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Book Review

Parental Alienation Syndrome: A Family Therapy and Collaborative Systems Approach to Amelioration

Chung, Peter Jinwu MD

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Journal of Developmental & Behavioral Pediatrics: September 2018 - Volume 39 - Issue 7 - p 572
doi: 10.1097/DBP.0000000000000605
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Parental alienation syndrome (PAS) is a concept that was popularized by psychiatrist Richard Garner in the 1980s and reportedly occurs with disputes over child custody, usually during parental separation. The diagnosis of PAS is based on the behavior of the child, who is brainwashed by the “alienating parent” (often the 1 with primary custody) into a “campaign of denigration” against the “alienated parent.” This campaign consists of the child's hateful assertions without supportive evidence (e.g., ranging from being unwanted to allegations of abuse) that seem to be adopted from the statements of the alienating parent. PAS is a controversial topic that has been criticized as being overly simplistic and lacking scientific support; it is not recognized as a formal diagnosis by the American Psychiatric Association, the American Psychological Association, the American Medical Association, or the World Health Organization. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, does not include PAS as a recognized syndrome, although it did add a code for “Child Affected by Parental Relationship Distress” to refer to some clinical manifestations of PAS. Despite the lack of formal recognition, however, PAS is strongly held as valid by its supporters and is still invoked in court during custody disputes.

Gottlieb, who is trained as a social worker and has a long history of working as a family and relationship therapist, has written this text with a clear vision in mind—to inform and educate professionals that interface with families undergoing custody disputes about the presence of PAS, including the roles that therapists, health care providers, social workers, law enforcement personnel, and judges can play in exacerbating or ameliorating its severity. Through the weight of her clinical experience, Gottlieb seeks to establish the real consequences of PAS and systemic changes that would help decrease its occurrence. Her text reflects the views also held on her website, www.endparentalalienation.com, which seeks to provide “education about this emotional form of child abuse.”

In the text, Gottlieb shares her clinical encounters with cases of PAS, demonstrating with examples how the behavior of the alienating parent and child fulfill Garner's 8 criteria for the syndrome. Stylistically, her prose is somewhat meandering and sometimes difficult to follow; the barrage of case history snippets can lose their impact because of the frequency with which Gottlieb switches between them. Still, there are powerful and compelling accounts about how the alienated parent can become vilified, ostracized, and even criminalized because of the custody conflict. The role that health and legal professionals can play in worsening these conditions (e.g., by limiting contact with the alienated parent) demands self-reflection of anyone who works with children and families. Health care providers may be particularly struck by statements regarding the frequency of psychiatric diagnoses and psychoactive prescriptions provided for children based solely on the history of the alienating parent. Some statements made by alienating parents about the alienated parent—e.g., his “anger management issues” or the “lack of routine or structure” at her home—may sound eerily familiar to clinicians who have worked with families undergoing acrimonious custody disputes.

The text's most significant limitation is in its primary reliance on subjective information. Data that are included consist mostly of statistics based on the author's own case history. The author's approach in discussing PAS consists mostly of anecdotes and excerpts of interviews with other mental health providers and legal experts reporting on their professional experiences with PAS. There are entire chapters dedicated to the first-person accounts of “alienated” parents, culminating in the author's own experience with PAS in her childhood and its ongoing effects on her familial relationships. Although the author is commendable for her transparency, the appeal to experience and emotion lacks logical authority. Major criticisms of the PAS construct have included the lack of scientific reliability and dearth of large-scale, longitudinal studies validating the diagnosis; these shortcomings are not directly or sufficiently addressed by the text. Finally, because the text was written before the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, it does not directly address new codes covering behaviors related to PAS (although curious readers can read Gottlieb's website to find her commentary on this topic).

The text serves as an excellent introduction to the reader who is unfamiliar with the PAS construct. Supporters of PAS will be emboldened by the gravitas of family experiences and their emotional impact on the reader, whereas critics of PAS are unlikely to be swayed by Gottlieb's lines of argument. Regardless of one's beliefs about PAS, however, Gottlieb makes a compelling argument for the “‘condition’ of a child being lost to 1 parent due to malicious programming by the other parent.” Professionals who have ever worked with children and families undergoing custody disputes will find this a thought-provoking text that invites self-contemplation and further exploration of the PAS concept.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.