Claudia Gabriela DUMITRIU (1), Livia Maria BUTAC (2), Camelia Mihaela POPA (3)
(1) PhD. Student, School of Advanced Studies of the Romanian Academy, “Constantin Rădulescu-Motru” Institute of Philosophy and Psychology, Department of Psychology, Romanian Academy, Bucharest, Romania; E-mail email@example.com (corresponding author)
(2) “Politehnica” University of Bucharest, E-mail: firstname.lastname@example.org
(3) “Constantin Rădulescu-Motru” Institute of Philosophy and Psychology, Department of Psychology, Romanian Academy, Bucharest, Romania; E-mail: email@example.com
Address correspondence to: Claudia Gabriela Dumitriu, School of Advanced Studies of the Romanian Academy, “Constantin Rădulescu-Motru” Institute of Philosophy and Psychology, Department of Psychology, Romanian Academy, Bucharest, Romania, 13 September Avenue, No.13, 5th District, Bucharest, 050711, Romania. Ph.: +40-726-231-833; E-mail: firstname.lastname@example.org
Objectives. The effectiveness of a therapeutic approach for the divorced parents (on an individual level as well as on the couple) was studied; the therapeutic process was aimed at improving the connection between parents and, subsequently, the child-parent relationship.
Material and methods. The study includes five divorced couples that have been submitted to psychological evaluation at the request of the legal system of Romania, between 2019-2020.
Both the children and the parental dyad have been evaluated in relation with awarding custody, in cases with moderate to high level of parental conflict – the cases had in common the child’s rejection of one of the parents. For the parents’ evaluation, Parenting History Survey, Parental Stress Index, Parental Competency Questionnaire and Cognitive Emotion Regulation Questionnaire have been used, together with a checklist of child’s rejecting behaviors towards one of the parents.
Following evaluation, the parents have been included in a psychological intervention program, consisting of individual sessions and sessions for the parental dyad. The inclusion criteria have been: conflictual parental relation, no psychiatric pathology of parents and absence of pre-divorce parental abuse history.
Results. The results have shown that the couples tended to improve their capacity to respect the children’s program of personal interaction with the other parent and that the frequency of rejecting behaviors toward the other parent diminished.
Conclusions. Children’s post-divorce adjustment is strongly impacted by the quality of the parental relationship and this, in turn, can be improved by specialized therapeutic intervention. Developing an intervention program adapted to the post-divorce needs of the family helps children in integrating the divorce and preserving their emotional balance.
Keywords: divorce, co-parenting, parental conflict, custody, parental interventions.
The crisis of the family is one of the noteworthy social trends that began to manifest starting with the second half of the twentieth century and continue nowadays. In all the societies that had passed through the industrialization stage, including Romania, the family dynamics was affected, resulting in an increased number of divorces and separations. The shift was connected with a significant change in the legal framework of divorce, which transitioned from strong barriers against familial dissolution towards extremely lax divorce laws.
A series of studies have analyzed the impact of legislative changes (that defined the so-called “divorce revolution”) on the divorce rate: some of them pointed to a long-term positive impact (Binner & Dnes, 2001; Brinig & Buckley, 1998; González & Viitanen, 2009; González-Val & Marcén, 2012), while others showed that the positive effects are only temporary (Gruber, 2004; Wolfers, 2006). The differences in the studies notwithstanding, all have shown empiric evidence that in most countries the divorce rates begun to raise before the legal framework was modified, proving that the legislative changes were a consequence of the increase in the divorce rate and not a cause for the phenomenon (Allen, 1998; Coelho & Garoupa, 2006; Sardon, 1996).
In contemporary Romania, the divorce became a social phenomenon; the overall trends show that the marriage is more problematic and the divorce easier as compared to the relatively recent past. Thus, the Romanian Statistical Yearbook published in 2019 shows a constant increase in the number of divorces from 27 188 in 2013 to 30 857 in 2018. Of this total number of divorces in 2013, 12 594 divorces occurred in families that had one to five children; in 2018, 12 618 divorces occurred in the same type of families (National Institute of Statistics, 2020). This indicates that every year, there are more than 10 000 children whose parents divorce.
Rada and Pănescu (2016) stated that Romanians are emotionally intelligent enough to form a couple, but this becomes insufficient when considering the long-term sustenance of the relationship (p. 38). In accordance with their observations, the main causes of dissolution in the Romanian couples are: violence, alcoholism and infidelity, the latter representing the reason for separation (Rada & Pănescu, 2016). In addition, the study conducted by Rada (2012) on the Romanian population indicates that faithfulness constitutes a crucial value for the Romanian couples and the lack of consensus on this matter frequently leads to the dissolution of the couple.
In a study conducted by Rada and Pănescu (2016), aiming at classifying the 10 most stressful life events, divorce is considered a major stress factor for the family and represents the second most stressful event, after the loss of the partner, when considering a series of 43 adverse experiences (Rada & Pănescu, 2016, p.88).
Moreover, the consequences of divorce do not stop solely to the children born in this kind of families. They also extend to the possibility of having other children, since divorce essentially means that the former spouses will no longer be engaged romantically. Thus, in a statistical analysis conducted by Rada and Tarcea (2010) on vital events with relevance for the family, the authors concluded that natality is three times more negatively impacted by divortiality: a divorce decreases the natality rate 9 times, while the nuptiality increases it 3 times.
The growing number of divorces in Romania, together with the lack of public policies for supporting divorced families and the absence of a culture of a “healthy” divorce have led to a decrease in the trust in the family as an institution and, implicitly, to a diminished interest of adults towards achieving conjugal consensus. Rada (2013, p. 266), citing the Olson model (1996) highlighted the following key characteristics of functional families: cohesion, flexibility and communication. All of these represent dimensions of the circumplex model of family assessment and intervention. According to Rada and Olson (2016, p. 13), these dimensions become more proeminent within the life cycles of the family, including the crises such as divorces. In situations of family crisis, the dysfunctional dimensions tend to intensify, generating inadequate coping mechanisms and difficulties in solving the crisis.
In a society that promotes individualism, the common tendency is for the adults to leave the family and raise/educate children separately, this in turn weakening the society as a whole. From a long-term perspective, the increase in the number of children resulted from divorced families can become a predictive factor for unstable and/or low-quality adult relationships that, in turn, will push the divorce rate even further. Moreover, the increased frequency of divorces induces a shift in the social values, promoting negative attitudes and expectations regarding marriage, couple relationships and family values.
