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Issues - PAS - definitions
ABSTRACT. The parental alienation syndrome is commonly seen
in highly contested child-custody disputes. The author has
described three types: mild, moderate, and severe--each of
which requires special approaches by both legal and mental
health professionals. The purpose of this article is to correct
some misinterpretations of the author's recommendations as
well as to add some recently developed refinements. Particular
focus is given to the transitional-site program that can be
extremely useful for dealing with the severe type of parental
alienation syndrome. Dealing properly with parental-alienation-syndrome
families requires close cooperation between legal and mental
health professionals. Without such cooperation therapeutic
approaches are not likely to succeed. With such cooperation
the treatment, in many cases, is likely to be highly effective.
_________________________________________________________________
Richard A. Gardner, M.D. is Clinical Professor of Child Psychiatry,
Columbia University, College of Physicians & Surgeons,
New York City.
THE PARENTAL ALIENATION SYNDROME
The parental alienation syndrome (PAS) is a disorder that
arises almost exclusively in the context of child-custody
disputes. It is a disorder in which children, programmed by
the allegedly "loved" parent, embark upon a campaign
of denigration of the allegedly "hated" parent.
The children exhibit little if any ambivalence over their
hatred, which often spreads to the extended family of the
allegedly despised parent. Most often mothers are the initiators
of such programming, and fathers are the victims of the campaigns
of deprecation. However, in a small percentage of cases it
is the father who is the primary programmer and the mother
who comes to be viewed as the "hated" parent. Furthermore,
we are not dealing here with simple "brainwashing"
by one parent against the other. The children's own scenarios
of denigration often contribute and complement those promulgated
by the programming parent. Accordingly, I introduced the term
parental alienation syndrome (PAS) to refer to both of these
contributions to the disorder. Because of the children's cognitive
immaturity their scenarios may often appear preposterous to
adults. Of course, if the hated parent has genuinely been
abusive, then the children's alienation is warranted and the
PAS concept is not applicable.
There are three types of parental alienation syndrome: mild,
moderate, and severe. It goes beyond the purposes of this
article to describe in full detail the differences between
these three types. At this point only a brief summary, however,
is important here. In the mild type the alienation is relatively
superficial and the children basically cooperate with visitation,
but are intermittently critical and disgruntled. In the moderate
type, the alienation is more formidable, the children are
more disruptive and disrespectful, and the campaign of denigration
may be almost continual. In the severe type visitation may
be impossible so hostile are the children, hostile even to
the point of being physically violent toward the allegedly
hated parent. Other forms of acting out may be present, acting
out that is designed to cause formidable grief to the parent
who is being visited. In many cases the children's hostility
has reached paranoid levels, that is, delusions of persecution
and/or fears that they will be murdered in situations where
there is absolutely no evidence that such will be the case.
Listed below are the primary manifestations of the PAS (Gardner,
1992):
The Campaign of Denigration
Weak, Frivolous, or Absurd Rationalizations for the Deprecation
Lack of Ambivalence
The "Independent Thinker" Phenomenon
Reflexive Support of the Loved Parent in the Parental Conflict
Absence of Guilt Over the Denigration and/or Exploitation
of the "Hated" Parent
The Presence of Borrowed Scenarios
Spread of the Animosity to the Friends and/or Extended Family
of the Hated Parent
This article has been written because of certain misinterpretations
of the recommendations I make in my book on the PAS. Although
these recommendations are stated in the book, there are situations
in which they have not been implemented in the appropriate
manner, sometimes with unfortunate and even disastrous results.
In addition, I present here certain refinements and elaborations
that I have come to appreciate since the publication of the
original book in 1992. (These are summarized in Tables 1 and
2.)
Because mothers are much more often alienators than fathers,
I will refer to the parent who induces the PAS as the mother,
and the parent who is the victim of the child's campaign of
denigration as the father. Obviously, in situations in which
the father is the one who is inducing the PAS in the child
and the mother the victim of the campaign of denigration,
then the recommendations made here for the mother should be
applied to the father.
