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Concerned About Unconventional Mental Health Interventions?

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

Sunday, September 9, 2018

Separation of Migrant Children: Commenting on Proposed HHS Rule Change

Some readers may be aware that the Department of Health and Human Services proposes to make a change in the Flores amendment that (in theory) limits separation of  undocumented migrant children from their parents to 20 days.  The new rule is described as:
The Department of Health and Human Services (HHS) Proposed Rule: Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children

You can comment on what rules should apply in these cases by going to 


Here is the comment I posted:

I am a developmental psychologist and the author of a book on infant development, one on emotional attachment in childhood, and textbooks on child development. I am concerned about the assumption that a HHS rule about separation of children from parents can be equally appropriate for children of all ages, birth to 18 years.  Clinical and observational studies of child development show that the impact of separation on children is most severe during the toddler period, roughly 10 months to 3 years of age. Preschool children are also negatively affected, but because of their better language development,  can tolerate separation somewhat better than toddlers can. Both toddlers and preschoolers show the impact of abrupt and long-term separations by crying, withdrawal, failure to play or explore, and problems with eating and sleeping. Notably, if separation  goes on for more than a few days, these effects will not disappear when the child is reunited with a parent, but will continue to be apparent for weeks or months, as the child has sleep problems or nightmares, is easily startled and frightened, and both clings to and behaves aggressively toward the parent. These reactions are difficult for any parent to cope with, but are especially so for a parent who is also frightened and distressed about an uncertain future.

School-age children are also distressed by separation, especially when they are confused by a new language, but their reactions and long-term responses are much less seriously negative than is the case for toddlers and preschoolers. In my opinion, decisions about rules on treatment of separated migrant children should focus on care of toddlers and preschoolers if triage needs to be done because of limited resources. Ideally, toddlers and preschoolers would remain with parents in whatever detention is used. A less ideal solution, but a better one than seems in place at this time, is that separation be limited to 20 days at the most, and that care for the separated young children follow guidelines for high-quality child care as provided by organizations like the National Association for Education of Young Children (NAEYC). These guidelines would set maximum numbers of children to be cared for by one caregiver , with a ratio of 1:3 for the youngest children in this group and 1:5 for older preschoolers; would provide that children have assigned caregivers rather  simply placing a number of caregivers to work with all of the children in a large group: would provide that these young children be cared for in small groups rather than large rooms full of children; and would emphasize individualized care for the children, with physical contact and talking prioritized.

Much concern has been expressed in recent years about the physical and mental health consequences of adverse childhood experiences (ACEs), and how these consequences continue into adult life. Most migrant children have already experienced a number of ACEs in their home countries-- these being the reason for the family's migration-- and have often experienced more on their journeys. For toddlers and preschoolers, separation from familiar caregivers is a seriously adverse childhood experience in and of itself. When this separation is abrupt and long-term, when the separation has occurred in frightening, even violent, circumstances, and when young children do not receive the care that could help them escape the worst effects of these events, we must consider the accumulation of traumas  that are being inflicted and their real consequences. Although we cannot undo the effects of earlier ACEs on migrant children, we can refrain from subjecting them  to further distress and further needs for social services that neither they nor their parents may have access to.

I do not mean by these statements to minimize the distress of 6- and 7-year-olds or of older children when confined to prison conditions following terrifying events before and on their journeys. However, my concern is that it is developmentally inappropriate and potentially harmful to assume that the youngest children can tolerate abrupt separation and the apparent loss of all they know in the same way that older children and adolescents can manage. It is time for the HHS rule to recognize the different needs of younger and older children and to assign resources accordingly.



*********** Readers, if you would like to comment on this issue, you should understand that you do not have to identify yourself or explain your credentials as I did. There is also a checklist that you can read before commenting that will give you an idea of how to approach this. I hope people will speak up while the chance exists. 

Monday, September 3, 2018

Autism Treatments, Science, Risks, & Benefits


The Association for Science in Autism Treatment (https://asatonline.org) is an interesting organization that includes some big names ( like Tristram Smith) and seems to have the admirable goal of providing information about autism treatments that can help parents make their own choices of treatment. The website has a considerable list of specific treatments and the empirical evidence that supports them, if there is any. It’s a good place to find definitions and descriptions of both well-known and obscure treatments that target autism spectrum disorders.

Looking at the evidence for various autism treatments as discussed at asatonline.org, we’re reminded of the great difficulty of outcome research in general and work on autism in particular. Because therapies have shared general factors (like individual attention) that can cause improved outcomes, it’s important always to compare the outcome of a type of treatment to the outcome seen when there is no treatment, or a treatment whose effectiveness is already known. It’s not enough to report that a group of people did better after a treatment than they did before—they might have done just the same (or even still better!) if they had no treatment at all. When a study focuses on children, this is a point of special importance, because children change quickly as a result of their natural development, even if they are on an unusual developmental trajectory like autism.

