider the commonality of cus-

tody litigation. One estimate suggested that 100,000 custody

battles occur each year. 183 If this estimate is divided by the num-

ber of counties in the United States of America (N=3066), 184

then an average of thirty-three litigated custody disputes occur

per county, per year. 185 More than likely, a significant number of

these custody litigants do not experience PAS; this then cuts the

number of available subjects even further. Taking into account

other factors that might reduce the available research subject

179

See A M . P SYCHOL . A SS ’ N , E THICAL P RINCIPLES OF P SYCHOLOGISTS

AND C ODE OF C ONDUCT (1992).

180

For example, volunteering as a research subject in a scientific study on

PAS could be interpreted by some as evidence of the presence of PAS — this

would be especially likely if the study only utilized subjects that met PAS

criteria.

181

Gardner, supra note 37.

182

See O’Leary, supra note 54.

183

See Ira Daniel Turkat, Custody Battle Burnout , 28 A M . J. F AM . T HER-

APY 201 (2000).

184

This figure is from the National Association of Counties, http://

www.naco.org.

185

Given this as an estimated average, many counties would be likely to

have more than thirty-three custody battles per year, and many would be likely

to have less. Also, the 100,000 ball park figure could be incorrect.

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pool (e.g., refusal to participate, need to study subjects at the

same time), the investigator faces an uphill battle in procuring

a sufficient cohort of PAS subjects to conduct high quality

research.

Given the above impediments, one might understand why

scientific research on PAS has not progressed as rapidly as one

might like. To correct the situation efficiently, significant coordi-

nation between the judiciary and mental health researchers inter-

ested in PAS must take place.

E. The Importance of Scientific Data on PAS

In light of the obstacles to PAS research, the phenomenon

remains a significant problem for the judiciary. Gardner has re-

ported that sixty-six courts have recognized PAS. 186 Facing the

dilemma of what to do when cases of this kind present in the

courtroom, 187 Gardner has articulated treatment options for the

judiciary to implement in pertinent PAS cases. 188

In some instances, Gardner advises that custody be switched

from the alienating parent to the victimized one — a recommen-

dation applied primarily to severe cases. 189 To support his posi-

tion, Gardner has provided follow-up data on cases involving his

treatment recommendations. 190 In those cases where he advo-

cated a change in custody or access, the PAS diminished or re-

solved in one-hundred percent of cases when the courts followed

his advice. Conversely, ninety-one percent of cases did not im-

prove or deteriorated when Gardner’s recommendations were

not adopted. 191

This report is particularly noteworthy. Few mental health

professionals devise innovative treatments and even fewer per-

form follow-up analyses years later that contain percentage data

on symptom outcome. Once again, Gardner has provided a use-

186

Richard A. Gardner, Comments on Carol S. Bruch’s Article “Parental

Alienation Syndrome and Parental Alienation: Getting it Wrong in Child Cus-

tody Cases , ” 35 F AM . L.Q. 553 (2001).

187

A review of the literature on the standards for the admissibility of testi-

mony on PAS is beyond the scope of the present manuscript.

188

Gardner, supra note 50.

189

Id.

190

Gardner, supra note 147.

191

Id.

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ful contribution. Further, the data reveal dramatic differences

when Gardner’s recommendations are accepted or rejected. Un-

fortunately, the study is plagued by numerous limitations, some

of which Gardner has articulated. 192 The present author is una-

ware of any scientific research designed exclusively to measure

the effects of PAS intervention.

Given the adversarial nature of custody litigation, it is un-

derstandable why PAS and Gardner’s proposed interventions for

it would provoke controversy. A parent accused of unjustly

alienating a child against the other parent is unlikely to welcome

such an allegation. A litigant facing a PAS-based recommenda-

tion to give up custody is likely to contest it. Because there is an

absence of pertinent scientific investigations to guide recommen-

dations to the court, the room for argument and disagreement is

enormous. Attacks on Gardner have come not only from the

battles of specific litigation, but also from various advocacy

groups. 193 In fact, Gardner has received so much attack from so

many different sources that he recently was compelled to publish

an article entitled, Misinformation Versus Facts about the Contri-

butions of Richard A. Gardner , M.D. 194

Advocacy in the courtroom can certainly encourage adver-

sarial interactions, 195 and emotionally charged custody litigation

is well known for it. 196 When an allegation is made during the

course of custody litigation where one parent may be unjustly

alienating the other parent, and such an allegation has implica-

tions for the placement of the children, it would be surprising if

Gardner was not attacked in some manner.

If one attorney charges that the opposing client is displaying

PAS, that litigant’s counsel may counter that no scientific evi-

dence supports the existence of the syndrome. 197 If the court be-

lieves that PAS is occurring in a particular case, arguments may

192

Id.

