517526_99507694In our earlier interview with Dr. William Bernet, author of Parental Alienation, DSM-5, and ICD-11. PA and the DSM-5. In this post, Dr. Bernet comments briefly on the history and prevalence of PA as well as various approaches to addressing the problem.

Dr. Bernet, is parental alienation (PA) a new disorder or is there evidence that PA has a history? How pervasive would you say PA is?

PA is not new at all. The concept of PA has mentioned and described in legal documents since the early 19th century. The concept of PA was discussed in the literature for mental health professionals since the 1940s. The actual term “parental alienation syndrome” was introduced in 1985 by Richard Gardner.

It is hard to determine the prevalence of PA because scholars and research personnel have different definitions and criteria for the concept of PA. In the book I edited (Parental Alienation, DSM-5, and ICD-11), we very roughly estimated that 1 percent of children and adolescents in the United States experience some degree of PA, either mild, moderate, or severe.

Is PAS a cultural problem? Is PAS more of an American phenomenon or does it exist in other cultures?

PA occurs all over the world. We have developed a large bibliography regarding PA: about 900 articles from the professional literature of 35 countries, all the way from Argentina to Latvia, Turkey, Algeria, India, and Japan.

We’ve written about PA in the past, and the responses from readers showed how raw and painful PA is for both parents and adult children who’ve been through it. We hear a lot about the heartbreak, but haven’t heard many success stories. How does this problem get solved?

PA is treatable, especially if it is identified in the early stages. Recent books on the treatment of PA were published by Linda Gottlieb (Parental Alienation Syndrome: A Family Therapy and Collaborative Systems Approach to Amelioration) and Amy Baker and Richard Sauber (Working with Alienated Children and Families: A Clinical Guidebook). The type of treatment depends on the severity of PA experienced by the child and the severity of the indoctrination by the alienating parent.

Suppose the alienating parent only makes a few negative comments about the other parent, but does not have serious intentions of harming the child’s relationship with that parent. And suppose the child has a mild degree of PA, i.e., the child resists contact with the target parent but enjoys his time with that parent once parenting time is underway. In that case, the intervention is fairly simple: the judge might strongly order the parents to stop badmouthing each other. Or, a mental health professional might provide clearly stated instructions or psychoeducation for the parents.

Suppose the alienating parent intentionally desires to criticize and undermine the child’s relationship with the other parent. And suppose the child has a moderate degree of PA, i.e., the child resists contact with the target parent and is persistently oppositional during parenting time. In that case, the intervention is more complex, which might include: a parenting coordinator to help the parents communicate in a constructive manner; individual therapy for the alienating parent to help him or her stop indoctrinating the child; and counseling for the child, to help the child avoid the parents’ battles.

Finally, suppose the alienating is obsessed with destroying the child’s relationship with the other parent. And suppose the child has a severe degree of PA, i.e., the child persistently and adamantly refuses contact and may hide or run away to avoid being with the rejected parent. In shared psychotic disorder, for example, the alienating parent may have paranoid delusions about the rejected parent, which are adopted by the child. In that case, the child should be removed from the influence of the alienating parent, so that the child can re-establish his relationship with the rejected parent. However, if the child returns prematurely to the home of the alienating parent, the PA may become established once again.

What happens when children who experience PA grow up?

There are several possible outcomes for “adult children of PA.” Some children remain convinced throughout their lives that the parent they rejected is evil and dangerous. Some adult children are influenced by therapists or close friends or new spouses to reach out to the parent they rejected many years earlier. That may lead to tentative and then substantive reunification. Some adult children decide spontaneously – because of changed life circumstances – to touch base with the previously rejected parent. For example, a young adult might go away to college and decide to learn more about the parent he had avoided for years. Some adult children might learn about PA from friends or the media, and they realize that is what happened to them.

What should parents do, whose children manifest a severe degree of PA?

Most authors recommend that alienated parents persistently but gently try to stay in touch with their children, who refuse to have contact with them. That might mean once or twice a year sending a card, a short note, or a small gift. It might mean sending a greeting through an intermediary, such as a friend or relative who was not rejected by the child. It probably is a good idea to save copies of those cards and notes, since they may be intercepted by the alienating parent. There are anecdotes of reunions – years later – when the adult child realizes how much effort the alienated parent put into maintaining their relationship.

Thank you for taking the time to answer our questions, Dr. Bernet. We are grateful to enrich our understanding of this very real—though hotly contested—problem.

William Bernet, M.D., a graduate of Harvard Medical School, has lived in Tennessee since 1988. He is a professor emeritus in the Department of Psychiatry at Vanderbilt University School of Medicine. Dr. Bernet is board certified in general psychiatry, child psychiatry, and forensic psychiatry. As an expert in forensic psychiatry, Dr. Bernet has testified in 34 counties in Tennessee and in 18 other states.

Dr. Bernet has published on a variety of subjects, including: group and individual therapy with children and adolescents; humor in psychotherapy; forensic child psychiatry; parental alienation; child maltreatment; true and false allegations of abuse; satanic ritual abuse; reincarnation; child custody and visitation; testimony regarding behavioral genomics; and risk management.

In 2001, Dr. Bernet and Dr. John Meeks published The Fragile Alliance: An Orientation to the Psychiatric Treatment of the Adolescent, 5th edition. In 2007, Dr. Bernet and Judge Don R. Ash published Children of Divorce: A Practical Guide for Parents, Therapists, Attorneys, and Judges. In 2010, Dr. Bernet published Parental Alienation, DSM-5, and ICD-11.

His next book will be Parental Alienation: The Handbook for Mental Health and Legal Professionals (2013), edited by Demosthenes Lorandos, William Bernet, and Richard Sauber.