Unfortunately, the term parental alienation syndrome is often
used to refer to the animosity that a child may harbor against
a parent who has actually abused the child, especially over
an extended period. The term has been used to apply to the
major categories of parental abuse, namely, physical, sexual,
and emotional. Such application indicates a misunderstanding
of the parental alienation syndrome. The term is applicable
only when the parent has not exhibited anything close to the
degree of alienating behavior that might warrant the campaign
of denigration exhibited by the child. Rather, in typical
cases the parent would be considered by most examiners to
have provided normal loving parenting or, at worst, exhibited
minimal impairments in parental capacity. It is the exaggeration
of minor weaknesses and deficiencies that are the hallmarks
of the parental alienation syndrome. When bona fide abuse
does exist, then the child's responding hostility is warranted
and the parental alienation syndrome diagnosis is not applicable.
Programming parents who are accused of inducing a parental
alienation syndrome in their children will sometimes claim
that the children's campaign of denigration is warranted because
of bona fide abuse and/or neglect perpetrated by the denigrated
parent. Such parents may claim that the accusation of parental-alienation-syndrome
induction is merely a "cover-up," a diversionary
maneuver, an attempt on the part of the vilified parent to
throw a smoke screen over the abuses and/or neglect that have
justified the children's campaign. There are indeed some genuinely
abusing and/or neglectful parents who will deny their abuses
and rationalize the children's campaign of hatred as being
programmed by the other parent. This does not preclude the
existence of truly innocent parents who are indeed being victimized
by a parental-alienation-syndrome campaign of denigration.
When such cross-accusations occur--namely, bona fide abuse
and/or neglect vs. a true parental alienation syndrome--it
behooves the examiner to conduct a detailed inquiry in order
to ascertain the category in which the children's accusations
lie, i.e., true parental alienation syndrome or true abuse
and/or neglect. In some situations, this differentiation may
not be easy, especially when there has been some abuse and/or
neglect and the parental alienation syndrome has been superimposed
upon it--resulting in far more deprecation than would be justified
in this situation. It is for this reason that detailed inquiry
is often crucial if one is to make a proper diagnosis. Combinations
of individual and joint interviews with the children and parents
is probably the best way to make this important differentiation.
In recent years some professionals use the term PAS to refer
to a false sex-abuse accusation in the context of a child-custody
dispute. In some cases the terms are used interchangeably.
This is a significant misperception of the PAS concept. In
the majority of cases in which a PAS is present the sex-abuse
accusation is not promulgated. In some cases, especially after
other exclusionary maneuvers have failed, the sex-abuse accusation
will emerge. The sex-abuse accusation, then, is most often
a spin-off, or derivative, of the PAS and is in no way synonymous
with it. Furthermore, there are divorce situations in which
the sex-abuse accusation may arise without the PAS present.
Under such circumstances, of course, one must give serious
consideration to the possibility that true sex abuse has occurred,
especially if the accusation antedates the marital separation.
Before one can make a decision regarding legal and therapeutic
approaches to the PAS child it is important that a proper
diagnostic evaluation be conducted in order to ascertain specifically
in which category the child's symptoms lie: mild, moderate,
or severe. Each type warrants a very different approach. Failure
to make this discrimination may result in grievous errors,
with significant psychological trauma to all concerned parties.
This principle is in line with the ancient medical tradition
that proper diagnosis must precede treatment. Furthermore,
evaluators should appreciate that the category of PAS is not
determined by the efforts of the programming parent, but by
the degree to which the indoctrinating attempts have been
successful. It is the resultant PAS manifestations in the
child that determines the categorization, not the degree of
parental efforts at indoctrination. A mother, for example,
may embark upon a relentless campaign, the purpose of which
is to denigrate the father to the degree that the child will
hate him formidably. However, the father's love and involvement
with the child has been deepseated. Accordingly, the mother's
efforts may not prove successful, so strong has the father's
bonding been. And the older the child, the less likely her
efforts will be successful.
MILD CASES OF PAS
Manifestations
Children in the mild category exhibit relatively superficial
manifestations of the eight primary symptoms: campaign of
denigration; weak, frivolous, or absurd rationalizations for
the deprecation; lack of ambivalence; the "independent
thinker" phenomenon; reflexive support of the loved parent
in the parental conflict; absence of guilt; the presence of
borrowed scenarios; and spread of the animosity to the extended
family of the hated parent. Most often only a few of these
eight symptoms are present. It is in the moderate type, and
especially in the severe type, that most, if not all of them
are seen. Visitation is usually smooth with few difficulties
at the time of transition. Once in the father's home the children
may be completely free of denigrating comments or, at most,
such comments are intermittent and mild. The children's primary
motive in contributing to the campaign of denigration is to
maintain the stronger, healthy psychological bond that they
have developed with their mothers.
