Dr. Steven Miller was deeply concerned about the profound harm to children from parental alienation. He devoted the last 20+ years of his life as a crusader against it.
Dr. Miller publicized about parental alienation and educated lawyers and clinicians about how to litigate and diagnose it. Dr. Miller helped alienated parents gather the evidence they need to win their alienation cases.
Here you will learn about Dr. Miller’s significant contributions to understanding and combatting parental alienation.
Who Was Steven G. Miller, MD?
In Dr. Miller’s own words:
I hold degrees in Psychology and Medicine from Brown University. I did my residency training at Brown University and Harvard University. For 30 years I was a faculty member at Harvard Medical School.
I specialize in clinical reasoning, clinical problem-solving, and clinical decision-making. My areas of special expertise include decision-making under uncertainty and how cognitive errors lead to professional errors.
I specialize in conditional probability (that is, the probability of one thing given another thing. An example of conditional probability is the probability that a child is alienated given that the child displays Gardner’s manifestations of an alienated child.
I have directed several hundred continuing education courses for physicians and other clinicians and have presented over 1000 lectures on professional reasoning, problem-solving, and decision-making.
I directed a forensic medical practice for more than 40 years and received requests from around the country to undertake forensic medical evaluations.
Scientific Method is Required to Assess for Parental Alienation
Dr. Miller’s greatest contribution to the field of parental alienation – among several vital contributions – is how to use the scientific method to make a finding of alienation.
The scientific method answers the question of the probability of an event (A) given the presence of evidence for or against it (B).
Dr. Miller mentored his colleagues about how to determine the probability of alienation (A) given the presence of (B): Gardner’s symptoms in the child, alienating behaviors in a parent, and the absence of child abuse or serious neglect on the part of a rejected parent.
The scientific method results in this: when qualified evaluators are presented with the same evidence in a case of a child’s rejection of a parent, all evaluators will find for the same cause of the rejection.
There are three scientifically recognized plausible causes (or hypotheses) to explain a child’s rejection of a parent – alienation, estrangement, and a hybrid.
FURTHER READING: Clinical Reasoning and Decision Making in Cases of Child Alignment
Parental Alienation Is Complex & Counterintuitive – It Requires Specialized Skills
In Dr. Miller’s own words:
Such cases are not for the novice. Cases of severe alienation often exceed the expertise of highly skilled practitioners unless their special expertise includes treatment of severe child alignment, treatment of severe mental illness, and treatment of severe personality disorders – on the part of the alienating parent.
Treatment of all three may be necessary to achieve a good outcome or even to prevent catastrophic deterioration.
Otherwise, cases of severe alienation are likely to be highly counterintuitive. Clinicians who attempt to manage them without adequate skills are likely to find themselves presiding over a cascade of clinical and psychosocial disasters.
The good news is that the errors tend to be predictable and, at least in theory, preventable. The bad news is that some of the most serious and common errors arise from fundamental flaws in human thinking that are deeply ingrained.
These are “hard-wired” as a result of natural selection and are notoriously difficult to eradicate or even modify. Since one can seldom correct a problem one does not recognize, it is important for clinicians to be aware of these limitations and pitfalls.
Clinicians who deal with PA may be particularly susceptible to such errors because of the emotional and complex nature of the subject.
Such errors can be divided into two groups: cognitive errors and clinical errors. Cognitive errors are thinking errors. They often reflect deep-rooted tendencies for humans to reason in erroneous ways.
Clinical errors are deviations from good clinical practice. Many clinical errors arise because of cognitive errors, others because of insufficient information, others because of inadequate understanding of scientific principles.
Alienating Parents Present With the 4-Cs
In Dr. Miller’s Own Words:
Alienating parents tend to present well. As a rule, alienating parents present with the Four C’s. They are cool, calm, charming, and convincing.
That is because effective alienators tend to be master manipulators who are highly skilled at mimicking normal behavior and managing impressions – especially initial impressions.
These traits are usually related to an underlying personality disorder, typically of the borderline, narcissistic, and/or antisocial types.
