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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, July 16, 2018

When Children Are Disruptive, Aggressive, Uncooperative: Thinking Outside the “Attachment Disorder” Box

It’s disturbing and even scary when children constantly disobey, disrupt, and behave aggressively toward other people. Small wonder that parents worry that they will not be able to control those child behaviors and the children will get worse and worse until they become dangerous criminals. Adoptive parents are often especially concerned because they wonder what unknown genetic element may be influencing the children’s development and personalities.

The answer given to these worried parents by some alternative psychotherapists is that the children are suffering from “attachment disorders”—that these disorders came from separation from the birth parents and adoption, or from painful medical experiences in infancy, or from institutional care. Alternative therapists may even claim that disruptive behaviors are part of the conventional diagnosis of Reactive Attachment Disorder, although they are not. When these claims about attachment effects are made, it is often suggested that the children need some form of “attachment therapy” that will correct the effects of their early experiences. If the children don’t get those treatments, the parents are told, they will become murderers, thieves, etc.—and their first victims will be their parents. This frightening argument can be very persuasive to anxious and uncertain parents, and they may well sign on for the treatment suggested.

Unfortunately, although the parents’ concerns are certainly legitimate, these disturbing behaviors have nothing to do with attachment, and even if they did, “attachment therapies” done by alternative therapists are not known to affect attachment. But what should they do? A recent article by Jonathan Perle, in Early Child Development and Care (2018), “Rethinking ‘wait and see’ philosophies for childhood disruptive behavior: A guide for paediatric medical providers” provides some suggestions about how families can work with their pediatricians to evaluate and work to correct disruptive behaviors like defiance, tantrums, aggression, and bad language in children from 2 to 7 years of age.

First, Perle points out that some disruptive behaviors like tantrums are very predictable in young children. Issues arise when the behaviors are more frequent than would normally be expected, persist to a later-than-usual age, cause disruption for the whole day rather than being resolved, or get more frequent with time. Difficult as disruptive behaviors may be for families, they cause even more problems for the children in the long run, as exasperated parents punish to the point of physical abuse,  schools isolate and fail to educate the “problem child”, and other children reject and avoid the disrupter.

Perle notes that the longer these problem behaviors go on, the more difficult they are to treat. Children learn to use disruption as an effective way to avoid things they don’t want to do (and every child is asked daily to do things he or she doesn’t want). Parents, teachers, and other children drop their demands in order to escape the unpleasantness created when they press a disruptive child to cooperate. Thus both the disruptive child and other people daily experience the reward of letting the child do as he or she likes. Repetition and reward lead to stronger learning, and adult attempts to withhold that reward by insisting on cooperation lead to such an outburst of unwanted behavior that they usually give in.

In Perle’s paper, he comments on previous research on children’s disruptive behavior that gives us an idea of what is common, “normal” behavior and what is not. Tantrums in children aged 3 to 5 are usually brief, no more than 5 to 10 minutes, and they are not very aggressive. The children scream, fall to the ground, cry, make mild aggressive remarks (“Don’t like you!”), and may impulsively strike or kick out, but do not usually bite, kick or hit with intensity. Children this age do not usually attack animals or people or destroy property in any severe way. The usual behaviors may include some sulking and pouting after the tantrum, but as children get older and develop better language and self-regulation skills there is less of that. By age 5 or 6, severely aggressive behaviors and daily tantrums with refusal of compliance even when adult raise their voices would be considered unusual and treatment would be a good idea for the child and the family. Adults particularly need to learn and practice ways to guide the child toward compliance without causing the disruptive behavior to escalate or to be maintained.

Importantly, Perle notes that disruptive and apparently aggressive behavior may emerge from a child’s anxiety. For instance ,“ a child who is afraid of insects such as bees or ants may begin to protest, then cry, then ultimately hit or kick an adult to get away from insects when brought to a park. Similar reactive avoidance-based disruptive behaviours could be seen related to a variety of emotional fears including dark situations, inclement weather, separation from a caregiver, social settings, or in response to sensory-based sensitivities (e.g. a child exhibits a tantrum in response [to], or to avoid over stimulating items or situations such as clothing, noises, smells, foods, or light”. In these cases, the child may have learned that disruptive behavior is rewarded by helping the child escape from a frightening situation, and unless the child’s anxiety is understood it will be difficult to understand what the reward is.