Legal Approaches
In mild cases of PAS all that is usually needed is the court's
confirmation that the mother will remain the designated primary
custodial parent. In such situations the PAS is likely to
alleviate itself without any further therapeutic or legal
intervention.
Psychotherapeutic Approaches
Most often, psychotherapy for PAS symptoms in the mild category
are not necessary in that they are likely to disappear once
the court makes a decision to designate the mother the primary
custodial parent. However, psychotherapy might be necessary
for other problems attendant to the divorce.
MODERATE CASES OF PAS
Manifestations
The moderate cases are the most common. It is in this category
that the mother's programming of the child is likely to be
formidable and she may utilize a wide variety of exclusionary
tactics. All eight of the primary manifestations are likely
to be present, and each is more advanced than one sees in
the mild cases, but less pervasive than one sees in the severe
type. The campaign of denigration is more prominent, especially
at transition times when the child appreciates that deprecation
of the father is just what the mother wants to hear. The children
in this category are less fanatic in their vilification of
the father than those in the severe category, but more than
those in the mild category. The rationalizations for the deprecation
are more numerous, more frivolous, and more absurd than those
seen in the mild cases. None of the normal ambivalence that
children inevitably have with regard to each of their parents
is present. The father is described as all bad, and the mother
as all good. The child professes that he (she) is the sole
orignator of the feelings of acrimony against the father.
The reflexive support for the mother in any conflict is predictable.
The child's absence of guilt is so great that the child may
appear psychopathic in his (her) insensivity to the grief
being visited upon the father. Borrowed-scenario elements
are likely to be included in the child's campaign of denigration.
Whereas in the mild category there may still be loving relationships
with the father's extended family, in the moderate cases these
relatives become viewed as clones of the father and are similarly
subjected to the campaigns of revulsion and denigration.
Whereas in the mild cases transition times present few difficulties,
in the moderate cases there may be formidable problems at
the time of transfer, but the children are ultimately willing
to go off with the father, while professisng significant reluctance.
Once removed entirely from their mother's purview, the children
generally quiet down, relax their guard, and involve themselves
benevolently with their fathers. This is in contrast to the
severe category where visitation is either impossible or,
if the children do enter the father's home their purpose is
to make his life unbearable by ongoing vilification, destruction
of property, and practically incessant provocative behavior.
The primary motive for the children's scenarios of denigration
is to maintain the stronger, healthy psychological bond with
the mother.
Legal Approaches
1) In moderate cases I still recommend that the mother remain
the primary custodial parent, her inducement of the PAS in
her children notwithstanding. In moderate cases, she has usually
still been the primary parent with whom the children have
been most deeply bonded and it therefore makes sense for her
to continue in this role. A court order finalizing this arrangement
can contribute somewhat to the alleviation of the PAS, but
it is not likely to evaporate entirely the symptoms, so deeply
have they usually become entrenched by the time of this order.
2) Because in most cases the court has decided that the mother
will remain the primary custodial parent, there is continued
resistance to visitation. This is the result of the entrenchment
in the brain-circuitry of both mother and children that the
father is somehow despicable. Accordingly, a court-ordered
therapist is often necessary who serves to monitor visits,
use his (her) office as a transition site, and report to the
court any failures to implement visitation. This therapist
must be someone who is knowledgeable about the PAS and comfortable
using the special, stringent therapeutic approaches necessary
for successful alleviation of symptoms in both parents and
children.
3) In most cases, recalcitrant mothers need to be warned by
the court that if the children do not visit with the father,
for whatever reason, court sanctions will be imposed. These
not only serve to "remind" the recalcitrant mother
to cooperate with visitation but are very useful for the children
as well. It gives them the excuse to visit and can assuage
the guilt they might otherwise feel if they were to admit
to their mothers that they themselves want to see the father.
In such situations the child can say to the mother: "I
really hate him, and I don't want to visit with him. However,
if I don't see him, I know the judge will punish you."
I cannot emphasize strongly enough this important factor in
the efficacy of sanctions, and even threatened sanctions.
