Parental Alienation is a disorder that arises primarily in the context of a child custody dispute and children may refuse or sabotage visitation with a parent or caregiver with whom they previously enjoyed a positive relationship. It is important for the therapist to differentiate realistic estrangement from parental alienation. Realistic estrangement occurs in the context of visit refusals relating to inadequate parenting, neglect, and/or abuse. Pathologically alienated children may denigrate and lobby allegations of mistreatment and abuse against a previously cherished parent that cannot be confirmed. Typically these children display anger, hatred and fear toward the rejected parent that is significantly disproportionate to any of the misdeeds they claim that parent may have committed

When children are alienated from a parent their behavior may be so outrageous during contact with their parent that visits become unsafe or impossible. Reunification involves the therapist facilitating the visits between the child and the rejected parent. This intervention occurs following intensive treatment with both the parents and the child. Treatment is family focused with the therapist working with each parent and the children toward the goal of reestablishing a more appropriate child/parent relationship. The therapist may also work with extended family including new step parents, step siblings or grandparents.

Reunification involves treatment of all family members that is usually court ordered. The best scenario for these cases involves early intervention before the alienation can become fully entrenched. Successful treatment will be related to a court order that links the treatment to the sanctioning and monitoring of the courts until such time that normal parent/child contact resumes.