In another case, failed separation between mother and daughter, age 4 at the time of the marital break up, was shown to contribute to an escalating pattern of the girl rejecting her father. The onset of PAS in a given family was found to occur before the parents separated, during the actual divorce proceedings, or years after the divorce decree. Dunne and Hedrick describe a two-and-a-half year-old girl whose parents were disputing custody where there had been a long series of allegations by the mother since the early months of her pregnancy. Some of the teens in this sample had enjoyed a lengthy and positive post-divorce relationship with a parent prior to rejecting that parent as part of a PAS scenario.

Lund

Psychologist Mary Lund examined factors in addition to parental programming which can contribute to estrangement between the child and a rejected parent (19). She wrote that the methods Gardner advocates, such as court orders for continued contact, fit many cases and may help prevent the child developing the kind of phobic-like reaction to the rejected parent which can occur when contact is discontinued during long, drawn out legal proceedings. Such legal interventions often form the cornerstone for treatment. In treating these families, Lund integrates Gardner's work with that of Janet Johnston. She assesses the family in terms of developmental factors in the child which may be contributing, such as normal separation problems among preschoolers and oppositional behavior during preadolescence and adolescence. Deficits in the noncustodial parent's parenting may also contribute to the problem. In her experience, the hated parent, usually the father, often has a distant, rigid, even authoritarian style which contrasts with the indulgent, clinging style of the loved parent, who may also need help with appropriate parenting. These are risky generalizations, however. In the experience of this author and others, alienating and target parents exhibit a wide variety of personality patterns which do not lend themselves to this type of generalization. In addition, where the father is the alienating parent, it is sometimes he who uses an overindulgent and materially lavish parenting style to overwhelm and override the children's healthier psychological bond with the mother.

According to Lund, PAS may also develop when the stress for the child of ongoing high conflict divorce becomes too much and the child seeks to "escape" being caught in the middle by aligning with one parent. Therapists, especially individual child therapists, can unwittingly become part of the system maintaining the PAS, such that a court order is required to break up the therapist's polarizing influence. Ultimately, a combination of strategic legal and therapeutic interventions are required to mitigate the PAS and keep the case manageable.

Cartwright

A Canadian psychologist, Cartwright makes eight points about PAS:

1) PAS can be provoked by conflicts other than custody matters, e.g., child support and relatively trivial differences;

2) alienation is a gradual and consistent process that is directly related to the time spent alienating;

3) time is on the side of the alienating parent, who may engage in a host of delay tactics;

4) slow judgments by courts exacerbate the problem;

5) alienating parents sometimes use the hint of sexual abuse to discredit the other parent, what Cartwright calls "virtual" allegations of sexual abuse;

6) judgments by the court which are clear and forceful are required to counter the force of alienation;

7) children subject to excessive alienation may develop mental illness and

8) successful parental alienation has profound, long term consequences for the child and other family members which are only beginning to be appreciated (24).

As an example of "virtual" allegations abuse, Cartwright describes a mother who insinuated sexual abuse by the father by alleging that he had shown the child a pornographic videotape which in fact was just a Hollywood comedy rented from a family video store. Regarding risk to the child of developing mental illness, Cartwright gives the example of disintegrating behavior by an alienated son, presumably latency age, who tried to poison his father by slipping air freshener into his stomach medicine. Later, the boy ran away during a visit with the father and the police had to be called. The folie a deux literature includes a report in 1977 of a 10-year-old boy who allegedly attempted to burn down his father's house two years after his parents divorced, apparently as a result of his folie a deux relationship with his disturbed mother (25). Such cases suggest that severe PAS can be indicative of significant emotional disturbance in the alienating parent with a proportionately disturbing effect on the child.

Cartwright poignantly describes the psychological effects on the child of being involved in severe PAS. "The child...experiences a great loss, the magnitude of which is akin to death of a parent, two grandparents, and all the lost parent's relatives and friends...Moreover...the child is unable to acknowledge the loss, much less mourn it" (24). The child's good memories of the alienated parent are systematically destroyed and the child misses out on the day-to-day interaction, learning, support and love which, in an intact family, usually flows between the child and both parents, as well as grandparents and other relatives on both sides.