Thomas (2020) identifies divorce as an adverse life event which can have notable consequences on the development of individuals.
Prolonged conflictual co-parenting may result both in emotional damage and social/educational consequences for the child, with dramatic long-term effects for the child’s development, including fear of abandonment in situations characterized by hostility, increasing child’s susceptibility to the persuasion or manipulation from one of the parents (O’Hara, Rhodes, Wolchik, Sandler, & Yun‐Tein, 2021; Kopystynska, Paschall, Barnett, & Curran, 2017). It may also lead to a less positive perspective on romantic relationships and to a lower possibility for the former children of divorce to engage in marital connection. Even if they do, they tend to be less stable (Roizblatt, Leiva, & Maida 2018). Other consequences that have been reported consisted of low self-esteem, attachment disorders, sleep disorders and externalizing disorders, particularly among boys (Pivniceru & Luca, 2016, p. 209).
The risk of developing a depressive disorder is identified as an effect of divorce on children, resulting from the suffering and stress they experience, given that they adopt self-sacrificial behaviors for the sake of their parents (Popa & Ciobanu, 2013, p. 123). Nevertheless, the authors point out that the increase in the suicide rate among adolescents cannot be associated with the increase in the divorce rate in the last few years, because divorce affects children and adolescents differently depending on: the age of children at divorce, personal characteristics of children and parents, remarriage, parent-child relationship, contacts with the mother and the potential psychopathology of the parent (Popa & Ciobanu, 2013, p. 123). Therefore, both the parent-child relationship after divorce and the psychological profile of the parents have an influence on the children’s post-divorce adjustment.
In a meta-analysis aiming at determining the long-term effects of divorce on the mental health and substance addiction in children, Auersperg, Vlasak, Ponocny, and Barth (2019) analyzed 54 studies from the period between 1990 and 2018, resulting in a total sample of 506,299 participants. The study highlighted a series of associations between parental divorce and the following types of symptoms in children (listed by frequency): depression, anxiety, suicide attempts, suicidal ideation, distress, alcohol consumption and nicotine and substance use. The conclusion of the research stated that it is necessary for the community of specialists to focus its efforts towards the development of programs aimed at enhancing the resilience of the children affected by the parental divorce (Auersperg et al., 2019).
The majority of children tend to develop psychological problems when the relationship between the parents is marked by conflicts before, during and after divorce (Roizblatt et al., 2018). Although parental conflict tends to be more pronounced immediately after divorce and then to decrease in time, there are many situations in which parental conflict after divorce persists, especially in cases in which the parents cannot agree upon the residence and the visitation program of the child.
The Diagnostics and Statistics Manual for Mental Disorders (DSM-5, 2013, p.716) introduces a new concept, namely “Child Affected by Parental Relationship Distress” defined as a category that “should be used when the focus of clinical attention is on the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the family, including effects on the child’s mental or other medical disorders”. This category becomes extremely important in the divorces with a high level of parental conflict.
Although there is no clear-cut definition of the divorce with high conflictual level, both researchers and practitioners accept that its main indicators are: long-term conflict, hostility, guilt, criticism and inability of the partners to take responsibility for their own role in creating and fueling conflict (Anderson, Anderson, Palmer, Mutchler, & Baker, 2010; Anderson, 2020). Conflictual parents may manifest domestic violence (Fotheringham, Dunbar, & Hensley, 2013) and tend to disregard the effects of the conflict on children (Amato, 2001; Johnston, 1994; Kelly & Emery, 2003).
In the case of children who experience parental separation, but where there are no instances of child abuse, neglect or substance abuse on the part of a parent, the most important method for minimizing the risk of developing a disorder is represented by maintaining of a close or constant relationship with both parents (Çaksen, 2021). This aspect can become challenging, if the post-divorce parental relationship is marked by conflict.
Under these circumstances, co-parenting (defined as the mutual implication and collaboration of both parents in raising, educating and planning the life decision regarding children) becomes a main factor influencing the post-divorce adaptation of the children (Lamela, Figueiredo, Bastos, & Feinberg, 2016).
Hetherington and Kelly (2003) identified three types of co-parenting:
- Conflictual co-parenting, characterized by interparental hostile behavior, manifested by fury, blame, physical/verbal abuse, most of these expressed in the presence of the child. According to the authors, these phenomena tend to decline with around 75% in about six years after the divorce.
- Parallel co-parenting – marked by reciprocal disregard, lack of collaboration and coordination of the activities linked to the child.
- Cooperative co-parenting – interparental interaction that gives priority to the child’s needs.
Maccoby and Mnookin (1992) describe a fourth type of co-parenting, the mixt one, with interaction marked by both antagonism and reciprocal support, in a dynamic in which the two parents try to find a balanced exchange for the benefit of the children.
In a study conducted in Spain, regarding the mediating role of co-parenting in the relation between the type of custody, the symptomatology of the parents and the symptomatology of the children, the authors discovered that in the cases in which parents did not display any symptoms and had a healthy co-parenting style, no signs of disorder have been identified in children regardless of the type of custody, while in the other case, children registered significant scores of the depression, anxiety and aggression dimensions (Martínez-Pampliega et al., 2021). The study showed that parental symptoms and co-parenting represent the key variables in terms of child symptomatology and they should be considered when child custody is decided. Likewise, in a literature review regarding the impact of joint physical custody on children’s well-being, Steinbach (2018) clarified that the majority of authors agree upon the fact that children benefit from this kind of custodial arrangement when it is characterized by cooperation and a low level of conflict between parents. As it turns out, the parental relationship has the strongest impact on the child’s post-divorce adaptation, its influence increasing with the level of parental conflict.
In the conflictual co-parenting divorces, there are frequent cases where the child is involved in the conflict, positioned on the side of one of the parents and consequently increasing the risk of the other parent’s rejection by the child. Gardner (1985) introduced the term of parental alienation as a concept covering a series of behaviors specific to the children from high conflict divorces. The concept of parental alienation describes the diminished or negatively affected relation of the child with one of the parents, as a result of the influence of the other parent (Gardner, 1998). The alienator (parent) consistently denigrates the alienated one, aiming at breaking the bond between the child and the other parent. Currently, parental alienation is no longer conceptualized as a syndrome, as it has been initially proposed (Gardner, 1999), but as a phenomenon having variable intensity (Harman, Kruk, & Hines, 2018), that disturbs family relationships after divorce and represents a form of violence towards the partner and an emotional abuse against the child (Harman et al., 2018; Harman, Bernet, & Harman, 2019; Verrocchio, Baker, & Marchetti, 2018). It is worth mentioning that the phenomenon of parental alienation requires a detailed analysis in order to correctly identify and exclude the possibility of child abuse that could justify the rejection of one of the parents by the child and the legitimate measures of the other parent to protect them (Willis & O’Donohue, 2018).
