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NJ Safe & Sound - NJ Safe and Sound

 



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


Questionnaire C

— For those who know of an alienation outside their own family

If you know of more than one instance, please fill out a separate Questionnaire C for each.

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

(If you have been or are now being turned against your family, please answer Questionnaire B.)

 

2. How old was the member of that family at first contact with the alienating influence?



 

3. Who tried to turn that person against his/her family? (Choose all that apply.)

 

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

 

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

 

6. What did the family do about the situation? (Choose all that apply.)

 

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

The family is in regular contact with their relative; their relationship is back to normal.



8. How old is the person who was turned against his/her family now?



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

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


 

 

 

 


 

"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

 

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