The child may encounter insurmountable obstacles if, later in life, he or she seeks to reestablish relations with the lost parent and his family. The lost parent may be unable or unwilling to become reinvolved. The parent or grandparents may have died. Some of these children eventually turn against the alienating parent, and if the target parent is lost to them as well, the child is left with an unfillable void.

PARENTS WHO INDUCE ALIENATION

Gender

Gardner's observation that mothers seem to engage in PAS behavior with significantly greater frequency than fathers is born out by divorce research, as well as by the clinical PAS literature. The California Children of Divorce Study found that in a nonclinical sample, mothers were twice as likely as fathers to form PAS type alignments with their children (2). When false allegations of abuse arise, as in more severe manifestations of PAS, mothers also seem to comprise the majority (3, 26-28). Mothers constituted 67 percent of the accusers in the nationwide study which revealed that allegations of abuse in divorce/custody disputes were found to be invalid about 50 percent of the time (12). Fathers were the accusers in 22 percent of cases while third parties such as relatives and professionals were the adult initiators 11 percent of the time. Where a third party was the initiator of the allegation, a parent might also believe there was abuse. The numbers reverse when it comes to physically abducting the child, with fathers the abductors from 60 percent to 70 percent of the time (18). There may be gender differences in how men and women go about gaining control of their children and taking revenge on an ex-spouse, with men more inclined to physical kidnapping and women more inclined to social/psychological abduction, which is how Clawar and Rivlin characterized severe PAS (7).

Never Married

Parents may engage in PAS behavior even if they were never married. In Johnston's study of children who refuse visitation, she found that from 6 percent to 15 percent of the high conflict parents she studied were not married (9). In the author's experience, one of the contributing factors to PAS with some of these couples is the mother's anger and resentment over the father's refusal to marry her, an effect which is exacerbated if the father becomes involved with a new partner. A mother in this position may have particularly strong proprietary feelings, similar to what Clawar and Rivlin describe (7), infuriated by the unfairness of joint custody laws which grant the father rights to a relationship with his child without his having fulfilled his obligations with respect to the mother.

New Partners

Johnston found that the new partner of either parent could be the primary instigator of efforts to gain custody of the child (8). Something similar happens when a divorcing parent joins a cult which actively strives to get the child from the noncult member parent, with the cult fulfilling the role of new partner in a sense, as shown in one of the case vignettes to follow.

Narcissistic Vulnerability

Johnston found that to varying degrees, one or both of the parents in high conflict divorce may be narcissistically vulnerable, lacking a well-established self identify and relying on primitive defenses such as externalization, denial and projection (8). The need of one or both parents to protect and defend themselves against narcissistic injury is at the root of many high conflict divorces. This may be a motivating factor for PAS in some cases, a dynamic described by Wilhelm Reich almost 50 years ago (29) when he foretold how parents of certain character types would seek to defend themselves against narcissistic injury in divorce by fighting for the child, using the technique of defaming the partner in order to alienate the child from that parent (italics added).

Need to Conceal Parental Deficits

According to Clawar and Rivlin, the campaign to alienate the child from the other parent is sometimes used to deflect unwanted scrutiny of the programming parent's personal problems, for example alcohol, drugs, neglectful parenting, physical and sexual abuse, criminal involvement, or socially unaccepted life-style (7). Sometimes parents engage in PAS behavior out of fear that they will be found wanting when compared to the more loving and capable target. The literature on false allegations in divorce/custody disputes often makes the point that the accusation helps the accuser level the playing field, so to speak.

Vulnerability to Separation and Loss

A factor in some high conflict divorces is the presence in one or both parents of specific underlying vulnerabilities to loss and conflicts around attachment and separation (8). A PAS scenario can develop when a troubled parent who was rejected in the divorce copes with loss and loneliness by turning to the child to fullfill emotional needs, resulting in what Wallerstein calls the "overburdened child " , discussed in Part II. For some parents, the divorce reactivates separation issues from earlier losses such as previous divorce, kidnapping or death of a child, or the loss of other family members. Such a parent may engage in PAS to defend against further "loss," that of having to share the child with the other parent. Some parents have long standing personality problems with separation and individuation. The ongoing conflicts over the child engendered by PAS help ward off feelings of loss and abandonment by maintaining the relationship with the ex-spouse. PAS can also be used by keep the other parent hostilily engaged, as in Medea Syndrome (4, 5) and Divorce Related Malicious Mother Syndrome (6, 30).