Since conflictual co-parenting is based in most cases on a low level of parental skills and other personality traits, the impact on children can be reduced through intervention and prevention programs for the divorced couples. Thus, starting from the observations in the scientific literature on the role of co-parenting in the post-divorce adaptation of children, an intervention especially aimed at the parental couple becomes necessary if the objective is represented by the healthy adjustment and the prevention of the symptoms corresponding to a disorder in children.
Given that the co-parenting relation is influenced by individual, familial and environmental factors, and in turn it influences the adaptation of the child, co-parenting can be seen as an important mediator to be used in the shaping of post-divorce intervention programs. Due to the expansion of the social phenomenon of divorce in Romania, a set of public policies that should include models of psychological intervention in the post-divorce parental dyad need to be implemented. This paper presents such a program, aimed at supporting families in crisis and the children affected by separation and parental post-divorce conflict.
Several families, in which the children had post-divorce adaptation problems, have been requested by the courts of law in Romania to participate in post-divorce counseling. From these, a number of 10 parents (5 couples) have consented to participate in an intervention program, focused on the child’s needs in order to achieve good post-divorce adjustment. The parents’ ages have been between 32 and 44 years and the time between the divorce and the intervention has been between 3 months and 1.5 years. The sample of subjects consisted of a total of 7 children, aged between 6 and 12 years old (two of the couples had 2 children each).
The couples’ inclusion criteria have been represented by conflictual parental relation and the children’s rejection of one of the parents in favor of the other. The initial assessment ensured that the reason for the rejection of one parent by the child was the conflictual co-parenting, while no other causes (such as accusations of abuse, neglect, violence or abandonment) were present.
The aim of the intervention (as stated by the law court) has been to re-establish the bonds between the children and the alienated parent. The court decision to refer the couples to the counseling program was a major advantage, since it became a legal obligation of the parents.
What was specific and new in the program presented here was that the counseling regarded exclusively the parents; the children participated only in the initial stage of psychological evaluation, aimed at assessing the family dynamics/symptomatology and the reasons for the rejection of one of the parents by the child.
The first part of the intervention program has consisted of the psychological evaluation of both the child/children and each of the parents.
Children’s evaluation has used clinical and interpersonal history interviews and BASC-2 (Behavior Assessment System for Children 2nd Edition) (Reynolds & Kamphaus, 2004).
In all the selected cases, specific symptoms of parental alienation (Gardner, 2001; Gardner, 2002) have been found, of mild or average intensity, as follows:
- Unconvincing argumentation of the child in support of parental rejection, reflected in phrases such as: when I was two, my mother broke a glass and slapped me because she (the mother) has been drinking (10 years old child); he (the father) never stayed with us, never slept with us, he was always, always at his job; grandmother (father’s mother) came to us and spoke bad of mother, calling her a hooker; she (the mother) used to drink each evening and cause a ruckus (…) she was drinking a glass of beer, or a bottle, I don’t know exactly;
- The absence of (or considerably diminished) ambivalence towards each of the parents; that the child considered one parent as completely good and the other completely bad. Examples of phrasing by the children: father has no good side … there is nothing I like in him; I do not have any good memory; he was always a source of scandal. We never had fun together; father is like a sheep; he is the best person in the world;
- The phenomenon of the independent thinker, reflected by affirmations such as: I do not want to see him/her anymore; I feel better without him/her;
- Unconditional support of the denigrating parent, through reactions/affirmations of validation or defense of his/her actions;
- Lack of guilt related to the exclusion of the alienated parent – expressed through affirmations such as for us it is better like this; I now have another mother, that understands me; I don’t care that he suffers;
- Scenarios borrowed from the preferred parent, translated into phrases and arguments identical to the discourse of the dominant parent and, in many cases, exceeding the child’s level of understanding;
- Extended animosity towards the family and/or friends of the targeted parent, resulting in the refusal to meet or maintain any relationship with them.
A second criterion used as an indicator of the parent-child bond has been the frequency of the contacts (of any type) between the child and the alienated parent. Out of the seven children investigated, only two did respect the program of personal contacts in accordance with the court’s orders, but – only after a few hours – they asked to return to the resident parent. Two of them were communicating exclusively by phone/texting and the other three did not maintain any contact whatsoever (they simply refused to see the other parent according to the legal program).
None of the children did present symptoms related to the area of anxiety, depression or behavioral disorders – the profiles obtained using BASC-2 (Behavior Assessment System for Children -2) have been, in all cases, relatively well balanced.
Parents’ evaluation has used Parenting History Survey (structured interview) (Greenberg & Humphreys, 1994), Parenting Stress Index (PSI-4) (Abidin, 2012), Parental Competency Questionnaire (Romanian instrument) (Glăveanu, 2012) and Cognitive Emotion Regulation Questionnaire (CERQ) (Garnefski & Kraaij, 2007), together with a checklist of child’s rejecting behaviors towards one of the parents.
Parenting History Survey (structured interview) has shown that out of the five investigated parental couples, three separated due to infidelity (in all cases the unfaithful partner did leave the couple), one separated due to the high level of couple conflict and one due to the lack of sexual intimacy.
Using the above-mentioned instruments for parents’ evaluation, the main types of co-parenting problems have been highlighted; these had become the objectives included in the design of the intervention plans:
- A low level of parental competency concerning the factors: knowledge of the specifics of the child’s developmental stage and stress management;
- Maladaptive communication styles, generating conflictual co-parenting;
- Anger caused by the infidelity of the partner, leading to alienation behaviors on the part of the betrayed parent;
- Maladaptive coping styles, based mainly on rumination and catastrophizing;
- Explicit conflictual co-parenting, that was active for all the investigated couples and manifested through hostile behaviors, accusations, insults, offences, blame or passive-aggressive communication styles
The evaluation results have pointed towards two directions of psychological intervention: (1) individual counseling with each of the parents (10 sessions of 1 hour each), based on an individual plan depending on the difficulties in the individual functioning, and (2) parental couple counseling, 10 sessions of 2 h for each parental dyad, based on an intervention plan aimed at the couple’s specific problems.
