CONFIDENTIAL:
Stepfamily Satisfaction and Quality of Shared Parenting Survey
Suspected Parental Alienation Experience Survey
Year: 2010
This is designed to provide statistical data about
stepfamily satisfaction and the quality of shared parenting interactions. Because many parents feel their children's
other parent is breaking down the quality of [his/her] relationship with the children, this momentous survey addresses and
aims to gather the statistical data critics of Parental Alienation Syndrome state is lacking. State to state in the United
States and country to country, what will the data reveal? Part One addresses satisfaction of home environment.
You can be a single, remarried or stepparent, or a stepchild who is 18 and older. Through this project, as advocates for strong parent-child relationships
and healthy shared-parenting, we look forward to publishing and providing the collective results of this study to researchers and educators in
the legal and mental health professions, and families. We desire to create more satisfying parent-child
relationships through support and services awareness and to reduce the risk of child
abuse and the academic neglect that is often paired with distracted parenting. Part Two is an effort to provide statistical
data that critics of Parental Alienation Syndrome have stated is lacking. The results of this survey aim to
put the controversy about parental alienation to rest. Thank you for participating
in the survey and for creating awareness of its purpose.
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Instructions: The survey takes about 15 minutes to complete. Copy
and paste into a new E-mail, mark as instructed, complete written answers and return to:
By postal mail, send to: StepfamilySystems.com,
Research Response,1101 California Avenue, Suite 100, Corona, CA 92881
(Don't worry if it prints out of alignment, we are able to discern line breaks.)
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Survey completed by: ____ Biological parent ____ stepparent ____ unmarried partner ____
grandparent ____ other:
____ adult son ____ adult daughter. I
___ had /___ presently have ___ stepfather, ___ stepmother, ___ both.
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State of residence/Country:
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PART 1 of 2: Satisfaction with Home Environment
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1. What are the characteristics of a successful stepfamily/post divorce parent-child relationship?
2. How do you define satisfaction?
3. Have you ever or do you plan on receiving support services?
a. If no, why not?
b. If yes, what type of support services have you had (_X_), presently
use (_P_), are you considering (_C_):
___ individual therapy
___ couples therapy ___ family therapy
___ stepfamily coaching ___ shared-parenting consulting/assimilation
management planning ___ self-help:
___ peer support through: ___on-line chats or ___ local support group ___ other:
c. Would you like a list of support service providers mailed or E-mailed
to you?
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I am presently:
4. Engaged – how long? 5.
Married – how long? 6. We
___ did / ___ did not have premarital counseling.
7. ___ Cohabitating – how long? 8.
___ Never Married 9. ___ Widow/Widower:
Yrs since death:
10. ___ Previously Married/ ___Separated:
___ Father/step ___: how many marriages?
How many children? Yrs since ___divorce or ___separation:
___ Mother/step___: how
many marriages? How many children?
Yrs since ___divorce or ___separation:
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11. Custody
Arrangements ___ are / ___ are not satisfactory / fair to me. General outline of custody arrangements.
(For example: every other month, plus four weeks of summer, every other Christmas and Easter in odd and even years, respectively):
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11(A): What process was used for determining dissolution details including alimony, child support and custody arrangements:
___ Litigation ___ Mediation ___ Self-help, no representation ___ Paralegal service Other:
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12.
My child’s other parent is: ____ remarried; ____ cohabitating; ____ dating;
____ living with family (or) ____friends; ___ incarcerated
13. My relationship with the other biological
parent: 10 very cooperative to 1 very unpleasant, or 0 for parent absent for the most recent twelve months or more.
(Best - 10
9 8 7 6 5
4 3 2 1 -
Not good) ___
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14. I believe the other parent ___has / ___has not targeted ___ me /
___ my spouse with alienating behaviors and ___is/___ is not damaging the relationship/s with the children. (If applicable, please complete Part 2)
14. a. I believe [her/his] ___ boyfriend, ___ girlfriend, ___ is
being lied to and believes they are supporting my chld's other parent.
14. b. I believe [her/his] ___ boyfriend, ___ girlfriend, ___ is part of the cause of our
problems because:
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15. My relationship with his/her new partner is:
10 9 8 7 6
5 4 3 2 1
0
16. My new mate’s relationship with my former spouse is: 10
9 8 7 6 5
4 3 2 1 0
A. I believe a stepparent has overstepped ___ his / ___ her boundaries by thie
following behavior:
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17. Communication: a. between households ___is /___
is not an issue; b. between adults and children ___is / ___ is not an issue.