I generally recommend that the first level of such sanctions
be financial, e.g., reduction of alimony payments. If this
does not serve to bring about visitation, then house arrest
for short periods should be ordered by the court. At the first
level of house arrest, the woman would merely be required
to remain in her home throughout the prescribed time frame
of the "sentence," with none of the traditional
monitoring by police. Generally a "sentence" of
a few days will suffice, e.g., the time frame of a child's
weekend visitation. The woman should be put on notice that
if she is found out of her home during that time frame she
will be arrested. If this fails, then a more formal arrangement
should be made with electronic transmitters placed on the
woman's ankle and telephone calls from the police to the home,
randomly made throughout the 24-hour time frame. If this fails,
then actual incarceration for limited periods should be utilized.
I am not recommending that these women be placed in prison
with hardened criminals. I am only suggesting short periods
in a local jail. In most cases, the awareness of financial
penalties and the possibility of incarceration is enough to
motivate such mothers to get their children to the father's
home, their resistance to such visits notwithstanding. Unfortunately,
my experience has been that courts are not generally willing
to impose these sanctions, and so mothers in the moderate
category have not been meaningfully deterred from continuing
the promulgation of a PAS in their children.
My general recommendation to courts is that they use the same
methods that they would for a father who reneges on alimony
and support payments. Although financial penalties are not
usually imposed under such circumstances, short prison terms
(especially on weekends), both at home and in jail, have proven
quite effective. Inducing a PAS in a child is a form of child
abuse, more specifically, emotional abuse. Reneging on alimony
and support payments is also a form of child abuse, in that
the children cannot but suffer from the privations generated
by such withholding. The court has the power to induce both
types of child abusers to reconsider their ways, and courts
can do this much more speedily and effectively than can therapists.
Psychotherapeutic Approaches
It is important that the court order treatment by someone
who is not only familiar with the PAS but who is comfortable
using the stringent approaches necessary for successful treatment
of this disorder. The therapist monitors visits, uses his
(her) office as a transitional site, and reports to the court
any failures to implement visitation. Without direct access
to the court and without meaningful sanctions that the court
is committed to implement, the treatment is likely to fail.
Details of this therapeutic program are provided on pages
230-245 of my Parental Alienation Syndrome book (Gardner,
1992).
In most cases of moderate PAS the aforementioned program should
prove efficacious. However, success depends upon the joint
efforts of both the court and the PAS family's therapist.
If the court fails to invoke sanctions (a common occurrence)
and/or a therapist does not satisfy the aforementioned provisos
of treatment (also a common occurrence), then there is little
likelihood of reduction of the children's symptoms. They may
then progress on to the severe category. In such situations,
the only hope of protecting the children from progression
to the severe category--and the likelihood of lifelong alienation--is
to transfer primary custodial status to the father. Such transfer,
however, should only be done in situations in which the mother's
programming is so deepseated and so chronic that it is obvious
that sanctions and a special PAS therapeutic program will
prove futile. An example of such a situation would be one
in which the mother is clearly paranoid, refuses to cooperate
at all in the special therapy, and it becomes clear that incarceration
is not going to in any way affect her delusion. Under such
circumstances, transfer of custody is necessary in order to
protect the children from progressing down the road to the
severe type of PAS and ultimate disintegration of the father-child
bond. Following transfer, varying degrees of maternal access
to the children are possible, depending upon the mother's
ability to reduce the PAS-inducing manipulations. Supervised
visitations with the mother are often indicated in order to
protect the children from her indoctrinations. This is similar
to the monitoring provided for abusing fathers. After all,
inducing a PAS in a child is a form of abuse from which children
need protection.
We have, then, two types of custodial plan for the mother
who programs children into the moderate level of PAS. The
majority, whose tendencies are not deepseated and longstanding,
may respond to the sanctions and special PAS therapeutic program.
Such mothers, in my experience, represent the majority of
programming mothers in the moderate category. There are a
minority of such mothers, however, whose programming tendencies
are so chronic and deepseated that sanctions and the special
therapeutic program have either proven futile or there is
every indication that they are doomed to failure. Under such
circumstances, custodial transfer is necessary to prevent
the children from progressing down the track to a severe PAS.
These two situations are referred to as Plan A and Plan B
in Table 2.