These problems of disruptive behavior, although very real and potentially becoming worse, have nothing to do with attachment, nor will they be improved by “attachment therapies”. Effective treatments involve various evidence-based types of parent management training. Happily, when these are used, families benefit not only from improved daily life, but they are also likely to feel that everyone is now better “attached” than they were.

Sunday, July 15, 2018

Woozling Parental Alienation

Like many other poorly substantiated events and entities, some alternative psychotherapies get woozled. The ones that don’t get woozled do not have much success.

Alterative psychotherapies (APs) are the psychological equivalents of complementary and alternative medicine (CAM), but as they are hardly ever used in a “complementary” fashion, along with conventional evidence-based treatment, it makes sense to call them “alternative” alone.  APs are lacking in research support, but they are also implausible—illogical, incongruent with what we know about development and personality, and dependent on unlikely mechanisms of change. They are potentially harmful, sometimes seriously so, but always causing harm in the sense of wasting time and money that could be invested in effective treatment. APs are not the same thing as experimental treatments; those are interventions that have not yet been supported by empirical work but that are logical, congruent with established information, and dependent on well-understood mechanism of change. Genuinely experimental treatments are used in ways that allow information about their effectiveness to be collected, but APs are not.

Woozling is a process by which people come to think that something exists or is effective just because they have heard of it before. This useful term comes from the Winnie the Pooh story in which Pooh and Piglet interpret their own tracks in the snow as an indication of ferocious beasts they call woozles—there’s no sign of the woozles except that Pooh and Piglet have seen those tracks before.

 How can psychotherapies become woozles? Like the celery stick the toddler refuses the first time he sees it, but accepts after several presentations, woozled therapies begin to look acceptable to many when they become familiar—even if they might seem ridiculous at first sight. Therapies that are somehow connected with emotional attachment tend to be easily turned into woozles, because the concept of attachment is now so familiar. This process has occurred with a range of APs that claim a basis in attachment: Attachment Therapy, Holding Time, Festhaltentherapie, Dyadic Developmental Psychotherapy. When a woozle has developed, its proponents benefit because they no longer have to argue in favor of their assertions when “everybody knows” that something is correct.

Like the Bellman in “The Hunting of the Snark”, who said “what I tell you three times is true”,  proponents of APs often depend on simple repetition to make their audience familiar with their claims and to facilitate the woozling process. But the world of the Internet offers many other routes to woozle status for AP advocates: Facebook pages, organizations of concerned supporters, and easy publicity in general. We are presently seeing the woozling process at work, as proponents of “parental alienation” (PA), its diagnostic methods, and its proposed treatments move forward to take PA out of the confidentiality of the family courts and into the public domain, so that public attitudes and pressure can in their turn exert pressure on the courts.

To recapitulate briefly, the theory of “parental alienation” is that in many cases where children of divorced couples are reluctant to visit one of their parents, the reason is that the other parent has created a state of alienation by persuading the child that the rejected parent is bad, abusive, or whatever.  PA proponents have argued (without presenting supportive evidence) that alienated children suffer from deficits in critical thinking and/or may develop narcissistic traits, and therefore are developing both intellectual and emotional problems that will become quite serious. Because the preferred parent has caused these changes, the PA advocates argue, that parent has been abusing the child and should therefore lose custody. Several programs are offered with claims to restore the child to emotional health as indicated by a new acceptance of the formerly-rejected parent; all of these involve court orders for removal from any contact with the preferred parent.

The assertions of PA proponents are without acceptable empirical support and have other parallels with the alternative psychotherapies (APs) described earlier. They are working toward woozle status, though. How, then, is the woozling process going on?

There are many people who want to create a PA woozle, but I am going to choose one who gives a good example of how this can happen. This person, who has done absolutely nothing illegal or even obviously unethical, is Jennifer Harman of Colorado State University. She is a psychologist by training, apparently not a licensed clinical psychologist, but a “coach” who provides services . Harman has had a very active professional life ( with a long-term interest in health issues, particularly HIV. In 2016, it appears, she made her first presentation about PA.