Revenge Clawar and Rivlin found that revenge was one of the most common and powerful reasons for parents to engage in alienating behavior (7). The personality makeup of some parents is such that revenge seems like their only viable option in response to feeling wounded by the divorce. The desire for revenge can be further kindled if infidelity is discovered, the alienating parent is left for someone else, or finds themselves immediately replaced by a new love object in the life of the parent who left.

Need for Control and Domination

Some alienating parents are driven by overriding needs for power, influence, domination and control (7). Engaging in PAS may provide the dual gratification of maintaining power, influence and control over the child and vicariously over the ex-spouse whose visitation and relationship with the child is frustrated by the alienating parent's control maneuvers. Needs for domination and control are sometimes acted out by abducting the child and using it to taunt and torment the frantic target parent. In addition to mothers and fathers, a new partner can be the one with inordinate needs for power, domination and control. For example, a mother may become involved with a new partner who first seduces her away from her relatively weak husband and then acts as a sort of one-on-one cult leader to mother and child, who are both programmed and brainwashed into compliance and submission.

Medea Syndrome

The need for revenge is taken to an extreme in Media Syndrome (4, 5). "Modern Medeas do not want to kill their children, but they do want revenge on their former wives or husbands-and they exact it by destroying the relationship between the other parent and the child...The Medea syndrome has its beginnings in the failing marriage and separation, when parents sometimes lose sight of the fact that their children have separate needs [and] begin to think of the child as being an extension of the self...A child may be used as an agent of revenge against the other parent...or the anger can lead to child stealing" (5). The "embittered- chaotic" parents described earlier by Wallerstein and Kelly may also fall in the revenge category (2). These parents act out their intense anger in a disorganized but chronically disruptive way which bombards the children, rather than protecting them, with the raw bitterness and chaos of the angry parent's feelings about the ex-spouse and the divorce.

Divorce Related Malicious Mother Syndrome

Turkat would have done better to call this disorder "Malicious Parent Syndrome," but be that as it may, this disorder describes a special class of alienating parents who engage in a relentless and multifaceted campaign of aggression and deception against the ex-spouse, who is being punished for the divorce (6, 30). Contrary to Turkat, the author has encountered several cases in which the father was the malicious parent, as illustrated in the case vignette at the end of this section. Discussing PAS by name, Turkat classified PAS as a moderate form of visitation interference as compared with Divorce Related Malicious Mother Syndrome. The parent with the latter disorder uses an array of tactics including excessive litigation, alienating the child from the target parent, and involving the child and third parties in malicious actions against the ex-spouse. Lying and deception are routinely used. A malicious parent might arrange to have the ex-spouse investigated for use of illegal drugs at work or file a complaint with authorities against the ex-spouse's new partner. Malicious parents are often successful in using the law to punish and harass the ex-spouse, sometimes violating the law themselves but often getting away with it. Their efforts to interfere with the target parent's visitation are persistent and pervasive, including attempts to block the target parent from having regular, uninterrupted visitation with the child and from having telephone contact, as well as trying to block the target parent from participating in the child's school life and activities.

Mr. C's suspiciousness and verbal attacks on his wife finally drove her to file for divorce. As on previous occasions, Mr. C. threatened that if she would not reconcile he would win custody of their four-year-old daughter and make sure the mother never saw her again. In the past, Mrs. C. had relented, fearful that Mr. C. would fulfill his threats, but this time she stood firm. Mr. C. filed for sole custody based on false allegations that the mother was unfit. When these allegations were not upheld, the father made up new ones. Within a year of filing, Mrs. C. became engaged to another man. Mr. C. succeeded in breaking up the engagement by accusing the fiance of sexually abusing the child. He had the police arrest the fiance at the mother's home. When child protective services informed the mother that they would take her daughter away for failure to protect, the mother canceled her engagement, terrified that Mr. C. would make good on his threat to take her daughter away. When police and child protection investigation of the sex abuse allegations resulted in a finding that no abuse occurred, Mrs. C. proceeded with her wedding plans. Father raised allegations of sex abuse against Mrs. C.'s new husband in family court and succeeded at one point in gaining temporary custody. Primary custody was returned to the mother after the court ordered evaluation found the allegations to be without merit and the father to be emotionally disturbed and pressuring the child to report abuse. During his visitation time, the father and a male friend continued to interrogate the girl about abuse by the stepfather and as time went by she felt increasingly pressured to meet their expectations. Away from the father's influence, however, the girl enjoyed her family with her mother and stepfather. She stated to several different therapists that she had only accused her stepfather of molesting her to please her father and his friend.