193

John Dunne & Marsha Hedrick, The Parental Alienation Syndrome: An

Analysis of Sixteen Selected Cases , 21 J. D IVORCE & R EMARRIAGE 21 (1994).

194

Richard A. Gardner, Misinformation Versus Facts About the Contribu-

tions of Richard A. Gardner , M.D. , 30 A M . J. F AM . T HERAPY . 395 (2002).

195

See L ENARD M ARLOW & S. R ICHARD S AUBER , T HE H ANDBOOK OF

D IVORCE M EDIATION (1990).

196

See Turkat, supra note 183.

197

See Cheri L. Wood, The Parental Alienation Syndrome: A Dangerous

Aura of Reliability , 27 L OYOLA . L. A . L. R EV . 1367 (1994).

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be presented for both the viability of Gardner’s treatment recom-

mendations, 198 as well as the lack of professional consensus

about them. 199 While one lawyer may point to Gardner’s aca-

demic credentials, 200 opposing counsel may offer evidence alleg-

ing Gardner is sexist. 201 Whether discussing false allegations of

abuse or actual domestic violence, some consider PAS as help-

ful, 202 while others view it as dangerous. 203 Positions for 204 and

against Gardner 205 are in no short supply. 206

In the end, good science is needed to resolve the quandary

in which many judges find themselves when it comes to PAS.

The reason is quite simple: until proper scientific evidence is gen-

erated, the judiciary will be forced to rely upon the opinions of

various mental health professionals. Since these opinions can be

highly discrepant, PAS will continue to provoke considerable

controversy in the foreseeable future.

IX. Management of PAS

In light of the stage of research progression that character-

izes PAS, the court must balance that literature with the practical

needs of the presenting case. How should the judiciary respond

when an allegation of PAS is placed before it? In this section, the

present author will attempt to provide some useful guidelines. 207

198

See Dunne, supra note 193.

199

See Warshak, supra note 55.

200

Clinical Professor of Child Psychiatry at Columbia University College

of Physicians and Surgeons.

201

See Gardner, supra note 194. Based on Dr. Gardner’s writings, the

present author does not believe that Dr. Gardner is sexist. See also Gardner,

supra note 111.

202

Douglas Darnell, Parental Alienation: Not in the Best Interest of the

Children , 75 N OTRE D AME L. R EV . 323 (1999).

203

See Ruth Busch, Leslie Drozd, Toby Kleinman, & Stephanie Dallam,

Parental Alienation Syndrome: Its Dangerous Use Internationally in CT. Cases

Involving Family Violence , Pre-Conference Workshop presented Sept. 25, 2002,

at the Family Violence and Sexual Assault Institute.

204

See Walsh & Bone, supra note 1.

205

See Carol S. Bruch, Parental Alienation Syndrome and Parental Aliena-

tion: Getting it Wrong in Child Custody Cases , 35 F AM . L.Q. 527 (2001).

206

See Warshak, supra note 55.

207

Given space limitations, the present manuscript does not address the

potential advantages and disadvantages of mediation in regard to disputes in-

volving PAS.

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It is recognized that no scientific study has been performed on

these recommendations. However, the same criticism holds true

for the recommendations offered in most psychological custody

evaluation reports. To date, the author is not aware of a scien-

tific study 208 that has demonstrated that the child placement rec-

ommendations of a psychologist yields an objectively determined

better outcome for the children involved in custody litigation, as

compared to the opposite recommendation or to no

recommendation.

In considering the management of PAS, it is instructive to

keep in mind that the DSM-IV specifically states that not all

mental disorders are listed in the current diagnostic manual. 209

The DSM-IV fully recognized that some conditions require psy-

chiatric interventions that are not listed by name in the nomen-

clature. 210 The utility of this position can be seen historically:

there was a time when AIDS was not listed as a medical disor-

der, 211 yet patients presented with the disease and received treat-

ment before the scientific body of research progressed to a

consensus.

The key issue in custody litigation is to determine what is in

the best interest of the child. If a serious allegation of PAS is

made, it should be investigated. Just as an allegation of sexual

abuse is taken with the utmost concern (despite the lack of pro-

fessional agreement on a definition of child sexual abuse), 212 so

too should an allegation of abuse based on unjust alienation of a

child against his or her parent. How then should this concern be

approached?

A. Recommendations for the Judiciary

First, the court must be made aware of PAS. If one does not

understand PAS well, it would be difficult to evaluate a PAS alle-

gation. In pertinent circumstances, an expert may need to testify

to educate the court. Ideally, this should be someone who is not

208

With proper experimental design to allow a strong inference about

cause and effect.

209

See A M . P SYCHIATRIC A SS ’ N , supra note 90.

210

See id.

211

See Gardner, supra note 7.