SEVERE CASES OF PAS
Manifestations
Children in the severe category are generally quite disturbed
and are usually fanatic. They join together with their mothers
in a folie à deux relationship in which they share
her paranoid fantasies about the father. All eight of the
primary symptomatic manifestations are likely to be present
to a significant degree, even more prominent than in the moderate
category. Children in this category may become panic-stricken
over the prospect of visiting with their fathers. Their blood-curdling
shrieks, panicked states, and rage outbursts may be so severe
that visitation is impossible. If placed in the father's home
they may run away, become paralyzed with morbid fear, or may
become so continuously provocative and so destructive that
removal becomes necessary. Unlike children in the moderate
and mild categories, their panic and hostility may not be
reduced in the father's home, even when separated from their
mothers for significant periods. Whereas in the mild and moderate
categories the children's primary motive is to strengthen
the stronger, healthy psychological bond with the mother,
in the severe category the psychological bond with the mother
is pathological (often paranoid) and the symptoms serve to
strengthen this pathological bond.
Legal Approaches
In severe cases of PAS, which represent a very small minority
of PAS cases (approximately five-to-ten percent, in my experience)
more stringent measures must be taken. If there is any hope
of alleviating the children's symptoms the first step must
involve a transfer of physical custody to the home of the
father. Whether this remains permanent depends upon the behavior
of the mother. Because the children typically will not cooperate
regarding going to the father's home, the therapist may be
confronted with one of the knottiest problems I have encountered
regarding the treatment of PAS families. Specifically, my
recommendation that the court remove such children from the
home of a parent who is inducing a severe type of PAS (especially
when paranoia is present) has not been met with receptivity
by judges and some mental health professionals.
One source of this unreceptivity relates to the deep-seated
notion that children should not be removed from their mother,
no matter how disturbed she may be. (As mentioned throughout
this article, for simplicity of presentation, I refer to the
programming parent as the mother because she, much more often
than the father, is the programmer. However, the same principles
apply when the father is the primary promulgator of the PAS.)
Courts have generally been much more receptive to my recommendations
for the mild and moderate categories of mothers, because my
recommendations do not include removal of the children from
the mother's home. Another source of unreceptivity relates
to the fact that the children in the severe category are often
so frightened of their father, and have been so imbued with
the notion that being in his home is dangerous and might even
be lethal, that transfer is considered impossible. My frustration,
resulting from the unreceptivity of courts to implement this
recommendation, has been made especially poignant by the recognition
that the children's remaining in the mother's home dooms their
relationship with their father and predictably results in
their developing longstanding psychopathology, even paranoia.
An intermediary disposition, an arrangement that does not
involve immediate transfer from the home of the mother to
the home of the father, can solve many of the problems attendant
to a direct transfer and can also reduce judicial unreceptivity
to this proposal.
Before describing the details of the transitional program,
it is important to emphasize that the transition points are
particularly difficult for PAS children. In such circumstances,
with both parents present, the children's loyalty conflict
is most acute. In the case of children suffering with the
severe type of PAS, transition under such circumstances is
practically impossible. The father is generally unable to
get the children out of the mother's home and, even if they
are transferred to his home by force, they are likely to run
away and do everything possible to return to their mother's
home. Temporary placement in a transitional site appears to
be an excellent solution to this problem. In such a transitional
site, the aforementioned confrontation is obviated in that
the children are not placed in a position in which they are
with both parents together.
It is also important to reiterate that mothers in the severe
category are not going to comply readily with court orders
to cease and desist from their brainwashing. In fact, their
ignoring of court orders is one of the reasons why they warrant
placement in the severe category. The main purpose of the
program presented here is to enforce the mother's separation
from the children--for varying periods depending upon the
case--in order to protect the children from the mother's ongoing
campaign of manipulation and programming. Accordingly, during
this early phase it is crucial that there be no contact at
all between the children and their mother, either directly
or indirectly, e.g., via telephone or mail. All these contacts
will be utilized by the mother to continue her brainwashing
and will thereby lessen significantly the likelihood that
this traditional program will be successful.
The Three Levels of Transitional Sites
There are three levels of transitional sites, ranging from
the least restrictive to the most restrictive environment.
The less restrictive environments should be tried first, using
the most restrictive as a last resort--and then only if the
less restrictive facilities do not prove adequate for the
purposes of the transfer. The program must be monitored by
a guardian ad litem or court-appointed therapist who serves
to monitor the program and who also has direct access to the
court for judicial support and the issuing of court orders
necessary for the success of the plan. Without such "clout"
the program is not likely to succeed. For each level of transitional
site there is a phased program, the purpose of which is to
facilitate the children's transfer from the mother's to the
father's home.
