Severe Parental Alienation: A Mental Health Emergency

Parental alienation occurs when one parent turns a child against the other parent.

• The alienation process generally begins with the alienator gradually instilling in the child negative views of the targeted parent, even though the targeted parent is generally the emotionally healthier one.
• As parental alienation becomes increasingly severe, the child acts with increasing hostility toward the targeted parent, eventually refusing contact altogether.
• By convincing the child to feel hatred and even terror at the idea of ever interacting again with the targeted parent — and blocking the child's visitation time with the targeted parent so the child has become totally dependent on the alienator — an alienating parent essentially kidnaps the child, both psychologically and physically.
• Alienators also may issue false accusations of sexual molestation or physical abuse against the targeted parent to further block the child from contact with that parent and to punish the targeted parent with expensive court costs for self-defense.

Dalia Erel MSW, a family and couples therapist from Israel, specializes in parental alienation treatment. I became interested in her views of how these cases should be handled after reading an article she had written for the resources page of the Parental Alienation Study Group website. PASG fosters three-way information-sharing between mental health professionals, legal professionals, and the public about parental alienation. [If this dreadful problem is of concern to you, do consider joining this free and very constructive organization.]

Dr. Heitler: What most strikes you as a therapist who treats severe cases of parental alienation?

Dalia Erel: Parental alienation cases are unique in that these children, who may be youngsters or teenagers, live in a state of high emotional risk. They live in a war zone, having been dragged by the alienating parent into their parents’ conflict and then convinced by the alienating parent to ally with them in treating the other as an enemy.

Sadly, the targeted parent is generally the healthier parent. Alienated children, however, must relinquish that formerly loving relationship in order to survive. They have to hate the targeted parent to please the alienating parent on whom they have come to depend.

Dr. Heitler: Yes. Alienating parents do splitting, that is, they insist that they themselves are all good and that the other parent is all bad — dangerous, selfish, crazy, etc.

As alienated children become increasingly isolated from the healthier parent and therefore increasingly dependent on the alienating parent, these children generally no longer feel that they have the option of expressing positive views of their other parent. They dare not lose their one remaining parent and therefore suppress their authentic voices, the voices within them that whisper, "I used to love that other parent. I miss him/her," or "The parent I am trusting is often good to me and often also scares me. Still, that's the only parent I have left, so I better do what s/he wants."

Dalia Erel: Exactly — which leads to the child or teenager often struggling with depression, anxiety, drug and alcohol use, and even suicidal thoughts.

Alas, alienating parents are generally too narcissistic and emotionally volatile to be relied upon as nurturing caretakers. Normal parents do not alienate; only parents with tendencies toward narcissism (It's all about me), borderline functioning (excessive emotionality), and anti-social personalities (lying and callous with regards to hurting others) do alienation.

And at the same time, alienated children, consciously or not, usually experience deep grieving, and also guilt, for the loss of the parent they used to love and now have rejected.

Dr. Heitler: How well does the court system help these children?

Dalia Erel: The current triangle of family court, therapists, and alienated children get stuck in a legal morass which can sometimes take years to yield decisions—and even then too often leaves the child in the custody of the alienator.

Therefore it is vital for the existing way in which PA cases are handled in the family courts to be changed, as you explained in an earlier post.

The reality is that currently these children too often are triply abused—by the alienating parent, by therapists who worsen the alienation by conducting individual treatment under the eye of the alienator without reunifying the child with the targeted parent, and by the expensive and interminable court system.

Dr.. Heitler: I have had at least one case in which a physically abusive (to the mother) and alienating dad with half-time parenting trained the son to be physically abusive to his mother, both during their marriage and post-divorce. The mother still was able to see her son, but in response to his episodic pushing and punching, encouraged by the father, the mother was considering removing herself from further contact with the young man. Have you seen that kind of situation?

Dalia Erel: Yes, alas. In situations where domestic abuse has occurred, the court is always at risk for believing an abuser's false accusations. These accusations can permit the alienating parent to continue post-divorce his abuse both of the child and of the targeted parent. The courts have a huge responsibility to get these cases right lest their decisions make the situation worse.

Dr. Heitler: What remedy do you propose?

Dalia Erel: Families with evidence of potential severe alienation no longer should be treated as a divorce case, but rather as an emergency rescue mission. The children’s wellness must become the primary issue, not the conflict between the parents. For the safety of the child, the courts need to be able to react with the speed of a medical emergency room.

Dr. Heitler: What else needs to change in how legal and mental health professionals respond to severely alienated children?

Dalia Erel: Again, the key missing piece is a SENSE OF URGENCY.

Alienation should be handled like an urgent medical case. In a medical emergency, the first step is triage to find out whether the pathology is mild, moderate or severe.

After triage, the patient is moved to the proper experts and setting for further treatment.

Similarly, in PA, the first step should be for family courts to sort and evaluate the situation. If alienation is severe, the child(ren) need to be transferred immediately to treatment.