The objective of the psychological intervention, as required by the courts of law, has been to restore the bond between the child and the alienated parent, in order to allow the continuing contact between the child and the parent, according to the program stated by the court.
This broader objective has been divided into sub-objectives both for couple therapy and for individual counseling. For couples, the objectives have been parental psycho-education and diminishing the parental conflict. For individuals, the problems that have been addressed were: adjustment of the maladaptive coping mechanisms consisting of rumination and catastrophizing, emotional support for processing the abandonment and betrayal feelings following the partner’s infidelity and developing an assertive communication style. For these five types of intervention (two for couple counseling and three for individual therapy) therapeutic strategies have been designed, according to the specifics of the problems addressed.
The therapeutic approach used in this study was based on integrative psychotherapy, due to its eclectic character which allowed for the development of an intervention plan adapted to each individual and interpersonal domain (Rada & Pănescu, 2016).
- The individual intervention strategy has been based on an integrative therapy intervention plan covering the main objectives resulted from the evaluation stage, as follows:
- Educating the assertive communication style has been one of the primary directions since communication difficulties were a problem for all couples. The methods used have been derived from the Cognitive Behavioral Therapy, Transactional Analysis and Schema Therapy areas. Passive and aggressive communication styles have been identified and explained (by example) to the parents, in order to help them recognize both the style and the provocative interpersonal impact. From the perspective of the Ego states, the intervention has been aimed at clarifying how psychological games are created in the transactional dyad Parent Ego State – Child Ego State; subsequently, parents have been taught to communicate according to the Adult Ego State perspective, with the help of exercises using the roleplay technique. The chairwork technique has been used to access various parts of the relational Ego (coping mechanisms) and to help in understanding how the adults involved in the conflictual exchange access both themselves and their partner (in terms of coping modes specific to Schema Therapy). Once the dysfunctional styles (Angry Child, Critical Parent, and Punitive Parent) have been identified, the healthy Adult style has been first introduced as a concept and then the relational dynamics of a healthy Adult have been explained. The healthy Adult mode has been trained as part of the parental dynamics using the guided imagery technique.
Since the main modes used by the participants have been Angry Child and Critical Parent, techniques of cognitive restructuring have been used in order to encourage the development of the Healthy Adult. Participants have been guided in reformulating their statements. Examples: Angry Child “it’s because of him that we are in this situation, I want a judge to see it and punish him“(A.B., female, 35y.o.) vs Healthy Adult “I think we share a common responsibility for this situation, I intend to do my best to contribute to an improvement“/“this is not a pleasant situation we are living now, and it’s not pleasant either that the child does not want us to communicate, but this is not the worst situation possible and I am willing to work towards changing it“. Critical Parent: “he is not able to take care of the child, not now and not when we were together, he was not preoccupied by the child, I was the one taking care of everything” (M.C., female, 28 y.o.) vs “it is possible that my ex-partner does not have all the parental skills that I wish for, but he has some strengths (lists the good points) and I am willing to support him to develop his weaker skills“.
Each participant to the individual intervention has been trained in assertive communication, aiming at both validating the other’s opinion and stating their own thoughts and emotions in a non-intrusive manner. As a result, alternate communication models for the passive-aggressive and aggressive communication styles have been developed. Examples: Aggressive style: “I will sue you again and again until you understand that you have to follow the program decided by the judge“/“I know that it’s you telling the kid bad things about me and that’s why he does not want to see me, but I will show you, you won’t get your way anymore” (C.P., male, 42 y.o.) vs “I understand that from your point of view I am not a good parent, and the fact that I do not have access to the child makes me sad. Let us adults meet and think about a common strategy in relation to the child. Would it be ok for you to see each other, at the beginning, in a park or at a place where the child can play?“.
- Adjustment of maladaptive coping mechanisms of rumination and catastrophizing. This was an objective for 4 participants in the individual interventions. The types of ruminating/catastrophizing discourses identified have been:
– Betrayal and cheating ideation – repetitive thoughts about being abandoned for another person: “if he wouldn’t have found someone else, we would have been a family now“; “probably I was not good enough for him, even if I sacrificed both my body and the most beautiful years of my life to birth him a child” (A.B., female, 35 y.o.).
- Catastrophic ideation: “because of him I won’t see my child ever again, the child won’t recognize me on the street, and this is terrible“, “the court won’t help me, in this country you cannot get justice, you are fighting windmills“, “what I am living now is a tragedy” (M.B., male, 37 y.o.).
The intervention has consisted of cognitive restructuring using the ABC model (David, 2006, p.70) to reformulate the cognitive distortions and to develop the coping mechanisms of Refocus on planning (steps to follow in order to face a negative event or planning to change a situation), Positive reappraisal (mental association of a positive meaning to a negative event in terms of personal growth, such as improved strength), Putting into perspective (comparing the event with others similar in order to reduce its impact and realize that there are worse things happening in the world).
- Emotional support for dealing with the abandonment and betrayal feelings generated by the partner’s infidelity. Besides the previously described techniques (that have been used for these issues as well), the empty chair technique and writing a letter to the partner have been employed to facilitate the symbolic dialogue and expression of the unverbalized emotions. Moreover, the early trauma of abandonment and rejection has been explored, in order to identify the internalized schemas that are put into action in the present moment.
Participants have been advised to enter a long-term therapy program to improve on the emotions associated to their maladaptive existential schemas.
- The intervention in the parental couple has been based on parental psychoeducation and diminishing the parental conflict and has been programmed after the individual intervention, so that the parents could be able to integrate the individual progresses in the dyad dynamics.
- Psychoeducation – has been considered a must since the participants have shown low to average knowledge of the specific needs of the child (others beside the basic needs) and difficulties in stress management. The intervention for each parental dyad has been tailored according to the specific emotional/ support needs for each child’s age, in the context of parental separation. The main theme of psychoeducation has been linked to the child developmental psychology, based on the psycho-social developmental stages (Erikson, 1968). For each parental dyad, the developmental needs of the child have been identified, and strategies have been developed to answer these needs. In this context, the negative effects of the parental conflict and alienation of one of the parents have been outlined. Special emphasis was put on how the child internalizes not only the parental models as such, but also the couple model/matrix (depending on the observed parental dynamics) and the long-term effects of this assimilation.
