HOMEResourcesArchive of Brown Newsletter
| Expert Speaks Out The dangers of attachment therapy: Parent education needed |
| Jean Mercer, Ph.D. |
| "All adopted children have behavior problems; most behavior problems come from attachment disorders; attachment disorders can be cured by Attachment Therapy." This series of misstatements is presented to parents in the United States and elsewhere through more than 80 Internet sites that advocate for or offer attachment therapy (AT). AT is also known as holding therapy, rage-reduction therapy, therapeutic holding, coercive restraint therapy and other names. (See About Attachment Therapy.) AT is a physically-intrusive practice that uses pain, emotional abuse, and intimidation with the purpose of changing children's emotions and behavior. Although there are many forms of AT, their common features are physical restraint and threats of abandonment. Practiced in various forms for over 30 years, AT came to public attention with the death of 10-year-old Candace Newmaker in Colorado in April, 2000. Candace was asphyxiated during an AT variant procedure called "rebirthing." The AT practitioners responsible for her death received a 16-year prison sentence. The therapists who killed Candace Newmaker were among a group of practitioners who personally carry out restraint of children. Another, and possibly more common, AT approach involves teaching parents to restrain their children. The parents do this either instead of or in addition to holding by a therapist. |
| Dangers very real |
| The count is uncertain, but five or six child deaths seem to have occurred at the hands of parents following the advice of AT practitioners. These deaths most often resulted from asphyxiation. In one case, the child died when her adoptive father lay on her with the full weight of his body; in one, the child was restrained with duct-tape in a high chair with her mouth covered; in another, the child died of hyponatremia after she was forced to drink large quantities of liquid as a punishment for disobedience. One therapist (none of whose clients are known to have died), advises parents to use prone restraint, the position most often associated with death in restraint. AT treatment is characterized by emotional abuse as well as by physical intrusion and pain. Children are routinely called by demeaning names. In one video of therapy, produced by a major AT organization, the therapist says to the child, "I'll lick your damn face." This therapist, who is still practicing, repeatedly tells the 10-year-old boy that if he does not change, "You're gonna kill somebody, some day." "How many times do you think about killing your mother?" he demands of the sobbing child. In addition to the potential for serious physical harm and intense emotional abuse during therapy, AT is associated with a problematic set of parenting/caregiving practices. Children receiving AT treatment may be sent to "therapeutic foster homes" where they live in a milieu designed to support the holding treatment. This milieu stresses the threat of abandonment by the parents if the child does not achieve the goals set by the AT practitioner: to be "respectful, responsible, and fun to be around." Parents following the advice of AT practitioners also use "reparenting" practices in which they cradle and rock older children, bottle-feed them, and offer them sweet foods while making eye contact. These actions are believed by AT proponents to be the foundation of emotional attachment. "Nurturing" actions are carried out only when the parent wants to do them, and are to be refused if requested by the child, because yielding would compromise the parent's absolute authority. All but one of the articles in a recent issue of the journal Attachment and Human Development were authored by clinicians who rejected AT practices and emphasized that AT is in no way derived from the attachment theory initially formulated by John Bowlby. Other work analyzing research on AT has shown no evidence basis for AT practitioners' claims. |
| Parent education critical |
| Most parents, of course, do not read professional journals, but find information about AT on Internet sites of practitioners or of associated adoption organizations. This material, although far from complete or accurate, has some degree of protection as commercial speech. Because parent education is a critical issue here, pediatricians, nurse practitioners, psychiatrists, and psychologists have essential roles to play in reducing the impact of AT practices. Families or children may present some attitudes and characteristics that will alert practitioners to the need for education about AT. Children adopted at any age are more likely to be AT targets, as are foster children. AT proponents regard schooling as a privilege, not a right, and it is possible that children who miss school frequently may be involved in AT. Certain language is common among AT proponents; for example, the child may be said to be "consequenced" instead of "punished." Finally, unexplained weight loss may be an indication that food deprivation is being used systematically. A cautious approach must be taken to families thought to be using AT practices. AT proponents and parents form a cult-like group and provide intense mutual support for their belief system, stressing that only they, not "the experts", can understand what they are doing. Practitioners who broach this subject risk having the parents break off contact. Nevertheless, the comments of a trusted professional may help a family disengage from harmful AT practices and seek appropriate mental health interventions if they are needed. Mercer J., Sarner L., and Rosa L. Attachment Therapy on trial. Westport, CT: Praeger, 2003. |
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About Attachment Therapy Attachment Therapy (AT) is a growing, underground movement for the "treatment" of children who pose disciplinary problems to their parents or caregivers. AT practitioners allege that the root cause of the children's misbehavior is a failure to "attach" to their caregivers. The purported correction by AT is - literally - to force the children into loving (attaching to) their parents. Robert Zaslow, who died in 2001, is the often forgotten Father of American AT. It was his creation, the "Z-Process" that gave roots to rage reduction therapy, holding therapy and the like. The attachment community makes light of findings against Zaslow, who was successfully sued in 1972 by one of his adult clients for a rage reduction session that didn't work. As a result, he lost his license to practice psychology in California, but he continued to teach the therapy he developed. Foster Cline has been dubbed the founder and pioneer in AT by many. When Zaslow lost his license in California, he fled to Colorado and Cline met him there. Cline founded the Youth Behavior Program in Evergreen, Colorado, which later changed its name to The Attachment Center at Evergreen and is in the process of changing its name again to "Institute for Attachment and Child Development." In 1995 Cline was charged with various breaches of professional conduct by the Colorado State Board of Medical Examiners. Mainstream mental health sources state that children with Reactive Attachment Disorder (RAD) have difficulty or are unable to form attachments in early life. The disorder may manifest itself through indiscriminant attachments, overfriendliness, or withdrawal from others. (Diagnostic and Statistical Manual-IV, 1994.) However, self-proclaimed "attachment therapists" claim that the disorder has many characteristics that DSM-IV omits. The Institute for Attachment and Child Development (formerly the Attachment Center at Evergreen; www.instituteforattachment.org), for example, states: Children who do not have healthy attachments with a loving caregiver: do not trust caregivers or adults in authority; have extreme control problems, manifested in covertly manipulative or overtly hostile ways; do not develop a moral foundation: no empathy, no remorse, no conscience, no compassion for others; lack the ability to give and receive genuine affection or love; resist all efforts to nurture or guide them; lack cause and effect thinking; act out negatively, provoking anger in others; lie, steal, cheat, manipulate; are destructive, cruel, argumentative and hostile; lack self-control; are impulsive; and are superficially charming and engaging. The Institute for Attachment also lists parental characteristics that may be used to help diagnose the child:  Feel isolated and depressed.Feel frustrated and stressed.Are hypervigilant, agitated, have difficulty concentrating.Are confused, puzzled, obsessed with finding answers.Feel blamed by family, friends, and professionals.Feel helpless, hopeless, and angry.Feel that problems are minimized by the helping profession.AT practices have not varied much during the past. In addition to these practices, AT has rarely, if ever, been subjected to pure scientific evaluation and peer review. What little "research" is available on the subject is usually done "in house" and is scientifically questionable. (Mercer, 2003) |