To: Clinical psychologists who are assessing, diagnosing, and treating attachment-related pathology surrounding divorce (AB-PA)
Re: Professional Competence
I am appalled that clinical psychologists are not recognizing and diagnosing a psychotic pathology that is sitting right in front of you in your office – an encapsulated persecutory delusion.
A psychotic pathology. Right in front of you. And you are totally missing recognizing it and diagnosing it.
Wow. You know what? You are a really bad clinical psychologist. Just awful.
We’re not talking some strange esoteric form of pathology. We’re talking psychotic pathology, right in front of you. And you are entirely missing it.
I mean, seriously… psychotic pathology. Wow. You are a really bad clinical psychologist if you can’t even recognize and diagnose psychotic pathology when it’s sitting right in front of you.
The child is displaying an encapsulated persecutory delusion – a fixed and false belief that the child is being malevolently treated – being “victimized” – by the normal-range parenting of the targeted parent.
Here, let me take you by the hand and lead you through this…
Does the child believe that he or she is being malevolently treated – being “victimized” – by the targeted parent? – Yes.
Persecutory belief.
Is this true? – No.
False belief.
Does the child evidence the ability to change this false persecutory belief in response to the actual reality that the child is NOT being malevolently treated – is not being “victimized” – by the normal-range parenting of the targeted parent? – No.
Persecutory delusion.
Does the child evidence delusions in other areas of life? – No.
Encapsulated persecutory delusion.
See how this diagnosis thing works? Jeez Louise, you’re supposed to be a clinical psychologist. This is your job. Holy cow.
But you are looking squarely at a psychotic pathology – an encapsulated persecutory delusion – and you are totally missing it.
Wow. I am absolutely floored. You are a really bad clinical psychologist if you can’t even recognize and diagnose a psychotic pathology.
Does the child have an endogenous psychosis, like schizoprhenia? No. Wait… You can’t possibly be such an awful clinical psychologist that you would actually think that the child’s encapsulated persecutory delusion represents an endogenous psychosis originating in the child… can you? I don’t know. I’m so stunned that you can’t even recognize and diagnose psychotic pathology that I’m not sure quite how bad things are with you.
But no, the child does not have an endogenous psychotic pathology. So if the psychotic pathology is not arising spontaneously to the child, then what is the source for the child’s encapsulated persecutory delusional belief that the child is being “victimized” by the normal-range parenting of the targeted parent?
Okay, take my hand again and let me walk you through this…
Can the normal-range parenting of the targeted parent create a delusion in the child – a false belief – that the child is being “victimized” by the normal range parenting of the targeted parent? No. Normal-range parenting cannot create a delusion.
Have you ever heard of any case in which a normal-range parent created a persecutory delusion in the child by normal-range parenting? – No. Normal-range parenting cannot create a delusion.
Okay, then we can safely rule-out the targeted parent as the source of this delusional belief evidenced by the child.
So now we’ve ruled out the child having an endogenous psychosis (or are you still thinking that this might be childhood schizophrenia? – It’s not – but you’re such a bad clinical psychologist I don’t know what you’re thinking – but it’s not. There is no evidence to suggest that the child is independently psychotic).
And we’ve ruled-out the targeted parent as the source of the child’s encapsulated persecutory delusion. Care to hazard a guess as to the next possible source to explore? Right, the allied and supposedly “favored” parent. Yay for you.
So, is it possible that the allied and supposedly “favored” parent has a false belief that the child is being “victimized” by the normal-range parenting of the targeted parent? Yes, that’s possible. Hmmm, how could we go about checking this out, to see if the allied and supposedly “favored” parent has the same beliefs as the child that the child is being “victimized” by the supposedly bad parenting of the targeted parent?
Hey, I know… how about we interview the allied parent and obtain this parent’s perceptions of the child’s supposed “victimization” by the parenting practices of the other parent. Whaddya think? Good idea?
And you know what, the allied and supposedly “favored” parent evidences exactly the same beliefs as the child. Wow. What a coincidence, eh? They both share the same persecutory delusional belief surrounding the child’s supposed “victimization” by the normal-range parenting practices of the targeted parent.
Okay, now here’s a tough diagnostic question… what is the pathology called when two people (who live together and are closely related by blood, and are in a close relationship in which one of them is dominant over the other one) – what is the clinical psychology pathology called when these two people share the same delusion? — Right, a shared delusion. Whew, I’m so proud of you. You’re doing great. When two people share the same delusion, the clinical pathology is called a shared delusion.
So we’ve now diagnosed a shared persecutory delusion – shared between the child and the allied and supposedly “favored” parent.
Okay, so we’re about to close out this diagnostic walk through, but before we do… you know what I find so amazing – and so incredibly appalling? That you never-ever reached this point in the diagnosis of the psychotic pathology that is sitting right in front of you. I am stunned.
You’re supposed to be a clinical psychologist, yet you entirely miss recognizing and diagnosing a psychotic pathology that’s sitting right in front of you with a flashing neon sign that says “Delusion – Encapsulated Persecutory Delusion” – and you’re just oblivious. Wow.
You are a really bad clinical psychologist. Really bad.
