Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, March 14, 2017

I'll Get to Scotland Before Ye: "Parental Alienation" Again

I recently received several documents related to an accusation of “parental alienation” (defined by its advocates as the intentional persuasion of children by one, perhaps mentally ill, parent, that they should avoid and reject the other parent). Proponents of this idea assume that unless there has been demonstrated abusive treatment by the rejected parent, such rejection is prima facie evidence that the preferred parent has emotionally manipulated the children. Such manipulation, they claim, is in itself prima facie evidence that child abuse has occurred and that the children’s mental health is threatened, so they must be rescued from the preferred parent and given treatment that will restore their mental health and with it their affection for the currently rejected parent.

There’s a lot of prima-facie-ness here, it seems, and the implausibility of these claims extends to the documents I received.

Much as I hate to do this, I am not going to reveal the source of the documents, the name of the family they allude to, or the treatment program involved. I am afraid that the identification of the source of the documents would cause trouble for someone. I am not going to discuss family details, but will focus on some of the claims made by people who assessed the family and then proposed and carried out a treatment that closely resembles other “parental alienation” treatments. It abruptly removes children from their home, places them in close contact with the rejected parent, and uses videos, games, and some threats to try to change the children’s attitudes. How is such a serious proceeding initiated ? A court order is obtained, upon the recommendation of the treatment proponents, who have been hired by the rejected parent.

There is much to be said about this situation, and I have already said various things to the effect that I am sure it is possible for “parental alienation” (as defined above) to occur, but that I see no evidence that it occurs often even among high-conflict divorcing families. I have also noted that proponents of treatments for the supposed problem have given no real evidence that their methods are effective ways to change children’s attitudes—although I have no doubt that the inclusion of threats will change children’s behavior.

In this post, I want to touch on the issue of evidence for effectiveness of treatments. To the best of my knowledge, there have never been either randomized controlled trials of the treatments, or well-designed nonrandomized studies. Instead, one proponent of a treatment claims that he has evidence for the effectiveness of his treatment in the form of a single-subject ABA design. This research method looks at behavior during one set of circumstances, usually just everyday life with no treatment given (A); then creates a new condition, generally involving an intervention of some kind (B) and looks at behavior during that period; finally, the A situation is returned and behavior is again observed. Graphs or other displays show whether the change from A to B, and back again, is accompanied by a change in the behavior of interest (in the parental alienation case, of course, this would be rejection of one parent).

That proponent notes, in one of the documents I have, that this method is “one of only two research designs that can definitively determine causality, the other design being a randomize control experimental design”. There are several problems with this statement. One is that no research design “definitively” determines causality, as the results of psychological research are reported in terms of the probability that a given outcome has occurred by chance alone, and this probability may be close to 5 % in cases where a significant difference between groups is found. In addition, a textbook on research in education points out that ABA designs are weak in terms of external validity and require many replications followed by a randomized study before the conclusion that a treatment has a given effect can be drawn.

The proponent of the treatment runs into an additional problem when claiming that the treatment causes a change in the child’s behavior. ABA studies are normally careful to identify a single variable whose effect is to be tested and to hold constant other factors that could affect child behavior. The treatment in this case changes multiple factors between A and B, and between B and a return to A. A, the original situation, has the child in his or her own home, with normal opportunities for play and other preferred behaviors, and in the company of the preferred parent. The B situation abruptly removes the child from the familiar setting and places him in an unfamiliar place, in the company of the rejected parent and of a therapist who demands attention to videos and may make threats about the child’s uncomfortable placement elsewhere if he or she does not cooperate, or about continuing separation from the preferred parent. The return to A  returns the child to a familiar, unpressured social and physical environment. Are we surprised that behavior would be different in A and in B, particularly in the light of threats made in the B situation? The failure to isolate an independent variable makes this use of ABA ineffective as a research design.

There is a further important point about material in the document that makes claims about the conclusions drawn from a variant on the ABA design. The document states that “A single-case ABAB reversal design quickly and efficiently identifies the cause of the issues and restores the child’s healthy development as quickly as possible.” The results of either ABA or ABAB studies are irrelevant to this claim. If well done, such studies could show that a treatment was effective in changing a behavioral symptom. This, however, would not identify the cause of a problem; causes of problems are not being studied by this method. (As an example, let me point to applied behavior analysis as a treatment for autism, where the fact that an operant conditioning technique is helpful to the child does not mean that he was autistic because the parents used different methods in their child care routines.)  

It seems that the “parental alienation” proponents involved in these documents are inclined to fancy footwork rather than logical analysis as they put forward claims for their methods of assessment and treatment. Unfortunately, it would appear that judges and attorneys have in some cases fallen for this line of chat, and challenges have been few.

(Could it possibly be that people who have heard once or twice of applied behavior analysis—also called ABA—recognize that abbreviation and think “oh yeah, that’s a thing, I heard of it”? I hope not, but stranger things have occurred.  )



11 comments:

  1. I'm genuinely curious. What do you think should be done if a child who has previously had a good relationship with a parent says they never want to see them again and gives a trivial reason (like saying their stepmother is "too nice," and I do know a case where a child said that)?

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    1. These things are not one-size-fits-all. How old is the child? What's the evidence that the previous relationship was good? What are the other circumstances?

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    2. Do you have an email I can send you more at?

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    3. You can find it on my CV on this site-- I'd rather not make it too easy for everybody to use it by just posting it here. But if you do send anything please be warned that it may be a while before I can get to it as I have some deadlines coming up--

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  2. "Proponents of this idea assume that unless there has been demonstrated abusive treatment by the rejected parent, such rejection is prima facie evidence that the preferred parent has emotionally manipulated the children."

    C'mon, Dr. Mercer, you know very well that this statement is untrue. Both the Gardnerian advocates and the Childress advocates have sets of criteria they use to diagnose "Parental Alienation." You may think these criteria are a bunch of bunk, and if so, it would be interesting to hear your critique, but it is disingenuous and intellectually lazy for you to mischaracterize the PA advocate's argument as "prima facie."

    "You keep using that word. I do not think it means what you think it means." --Inigo Montoya

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    1. Unless the diagnosis includes direct assessment of the preferred parent and his or her actions, I stand by my statement. As for the other criteria you mention, as they are not considered in terms of developmentally typical behavior, I don't see what they add to the discussion. My point is really that no alternative hypotheses seem to be examined or entertained by PA proponents. Can you argue otherwise? It would be fair for you to say that I am making mistakes by drawing conclusions only from cases that have involved lengthy legal battles--that these biases do not ordinarily happen in PA work. Can you provide evidence that I don't have, to that effect?

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  3. Eesh, Jean, thanks for this. There's a Palestinian blogger I've been reading and I was looking for a counterpoint to these alienation stories. As I suspected, they're badly tilted to the better abuser, and the one with lawyer money and friends. But a nicer thought was what prompted me to comment: half of this stuff falls into the kids give the love to the parent who needs it more, right, either from altruism or from the kids' knowing which parent will make their life worse if the child appears to reject them? All this starting with the idea that the kids are having some choice laid on them, who to love, who to listen to.

    BTW, this dynamic has destroyed my life, but after they were nearly grown up, like 17 and 20. Or I think it's involved, only I apparently see us as having given them some either/or situation to deal with, so we're stalemated . . . only offered for its scientific interest, of course.

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  4. yes, Masbout, I believe. I like seeing his headlines, having some clue of the perspective from his side, but I take no-one's talk about parenting with quiet ears

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    1. yes, Daniel - here, his wordpress page https://wordpress.com/read/feeds/50748137

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