212

See Jeffrey J. Haugaard, The Challenge of Defining Child Sexual Abuse ,

55 A M . P SYCHOL . 1036 (2000).

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only an authority on PAS, but has virtually no knowledge of the

presenting case and sees his or her role merely as serving as a

neutral educational resource.

Second, the court must evaluate the current evidence for the

PAS allegation. Should any information emerge that lends rea-

sonable support to the allegation, the court should order an ap-

propriate psychological evaluation of the parties.

This

examination should be performed by a psychologist or psychia-

trist with the following minimal characteristics:

1. Has Never Had Contact With the Litigants or Their

Children

The reason for this is simple: the evaluator should be free of

any potential allegiance or bias toward any of the parties in-

volved. When a therapist takes on a case, he or she is agreeing to

be helpful to that client. When external inquiries are made about

the client or attacks are brought upon the client, the therapist’s

supportive efforts will typically include becoming an advocate for

the client. 213 Such a relationship is likely to color how that

mental health professional views events that pertain to his or her

client. The American Psychological Association (APA) recog-

nized the threat to a therapist’s integrity by serving in dual rela-

tionships (e.g., as therapist to one litigant and evaluator of both

litigants), and warned that improper relationships of this kind vi-

olated the APA ethical code. 214

2. Has Documented Knowledge of PAS

The DSM-IV lists hundreds of mental disorders. 215 No psy-

chologist, therefore, can be expert concerning them all. If con-

fronted with a violent and actively psychotic 216 mental patient,

the court would be ill advised to seek out a psychologist who

specializes in treating the study habit problems of college stu-

dents. Instead, a mental health practitioner with considerable ex-

213

See Grant L. Iverson, Dual Relationships in Psycholegal Evaluations:

Treating Psychologists Serving as Expert Witnesses , 18 A M . J. F ORENSIC

P SYCHOL . 79 (2000).

214

See A M . P SYCHOL . A SS ’ N , supra note 179.

215

See A M . P SYCHIATRIC A SS ’ N , supra note 90.

216

The term “psychotic” is used here to mean being out of touch with

reality and experiencing serious hallucinations or delusions.

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168 Journal of the American Academy of Matrimonial Lawyers

perience with violent psychotics would be the clinician of choice.

The overwhelming majority of psychologists have no experience

with PAS; 217 such individuals would be at a distinct disadvantage

in evaluating a case where PAS was an issue.

3. Believes That Cases of PAS Exist

A mental health practitioner who does not believe that PAS

exists runs the risk of making a false negative diagnostic error

(i.e., claims that PAS is not present when in fact it is). Having a

psychologist, who does not believe that PAS exists, evaluate a

family for the presence or absence of PAS limits the court’s abil-

ity to assist that family if indeed a PAS is present. For this rea-

son, the court should be aware of the mental health practitioner’s

opinions on the existence of PAS before ordering such a person

to perform an evaluation of this kind.

4. Believes That Cases Involving False Allegations of PAS

Exist

A psychologist who believes that false allegations of PAS are

not made runs the risk of making a false positive diagnostic error

(i.e., claims that a PAS is present when it is not). In order for a

mental health professional to properly evaluate whether PAS is

present in a particular family, he or she must believe that cases

can occur where PAS exists, and those where PAS is falsely

alleged.

5. Can Articulate Obstacles to Effective Treatment in PAS

Cases

Successful treatment of an individual presenting psychopa-

thology begins with a formulation of the case. 218 A proper case

formulation outlines (among other things) the expected obstacles

to successful intervention. 219 Without a priori specification of

likely pitfalls, the prognosis may depreciate because effective

treatment must manage those factors that interfere with a suc-

cessful outcome. This point is especially important given the ab-

217

This is due to several factors, most notably, that only a very small per-

centage of psychologists perform custody litigation-related work.

218

See I RA D ANIEL T URKAT , B EHAV . C ASE F ORMULATION (1985).

219

See I RA D ANIEL T URKAT , The Behavioral Interview , H ANDBOOK OF

B EHAV . A SSESSMENT (Anthony R. Ciminero et al. eds., 2d ed. 1986).

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sence of scientific guidelines to direct intervention with a PAS

case. 220 If a mental health practitioner cannot identify the obsta-

cles that are likely to appear in treating a particular case of PAS,

he or she may be at an increased risk for recommending an inad-

equate therapeutic regimen. Prior experience with PAS cases fa-

cilitates identification of common intervention pitfalls.

6. Has a Strong Background in Adult Psychopathology

Given that PAS cannot exist without the training efforts of a

parent, 221 a psychologist with a weak background in adult psy-

chopathology would likely be at a disadvantage in evaluating the

parents. Failure to formulate why a particular parent may be in-

stituting unjust alienation in his or her children reduces the likeli-

hood of devising a treatment recommendation that will address

the factors causing the problem in the first place.

7. Has