Site Level 1. In this category of transitional site, I include
the home of a friend or relative with whom the children have
a reasonably good relationship. Although this might be the
home of one of the father's relatives, it would not be a suitable
place for transition if the mother has been successful in
programming the children to believe that these individuals
are part of the father's extended network of people who will
also cause them significant harm. While living with these
people, arrangements have to be made for the children's attending
a local school. In order to serve effectively, these caretakers
have to appreciate the depth of the mother's pathology and
have to be strong enough to prohibit mail and telephone calls
(during a prescribed period--see below) and report to the
proper authorities (e.g., a guardian ad litem or a court-appointed
therapist) the failure of the mother to obey the court order
restraining her from visiting the children or even coming
into their neighborhood or school. The caretakers at this
site would also have to be able to exert control over the
children's antics during the periods of their father's visits
with them (see below).
Another type of transition site in this category would be
a foster home. Here, again, the foster parents would have
to satisfy the aforementioned criteria of vigilance and stringency.
If the situation is so bad that a level-1 transitional site
is not feasible, then a more restricted environment must be
considered. This would be necessary if the mother continued
to ignore court orders not to call or visit the children (either
in the transitional home or in the school environment). It
would also be necessary if the children continued to run away
from a level-1 transitional site in order to return to their
mother. Under such circumstances, a level-2 transitional site
would have to be considered.
Site Level 2. A possible site in this category would be a
community shelter--the kind of setting where are placed delinquents,
abandoned children, abused children, and others warranting
removal from their homes. It is preferable that the school
be incorporated into this facility (sometimes the case). Here
there would be much more stringent surveillance and control
of the children's behavior, especially when the father visits
(see below), as well as the mother's potential to visit and/or
communicate with the children.
This facility might not prove feasible if the children's antics
became unmanageable, if the mother continues to visit the
premises (in spite of a court order), and/or if the children's
behavior becomes uncontrollable at the time of the father's
visits. Under those circumstances, a level-3 transitional
site would have to be considered.
Site Level 3. Hospitalization. Obviously, this is the most
restrictive environment, one in which there is the greatest
degree of control over the situation. This should only be
tried after transitional sites 1 and 2 have been considered
and, preferably, tried. obviously, here the children would
have the least opportunity to go back to their mother's home,
and there would be the greatest degree of control over mail,
telephone calls, and visits by the mother. Here, too, there
would be the greatest degree of control over the children's
behavior at the time of the father's visits. It is crucial
that the treating personnel have knowledge of the, PAS and
the opportunity for input to the court, either directly or
indirectly. Because most hospitals have affiliated schools,
the children could attend school while hospitalized.
The Six Phases of Transition at Each Site
At this point I will address myself to the details of the
six-phase sequence developed to effect a transfer from the
mother's to the father's home via the transitional site. Although
the program may be under the auspices of a therapist, what
is done here is far less therapy than "movement of bodies."
The main goal is to provide the children with living experiences
that their father is not the terribly dangerous person he
has been portrayed to be by the mother. The ultimate aim is
to get the children into the father's home as soon as possible,
but it is important to recognize that the amount of time spent
in the transitional site will vary from case to case, and
transfer must be monitored carefully by the people involved
in administering the transitional program. I propose a program
that follows this sequence:
Phase 1. Placement in the transitional site. Here, the children
are removed from the mother's incessant campaign of programming,
yet they are not with their father, with whom they believe
terrible things will happen to them. During this period at
the transitional site, all contact with the mother should
be cut off, including mail and telephone calls. Then, after
a few days of accommodation to the new site, the father should
visit the children at the site. There, they will start to
have the living experience that no harm will come to them.
Over the next few days or weeks (depending upon their tolerance),
visits with the father (again at the site) should increase
in both frequency and duration.
Phase 2. At some point (hopefully in a short period), the
children should begin visiting their father for short periods
in his home, after which they return directly to the transitional
site. Gradually, the visits to the father's home should be
lengthened, until the point where they can start living there
on an ongoing basis. During this period there should be no
contact with the mother, even via mail and telephone calls.