So why do I point to Harman as an example of PA woozling? First of all, she has initiated the Colorado Parental Alienation Project, in which, as far as I can tell, she will have undergraduate research students analyze interviews with persons who believe they have been affected by parental alienation; this project is discussed at In other words, like the PA proponent Amy Baker, it appears, she is collecting information from people who believe they have lost their children’s affection because their ex-spouses campaigned to denigrate them, rather than for any of the other reasons (not even including experiences of abuse) why a child or teenager might resist contact with someone.  This seems to have become rather a tradition among PA researchers—find some people (rejected parents or rejecting children) who believe that PA has occurred, then ask them about it, but don’t compare them to people who do not believe this has happened to them. Do, however, make this research project widely known so that PA becomes familiar to a wide audience.

In a conspicuously woozling move, Harman had at the time of the CV linked above made a grant application for a project on strategies to address  PA in schools. This is indeed a classic woozling approach, successful for organizations like Love & Logic and of course for a myriad of APs dating back to “patterning”. Put your assertions in front of teachers and parents, as well as kids who will learn from them, and the familiar woozle will begin to emerge, helped along by TV and print journalists who will announce the services the schools are providing.

But, you say, don’t people using conventional psychotherapies do these things too? Don’t they have websites, have research projects and advertise for participants, and offer training to schools? Yes, indeed they do. So why are those treatments not woozles? It’s because they have bothered to find the empirical support for their programs first , before making these public presentations. They have demonstrated effectiveness, not just assertions. Woozles, in contrast, use public presentation and the ensuing familiarity of their ideas to create an impression of empirical support when there is none—and this seems to be the direction some PA proponents are presently going.

Once again, I do not say that Harman is doing anything illegal, or even anything unethical by any ordinary professional guidelines. She has a perfect right to use information she believes is correct for any purpose she can. The problem is that while she and others move PA closer to woozle status by making it familiar to the public, it becomes essential for psychologists, lawyers, and other professionals to spend more of their time on anti-woozle duty and on communicating the realities to each other as well as to the wider audience. When presenting about PA at ABCT a couple of years ago, by the way, I got the distinct impression that few of the psychologists there had ever even heard of PA—that’s why I point out the need to communicate to each other as well as to the public.


Thursday, July 12, 2018

What to Expect When Young Children Are Separated from Parents—and What Can Be Done About It

Many more eloquent writers than I am have recently protested against the separation of migrant children from their parents who have entered the United States illegally or in the hope of asylum. In the last day or so, journalists have published descriptions of the reunions of a small number of the youngest children with their parents. Those descriptions are not surprising, although they are not what we would expect when we look at the separations and reunions “adultomorphically”—that is, as if the children should have the same thoughts and emotions that we adults would have if we were in their shoes (which they don’t).

What seems to have surprised some people is that 2- and 3-year-olds who have been very distressed by separation from their parents do not seem happy when reunited. They often stare as if they don’t recognize the parent, then begin to cry. Although they have been separated for only a few weeks, there seems to have been a dramatic impact on their responses to their parents. If they are followed up for further weeks or even months, it’s predictable that they will still behave differently than they did before, but that their behavior now will involve clinging to the parent “insatiably” as well as showing irritability and easy anger.

Parents who have gone away for a cruise or other child-free vacation for a couple of weeks, leaving a young child with a familiar grandparent or babysitter in their own home may recognize some of this mood and behavior that occurs on their return. Even pick-up after a day in child care may be fraught in the same way, with the child snubbing the parent and resisting going-home tasks like putting a jacket on.

Years ago, the attachment theorist John Bowlby made a short film called “Nine Days in a Residential Nursery” which you can read about at In this documentary film, we see 17-month-old John who is left in a nursery while his mother is having another baby. His father visits occasionally. As was considered normal in the 1940s, the mother is in the hospital for over a week and the father is not expected to care for John during this time. John’s distress and difficulties with eating and sleeping are clear, and in short order he develops a cold as well. There are many other toddlers in the nursery, some of whom live there full-time and are much more noisy and aggressive than John is used to. The nurses are kind in an impersonal sort of way, but change frequently according to their work schedules, and there is no single reliable person that John can seek for comfort. When John’s mother comes home and comes to pick him up, he snubs and resists her and she is surprised and distressed. Whether her own distress increases John’s is not discussed.

