**6. Prescriptions for the justice system, child protection, and mental health services**

The construct of PA and its damaging effects is largely misunderstood by the public, the judges, and many professionals who work with children [56, 57], perhaps because of the controversy surrounding the concept. Years of discussion about whether it should be considered a psychiatric syndrome and catalogued within the DSM or whether it complies with the criteria for a mental disorder has distracted and obstructed the development of effective solutions. Problematic situations do not receive the necessary attention to prevent children submitted to PA processes from suffering the consequences. There are no consistent and systematic measures of the prevalence of PA cases within the family justice system. There are no specialised services and personnel to address PA cases effectively. In addition, poor understanding of the relationship dynamics and psychological mechanisms involved in PA leads to mistakenly identifying PA where it does not exist (i.e., false positives) and dismissing legitimate PA cases (i.e., false negatives) [58]. Besides, PA is neither a yes/no construct nor it is a static process. On the contrary, alienating behaviours by the AP and by the child most likely worsen over time [2]. For example, Göran reported, "It got worse when I met another woman who cared for the kids, and they liked her. But after a while, it got bad, and my daughter told me 'I don't want to live with you' […] somehow, they were getting more and more alienated".

Concurrently to PA, the AP's false allegations of domestic violence and child sexual abuse by the TP causes the immediate interdiction of the TP's visits to the child on many occasions. Allegations of abuse further complicate investigation and intervention. Like PA, false allegations are largely understudied. Some asseverate that is a rare phenomenon [59] but as Silva [46] pointed out, what surfaces might be just the tip of the iceberg. Allegations of abuse take time to investigate, time that the AP has to manipulate and alienate the child further. If the AP further complicates the case by not complying with court orders or by taking actions that purposefully delay court proceedings, any attempt to recover the relationship between the TP and the child will undoubtedly fail.

In addition, the lack of economic and psychological resources to continue lengthy litigation possibly drives the TP to desist from pursuing judicial action. Many TPs feel hopeless after their repeated unsuccessful attempts to manage the problem through the family justice system [2]. Eventually, doubts about the best course of action arise in the mind of the TP. Göran reported, "They [child protective services] claimed they would actually argue that the children should live with me and have minimal or no contact with the mother. But they were afraid of how that would work because the children were so against being with me. They didn't have anything to complain about me as a father, neither had the school in their opinion, when they wrote the report. But, on the other hand, they thought the children didn't have enough bad time with the mother that they would require to enforce drawing them away of her. And I was kind of… reflecting… what is the best for my children? […] May be it is better to leave them with the mother and try to manage my life and show them I love them, I want to be with them and that I'm waiting for them to come when they feel like it."

In some cases, TPs feel so powerless due to their repeated fail in getting closer to the child, they may threaten to abduct the child or harm the AP in some way. However, as Haines and colleagues [2] indicated, the threats are the result of the distress and frustration produced by the alienation dynamic rather than a wellformulated plan of action.

Due to the severe short- and long-term consequences PA processes produce in the child, prevention and intervention should be prioritised, and PA should be considered a public health issue [57]. Preventive efforts must be a shared responsibility among professionals, schools, organisations, and the public. At-risk children must be identified as soon as possible so that case-based, individualised interventions with the children and their families can take place during an early stage. Since PA is a dimensional construct, principles of proportionality should apply to case management. Severe cases will require a long time to heal and APs might recidivate in alienating practices when institutional support ends. Therefore, interventions ought to include relapse prevention.

It is essential that children are considered a priority and placed at the centre of institutional actions as plotted in **Figure 2**. To protect the child's wellbeing and mental health is an overriding objective beyond the legal resolution of the conflict between the parents and the parents' rights. The family justice system, child protection, and mental health services must coordinate their efforts to achieve successful results.