In the meantime, Mr. C. and friend continued to make abuse reports against the stepfather, creating significant distress for Mrs. C., her new husband and the child. Eventually, when the girl was 10, the father succeeded in getting the juvenile court to take jurisdiction and give him custody, although medical examination of the child did not support the increasingly serious accusations. Mrs. C. was not allowed to see her daughter. When she tried to contact the therapist who was now seeing the girl for sex abuse by Mrs. C.'s new husband, the therapist was rude and a refused to speak with her. The mother was tortured by reports from a series of child protection workers which indicated that her daughter was acting out in bizarre and often self-destructive ways. At the age of twelve, she was picked up by the police for prostitution and had to be psychiatrically hospitalized. Several professionals who were involved when the mother had custody wondered if Mr. C. was deliberately destroying his daughter so as to get revenge against the mother. Mr. C. was able to retain custody, however, by focusing the attention of authorities on allegations of sex abuse against the stepfather.

Long before Divorce Related Malicious Mother Syndrome was identified by Turkat, a male psychologist, whose ex-wife undoubtedly exhibited the disorder, wrote a book about his ordeal (31 ). Accusing him of sexually abusing their young daughter, the mother arranged for the police to arrest him at his office in front of his clients and staff. She also arranged for newspaper reporters to be present so that pictures of the shocked psychologist being handcuffed and hauled off to jail were widely broadcast. The father fought back and eventually obtained joint custody after the court found that mother's extreme efforts to sever the father's relationship with his child were detrimental and stripped her of sole custody.

Personality Characteristics of Parents Making False Accusations of Sexual Abuse in Disputes

Wakefield and Underwager undertook a systematic review of divorce/custody case files to examine and compare the characteristics of 72 false accusers, 103 falsely accused parents and a control group of 67 parents disputing custody but without allegations of abuse (28). Criteria for determining whether a parent had falsely accused included a finding by the justice system that there had been no abuse. Of the three groups, the falsely accusing parents were much more likely to have been diagnosed by a professional as exhibiting a personality disorder including mixed, unspecified, histrionic, borderline, passive-aggressive or paranoid. Approximately one-fourth of the false accusers did not exhibit significant pathology, while most of the parents who were disputing custody without abuse allegations were assessed as normal. Some of the false accusers were so obsessed with anger toward their estranged spouses that this became a major focus of their lives. They continued to be obsessed with abuse despite negative findings by mental health professionals and the courts, similar to what is found in cases of delusional disorder and Munchausen Syndrome by Proxy. The relationship of falsely accusing parents with their children was often characterized in the record as extremely controlling and symbiotic. Two were Qiven a formal diagnosis of folie a deux between parent and child. Several exhibited extremely serious dysfunction, such as unpredictable bizarre behavior, belief that they possessed supernatural powers and delusions of grandeur. These authors found more similarities than differences between mothers and fathers who falsely accused, with mothers very much in the majority.

