Like many psychiatric disorders, the severity of PA may be classified as mild, moderate, and severe.This is an important feature because the appropriate intervention for this mental condition depends on the severity of a particular case. While the choice of treatment depends primarily on the symptoms in the child, it may also depend on the intensity of the indoctrination and the attitude of the alienating parent.
Mild PA means that the child resists contact with the alienated parent but enjoys a relationship with that parent once parenting time is underway. A typical intervention for mild PA is strongly worded instruction or psychoeducation. For example, a judge might clearly order the parents to stop exposing their child to conflict and stop undermining the child’s relationship with the other parent. Or, a parenting coordinator might meet with the parents to help them communicate in a constructive manner and support each other’s relationship with the child.
Moderate PA means that the child strongly resists contact and is persistently oppositional during parenting time with the alienated parent. The treatment for moderate PA-assuming both parents are committed and cooperative with the intervention-usually focuses on changing the behavior of the parents (ie, reducing the amount of conflict, improving communication). A parenting coordinator works with the parents together and individual counseling or coaching is usually arranged for the alienating parent, the alienated parent, and the child. However, this approach will not work if the preferred parent does not endorse and support the treatment program and continues to engage in alienating behaviors.
Severe PA means that the child persistently and adamantly refuses contact and may hide or run away to avoid being with the alienated parent. When the child manifests a severe level of PA, the alienating parent is usually obsessed with the goal of destroying the child’s relationship with the targeted parent. The alienating parent has little or no insight and is convinced of the righteousness of their behavior.
It is usually necessary to protect the child from the influence of the alienating parent by removing the child from their custody, greatly reducing the parenting time with that parent, and requiring the parenting time to be supervised. That is, when a parent purposefully causes a child to reject their relationship with the other parent, that constitutes child psychological abuse. The intervention is similar to what happens in cases of physical or sexual abuse, i.e., removal of the child from the care of that parent, at least temporarily.
It is important to identify PA in its early stages when the condition is mild and relatively treatable; severe cases of PA are much more difficult to address and reverse. For example, it is likely that very early cases of PA come to the attention of therapists in private practice and at mental health centers, who work with children of parents who are headed toward divorce. As PA becomes better understood by front-line clinicians, they will be able to intervene with parent counseling and psychoeducation at an early stage when the condition is highly treatable.
Of course, prevention is even more important than early intervention. Various authors have proposed strategies for the prevention of PA, ranging from interventions with individual children to educational approaches for judges to systemic changes to the entire family court system in the US. For example, there is a prevention approach called I Don’t Want to Choose: How Middle School Kids Can Avoid Choosing One Parent Over the Other.8 It is a structured program for group discussions with children of divorced parents, which can be implemented by school counselors.