Okay, but let’s finish off this hand-holding diagnostic walk-through…
The child has an encapsulated persecutory delusion. We’ve ruled-out that the child has an endogenous psychosis (like schizophrenia – you’ll agree with me on that, right?), and we’ve ruled-out the normal-range parenting of the targeted parent as a potential source for creating a persecutory delusion in the child, and we’ve identified that the child and the supposedly “favored” parent share the same delusion, so… what do we know about a shared delusion?
Let’s turn to the American Psychiatric Association in the DSM-IV TR. Yes, I know we’re using the DSM-5 now, but for more than a decade the diagnosis of a shared delusion (which they call a Shared Psychotic Disorder) was acknowledged by the American Psychiatric Association, let’s just look at what they say about the pathology:
From the American Psychiatric Association: “Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person.”
So, who is “dominant” in this case? A: The allied and supposedly “favored” parent.
And did the child’s persecutory delusion toward the targeted parent develop gradually over time? A: Yes.
So this would seemingly indicate that the allied and supposedly “favored” parent is the “inducer” and the child is “the more passive and initially healthy second person.”
From the American Psychiatric Association: “Individuals who come to share delusional beliefs are often related by blood or marriage and have lived together for a long time, sometimes in relative isolation.”
Are the child and the allied parent “related by blood”? A: Yes.
Have they “lived together for a long time?” A: Yes.
So far the pathology fits perfectly.
From the American Psychiatric Association: “If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear.”
Oh wow, here we’re getting some potentially useful treatment recommendations. If we separate the child from the pathology of the parent, the child’s encapsulated persecutory delusion regarding the targeted parent will “diminish or disappear.” Good to know, don’t ya think?
From the American Psychiatric Association: “Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur in larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.” (p. 333)
“…especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.”
Wow. Sounds pretty much like an exact fit to me.
Does the American Psychiatric Association have anything to say about the course of a shared delusional belief? Why yes they do.
From the American Psychiatric Association: “Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change.”
Pretty spot on, don’t ya think? Does the American Psychiatric Association have anything to say about treatment? Whaddya know, yes they do.
From the American Psychiatric Association: “With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.” (p. 333)
Well, there ya go… “With separation from the primary case, the individual’s delusional beliefs disappear…”
So, according the the American Psychiatric Association, the child’s persecutory delusional beliefs that the child is being somehow “victimized” by the normal-range parenting of the targeted parent will “disappear” with the child’s “separation” from the “inducer” of the allied and supposedly “favored” parent.
Wow. From the American Psychiatric Association. Shared delusional pathology fits exactly. Seriously, I can’t imagine a more perfect diagnostic fit. With treatment recommendations even. American Psychiatric Association… the child’s symptomatic rejection of the targeted parent will “disappear” with the child’s “separation” from the allied parent. Wow. There ya go.
All that’s needed is a competent clinical psychologist. Dang, instead we have you. Dang, dang, dang. Tough luck for the family then, because they have an ignorant and incompetent clinical psychologist who is going to sacrifice the child to a psychotic psychopathology because of flat out ignorance and incompetence. Dang.
And did you also know that the diagnosis of Shared Psychotic Disorder is still in the ICD-10 diagnostic system (a diagnostic code of F24) of the World Health Organization, so you can still make that diagnosis if you want to, just use the ICD-10 diagnostic system. The ICD-10 diagnostic system is a fully credible and accepted diagnostic system. Internationally accepted. World Health Organization. All insurance companies in the U.S. require an ICD-10 diagnosis. You’d be completely on solid ground making the ICD-10 diagnosis of F24 if you wanted to.
But you know what? You are such a really-really bad clinical psychologist that this isn’t even an option for you because you can’t even recognize when you have a psychotic pathology sitting right in front of you. Whoosh, nothing. Completely oblivious to a psychotic pathology sitting right in front of you.
In Chapter 6 of Foundations I even describe in detail exactly the communication dynamic between the child and the allied parent that creates the child’s persecutory delusional belief, and in Chapter 7 of Foundations I describe in detail the origins of the delusional belief in the false trauma reenactment narrative contained in the internal working models of the allied parent’s attachment networks. I explain it all for you in Foundations.
But here’s the thing… bottom line…
You’re supposed to be a clinical psychologist, but you can’t even recognize and diagnose psychotic pathology when it’s sitting right in front of you. You seriously need to review your diagnostic skill set and you need to start to care about developing basic, minimal, standards of professional competence.
Start with the psychotic disorders – the really clear stuff. Schizophrenia, hallucinations, delusions. Then move to the mood disorder pathologies, major depression, anxiety disorders, panic attacks. Don’t take on the subtler diagnostic stuff like PTSD or autism-spectrum disorders until you get the really clear and basic stuff down. Get your feet under yourself first.
Seriously, if you cannot even recognize psychotic pathology when it’s sitting right in front of you, you shouldn’t be practicing clinical psychology – because you’re a really bad clinical psychologist – and when you’re such a really-really bad clinical psychologist, you are then directly responsible for destroying the lives of children and families who come to you for help.
You shouldn’t destroy the lives of children and families. Go become a plumber or a shopkeeper, because you should not be a clinical psychologist. If you cannot diagnose psychotic pathology that’s sitting right in front of you, then you are a really bad clinical psychologist who will destroy the lives of the children and families who come to you for help.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857
Low expectations are one of the most subtle yet devastatingly effective forms of sabotage we can do to others and ourselves. Low expectations often masquerade as kindness yet they are the cruelest cuts because they deny an individual or an organization its opportunity for greatness.
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