SAID Syndome

Blush and Ross have come up with three psychological profiles for mother false accusers and a typical profile of father accusers (3, 26, 27). Mothers tend to present as "fearful victim," "justified vindicator," or to some degree psychotic. The "fearful victim" presentation involves manipulation of social image around a specific theme to which others respond with sympathy and support, such as child abuse or spousal abuse. The "justified vindicators" initially present as intellectually organized with a knowledgeable, even pseudo-scientific sounding agenda, similar to what Clawar and Rivlin report regarding self righteousness as an important motivation of some programming parents. Women in the third group present with a combination of borderline and histrionic features, which interact with the stress of the divorce to impair the mother's reality testing and significantly interfere with her functioning, sometimes to the point of a psychotic or quasi-psychotic presentation. Similar to Wakefield and Underwager's findings (28), mothers in all three categories tend to be histrionic in presentation, so emotionally convinced of the "facts" that no amount of input, including from neutral professionals, can dissuade them from their perceptions. According to Blush and Ross, the typical profile for father accusers is one of intellectual rigidity and a high need to be "correct," possibly male counterparts of the "justified vindicator" presentation among mothers. By history, these men were hypercritical of their wives while the marriage was still intact, quick to suspect them of negligence and to accuse their wives of being unfit mothers. Gardner's work is referenced in the second and third SAID syndrome articles by these authors (26, 27).

Accuser and Accused Dyads

Important information about a programming parent using false allegations of abuse is to be found in the particular choice of accused. The study reported by Thoennes and Tjaden showed that the battle goes beyond simply mothers against fathers and vice versa (12). Parents were found to accuse not only each other but the other's new partner, or relatives such as grandparents or the new partner's teenage son. A parent who accuses the ex-spouse's new partner may fulfill a number of goals simultaneously, expressing feelings of jealousy, revenge, and trying to keep the child from forming a positive attachment with the new parent figure. Accusations against the target parent's relatives may provide a combination of revenge, allegations that are difficult for the ex-spouse to defend since they are not directly against him or her, and a means to exclude the relatives from post-divorce involvement in the child's life. The accuser can set up a devastating conflict for the target parent by accusing his teenage son from a previous marriage or the new partner's teenage offspring from a previous union. This has the effect of forcing the target parent to "choose" between his child involved in making the allegation and another child whom he loves and is responsible for. This enhances the alienating parent's ability to convince the child that daddy does not care.

The Delusional Parent

Rogers refers to PAS in her report on five divorce/custody cases in which the falsely accusing parent, all mothers in this sample, suffered from delusional disorder (32). The children were subjected to undue influence to get them to accept the accusing parent's psychotic belief and concomitant rejection of the other parent in a severe PAS scenario. Where the child succumbed, a diagnosis of shared paranoid disorder, otherwise known as folie a deux might also be made. According to Rogers, the first stages of the mother's delusional disorder were present to some degree during the marriage and exacerbated parental conflicts prior to the separation. However, these subtle signs were not immediately discernible as a psychiatric illness and were only recognized in retrospect, as the mother's symptoms became worse in the course of the divorce and its attendant disputes. One of the severe PAS cases reported by Dunne and Hedrick appears to be an example of the mother developing delusional disorder. The "subtle signs" were expressed as suspicions during her pregnancy that the father would molest the child, similar to a case encountered by the present author in which suspicions harbored by the mother even before the child was born prompted her to abduct the child a few months later. According to Rogers, the mothers who became delusional were usually the main caretakers for the children. In two cases they were awarded custody during the first round of custody litigation, before more noticeable deterioration in their parenting capabilities had occurred. With continued custody litigation, the intractable nature of their mental illness became apparent and the court gave custody to the father in four of the five cases.

Munchausen Syndrome by Proxy

Some cases of PAS, especially those with false allegations of abuse, may have important features in common with Munchausen Syndrome by Proxy (MSP) in which parents fulfill their needs vicariously by presenting their child as ill (23). In cases of "classical" MSP, parents repeatedly take their children to doctors for unnecessary, often painful tests and treatments which the physician is induced to provide based on the parent's misrepresentations. "Contemporary-type" MSP occurs when a parent fabricates an abuse scenario for the child and welcomes or actively seeks out repeated abuse interviews of the child by police, social workers and therapists (23). The concept of contemporary-type MSP elaborates on the idea put forth by Sinanan and Houghton that new types of MSP behavior will evolve in parallel with the evolution of new medical and social services, e.g., the child protection system (33). MSP parents may change or come up with new "symptoms" for the child so as to better elicit the desired response from a particular care provider or an institution offering specialized services. Thus, the same child may be receiving attention simultaneously for fabricated physical symptoms from several medical providers and for fabricated sex abuse from therapists and public agencies who specialize in abuse. Careful evaluation and thorough investigation of sex abuse allegations which turn out to be questionable or false will sometimes bring a parent to the attention of authorities for practicing "classical" as well as "contemporary- type" MSP (34).