The court must monitor whether parents comply with its prescriptions and impose sanctions if they fail, and in coordination with mental health services, must oversee the progress of family therapy and parent–child reconciliation [57]. It is necessary to ensure that mental health support is available for every child who suffers a PA process. Psychiatric care may be essential to treat severe cases. Unfortunately, that is not always the case. As Göran reported, "My daughter hadn't been with me for a few months, and when I told her we should have some contact,

she claimed that she didn't want to live. She threatened that she didn't want to live twice. She made scars in her skin although she didn't cut herself. My ex-wife took them [the children] to a child psychologist but with no results. She only tried to give my daughter advice 'When you feel like this it is better to paint. So, yeah… that's how much of psychology she had. I think that's a big shortcoming in the Swedish system that we don't have child psychiatrists or a psychiatrist that could help us parents." In general, the PA process does not end when the interaction between the TP and the child ceases. The AP continues their alienating dynamics until the child completely demonises the TP. The alienation feeds itself in the absence of the TP, because it distortedly confirms their abandonment and neglect, therefore justifying the alienating behaviour. Therefore, support services must be fast and flexible, primarily when highly dysfunctional parenting by the AP, and complete cessation of the relationship with the TP concurs.

To ameliorate the child's alienating behaviours and prevent the psychological consequences of PA, a change in custody or residential arrangements favouring the TP may prove effective [60]. Family therapy ought to target the relationship dynamics of each node (child-TP, child-AP, AP-TP) and the family as a whole. Re-establishing the bond between the child and the TP is essential, but there is also a great need to restructure the dysfunctional relationship between the child and the AP. If there is more than one child in the family, PA may affect each of them differently. Likewise, PA can involve the stepparent and the extended family (e.g., grandparents, uncles, aunts) who should also take part in family therapy sessions. Clinical intervention with the AP and to prevent them from continuing the alienating practices is crucial, but it is challenging when there are underlying personality disorders.

Although PA has been considered in legal and clinical work for more than 40 years, and there are available some reviews of the scientific literature in the field [20, 60, 61], the phenomenon is still largely unstudied and in need of more research. In this regard: (1) the construct validity explored for example by Baker and colleagues [31, 62, 63] needs to be replicated, (2) whether PA should be defined as a syndrome and introduced as a new diagnostic entity in the DSM [64] or it is better defined as a form of family violence [65, 66] has to be settled, (3) the

implications of PA for judicial outcomes examined by Harman and colleagues [67] calls for more studies, (4) available assessment tools [68, 69] need to be further tested and new ones developed if necessary, (5) more studies that determine the prevalence of PA in different stages of family conflict are also necessary, and (6) more research is required to fully understand how PA affects each of the family members. Only after we completely understand what the PA problem is in all its spheres, we can effectively design, implement, and evaluate programs and interventions to combat it.

## **7. Conclusions**

PA has severe consequences for the child's psychological wellbeing. Even in mildest levels, alienating strategies can potentially cause the child to develop the feeling they are not loved and a sense of abandonment, and neglect by the TP. The AP teaches the child to disparage, reject, and hate the TP while creating traumatic bonds with the AP. Under these circumstances, parenting is highly dysfunctional. Any parenting effort by the TP is rejected by the child and can eventually come to a halt if the AP successfully interrupts the interaction between the TP and the child. At the same time, the AP's emotionally abusive strategies reflect a significant impairment in the relationship with the child. In addition, the APs' authoritarian or permissive parenting styles leave no space for the healthy development of the child, precipitating the development of psychopathologies, such as anxiety, depression, alcohol and drug abuse, and violent behaviour. It is in the child's best interest for the family justice system, child protection, and mental health services to coordinate their efforts to intervene as early as possible. Likewise, for the benefit of society, there should be an investment in research in this field to produce empirical evidence that supports the development of necessary prevention and intervention programs.

#### **Conflict of interest**

The author declares no conflict of interest.

### **Author details**

Teresa C. Silva Mid Sweden University, Sundsvall, Sweden

\*Address all correspondence to: teresa.silva@miun.se

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Parental Alienation:* In the Child's Worst Interest *DOI: http://dx.doi.org/10.5772/intechopen.101231*