- Emotional support and stress management – the strategy has been aimed at identifying efficient prevention methods and coping mechanisms for the familial stress, in order to facilitate the management of stressful situations, in direct connection to the objective of reducing the parental conflict. The previously learned assertive communication models have been used, in role play and situational interventions. The parental dyads have been given the task to keep a journal with the conflictual interactions and to postpone the contradictory interactions until the following counseling session.
After the program’s completion, the cases have been re-evaluated in accordance with the objective designated by the law court, respectively re-establishing the bond between the child and the alienated parent, in order to allow a personal interaction program as decided by the court’s order. The checklist of child’s rejecting behaviors towards one of the parents has been used, and it has been found that at the end of the program all children developed personal interactions with the parent that they previously rejected, such as:
– Daily phone contacts, verbal or by texting;
– Meeting with the alienated parent, while being accompanied by the resident parent;
– Two of the children agreed to spend time alone with the non-resident parent (including staying overnight).
Moreover, higher scores have been obtained both in the Parental Competency Questionnaire (average score 74 as compared to the initial score of 58 on the dimension “Knowledge”; average score 64 as compared to the initial score of 48 on the dimension “Emotional support and stress management”) and Cognitive Emotion Regulation Questionnaire (CERQ) – average score 12, as compared to the initial average of 18 for the Rumination scale and average score 10, as compared to the initial average of 16 for the Catastrophizing scale.
The present study describes a pilot program of integrative psychotherapy that was aimed at testing if a post-divorce intervention involving exclusively the parents (from a conflictual couple) would lead to a decrease in parental alienation. The intervention was based on previous experience in supporting the children of divorced couples, experience that has shown that working only with the children led either to the lack of changes or to weak and unstable results, thus highlighting the need for a systematic intervention on the parental dynamics.
This aspect highlighted an issue that has been ignored in the majority of divorce cases – the emotional and mental state of the parents – in favor of the focus on child’s adaptation. This approach is partly incorrect because in these specific situations, as shown by other researchers (Moore, 2020), children’s adaptation is rather the result of a successful co-parenting plan. From this point of view, the usual interventions do not show much focus on the post-divorce adjustment of the parents. The conclusions of this study are similar to those formulated by Moore (2020) who also states that divorced parents are often denied the rights to feel anger, guilt or loss and to give themselves time to process these emotions because they have to focus mainly on the child’s best interest. Thus, understanding parental emotions and giving space for their processing after divorce represent fundamental conditions for a successful integration of this experience by each member of the family.
The intervention program was designed in a form that starts with the assessment of the personal problems of the parents and the way in which they influence the dynamics of the parental dyad. The obtained results show that this type of structure is recommended because when the parental conflict is active, its approach within the dyad can prove to be inefficient as long as each parent does not benefit from enough time and space to process their own difficulties related to personality or unresolved problems stemming from the couple relationship (as it was the case for infidelity, which was identified in three of the presented cases).
In order for the main objective of the program to be achieved (reestablishing contact between the child and the alienated parent) it was necessary for the parents to go through the process of emotional adjustment to separation. The present study showed that the emotional adaptation of the parents to this situation increases their availability for healthy co-parenting. In this sense, the assessment process was aimed at identifying a series of individual characteristics in order to develop the intervention plan. The results obtained after the evaluation underlined a series of dysfunctional coping strategies, which represented the objectives of the individual intervention, with the aim of developing adaptive coping mechanisms. The intervention strategy was similar to the conceptual model of emotional adaptation to relationship dissolution (Millings, Hirst, Sirois, & Houlston, 2020), according to which the factors that influence emotional adaptation to relationship dissolution are represented by the individual strengths and weaknesses on one hand and on the other, the employed coping mechanisms, which can be adaptive or maladaptive.
In the present study, Rumination and Catastrophizing have been identified among the dysfunctional coping mechanisms used by parents, which contributed to maintain the conflict. These findings are similar to those of Willén (2015), who stated that hostile interactions between the parents and emotionally negative co-parenting lead to rigid parental relational patterns, which are maintained by rumination and blaming the other. As in the present study, which demonstrated the effectiveness of cognitive restructuring in order to achieve emotional regulation, Willén (2015) observed positive results after applying this method to divorced parents with high levels of conflict generated by dysfunctional coping mechanisms.
The preliminary evaluation in the present study took into account the parental competencies, since low levels of competency have been identified in the involved parents when considering the domains of Knowledge of the specifics of the child’s developmental stage and Stress management. For this reason, psychoeducation was a part of the parental intervention strategy, along with the practice of healthy coping strategies, followed by techniques to improve communication, assertiveness and strategies for managing negative emotions, both individually and in the dyad. The part of psychoeducation that focused on the knowledge of the specifics of the child’s developmental stage represented a key point of the program because it allowed the intervention to have an individual approach according to these specifics. The participating parents did not lack the general basic knowledge but rather the perspective of their own situation and the emotional connection to the actual needs of their child. This awareness in itself contributed to the motivation of every person to engage in the intervention program and work on those individual characteristics which had a role in the maintaining of the conflict. The results obtained after the parental evaluation in the present study confirm the findings of other studies with evidence indicating that many parents report decreased parental skills immediately after divorce, which seems to contribute to some of the problems experienced by children (Short, 2002). The experience of divorce can temporarily incapacitate parents in activities such as monitoring and supervising their children and ensuring discipline and a warm and consistent environment. After divorce, the level of parent-child conflict often increases while the level of family cohesion decreases.
This study confirms the effectiveness of the post-divorce parent-centered therapeutic strategy, which has been identified in other studies that have tested this model in several countries around the world. Thus, in 2004 the Supreme Court of Virginia has approved a pilot program dedicated to divorced couples with a high level of parental conflict (Whitehurst, O’keefe, & Wilson 2008) that had objectives which were similar to the program presented here, i.e. parental education about the impact of the conflict on the child, development of better communication skills, anger management, etc. Also, an educational program in the USA, 2008 (Whitehurst et al., 2008) has been ordered by the courts of law, addressed at divorced parents with high levels of conflict and consisted of psychoeducation regarding the child’s adjustment and conflict management; again, participating in the program has been proved to have positive results on the co-parenting skills. Moreover, parental education has resulted in reduced levels of conflict and improved relational and functional competencies (Whitehurst et al., 2008). These effects have also been confirmed in the present study.
