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For Every Person, for Every Family —
Protection Under the Law from the
Psychological Abuse of Undue Influence and Predatory Alienation

Questionnaire B

— For those turned against their family

(If you are the parent, guardian, or relative of someone who has been or is now being alienated from your family, please answer Questionnaire A.)

(If you also know of an alienation outside your own family in which someone has been or is now being turned against his or her family by an external influence, please answer Questionnaire C.)

1. Select your state:

New Jersey residents, select your county:

2. How old were you at first contact with the alienating influence?

16 or under
17-21
Over 21

3. Who tried to turn you against your family? (Choose all that apply.)

Your friend or acquaintance

Family of your friend/acquaintance

Your boyfriend/girlfriend

Family of your boyfriend/girlfriend

Authority figure. Please specify:

Other. Please specify:

4. Did the alienating influence: (Choose all that apply.)

Make frequent or excessive contact with you via phone, text, email, or IM?

Contact you at inappropriate times, such as late at night or during school hours?

Question you about your upbringing or family environment, persuade you to share personal details, and/or criticize your parents’ decisions and parenting style?

Instill unreasonable fears in you?

Ask you probing questions about your and/or your parents’ savings/finances?

Encourage you to miss key family events and celebrations?

Insist that you not visit family unless accompanied by someone approved by the alienating influence?

Require you to maintain contact (by phone/text, for example) with the alienating influence during family visits?

Try to isolate you from longtime friends as well as family?

Offer you a reward of any kind (not necessarily money) for obedience to them?

Entice you with sex, either with them or with someone else?

Interfere with your decision-making process regarding major life choices, such as moving away from home, selecting a college, choosing a job, getting married?

Require you to get their advice/permission before making key decisions?

Insert themselves into your life as the go-to person for direction on all things from emotional issues to finances?

Try to convince you that your parents were controlling and/or that your relationship was unhealthy?

5. What kind of lifestyle changes did you make for the sake of the alienating influence? (Choose all that apply.)

Severed relationships with friends

Severed relationships with family

Left home

Quit school

Gave up a favorite activity. Please specify:

Altered my belief system

Turned over savings/other source of income

Underwent a radical change in personality (for example, you became secretive, distant, and/or fearful of people you used to be close to)

Underwent a radical change in appearance

Other. Please specify:

6. What was done about the situation? (Choose all that apply.)

My family retrieved me at my request

My family retrieved me without my request

My extended family or friends reached out to me

School officials reached out to me

The police or other law enforcement official reached out to me

A lawyer reached out to me

A court official intervened

A member of the clergy reached out to me

A mental health professional or other helping professional reached out to me

A legislator or other government official reached out to me

My family tried to reason with the alienating influence

Nothing.

Other. Please specify:

7. Which statement best describes the current status of your situation?

I am in regular contact with my family member; our relationship is back to normal.
I have some contact with my family member, but our relationship is not back to normal.
There is no contact between me and my family member.

8. How old are you now?

16 or under
17-21
Over 21

9. How long did the alienation last/how long has it been going on? Duration:

10. May we contact you? If so, please enter your name and an email address or telephone number below:

Email:

Phone:

Name:

"The family is the natural and fundamental group unit of society
and is entitled to protection by society and the State."

— Article 16.3, Universal Declaration of Human Rights of the United Nations

Home | Legislative Update | Letters to Legislators | Questionnaire

For Every Person, for Every Family — Protection Under the Law from the Psychological Abuse of Undue Influence and Predatory Alienation

Questionnaire B

For Every Person, for Every Family —
Protection Under the Law from the
Psychological Abuse of Undue Influence and Predatory Alienation