Therapist Linda Gottlieb and others have clarified that appropriate treatment of severe alienation requires that the courts transfer full domicile and custody for a period of at least three months solely to the targeted parent. During that time period the alienating parent must be court-ordered to have zero contact with the child(ren). This separation period gives the child a safe zone within which to begin the healing process.

The alienator also needs to engage in therapy that confronts the alienating behaviors to ensure that these behaviors will not be resumed after the separation period.

Dr. Heitler: I get it. After a car crash, would we leave the victims bleeding in the car while lawyers fight over who caused the crash? Of course not. We would first rush the victims to appropriate medical treatment.

Dalia Erel: Exactly. Extreme measures such as an immediate transfer to the targeted parent's full custody and a separation period from all contact with the alienating parent are essential to stop further deterioration of the children’s mental health. These court-ordered changes provide a safe environment in which a healing therapy process can begin.

Dr. Heitler: How well are the courts currently equipped to take these extreme measures?

Dalia Erel: The legal system must build a process for separating these cases immediately from day-to-day divorce cases, that is, a re-routing for handling them through different and separate channels and procedures.

Ideally, family court judges would have enough training in alienation to be able to identify early on whether a divorce case has serious alienation potential. In addition, the courts would have access to evaluations and recommendations by court-associated social workers who have special training in and experience with alienation families.

These cases then should be transferred to therapists who specialize in alienation treatment that reunites the child with the healthier parent, helps them to rebuild a trusting parent-child bond, and inoculated the child with enough understanding of alienation that s/he becomes immune to an alienating parent's potential later attempts at re-alienating the child.

Throughout this intervention process, the judicial system will still need to play an active, if backstage, role. Judges need to be kept informed of progress and ready to apply legal sanctions according to the therapists’ recommendations whenever necessary.

Dr. Heitler: What more can courts do to prevent severe alienation from developing?

Dalia Erel: Like colds can develop into pneumonia, alienation is a progressive mental health disorder. Responding urgently and effectively to initial small evidence of a child's budding hostile stance toward a parent can prevent the development of moderate and ultimately severe alienation, and can reverse its development up to that point.

Dr. Heitler: Yes. It makes sense that the earlier the intervention, the more likelihood of success both in preventing a worsening of the alienation and in healing alienation after it has developed.

The flip is true as well: Long legal battles definitely prolong and intensify alienation. The longer the courts take to intervene, the worse the alienation is likely to become, and the harder to reverse.

Dr. Heitler: Can therapists treat alienation, and if so, how?

Dalia Erel: Yes, appropriate treatment can be highly effective provided that the therapist utilizes the treatment protocols specific to alienation. Standard individual therapy treatment methods for depression, anxiety and behavior problems, however, are likely to backfire; they often make the problem worse.

Dr. Heitler: I agree. See my earlier post on what therapists need to know to treat alienation effectively as per the targeted-parent and alienated-child reunification treatment developed by therapists such as Linda Gottlieb, MSW and Richard Warshak, Ph.D.

Dalia Erel: In addition, I use a therapy model developed by Dr. Inbal Baron. This treatment method works by having both parents together build a shared understanding of the needs of the child. That is, we focus on the child's need for a stable and healthy connection with both of their parents.

The court plays potentially crucial roles. Initially, family courts may need to remove severely alienated children from all contact with the alienating parent. They need to transfer full domicile and decision-making to the targeted parent in order to allow the child a phase of safe time and space to rebond with the targeted parent without fear of retribution from the alienator.

The court also may need to stipulate that subsequent alienation behaviors will incur serious penalties such as extended the period of time when contact between the child and the alienator is not allowed, issuing fines, and even imposing jail on repeat offenders.

Again, responding to alienating behaviors with URGENCY is imperative.

Dr. Heitler: My impression is that the need for court involvement depends on the extent to which an alienating parent is resistant to change. Some alienating parents have been genuinely unaware that alienation is a form of child abuse. Once they realize how damaging it is to children to turn them against their other parent, they decide without court interference to change. In other words, court involvement is essential in cases of severe alienation, and potentially necessary as well with a severe alienator even if the process is still in the earlier stages as far as the child showing just mild to moderate alienation symptoms.

Dalia Erel: I agree. That observation fits with my experience.

Dr. Heitler: In sum, thank you Dalia Erel for clarifying that parental alienation must be regarded as a serious emergency mental health condition that needs immediate intervention. Alienation needs to be treated with far more urgency than the way it is currently handled, even at the initial stages of its appearance and especially when the child's alienation has reached severe levels.

Targeted parents also may need immediate help with the anxiety, anger, and depression that they suffer. Alienating parents need immediately to stop their alienating behaviors. And alienated children need urgently to be aided in being able to enjoy, safely, the best from both of their parents.

Dalia Erel is an Israeli family and couples therapist who specializes in PA. Her website (in Hebrew) is www.daliaerel.co.il.