However, requests for psychological support in Romania continue to mostly focus on services provided to children resulted from divorce while their parents participate only as tutors in the preliminary procedures and only if they agree to do so.
The encouraging results obtained were both due to the parents’ interest and the law court’s order for the couples to enter a counseling program. The court’s order was not addressed specifically to the parents, stating only the general objective of re-establishing the bond between the child and the rejected parent; however, the couples have accepted to enter the program of parental intervention, without a specific order to do so. This is further proof that parents can make an active effort to facilitate their children’s adaptation, as well as their own, if they understand the importance of co-parenting in the post-divorce economy of the relationship.
In Romania, the psychological interventions in cases of parental rejection by the child were in small numbers and mostly individual cases – either as a result of the court orders or by decision of one of both parents involved in the dyad. Counseling was directed mostly towards working with the child, and less towards educating the adults – as it has been mentioned before, the results were not stable in time. The program presented here is a first step in creating a wider frame of co-parenting intervention, which, once implemented in the case of divorced couples, it can improve the child’s adjustment to divorce and reduce both the physical and psychological abuse risk.
Although the therapeutic approach of parents in situations of post-divorce conflict that can impact the parent-child relationship is in its early stage in Romania, addressing the co-parenting problems at large is not a new concept – in several countries, intervention programs for divorced couples have been developed to provide improved strategies for managing the problems related to the child in the context of divorce. Another intervention program (Shifflett & Cummings, 1999) aiming at reducing the frequency of conflictual situations has been implemented in both the UK and the USA and studies have shown that the set of attitudes and behaviors at which the program was aimed have been maintained over time.
The limits of the study consist of the low number of cases included in the program, which reduces the possibility of generalizing the strategy and the fact that the program included only cases of mild or average alienation, excluding the severe situations.
Another limitation of this study is represented by the short period of time dedicated to the individual intervention, which allowed only for a superficial approach to some issues that would have required in-depth intervention. The psychotherapeutic approach to the infidelity of the partner as a cause of divorce implies the facilitating of the emotional labor which could be completed, considering the reduced number of sessions dedicated to each person. At the end of the program, the parents were recommended to engage in individual psychotherapy, which would allow them to elaborate the individual problems that have been underlined during the sessions.
Considering the impact of divortiality in Romania and the fact that culturally, Romanians are not prepared for a balanced and healthy approach to this phenomenon, the present study indicates that parental support and education regarding the competence of being separated parents, while taking into account the healthy adjustment of the family members is a priority.
The present study represents a first step in establishing an intervention program (based on integrative psychotherapy) aimed at supporting the families with a moderate to high level of parental conflict that led to different degrees of rejection of one parent by the child (ranging from resistance to interaction to completely refusing any communication whatsoever).
The bidimensional approach of the conflict (both individual and in the dyad) allowed for a more efficient integration of this intervention, focusing both on self-awareness regarding individual dysfunctional mechanisms that encourage interparental conflict, but also on applying new strategies in the direct relationship with the other parent.
The fact that, as a result of this intervention program, the parental relationship and the child-parent relationship have improved significantly indicates the necessity for a focus of the intervention on the coparental relationship in this type of cases. This would represent a foundation for the child-parent post-divorce healthy relationship and a proper post-separation adjustment of the child.
Worth mentioning is the fact that the most difficult part of the intervention is working with the parental dyad, because of the high risk for the re-creation of conflicts. This stage would not have provided such results if the two parents had not followed previous individual counseling sessions. Considering this aspect, the strategy for approaching the case is, in itself, integrative, as it encompasses both individual difficulties and issues concerning the parental couple.
To conclude, the present study introduces a new direction for intervention regarding the management of post-divorce conflictual couples. It also contributes to the scientific literature in this field and provides suggestions with regard to the methods and intervention strategies that should be applied in the future. Furthermore, it suggests new directions for strategy improvement in order to address the couples with high levels of parental conflict who may reject the intervention programs, cases in which the risk of permanent alienation of the child in relationship with one of the parents is very high.
The present study is a pilot work to be used in implementing a more general program for developing parental competencies in cases of moderate to high conflict divorce. A set of public policies are needed in Romania to help families in crisis to adequately support the affected children and the program presented in this study can be used as a model for future institutional plans of intervention for divorces with high levels of parental conflict and parental rejection. Plus, the present study will constitute the foundation for the development of an intervention guide that can provide models of good practice for the specialists who work with divorce cases.
The authors would like to thank all parents for their participation in this study.
A summary of this paper was presented at the online international conference: Individual, family, society – contemporary challenges, fourth edition, October 6 to October 7 2021, Bucharest, Romania and published in the journal Studii şi Cercetări de Antropologie, No. 7/2021.