Phase 3. The children are discharged from the transitional
site and live with their father on an ongoing basis. In the
early part of this phase, once again, no mail or telephone
calls from the mother should be allowed. If she is seen in
the area of the father's home, this is to be reported immediately
(through proper channels) to the court, after which serious
sanctions, such as a fine, a reduction in alimony payments,
and even incarceration (or hospitalization (in selected cases])
should be seriously considered. The children require the living
experience that the terrible consequences that they have anticipated
will not be realized. Any interruption of this process by
the mother is likely to cause them to regress.
Phase 4. Carefully monitored contact with the mother can be
permitted--on a trial basis. The first step should be limited
and monitored telephone conversations. It is not likely that
the mother will reduce her programming, but at least limitations
can be placed on it. If it appears that she has enough self-control
and/or that her obsession with brainwashing the children is
somewhat under control, longer telephone conversations can
be permitted. During this phase, similarly monitored mail
communications may be allowed.
Phase 5. Monitored visits with the mother in the father's
home may be tried, the frequency and duration determined by
how much she can reduce her inculcation of animosity toward
the father.
Phase 6. In some cases, carefully monitored and judiciously
restricted visits to the mother's home might be tried. Obviously,
this would only be possible in those situations in which the
mother's animosity has become reduced to the degree that there
is only limited risk of programming (which runs the risk of
undoing all the benefits derived from the implementation of
the previous phases in this program). There are some cases
in which this phase would never be reached because the mother
might kidnap the children, refuse to return them, or otherwise
subject them to unrelentless programming against the father.
It is to be hoped, however, that this does not prove to be
necessary and that some contacts with the mother might be
possible.
Further Comments on the
Transitional Site Program
The transitional-site program might be conducted under the
auspices of a psychologist, psychiatrist, or guardian ad litem,
who is court appointed and who has the freedom to report back
to the court any problems that may arise. In recent years,
courts have become increasingly appreciative of the importance
of strong sanctions (fines, garnisheeing of wages, attachment
of property, and even incarceration) for fathers who have
failed to fulfill their financial obligations to their former
wives. Courts, however, have not been equally receptive to
recommendations that PAS mothers know that they cannot ignore
the court's orders with impunity. The threat of fine and incarceration
can help most such women "cooperate." Another issue
relevant here is the power of the court to hospitalize the
children. Courts certainly hospitalize insane people and/or
individuals who are a danger to themselves and others. Many
people are committed for short periods, such as thirty days,
pending a final decision of the court regarding their permanent
disposition. A similar procedure could be utilized to hospitalize
PAS children, and a thirty-day limit would, I suspect, be
adequate to achieve the aforementioned goals.
Community shelters and psychiatric hospitals are not famous
for their plushness. In fact, many are referred to as "zoos,"
and this reputation is sometimes warranted. However unfortunate
this situation may be in other circumstances, it may serve
to speed up the transfer program for PAS children. Recognizing
that they cannot return to their mother and appreciating that
their antics may prolong their stay in the transitional site,
may enhance their motivation to move rapidly into the home
of their father. And even the level-i transitional site may
serve this purpose if it is inhospitable enough for the children.
I am not recommending that one go out of one's way to select
the most inhospitable sites for these children; but I am not
recommending that one search for the most plush arrangements
either.
To date, I have had little direct experience with this proposal,
mainly because of the unreceptivity of courts to implement
it. Others, however, have described some success with it.
I recognize that this proposal, like many of the other proposals
in life, are more likely to be put into effect if there are
financial resources to support it. This is no different from
any other recommendation made in psychiatry, or in medicine
in general. The facts are that the more money available for
any program (medical or otherwise), the greater the likelihood
it will be implemented and the greater the likelihood of its
success. To the degree that community and/or personal resources
are available to implement this program, to that degree is
it likely to prove successful.
It is crucial to reiterate that the only hope these children
have for bonding with their father and being protected from
the induction of their mother's severe psychopathology is
permanent transfer to the home of the father and his designation
as the primary custodial parent. Without such transfer, the
bonding with the father is inevitably going to be destroyed,
and the children will predictably develop the mother's psychopathology.
This plan is not designed for PAS families in the mild and/or
moderate categories. Mothers in these categories generally
have healthier bonding with their children, have most often
been the primary caretakers, and (their antics notwithstanding)
still warrant being designated the primary custodial parent.
Accordingly, no such transfers are indicated for mothers in
the mild and moderate categories.
