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Pathological narcissism never presents to psychotherapy for treatment. They are incapable of self-reflection and react extremely poorly to negative information.

They don’t like therapy. We don’t suit them or what they want. So they avoid us. The only time psychotherapists see pathological narcissism is in marital therapy when the spouse brings them in (or in prison therapy). But that doesn’t last long. Typically three sessions before there therapist says something mildly critical about the narcissist. They’re not coming back, therapy’s over.

Therapists never see pathological narcissism in their practice. Narcissists don’t react well to therapy. They don’t like it.

Borderlines are more comfortable with psychotherapy because they play the victim role to obtain nurture. So the first five or six sessions with a borderline they are movingly reporting on all the stress and “abuse” in their life. That’s bread-and-butter for the psychotherapist… “Oh, you poor thing” – and the borderline is in heaven.

This early stage of therapy is also the “all-wonderful” period of the splitting pathology, so the borderline is feeding the therapist’s narcissistic supply as the all-wonderful therapist; “the best therapist ever – so much better than my last therapist” (they eat therapists, seriously, they devour the emotional structure of the therapist).

Somewhere in about the forth to sixth session, there is some minor empathic failure, typically the therapist couldn’t be reached after hours to handle some “emergency,” and then it’s game on with therapy. The split shift to demonized and let the trauma-drama begin.

The rule-of-thumb for therapists is to only have one borderline personality on your caseload at a time because they take soooo much time. If you have several borderline patients on the caseload, the psychotherapy practice become too chaotic, too many “emergencies,” and too high a level of sustained “drama.” Only one borderline at a time.

Most therapists won’t work with borderlines. They are terrified of the suicidal aspect of borderline personality manipulation (called suicidal gestures and para-suicidal behavior). Very stressful for the therapist because of the liability issue (and possible death issues) surrounding borderline para-suicidal behavior. You can’t ignore it because it’s suicidal-spectrum, but it’s 100% manipulative.

So narcissistic pathology avoids therapists, and therapists avoid borderline pathology.

Very few therapists have experience treating narcissistic and borderline personality pathology.

That has implications.

Now imagine if they were treating autism, and had no experience treating autism. Would they be qualified to treat autism? Or eating disorders. If they had no experience treating eating disorders, should they be allowed to treat eating disorders?

In everywhere else but forensic psychology, the answer would be no, you’re not allowed to treat a pathology that you have no experience treating. That’s called boundaries of competence.

But apparently, forensic psychology is exempt from that requirement to know what you’re doing. They apparently think that something about being court-involved means that they are exempt from boundaries of competence. They just make up new stuff, new forms of pathology, and do messed up “therapy” that fixes nothing and destroys families, and they’re are all confused and stuff. And that seems to be okay, totally another day at the office in forensic psychology.

I am drop dead astounded as a clinical psychologist by the complete absence of professional knowledge applied by forensic psychology. Zero. Nothing. Not attachment. Not family systems. Not complex trauma. Not personality disorders. Nothing.

<sigh>

An attachment-based model of parental alienation (AB-PA) represents the return of clinical psychology to court-involved practice.

AB-PA represents the application of the standard and scientifically established knowledge of professional psychology; attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain during childhood.

AB-PA is not a “new theory.” There is no such thing as AB-PA. It is a label of convenience to stand for the scientifically established knowledge of professional psychology. If you disagree with something about how I applied the knowledge of professional psychology – attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain – then you do it.

Go ahead. You do it.

You apply the scientifically established knowledge of professional psychology – attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain – you apply it and see what you come up with.

When I did it, I came up with the pathology I describe in Foundations. I use the label of AB-PA for that description so I can conveniently talk about the pathology described in Foundations in my sentences to other people. AB-PA is a label for the application of the scientifically established knowledge of professional psychology.

If you disagree with anything I’m saying, you do it.

You apply the scientifically established knowledge of professional psychology and see what you come up with – attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain in childhood.

You apply that knowledge, and then tell us what you come up with.

Because you know what? That’s what you are supposed to be routinely doing. Routinely.

Applying the knowledge of professional psychology is called professional standard of practice. It’s the “professional” part. The “standard of practice” part means routinely. Professional standard of practice.

If you are not doing that – routinely- then you are practicing… beneath… professional standards of practice.

I’m trying not to go too fast here.

Because if you’re not applying the knowledge of professional psychology – then you’re a plumber, the salesperson at the counter, an architect – but you’re not a mental health… professional. It’s that professional part of mental health professional.

Because a professional applies the knowledge of professional psychology – attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain in childhood.

Do you know why? Because it’s their job. They have a professional obligation to their patients, to the children and families they treat. That’s why. It’s because of their professional obligation to their clients and patients.

It’s called duty of care.

Craig Childress, Psy.D.

Clinical Psychologist, PSY 18857