- Abidin, R. R. (2012). Parenting stress index–fourth edition (PSI-4). Lutz, FL: Psychological Assessment Resources. Purchased from https://www.parinc.com/Products/Pkey/333
- Allen, D. W. (1998). No-fault divorce in Canada: Its cause and effect. Journal of Economic Behavior & Organization, 37(2), 129-149. https://doi.org/10.1016/S0167-2681(98)00080-8
- Amato, P. R. (2001). Children of divorce in the 1990s: an update of the Amato and Keith (1991) meta-analysis. Journal of family psychology, 15(3), 355. Retrieved July 25, 2021 from https://psycnet.apa.org/buy/2001-11319-001
- Anderson, R. (2020). Apart Yet Still Together: An Interpretative Phenomenological Analysis of How Coparents Navigate Conflict Post-divorce(Doctoral dissertation, Nova Southeastern University). Retrieved June 14, 2021 from https://www.proquest.com/openview/7a3ded186a746753641d264e3c1646de/1?pq-origsite=gscholar&cbl=44156
- Anderson, S. R., Anderson, S. A., Palmer, K. L., Mutchler, M. S., & Baker, L. K. (2010). Defining high conflict. The American Journal of Family Therapy, 39(1), 11-27. https://doi.org/10.1080/01926187.2010.530194
- Auersperg, F., Vlasak, T., Ponocny, I., & Barth, A. (2019). Long-term effects of parental divorce on mental health – A meta-analysis. Journal of Psychiatric Research, 119, 107-115. https://doi.org/10.1016/j.jpsychires.2019.09.011
- Binner, J. M., & Dnes, A. W. (2001). Marriage, divorce, and legal change: New evidence from England and Wales. Economic Inquiry, 39(2), 298-306. https://doi.org/10.1111/j.1465-7295.2001.tb00067.x
- Brinig, M. F., & Buckley, F. H. (1998). No-fault laws and at-fault people. International Review of Law and Economics, 18(3), 325-340. https://doi.org/10.1016/S0144-8188(98)00008-8
- Çaksen, H. (2021) The effects of parental divorce on children, Psychiatriki (2021) https://doi.org/10.22365/jpsych.2021.040
- Coelho, C., & Garoupa, N. (2006). Do divorce law reforms matter for divorce rates? Evidence from Portugal. Journal of Empirical Legal Studies, 3(3), 525-542. https://doi.org/10.1111/j.1740-1461.2006.00078.x
- David, D. (2006). Tratat de psihoterapii cognitive şi comportamentale [Treatise on cognitive and behavioral psychotherapy]. Iași:
- Erikson, E. H. (1968). Identity: Youth and crisis. New York, NY: WW Norton. Retrieved July 2, 2021 from https://books.google.ro/books?hl=en&lr=&id=EIBLC0JimYYC&oi=fnd&pg=PP2&ots=yxDxJqvGe8&sig=fFKMboaWqdXUDICvVgazDNvK6BA&redir_esc=y#v=onepage&q&f=false
- Fotheringham, S., Dunbar, J., & Hensley, D. (2013). Speaking for themselves: Hope for children caught in high conflict custody and access disputes involving domestic violence. Journal of family violence, 28(4), 311-324. https://doi.org/10.1007/s10896-013-9511-3
- Gardner, R. A. (1985). Recent trends in divorce and custody litigation. Academy forum, 29(2), 3-7. Retrieved July 10, 2021 from https://pasg.info/app/uploads/2015/06/Gardner-Richard-1985.pdf
- Gardner, R. A. (1998). The parental alienation syndrome. 2nd. Cresskill, New Jersey: Creative Therapeutics, 1-5. Retrieved June 28, 2021 from https://themenscentre.ca/wp-content/uploads/2013/08/Parental-Alienation-Syndrom-2nd-ed..pdf
- Gardner, R. A. (1999). Differentiating between parental alienation syndrome and bona fide abuse-neglect. American Journal of Family Therapy, 27(2), 97-107. DOI: 1080/019261899261998
- Gardner, R. A. (2001). Parental alienation syndrome (PAS): Sixteen years later. Academy Forum, 45(1), 10-12. Retrieved July 12, 2021 from https://www.anthonyinc.co.za/images/pdf/Parental_Alienation_Syndrome_PAS__Sixteen_Years_Later.pdf
- Gardner, R. A. (2002). Parental alienation syndrome vs. parental alienation: which diagnosis should evaluators use in child-custody disputes?. American Journal of Family Therapy, 30(2), 93-115. https://doi.org/10.1080/019261802753573821
- Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European journal of psychological assessment, 23(3), 141-149. https://doi.org/10.1027/1015-57188.8.131.52
- Glăveanu, S. (2012). Competenţa parentală. Modele de conceptualizare şi diagnoză [Parental competence. Models of conceptualizing and Diagnostics]. București: Editura Universitară. Purchased from https://www.editurauniversitara.ro/psihologie-6/competen%C5%A3a-parental%C4%83-modele-de-conceptualizare-%C5%9Fi-diagnoz%C4%83.html
- González, L., & Viitanen, T. K. (2009). The effect of divorce laws on divorce rates in Europe. European Economic Review, 53(2), 127-138. https://doi.org/10.1016/j.euroecorev.2008.05.005
- González-Val, R., & Marcén, M. (2012). Breaks in the breaks: An analysis of divorce rates in Europe. International Review of Law and Economics, 32(2), 242-255. https://doi.org/10.1016/j.irle.2012.01.005
- Greenberg, S.A. & Humphreys (1994) Parenting History Survey. Retrieved June 25, 2021 from http://www.drtysonbailey.com/docs/PHS.pdf?fbclid=IwAR0tXVvyAX3guugSYhS2apvebQDTM8059QAEUAC2ZCIB8i3LYKNE4pB8Jc8
- Gruber, J. (2004). Is making divorce easier bad for children? The long-run implications of unilateral divorce. Journal of Labor Economics, 22(4), 799-833. https://doi.org/10.1086/423155
- Harman, J. J., Bernet, W., & Harman, J. (2019). Parental alienation: The blossoming of a field of study. Current Directions in Psychological Science, 28(2), 212-217. https://doi.org/10.1177/0963721419827271
- Harman, J. J., Kruk, E., & Hines, D. A. (2018). Parental alienating behaviors: An unacknowledged form of family violence. Psychological Bulletin, 144(12), 1275. https://doi.org/10.1037/bul0000175
- Hetherington, E. M., & Kelly, J. (2003). For better or for worse: Divorce reconsidered. New York, United States: WW Norton & Company.