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18.a
. ___ You experience stress during custodial transitions 18.b. ___ Your spouse shows
anxiety during custodial transitions
19. ___ The children show anxiety
when leaving: 19.a. ___ those at home full-time, or 19.b. ___ those
changing households
20.
___ The children show anxiety when arriving: 20.a. ___ those
at home full-time, or 20.b. ___ those changing households
.
21.
Finances: ___ are / ___ not
a concern. We are a ___ single- / ___ two-income household, and ___ have / ___ have not experienced
___ job loss / ___ reduced income in the most recent two years. We ___
have / ___have not lost a home to foreclosure in the last two yrs.
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22. Child
Support:
a. Our household ___ pays, ___ receives, ___ pays and
receives ___ regularly (or) ___ irregularly. Clarification, if needed:
b.
Child support payment status is: ___ current, ___ behind, ___ seldom current, ___seldom behind
c. Child support received status is: ___ current, ___ behind, ___ seldom current, ___ seldom behind
d. I ___ do believe/___ do not believe
child support is an appropriate amount because:
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23. Education:
My highest level of education: ___ High School, ___
Some College, ___ Vocational; ___ 2, ___ 4, ___ 6+ yrs degree:
Spouse’s
___ High School, ___ Some College, ___ Vocational; ___ 2, ___ 4, ___ 6+ yrs degree:
My ex ___
High School, ___ Some College, ___ Vocational; ___ 2, ___ 4, ___ 6+ yrs degree:
Ex’s new partner ___ High
School, ___ Some College, ___ Vocational; ___ 2, ___ 4, ___ 6+ yrs degree:
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24. Housing: Each child:
a. ___ has / ___does not have own bed here; ___ has
/___ does not have own bed at other home.
b. ___
shares / ___ does not share bedroom ___ here; ___ shares / ___ does not share bedroom at other home.
c. ___ has / ___ does not have own drawers and closet space here; ___
has /___ does not have own drawers and closet space there.
d. ___ prefers to live out of own
suitcase while ___ here / ___ there.
Any clarifications:
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25. Boundaries: We ___ have / ___ haven’t
talked about the importance of physical and emotional boundaries & sensitivities because:
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26.
We ___ do / ___ do not have family traditions of our own. They are:
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27. We ___ do / ___ do not worship / religious study together. Religion/denomination
of faith:
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Academic
Performance:
28. Do you feel your child has under-performed academically due
to distressed stepfamily or shared-parenting dynamics? Why?
29. Is there or has there ever been a problem with receiving your children’s report
cards and attending school functions?
30. Their school ___ does / ___ does not make a good effort to keep me informed. ___They do / ___ do not return calls
I make.
Clarifications:
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31. Life events and concerns most recent two years (this household = TH
/ other household - OH):
___ Separation from present
spouse ___
Intimacy Issues
___ New litigation over child support
___ Anxiety / Depression ___
Commitment to therapy
___ New litigation over custody
___ Other major health
issues
___ Resistance to therapy
___ Concerns for legal fees repayment
___ Active duty, military / ___ returned
___ Drug / ___ Alcohol Use ___
Poor grades in school
___ Out-of-marriage pregnancy/birth ___
Jail / prison, ___ returned
___ Domestic Violence
Clarifications:
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32.
We do not have any difficulties with the other household. It took _____ (number)
years to achieve harmonious relationships.
We
believe things are working well for us because:
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Part 2 of 2: If applicable: Parental Alienation or Divorce-Related Malicious Mother
Syndrome Experience
(If not applicable, please skip to bottom
of the survey, "To Conclude")
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“The manner in which parents resolve conflict has been determined to affect child adjustment,”
reports the American Psychological Association website. Furthermore, the 1997 American Coalition for Fathers and Children Shared Parenting Tool Kit reported, “A
number of general research studies consensus
indicate that children adjust much more successfully in the immediate post-divorce period when a strong, positive relationship is maintained with both parents (Cowan, 1982; Hetherington, Cox & Cox, 1982; more).
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The issues of deadbeat dads and wicked stepparents have overshadowed an area of equal or greater importance
– the alienating parent; this study
will be closely looking at this as we strive to receive a minimum of 10,000 surveys. The manipulation, programming or brainwashing
of the children can be difficult
to prove. Douglas Darnall, Ph.D., author of “Divorce Casualties: Protecting your Children from Parental Alienation,”
defines parental alienation as any constellation of behaviors, whether conscious or unconscious, that could evoke a disturbance
in the relationship between a child and the other parent.” Critics
of PAS have stated that sufficient statistical data is lacking. Let us give it to them and the results will provide answers.