As with PAS, MSP is most often practiced by mothers, although fathers and other caretakers are sometimes found to engage in the behavior. MSP parents maintain their psychic equilibrium through control and manipulation of external sources of social gratification, including the child and care providers who serve children. Medical and other care providers are sometimes referred to as the "third party participants" in the MSP, because of their importance in carrying out the parent's agenda, including false allegations of abuse. There are at least four different presentations where MSP and PAS overlap: 1) an MSP mother may, during the marriage, add false allegations of abuse to the child's fabricated physical symptoms, thus precipitating the divorce; 2) where the MSP parent feels angry or rejected in divorce, manipulating the child's medical care and involving the child in false allegations of abuse may serve multiple functions including revenge, maintaining the symbiotic bond with the child and preserving the freedom to continue the MSP behavior; 3) a parent dealing with the losses and stress of divorce may respond with MSP type behavior to obtain social support from the child and care providers; 4) an alienating parent may exhibit MSP type behavior by manipulating the child's medical care for the primary purpose of furthering the alienation agenda (35).

In PAS with features of MSP, the alienating parent may gain legal authority to control and determine whom the child sees and what treatment is given. The child may be taken to the doctor after visits with the target parent for fabricated or induced symptoms which are attributed to abuse and neglect by the other parent. The child is likely present while the alienating parent makes this negative presentation about the other parent to the doctor, who inadvertently lends support to the denigrating account by listening to it, asking questions and examining the child. The target parent may be rendered ineffective to stop this cycle because providers retained by the alienating parent, and who take her assertions at face value, often refuse to talk to the target parent or allow the target parent access to child's medical records. The result for the child is what Rand calls MSP type abuse. Rand expands Meadow's formulation of MSP as a complex form of emotional abuse by applying Garbarino's five types of psychological maltreatment. Research on MSP shows that it sometimes overlaps with other forms of abuse and neglect (36).

Parental Child Abductors

According to Huntington, post-divorce parental child stealing has been on the increase since the mid-1970s, paralleling the rising divorce rate and the explosion of litigation over child custody (18). An abducting parent views the child's needs as secondary to the parental agenda which is to provoke, agitate, control, attack or psychologically torture the other parent. It should come as no surprise, then, that post-divorce parental abduction is considered a serious form of child abuse. Psychological maltreatment may predominate or be accompanied by physical abuse and neglect. Abducting parents take the idea that the child would be better off without the other parent to an extreme. Clawar and Rivlin found that would-be abductors often felt frustrated in their efforts to gain access to their child through the legal system and felt "forced" to abduct the child (7). Sometimes, they became so convinced of the terrible scenario they were broadcasting about the target parent that they felt no "choice" but to flee with the child and go into hiding. In order to win the child's cooperation in maintaining concealment, the abductor must continue to brainwash the child with fear of the target parent and what would happen if the target parent should find the abducting parent and child.

CONCLUSION TO PART I

Review of this first portion of relevant literature and research indicates that Gardner's concept of PAS has been increasingly discussed and referred to since he introduced the term in 1985. Research on divorce since the early 1980s has been progressively converging with Gardner's work. Johnston's studies of high conflict divorce in particular suggest that it is not sufficient to lump PAS with high conflict divorce in general. In its more severe forms, PAS is clearly distinctive. It is also more destructive for children and families and can be irreversible in its effects. As the section on alienating parents indicates, the divorce population includes a significant proportion of parents who have' psychological problems and disorders. The degree to which such problems are expressed in efforts to alienate the child from the other parent has to be evaluated in the total divorce context, including psychological factors of the child and character and conduct of the target parent. Severe PAS is destructive irrespective of the gender of the alienating parent.

Part I attempts to integrate Gardner's work on PAS with the relevant literature and research under the following topic headings: The Child in PAS; The Target/Alienated Parent in PAS; PAS and its Third Party Participants; Attorneys on PAS; Forensic Evaluation and PAS; and Interventions for PAS, including strategic combinations of court orders and therapeutic interventions, appointment of a Special Master, appointment of a Guardian ad Litem, changing custody, use of hospitalization and other transitional sites to facilitate custody changes, and the appropriate application of sanctions to help certain programming parents to better act in their children's best interests.