LEARN MORE: The Four C’s – Unmasking the Facade of Alienating Parents
Alienated Parents May Present with the 4-As
In Dr. Miller’s Own Words:
Alienated parents are trauma victims due to the alienation. They have post traumatic stress disorder (PTSD) or something very much like it. Consequently, they may present with the four A’s – they tend to be anxious, agitated, angry, and afraid.
Alienated parents are attempting to manage one horrific family crisis after another. They are rarely successful at this. They are often attacked by professionals who fail to recognize the counterintuitive issues in alienation.
When non-specialists attribute negative traits to alienated parents, they are likely committing the “fundamental attribution error.” This error means to conclude that behaviors are dispositional when in fact they are situational, having been caused by the alienation.
Non-specialists often get alienation cases backwards. They erroneously conclude that the alienating parent is the competent parent and the alienated parent incompetent.
Even worse, non-specialists erroneously conclude that the alienating parent is a protective parent and the alienated parent to be an abusive parent.
The result is likely to be catastrophic unless a judge or other more sophisticated observer recognizes and corrects it.
FUTHER READING: Parental Alienation – the Four A’s That Lead to False Accusations
Children Typically Align with Abusive Parents
In Dr. Miller’s Own Words:
Children tend to bond with an abusive parent. The greater the abuse, the greater is the child’s bonding with the abusive parent and the stronger are the child’s attachment efforts.
Some find it implausible that children bond to an abusive parent. However this counterintuitive behavior is well-validated by child development research and flows logically from what we have learned from abused and neglected foster children.
Children are genetically wired to cling to their parents—even to cling to abusive parents whom they fear may leave or abandon them. It is a child’s instinct for survival that impels them to bond to an abusive parent.
When confronted with a case in which a child is strongly aligned with one parent and has rejected the other parent, and this is occurring in the absence of abuse or severe neglect, there is a high probability that the parent to whom the child is bonded is an alienating parent.
Accordingly, parental alienation should be a leading hypothesis, if not the leading hypothesis, in such cases.
FURTHER READING: Assessment of the Attitudes and Behaviors of Moderately to Severely Physically Abused Children
Pathological Enmeshment Between the Alienating Parent and Child
In Dr. Miller’s Own Words:
Clinicians who do not specialize in this area often mistake pathological enmeshment for healthy bonding. Pathological enmeshment is a family dynamic in which a parent essentially engulfs a child.
The enmeshed parent typically adultifies or parentifies the enmeshed child. Alternatively, the enmeshed parent may seek to keep the child dependent by infantilizing the child – treating the child as younger than his or her age.
Either way, the enmeshed parent treats the child in a way that is not age-appropriate.
By definition, this involves severe boundary violations of the child by the parent to the point that the parent not only violates the child’s boundaries, but erases them—obliterates them. Enmeshment is very damaging to a child, and the damage is often permanent.
Tragically, in cases of PA, pathological enmeshment is mistaken for healthy, empathetic bonding by the alienating parent. The alienating parent and child are too close— pathologically and dangerously close.
Enmeshment is anything but healthy – it is a potentially life-threatening psychiatric emergency. Similarly, pathological enmeshment does not indicate empathy. It represents a cascade of severe boundary violations and is the extreme opposite of empathy.
Children Rarely Reject a Parent Absent a Powerful Alienating Influence
In Dr. Miller’s Own Words:
It is counter-instinctual for a child to reject a parent. Children will almost never do anything counter-instinctual unless they are induced to do so by a third party. Children will therefore rarely – if ever – reject a non-abusive parent.
Evaluators and other professionals need to understand that: (1) in the absence of abuse or very significant neglect by a rejected parent and (2) in the presence of multiple signs of alienation in the child, most cases of severe alignment are due to alienation—not estrangement.
The Pathology of Severe Parental Alienation
In Dr. Miller’s own words:
Severe cases tend to be clinical in a medical sense of the word—the underlying psychopathology is often associated with severe cognitive distortions (including shared delusions and/or other psychotic or quasi-psychotic thinking), profound emotional dysregulation, and extreme or bizarre behavior – on the part of the alienating parent and child.