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1. ___ My spouse / ___ I filed for the origianl divorce
2. ___ My spouse / ___ I had an affair
Clarifications:
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Our children:
The other parent:
___ Parrot negative statements made by the other parent ___
Attempts to interrupt visitation / my custodial periods
___ Display nonverbal messages of fear or panic
___ Engages in whispering/finger pointing when I am present
___
Make statements they could not have possibly constructed ___
Sends Email or Calls more than weekly or without reason
___ Have difficulty showing excitement or enjoyment with me ___
Mishandles money, then tells the children I do not pay enough
___ Lied to officials regarding what goes on at our home ___
Has not forgiven me for
having an affair
___ Show uncertainty about expressing
or receiving affection ___
Does not tell the children when I call or give them my mail
___ Get mouthy and make threats over small disagreements ___
Does not inform me of school progress / ___ functions
___ Appear to have been recruited to keep secrets ___
Has told lies about me / my spouse to friends, family, school
___ Demonstrate an alliance with other household and
refuses to make things right by correcting the stories
___ Have been caught snooping for income and other information ___
Has had boyfriend / girlfriend make harassing contact / threats
___ Makes good parent / bad parent remarks ___ Has
personally made threats toward me, and ___ my partner
___ Have extreme emotional outbursts ___
Has taken excessive legal action against me
___ Are ordered to call other parent’s spouse “mommy / daddy” ___
Exaggerates / twists facts to appear victimized by me/my partner
___ Ask why I am mean to mommy / daddy ___
Had an affair, did not take responsibility and lied about facts
___ Say they do not want to see my parents anymore ___ Discourages
the children from saying "I love you"
___ Tell lies to friends,
family and teachers ___
Withholds the children until I meet demands
___ Children elbow/hush/guard each others words ___
Insists the kids do not call my spouse "mom/dad"
___ Cannot take a call without parent nearby
___
Insists the kids call his/her spouse "mom/dad"
___ Makes derrogatory remarks about my parents, disrupting the
grandparen/grandchild relationship
___ Expressions of love are withheld from the children
PAUSE for reflection. As you have noted
what is applicable to the children and other parent's behavior, have you found any of the above also apply to your
own or your current partner's behaviorial choices? Conversational research indicates there is a point reached when
many target-parents tire of being alienated and they will walk away or distance themselves from parent-child relationships
in frustration, or they begin to respond in-kind with similar choices out of fear of losing the respect of their
children or the parent-child relationship altogether if they do not defend themselves. If any also apply to you
or your spouse, please go back and place + (plus) symbol by the appropriate selections.
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In your opinion, rank these
in order 1 (highest) - 4 (lowest) of detriment to the overall development of children: ___ arguing parents who yell
and scream but end up working together; ___ silent parents who feel walking away it is the only way of attaining peace; ___
alienating parents who strategise "underground" so that the children are unaware of the maniulation; ___ parents
who find ways around paying child support. Other, or additional comments:
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To conclude, you may add up to 250 words (please use word count and print) of information
you believe would be relevant to the study. If you believe alienation has occured, do you believe it is possible
for the targeted parent/s to experience restored relationships with the children once the children are grown?
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___ I choose to submit anonymously, and realize because its integrity cannot be verified nor can any clarifications
be made, if needed, my
Survey
will be analyzed with other anonymous submissions, separate from the collective, published findings of identified group.
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___ I realize confidential practices are maintained among researchers. No identifying
information is sold. The surveys become property of StepfamilySystems.com and only collective results of the study will publish.
___ I think authorities should be called, but I am afraid. Please send
me shelter and family services information for my area to the following Address:
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___ I would
like to participate in this annual study for the 15 year period. The results could benefit the children and grandchildren.
___ E-mail my surveys to: ___ I DO
NOT wish to receive confirmation that you received my response.
___
Postal mail my surveys to:
___ My phone number, for verification or clarification
purposes only, is: ( )
___ You may call me anytime for stepfamily-related research purposes. I understand they will
be used for a dissertation project and a select team of researchers will have the opportuntiy to apply research methods.
No identifying information will be sold under any
circumstances.
All rights reserved. No part of this survey may be reproduced by any process whatsoever for use apart from
the individual survey responder without the written permission of the research survey developer, StepfamilySystems.com. Permission to copy for school-based participation
is granted; surveys must be returned exclusively to
StepfamilySystems.com. Survey alterations are strictly prohibited. Terms of use and website Disclaimer on last page of StepfamilySystems.com
website. Fourth revision: 05/08/2010