John’s experience has some but not all the elements experienced by young migrant children separated from their parents. The separation is abrupt and inexplicable from his point of view and he does not have enough language development to ask or understand what is happening. He is placed in a completely strange physical environment, with strange and ever-changing caregivers, and with large numbers of other children. No one knows (or apparently cares much) about his own familiar habits, his expectations, or his ways of communicating that work well with his parents but not with strangers. When his mother returns, she too is distressed, and her face tells him that something scary is happening—he can’t know that it is his own behavior that is scaring her.

In addition to all these elements they share with John,  today’s separated migrant children have already been brought far from their familiar homes and have missed their usual schedules of eating and sleeping for weeks or months in the past. They may be suffering from untreated illnesses at a time of life when fatigue, fear, sickness, or injury would normally make them seek comfort from familiar caregivers who are now absent. Whatever language development they have attained is of little use if caregivers do not speak their languages. The children’s forced removal from their parents is carried out by intimidating people, frightening both parent and child, and the parent’s expression of fear, added to the probably grim expression of the official, add to distress. The separation then lasts for much longer than what John experienced and in some cases will undoubtedly become permanent. Even when reunion occurs, the parents’ fear, depression, and distress during their own detention make it difficult for them to respond sensitively to the children’s needs.

Without wanting to get into the morass of discussion about separation of migrant parents and children, I do want to point out that the young children’s experiences do not have to be so distressing. It would cost money to make them less so, so I am sure this won’t happen. However, John and Joyce Robertson, colleagues of John Bowlby, showed that the distress of separated toddlers and preschoolers was much less if they had a consistent, predictable, sensitive, responsive caregiver who would work to understand their communications and to offer comfort and help as needed. Insights from child care can also be helpful in supporting young children in these stressful conditions; for example, not only is it important to have a low ratio of children to caregivers, but young children do best in small groups rather than in a large room with many children and adults. Caregivers trained in sensitive practices like Floortime can also buffer the effects of the adverse experiences of separated children.

But, as I said, that would all cost money…

Tuesday, June 26, 2018

Children Separated at the Border: Explaining to Your Young Children

Saturday, June 16, 2018

Is Facilitated Communication a Potentially Harmful Treatment for Children?

Not long ago, I published an article about potentially harmful psychotherapies for children in  Child and Adolescent Social Work Journal. I was more than happy to receive the message below. You can read the article itself for free by clicking on the link and then on the box that says Social Sciences.
We asked our Editors-in-Chief across Springer Nature journals to nominate just one articlepublished in their journal in 2017 that could help humanity and protect and preserve our planet.

We are happy to let you know that your article was selected:

You can find your article on our Change the World website alongside other outstanding work acrossSpringer Nature.

Please do share with your friends and colleagues and let them know that “My article can change the world! Read it here

 In the article, I argued that although most people think of any “therapy” for children as beneficial and certainly as safe, there are some treatments still in use that have the potential for doing harm rather than good. Some of these treatments have even caused child deaths, though obviously not all the children undergoing the treatments die or even sustain injuries. I proposed in the paper that rather than waiting until after children are hurt, we may be able to identify potentially harmful treatments for children (PHTCs) by looking at certain characteristics they share. As a group, PHTCs are implausible—they involve weak logic and are not in agreement with things that are well-known about child development. They use methods that resemble abusive actions like isolating or terrorizing a child. They are also lacking in any systematic research that supports their effectiveness and safety.

If children (or families) have already been hurt by a treatment or method, that piece of evidence should draw our serious attention to the cause of the injury. Researchers nowadays are told to report adverse events related to the methods they are investigating, but of course it is much more difficult to study these relatively rare events than to look at whether a treatment is effective. Some practitioners will reject reports of harm to treated children as “anecdotes”, but it has been pointed out that the anecdote is the first line of defense for maintenance of treatment safety. Reports of harm are the canaries in the therapeutic coal mine and deserve attention and analysis.