- Johnston, J. R. (1994). High-conflict divorce. The future of children, 4(1), 165-182. https://doi.org/10.2307/1602483
- Kelly, J. B., & Emery, R. E. (2003). Children’s adjustment following divorce: Risk and resilience perspectives. Family relations, 52(4), 352-362. https://doi.org/10.1111/j.1741-3729.2003.00352.x
- Kopystynska, O., Paschall, K. W., Barnett, M. A., & Curran, M. A. (2017). Patterns of interparental conflict, parenting, and children’s emotional insecurity: A person-centered approach. Journal of Family Psychology, 31(7), 922. https://doi.org/10.1037/fam0000343
- Lamela, D., Figueiredo, B., Bastos, A., & Feinberg, M. (2016). Typologies of post-divorce coparenting and parental well-being, parenting quality and children’s psychological adjustment. Child Psychiatry & Human Development, 47(5), 716-728. https://doi.org/10.1007/s10578-015-0604-5
- Maccoby, E. E., & Mnookin, R. H. (1992). Dividing the child: Social and legal dilemmas of custody. Cambridge, Massachusetts: Harvard University Press. Retrieved June 14, 2021 from https://www.hup.harvard.edu/catalog.php?isbn=9780674212954&fbclid=IwAR1S5KZpJA_ffoKpozSHXt5tIG5QzF8bAXes6RjortiHXi93LUN_0NvfAjo
- Martínez-Pampliega, A., Herrero, M., Cormenzana, S., Corral, S., Sanz, M., Merino, L., … & Álvarez, I. (2021). Custody and Child Symptomatology in High Conflict Divorce: An Analysis of Latent Profiles. Psicothema, 33(1), 95-102. doi: 7334/psicothema2020.224
- Millings, A., Hirst, S. L., Sirois, F., & Houlston, C. (2020). Emotional adaptation to relationship dissolution in parents and non-parents: A new conceptual model and measure. Plos one, 15(10), e0239712. https://doi.org/10.1371/journal. pone.0239712
- Moore, E. (2020). Divorce, Emotions, and Legal Regulations: Shared Parenting in a Climate of Fear. In Kreyenfeld, H. Trappe (eds.), Parental Life Courses after Separation and Divorce in Europe, Life Course Research and Social Policies, 12. https://doi.org/10.1007/978-3-030-44575-1_7
- O’Hara, K. L., Rhodes, C. A., Wolchik, S. A., Sandler, I. N., & Yun‐Tein, J. (2021). Longitudinal Effects of PostDivorce Interparental Conflict on Children’s Mental Health Problems Through Fear of Abandonment: Does Parenting Quality Play a Buffering Role?. Child development. https://doi.org/10.1111/cdev.13539
- Olson, D. H. (1996). Clinical assessment and treatment interventions using the family circumplex model. In F. W. Kaslow (Ed.), Handbook of relational diagnosis and dysfunctional family patterns(pp. 59–80). John Wiley & Sons.
- Pivniceru, A., & Luca, C. (2016). Interesul superior al copilului. Expertiză psihologică în caz de separarea/divorțul părinților [The best interests of the child Psychological expertise in case of separation / divorce of parents]. București: Editura Hamangiu.
- Popa, C & Ciobanu, A., M. (2013). Tulburarea depresiva. Noi directii de cercetare [Depressive disorder. New research directions] 1. București: Editura Universitară.
- Rada, C. (2012). The prevalence of sexual infidelity, opinions on its causes for a population in Romania. Psih., 58(3), 211–224.
- Rada, C.(2013). Valori identitare ale familiei româneşti contemporane în contextul globalizării. O abordare antropologică, [Identitary Values of the Contemporary Romanian Family in the Framework of the Globalization. An Anthropological Approach]. Bucureşti: Editura Muzeului Național al Literaturii Române, Colecția AULA MAGNA.
- Rada, C.,& Olson, D. H. (2016). Circumplex Model of Marital and Family Systems (Faces III) in Romania. Annuaire Roumain D’anthropologie, 53, 11– București: Editura Academiei Române. Retrieved June 17, 2021 from http://annuaire.antropologia.ro/volume-53-2016
- Rada, C., & Pănescu, O. M. (2016). Psihologia, psihoterapia familiei şi cuplului. Teorii, cercetări, intervenţii [Psychology, family and couple psychotherapy. Theories, research, interventions]. București: Editura Universitară.
- Rada, C., & Tarcea, M., (2010), Viaţa sexuală şi familia în mediul urban românesc, Studiul Rada-Tarcea [Sex life and family in the Romanian urban environment, Rada-Tarcea study]. Iași: Editura Institutul European.
- Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior Assessment System for Children—Second Edition (BASC–2). Circle Pines, MN: AGS. Purchased from Testcentral, commercialized by D&D Consultants Grup. https://testcentral.ro/test/behavior-assessment-system-for-children-2
- Roizblatt S., A., Leiva F., V. M., & Maida S., A. M. (2018). Separación o divorcio de los padres. Consecuencias en los hijos y recomendaciones a los padres y pediatras [Parents separation or divorce. Potential effects on children and recommendations to parents and pediatricians]. Revista Chilena de Pediatría, 89(2), 166–172.doi:10.4067/s0370-41062018000200166
- Sardon, J. P. (1996). L’évolution du divorce en France [The evolution of divorce in France]. Population (french edition), 51(3), 717-749. https://doi.org/10.2307/1534490
- Shifflett, K., & Cummings, E. M. (1999). A program for educating parents about the effects of divorce and conflict on children: An initial evaluation. Family relations, 48(1), 79-89. https://doi.org/10.2307/585685
- Short, J. L. (2002). The effects of parental divorce during childhood on college students. Journal of Divorce & Remarriage, 38(1-2), 143-155. https://doi.org/10.1300/J087v38n01_08
- Steinbach, A. (2018). Children’s and Parents’ Well-Being in Joint Physical Custody: A Literature Review. Family Process, 58(2), 353-369.doi:10.1111/famp.12372
- Thomas,B. (2020).The Effects of Divorce on Children. Retrieved March 26, 2022 from https://digitalcommons.sacredheart.edu/cgi/viewcontent.cgi?article=1420&context=acadfest
- Verrocchio, M. C., Baker, A. J., & Marchetti, D. (2018). Adult report of childhood exposure to parental alienation at different developmental time periods. Journal of Family Therapy, 40(4), 602-618. https://doi.org/10.1111/1467-6427.12192
- Whitehurst, D. H., O’keefe, S. L., & Wilson, R. A. (2008). Divorced and separated parents in conflict: Results from a true experiment effect of a court mandated parenting education program. Journal of Divorce & Remarriage, 48(3-4), 127-144. https://doi.org/10.1300/J087v48n03_08
- Willén, H. (2015). Challenges for Divorced Parents: Regulating Negative Emotions in Post-Divorce Relationships. Australian and New Zealand Journal of Family Therapy, 36(3), 356–370. doi:10.1002/anzf.1115
- Willis, B., & O’Donohue, W. (2018). Síndrome de alienación parental: una crítica || Parental Alienation Syndrome: A critique. Revista de Estudios e Investigación en Psicología y Educación, 5(2), 74-81. https://doi.org/10.17979/reipe.2018.5.2.4364
- Wolfers, J. (2006). Did unilateral divorce laws raise divorce rates? A reconciliation and new results. American Economic Review, 96(5), 1802-1820. DOI: 10.1257/aer.96.5.1802
- *** American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
- *** National Institute of Statistics. (2020). Romanian Statistical Yearbook 2019. Bucharest. Retrieved 14 May, 2021 from https://insse.ro/cms/files/Anuar%20arhive/serii%20de%20date/2019/anuarul_statistic_al_romaniei_2019.pdf