It is not the purpose of this program to preclude the mother
entirely from the children's lives. In fact, as described
therein, it provides for expanding opportunities for access,
depending upon the degree to which the mother can reduce her
PAS-inducing indoctrinations. In most cases there will ultimately
be varying degrees of maternal access, depending upon the
mother's ability to reduce the PAS-inducing manipulations.
Supervised visitations with the mother are often indicated
in order to protect the children from her indoctrinations.
This is similar to the supervision provided for abusing fathers.
After all, inducing a PAS in a child is a form of abuse from
which children need protection. The transitional program does
not necessarily preclude the mother ultimately reverting back
to the status of primary custodial parent, although this is
not likely in the severe category because these mothers often
suffer with significant psychiatric disturbances. It is important
to emphasize that it is only in the severe cases of PAS (again,
representing five-to-ten percent of cases) that primary custodial
status should be shifted from the mother to the father.
Psychotherapeutic Approaches
The transitional site program should be monitored by a therapist
who is not only familiar with the PAS but is comfortable with
the kind of stringent approaches necessary for the implementation
of the transitional site program. In short, this therapist
must have the same qualifications as the therapist ordered
by the court to implement the treatment of families in the
moderate category. If the therapist does not have these qualifications,
the transitional site program is not likely to succeed.
CONCLUDING COMMENTS
The differential diagnostic and treatment approaches to the
PAS are summarized in Tables 1 and 2. I cannot emphasize strongly
enough that evaluators should never lose sight of the crucial
medical dictum: diagnosis before treatment. Evaluators from
nonmedical disciplines tend to lose sight of this important
principle. One wants one's heart or brain surgeon to conduct
the proper examinations and tests before opening up one's
heart or head to operate. Most would not submit to such a
procedure without diagnostic evaluations and tests. Yet, evaluators
and courts are implementing PAS recommendations that are improper
for the particular diagnostic category.
I cannot emphasize strongly enough the importance of accurately
defining the category of PAS before implementing any therapeutic
or legal measures. Not to do so is likely to result in grievous
errors that will predictably cause significant psychiatric
disturbances in all concerned parties. I have seen reports
of mental health professionals and courts dealing with mild
or moderate cases of PAS as if they were severe, injudiciously
and erroneously, then, transferring custody to the father,
and even putting women in jail whose level of indoctrinations
are minimal and might even be reversed once they had the assurance
that they would remain the primary custodial parents. I have
seen cases in which courts and mental health professionals
have assessed PAS on the basis of the mother's indoctrinations,
and not the degree to which the programming process has been
successful in the child. In such cases the children may have
exhibited only mild PAS manifestations, but the mother was
treated as if the children were in the severe category and
thereby deprived of custody.
Again, the diagnosis of PAS is not made on the basis of the
programmer's efforts but the degree of "success"
in each child. The treatment is based not only on the degree
to which the child has been alienated but also on the mother's
degree of attempted indoctrinations. In most cases the mother
will still remain the primary custodial parent. It is only
when she cannot, or will not, inhibit herself from such indoctrinations
that custodial transfer and the transitional site program
should be implemented. Not to do so will predictably bring
about progressively more pathological levels of PAS symptomatology
in the children.
It is only in the severe category that custodial transfer
from the mother to the father will generally be indicated.
In some cases of moderate PAS, however, such transfer might
be necessary because of the mother's deepseated compulsion
to indoctrinate the children against the father and the real
danger that she will not desist from her indoctrinations after
the trial. Often, the main reason why these moderate PAS children
have not progressed to the severe category is the healthy
input from the father. In such cases, the transitional site
program is not necessary because the children are still visiting
with their father, although they may be causing him grief
in association with their moderate levels of PAS.
In my experience, it is rare that custodial transfer is warranted
in the mild cases. However, the examiner should still consider
such transfer for mothers who are so fanatic that it is unlikely
they will desist from their indoctrinations after the trial.
The only reason why the children are only in the mild category
is that the programming has not "taken," probably
because of the father's healthy input.
Obviously, the presence of a PAS is only one consideration
in assigning primary custodial status. Other factors must
be considered, but the presence of a PAS--especially with
regard to its level--is crucial if one is to make a proper
custodial recommendation in families where it is present.
REFERENCE
Gardner, R. A. (1992). The parental alienation syndrome: A
guide for mental health and legal professionals. Cresskill,
New Jersey: Creative Therapeutics, Inc.
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