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Parental Alienation

Treating Child Anxiety in Cases of Parental Alienation

Treatments for anxiety usually include exposure not avoidance.

Key points

  • In cases of parental alienation children resist contact with a previously loving parent without justification.
  • Family courts and professionals often reinforce an alienated child’s anxiety by allowing avoidance.
  • Avoidance worsens anxiety, whereas exposure to a feared experience that is safe reduces it.
  • Family courts and professionals need education about how to treat child anxiety.

In cases of parental alienation, children resist spending time with one of their parents during and after separation and divorce when the rejected parent has done nothing to justify this behavior. If there was child abuse, domestic violence, or another harmful behavior from the rejected parent, then it would not be alienation, but rather realistic estrangement. In alienation cases, when abusive behaviors have been considered and not found, a child’s resistance appears to grow from messages from the favored parent, including badmouthing the rejected parent, sharing intensely upset emotions about the rejected parent, and interfering with the rejected parent’s time with the child.

Source: Fizkes/Shutterstock

Lack of Emotional Boundaries

While many parents and professionals believe that favored parents intentionally promote a campaign of denigration of the rejected parent, I personally have observed—from my 40 years of experience as a therapist, lawyer, and mediator—that the driving factor is the favored parent’s emotions that are shared intensely with the child. The primary resulting emotion for the child appears to be anxiety. (See my previous post, “The Role of Anxiety in Parental Alienation.”) The favored parent’s anger, hurt, sadness, tears, distress, and other emotions are often too intense for the child to cope with so the child absorbs and adopts similar emotions and grows to feel incredibly anxious about being with the rejected parent. This occurs, I believe, primarily outside of the parent’s and the child’s conscious awareness—yet it drives the case.

The result: The child truly becomes anxious at the thought of spending time with the rejected parent. This is the point at which family courts and family law professionals (including judges, mediators, lawyers, and therapists) often make a huge clinical mistake. They are used to thinking about abuse and the reality that abused children need to ease back into a relationship with an abusive parent (when it is safe), often following the child’s lead about when to increase time with that parent.

Unfortunately, in cases of parental alienation, professionals believe that the anxiety that the child displays means that the child should ease back into a relationship with the rejected parent only when the child reports feeling ready. They don’t want to force the child to have a relationship with a rejected parent (even though the parent has done nothing wrong). Yet the child’s anxiety is too high and never becomes more comfortable with that idea and becomes more resistant, and often more anxious, instead. Then, many family law professionals simply give up. This is because they don’t understand anxiety and anxiety treatment.

Treatments for Anxiety

Treatments for anxiety rely primarily on exposure to the feared object, experience, or person, not avoidance of the feared object, experience, or person, as described in a recent research paper about treating anxiety for children:
Evidence-based psychological interventions for pediatric anxiety, namely exposure-based cognitive behavioral therapy, improve outcomes for youth, including reducing anxiety-related impairment and delivering secondary prevention of long-term consequences, including suicidality. Exposure-based treatment involves patients taking steps to face their feared experiences (such as reducing impairing avoidance).

Consistent with best practices, the behavioral approaches should prioritize starting exposures as soon as possible (ideally within the first few sessions). After providing initial psychoeducation, clinicians should work with the youth and family to identify primary areas of impairment and collaboratively develop a plan for structured exposures. [Inhibitory learning] exposures use an inhibitory learning approach that effectively and efficiently supports new learning to counteract previously learned fear responses. Inhibitory learning exposures aim to teach the patient through experiential learning that their fear expectations do not match reality so that previously avoided situations are experienced as safe and manageable, and as a result, the body stops producing such a strong, unnecessary fear response.1 (Emphasis added)

The Family Law Mistake

The very common mistake of family law professionals is to promote avoidance rather than exposure. By putting the child in individual therapy until the child feels ready to face the feared rejected parent, they guarantee that the child will never face the fear. Instead, rather than leaving it up to the child to decide when he or she is ready, the professionals (the court if necessary) should as soon as possible develop a plan for exposure.

However, if the child continues to be exposed to the favored parent’s anxiety, and other extreme emotions and behaviors, the structured exposure to the rejected parent is unlikely to work. This negative feedback will prevent the child from experiencing that there is nothing to fear by being with the rejected parent. For this reason, rather than isolating the child with the favored parent until he or she is ready, there should be limitations set on the favored parent’s negative messages—either through counseling to change those messages or a period of no contact.

The Plan

As described above, the ideal treatment for child anxiety involves both parents developing a step-by-step plan for exposure to the feared parent (without negative feedback from the favored parent) as soon as possible.

In extreme cases of severe parental alienation, courts have changed custody to the rejected parent and that parent has gone through an intensive few days of activities with the child. Amazingly, the child returns to a normal relationship with the parent, usually within hours. This fulfills the explanation above: Exposure to an unwarranted fear can totally eliminate the fear. The most successful plans often include a no-contact period from the favored parent and their emotionally intense messages, who then gets counseling to re-integrate with the child without these messages.


Family courts and family law professionals need education about the treatment of child anxiety and the importance of exposure to a rejected parent, rather than avoidance, as soon as possible.


1. Blossom JB, Jungbluth N, Dillon-Naftolin E, French W. “Treatment for Anxiety Disorders in the Pediatric Primary Care Setting.” Child and Adolescent Psychiatry Clinics of North America, 2023 July; 32(3):601-611. doi: 10.1016/j.chc.2023.02.003. Epub 2023 Apr 4. PMID: 37201970.

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