Severe cases are often associated with serious co-morbid psychopathology, particu- larly on the part of the alienating parent. Therefore, treatment of the relation- ship problems per se, while necessary, is seldom—if ever—sufficient.
Effective intervention invariably requires treatment of both the alienation and any co- morbid condition (such as mental illness or a personality disorder).
If clinicians fail to consider the total clinical picture—including any underlying psychopathology—they may fail to appreciate the severity and complexity of the situation. That, in turn, has major implications for diagnosis, treatment, prognosis, and outcome.
Alienating Parents Are Committing Child Abuse – The Treatment Priority Is Child Protection
In Dr. Miller’s Own Words:
It is common for the Courts and professionals to ignore or downplay the abuse issues in parental alienation. They instead focus on the child’s relationship with the rejected parent.
Instead of taking appropriate measures to ensure the child’s safety, the Court orders “reunification therapy.” This is problematic for many reasons, including the fact that, in moderate or severe cases, traditional reunification therapies virtually never work.
One of the oldest heuristics in medicine is primum non nocere—Latin for “first, to do no harm.” It would be difficult to find a more common yet egregious violation of this heuristic than an order for what amounts to traditional “reunification therapy” for PA.
Not only are such therapies known to be ineffective, they are known to be potentially harmful.
Failure of Traditional Reunification Therapy to Remedy Parental Alienation
In Dr. Miller’s Own Words:
Traditional Reunification therapies are of little, if any, benefit in regard to treating PA. These therapies usually make the situation worse, often catastrophically worse. Such therapies waste time that could be used to provide effective interventions.
Traditional therapies tend to “validate” the child’s feelings, encourage the child to express grievances, and give the child some “control” or choice while advising the rejected parent to listen, empathize, validate, and apologize (or even to “find something to apologize for”).
This seemingly logical but misguided approach runs rampant in some quarters where, referring to the parents, it is common to claim, “Both parties always participate.” In effect, this further empowers the already over-empowered child, and further disempowers the already disempowered parent.
This is not only likely to be futile, but the exact opposite of what effective therapies do.
Effective therapies disempower the over-empowered child and re-empower the disempowered rejected parent. And this is only one major difference between effective and traditional therapies—there are more than a dozen.
Seen in this light, traditional therapies are contraindicated except, perhaps, as a brief therapeutic trial (for a few weeks, not a few months) if and only if the diagnosis is unclear.
Lay readers should note that the word contraindicated does not mean “not indicated.” It means forbidden. If a patient is allergic to penicillin, then penicillin is contraindicated. In the face of a penicillin allergy, it would not be proper to prescribe penicillin to see what happens.
Specialized reunification therapies employ substantially different approaches and techniques from those of traditional therapies.
FURTHER READING: Why Traditional Therapy Fails in Severe Parental Alienation
How Should Parental Alienation Cases Be Treated?
In Dr. Miller’s own words:
It is in the child’s best interest regarding major life decisions to be made by those who are qualified to make those decision. This certainly applies to custody, parental access, and child protection.
Since PA is exceedingly counterintuitive, it is absolutely essential for those who deal with PA to have a deep understanding of the counterintuitive issues. Those who attempt to manage such cases using intuition—even professional intuition—instead of a deep knowledge of the science, are likely to make catastrophic errors.
Clinicians who attempt to manage them without adequate skills are likely to find themselves presiding over a cascade of clinical and psychosocial disasters.
At present, such errors run rampant in both the mental health and legal arenas. At a minimum, adequate expertise requires highly sophisticated pattern recognition for alienation.
FURTHER READING: Turning Points for Families – Healing for Parental Alienation
Conclusion
Dr. Steven G. Miller was my friend, colleague, mentor, advisor, and guru. Steve is missed for his wisdom, insight, dedication, and self-sacrifices.
Dr. Miller’s legacy remains life and well and will continue until parental alienation has been eradicated.
