INTRODUCTION
Parental alienation (PA) is a type of peri-divorce familial dysfunction characterized by the preoccupation of children with the denigration and the excessive criticism of one, most often the non-custodial, parent (Gardner, 1987; Wallerstein & Kelly, 1976). First recognized in their seminal study on the children of divorce, Wallerstein and Kelly (1976) identified children who, they theorized, willfully severed any connection with their fathers in response to the needs of their psychologically compromised mothers.
They called this presentation “The Medea Complex” in reference to the infanticide committed by Medea as revenge for her husband’s disloyalty.
Since then, additional case reports of children with frank parental alienation (Fidler, 1988; Jacobs, 1988; Wallerstein, 1984) or other studies reporting high rates of children refusing to visit non-custodial parents (possibly indicating cases of unreported parental alienation) (Kalter, 1989; Oppenheimer, 1990; Racusin, 1994; Thoennes, 1990), demonstrate the commonness of this phenomenon as well as how little child psychiatrists know about its etiology or its impact on children and their families. Bernet, W., Von Boch-Galhau, W., Baker, A., J., L, Morrison, S.L. (2010). Despite its relevance to children’s mental health and to child psychiatrists’ daily clinical work, there are very few articles addressing parental alienation in the child psychiatric literature over the last decade. Bernet and coworkers (2010) estimate that 1% of children and adolescents in the U.S. experience parental alienation, and suggest that the concept of parental alienation be included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM-V), and the International Classification of Diseases, Eleventh Edition (ICD-11).
Though children possess a great deal of resilience and can successfully recover from the divorce of their parents, research has shown that children who are exposed to the stresses of divorce and prolonged custody conflicts have higher levels of sychological, behavioral, and educational problems (Amato, 2001; Schor, 2003). This includes behavioral disorders (Wallerstein, 1980) and negative attitudes toward future relationships (Laumann-Billings, 2000). Furthermore, the amount of verbal and physical aggression expressed between parents during their separation was predictive of total behavior problems, depression, withdrawn/uncommunicative behavior, somatic complaints, and aggression in their children at two-year followup (Johnston, 1987). As such, the psychiatric and pediatric literature stresses the importance of physician intervention (e.g., counseling, couples therapy, behavioral therapy) both with the divorced parent and their children (Schor, 2003).
Group Treatment for Parental Alienation 189 Even with ample evidence that stressful divorces have detrimental psychological consequences on children’s wellbeing, the psychological impact of divorce and custody conflicts on children is frequently underestimated or overlooked in the context of prolonged divorce proceedings (Emery et al., 2001). Additionally, even if appropriate attention were to be paid to the needs of the children, in cases of parental alienation, traditional interventions have not been successful in assisting the child or their families resolve this problem (Dune and Hedrick, 1994; Gardner, 1999; Ellis & Boyan, 2010). Consequently, researchers and clinicians have suggested exploring legal and psychological therapeutic interventions that engage all parties involved in the dysfunctional dynamics (Dune and Hedrick, 1994; Johnston, 2003).
A model of short-term group therapy for children with parental alienation was created and implemented by our group. To the best of the authors’
knowledge, this is the first interventional study using a parallel group psychotherapy model in this population published in the literature. The aim of this study is to present the results achieved by this treatment program. In addition, we hypothesized (1) that the quality of parental object relations is inversely correlated with measures of depression and anxiety in children with parental alienation, and (2) that poor parental object relations are directly correlated with increased resistance to treatment.