When I wrote about PHTCs in that article, I did not even think about including Facilitated Communication (FC) as an example of a PHTC. I thought FC, a method claiming to let children who cannot speak or communicate in other ways with the help of a keyboard and a helper who guides the child to say what he or she wants, had been rejected years ago! I thought this because of various canaries in the coalmine in the form of reports that FC was driven by the helper, and not the child’s intentions, and had resulted in unfunded accusations of abuse against parents, and resulting family disasters. But no, not at all, FC is apparently still around. The following newspaper article describes a conference advocating FC at the University of Northern Iowa and the distress with which this has been met by people who understand the FC facts:

Is FC a PHTC? Certainly, attention has been drawn to the method by reports of FC-created, unfounded abuse accusations and their adverse effects on accused parents, with subsequent impacts on the children who are already severely affected by their disabilities. These reports indicate that the canaries have stopped singing and we had better see what the problem is, so let’s look at the other issues involved with PHTC status.

Is there evidence from systematic, well-designed, well-implemented research that facilitators enable communication-disabled children to make their thoughts and wishes known?  No, on the contrary, when children have seen one thing and their helpers another, the answers about what they have seen reflect what the adult saw, not what the child saw. FC keyboarding shows what the adults think, and what they assume the child thinks—sometimes correctly, no doubt, but always with a strong chance of being wrong.  

Is FC a plausible method? Is it logical and congruent with what we know of child development? No, it is not. There is no reason why the introduction of a keyboard would make an adult especially sensitive to a child’s thoughts. If the adult knew what the child thinks, he or she could speak for the child, but this does not happen. The keyboard is simply a distraction from the fact that the adult is creating the communication, just as a person with a Ouija board is causing a sequence of letters to be chosen.

Is FC in itself a harmful method, as some child psychotherapies have directly harmful components? No, it is not in any serious sense directly harmful for an adult to manipulate a keyboard together with a child. We might even look for some psychological benefits of the added contact and interaction. In terms of communication benefits, however, there may be distinct opportunity costs--  the loss of family time and resources, as well as the failure to use more effective methods when they exist.

What does the real harm is FC in the hands of some volunteers or practitioners, who use their position to accuse innocent parents of abuse and thus create situations in which a parent may not be allowed near the child (who must be distressed at the disappearance of a familiar person) and may potentially go to prison if not exonerated. Even exoneration will not make up for loss of jobs, friends, even the marriage, as well as disruption of the relationship with the child. Why are such accusations made? Is it some extreme form of “rescuing” the child or a way to commit hostile acts against the parents? This is not clear, but what is evident is that FC, a method associated with harm, implausible, and rejected on the basis of strong evidence, is potentially harmful to many if not all children and should not be taught or practiced anywhere.

When the canaries are quiet, the rest of us had better speak up.

Monday, June 11, 2018

Potentially Harmful Treatments for Children-- Springer Nature Agrees

I received this email this morning and can't help boasting-- in addition, though, I want to thank Bruce Thyer, the editor of Child and Adolescent Social Work Journal, who nominated this article and has been enormously supportive of concerns about alternative treatments for children.
If you're interested in children's welfare, please take the chance to read this article for free! Click on the social sciences box after using the link.

Change the World, One Article at a Time

Dear Jean Mercer,

We asked our Editors-in-Chief across Springer Nature journals to nominate just one articlepublished in their journal in 2017 that could help humanity and protect and preserve our planet.

We are happy to let you know that your article was selected:

You can find your article on our Change the World website alongside other outstanding work across Springer Nature.

Please do share with your friends and colleagues and let them know that “My article can change the world! Read it here

About Change the World

Despite living in an age of unprecedented advancements across science, technology and medicine, the world still faces many challenges which affect both our environment and welfare.

Now in its third year, our Change the World initiative asks the Editors-in-Chief of Springer Nature journals to select the scientific findings published in the past year that they believe could have the greatest impact on society’s most pressing problems.

See all the articles in our Change the World initiative in 2018:

We are delighted to feature your article as part of our initiative.  Thank you for submitting your research to one of our journals.
Best wishes,
Springer Nature