Whether or not one chooses to use Gardner's terminology, the problems posed by these cases to families, professionals and the courts are very real. Reluctance to consider Parental Alienation Syndrome by name, along with the diagnostic and interventions it entails, tends to contribute to the perpetuation of the problem in a variety of ways. Like any other label, that of PAS has the potential to be misapplied and misused. Whether or not it is the appropriate diagnosis in a given instance must be determined based on facts of the case, corroborated historical evidence and data from multiple sources. An appropriate diagnosis of PAS, including level of severity as Gardner recommends, can make the difference between allowing a case to go beyond the point of no return or intervening effectively before it is too late.

REFERENCES

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2. Wallerstein JS, Kelly JB: Surviving the breakup: how children and parents cope with divorce. New York, Basic Books, 1980

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9. Johnston JR: Children of divorce who refuse visitation, in Nonresidential Parenting: New Vistas in Family Living. Edited by Depner CE, Bray JH, London, Sage Publications, 1993

10. National Center on Child Abuse and Neglect: executive summary: study of national incidence and prevalence of child abuse and neglect. Washington DC: Department of Health and Human Services 1988, Contract 105-85-1702

11. Stewart JW: The molestation charge. California Family Law Monthly 1991; 7:9:329-335

12. Thoennes N, Tjaden PG: The extent, nature, and validity of sexual abuse allegations in custody visitation disputes. Child Abuse & Neglect 1990; 12:151-63

13. National Council on Children's Rights: CAPTA revised to provide relief for false allegations. Speak Out for Children, Fall 1996/Winter 1997

14. State of California: The California Child Abuse & Neglect Reporting Law: Issues and Answers for Health Practitioners, 1991

15. Gardner RA: The Parental Alienation Syndrome and the Differentiation Between Fabricated and Genuine Child Sex Abuse. Cresskill, NJ, Creative Therapeutics, 1987

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18. Huntington DS: The forgotten figures in divorce, in Divorce and Fatherhood: The Struggle for Parental Identity. Edited by Jacobs JW, Washington DC, American Psychiatric Association Press, 1986

19. Lund M: A therapist's view of parental alienation syndrome. Family and Conciliation Courts Review 1995; 33:3:308-316

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23. Rand DC: Munchausen syndrome by proxy: a complex type of emotional abuse responsible for some false allegations of child abuse in divorce. Issues in Child Abuse Accusations 1993; 5:3:135-155

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28. Wakefield H, Underwager R: Personality characteristics of parents making false accusations of sexual abuse in custody disputes. Issues in Child Abuse Accusations 1990; 2:3:121-136

29. Reich W: Character Analysis. New York, WR Farrar, Straus and Giroux/Noonday Press, 1949

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31. Spiegel LD: A Question of Innocence. Parsippany, NJ, Unicorn Publishing House, 1986

32. Rogers M: Delusional disorder and the evolution of mistaken sexual allega lions in child custody cases. American Journal of Forensic Psychology 1992; 10:1:47-69

33. Sinanan K, Houghton H: Evolution of variants of the Munchausen syndrome. British Journal of Psychiatry 1986; 148:465-467

34. Meadow R: False allegations of abuse and Munchausen syndrome by proxy. Archives of Disease in Childhood 1993; 68:4:444-4.47

35. Jones M, Lund M, Sullivan M: Dealing with parental alienation in high conflict custody cases, presentation at conference of the Association of Family and Conciliation Courts, San Antonio, TX, 1996

36. Bools CN, Neale BA, Meadow SR: Co-morbidity associated with fabricated illness (Munchausen Syndrome by Proxy). Archives of Disease in Childhood 1992; 67:77-79

ABOUT THE AUTHOR

Deirdre Conway Rand, Ph.D. practices clinical and forensic psychology in Mill Valley, California. She specializes in complex forms of emotional abuse, such as severe Parental Alienation and Munchausen Syndrome by Proxy. She is the author of articles on the latter and of two chapters in the book, Spectrum of Factitious Disorders, published by the American Psychiatric Association.

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