When a comparison group is used in studying treatment outcomes, it’s essential that every person being treated has an equal chance of getting into the treatment group or into the comparison group. They need to be randomly assigned to groups, not allowed to choose for themselves which group they prefer. If that’s not done, it may appear that a treatment is more effective than the comparison simply because the people who chose it are in better shape to begin with or are more sensitive to treatment.

You can see how difficult these things may be to do, especially with respect to autism. Permission for autistic children to be in outcome research has to be sought from their parents, who may be horrified at the thought that their children will be “guinea pigs” , may be frightened of what researchers might do, may be extremely protective of their vulnerable children, and may simply have so many demands in their lives that they cannot cope with the inconvenience of being responsible  for participation in research. They may resent the idea of having their children assigned at random to treatment conditions or to a comparison group, even if they are promised that each child will eventually get treatment. The children themselves may be reluctant, anxious, oppositional, or in other ways require a great deal of individual handling.

It’s far from surprising that no autism treatment has nearly enough empirical work supporting it, and it’s to the credit of ASAT that they do their best to make this plain. However, there are some points they fail to make as clear, and I am not sure whether this failure occurs because the website authors don’t want to offend anyone who proposes an autism treatment.

The first problem I see on this website is that quite a few proposed treatments are listed under the heading “doesn’t work or is untested”. Now, although I am quite aware that it is not possible to show that something does not exist (unless you can find some mutually exclusive thing that can be shown to exist), but I would argue that there is a big difference between treatments that have been thoroughly tested  and shown to be ineffective, like Facilitated Communication, and those that have never been tested in any systematic way, like Son Rise.  When a treatment has been systematically tested, there are some things we can know about it, for example that there are people who have been trained to apply the method in a predictable way. In addition, we have evidence that the treatment does not make a condition worse; not all therapies are really “therapeutic”, and some actually exacerbate problems. Systematic investigation of a therapy can also tell us whether other forms of harm were done, including whether autistic children (or others) found the treatment distressing or frightening. Choosing a treatment scientifically requires attention to both demonstrated benefits and demonstrated risks of the treatment.

The asatoline.org website is not very different from some similar sites with respect to this problem of grouping together untested and tested but ineffective treatments. The California Evidence Based Clearinghouse for Child Welfare (www.cebc4cw.org) similarly confuses issues  as it rates treatments both in terms of their evidence basis and of their importance for child welfare concerns; users may not notice the difference between these ratings. In addition, cebc4cw.org bases its rating on information provided by advocates of treatments. The California site also rates many of the listed treatments NR (not rated) because no evidence is provided—leading to a situation somewhat like that of asatonline.org, where the listing of a treatment does not necessarily indicate that its outcome has been tested systematically or that it has been shown to be effective.

A second problem of the asatonline.org site is that the material presented mentions almost nothing about potential harms associated with treatments. This topic has received increasing attention over the last twenty years or so, and that attention has been strongly focused on unwanted effects on vulnerable individuals like autistic children. The journal Clinical Psychology is preparing to do a special issue on potentially harmful psychotherapies. Potential harms from mental health interventions can range from physical injury and death to “opportunity costs”, the loss of opportunities to make use of effective treatments or of limited resources like time and money that might be better spent on other needs of an autistic child or of other family members.

The ASAT website lists “patterning” as an ineffective or untested treatment. Patterning is a physical movement therapy that involves having five adults move a child’s head and limbs through positions characteristic of infant reflex movements, on the assumption that the nervous system can be “rebuilt” by this reenactment of early life. Patterning for autism and nervous system injuries has been rejected twice by committees of the American Medical Association It  has not only never been shown to be ineffective, it also has the potential for physical injury as untrained people move the child’s head and limbs into different positions. Above all, patterning has opportunity costs, as it is to be done several times a day, exactly on schedule, by a number of adults greater than is found in most Western households. Patterning is privileged over adult work and the needs of other children in a household, so that family functioning is negatively affected, as are relationships with family members, friends, and neighbors who are repeatedly asked to help with the therapy.

Similarly, asatonline.org lists Faciitated Communication (FC) as an unsupported or untested therapy for autism. FC is a method by which an adult works with a child to use a keyboard with the intention of understanding thoughts the child cannot express in speech. FC has received systematic investigation and it has been demonstrated that what is “said” on the keyboard stems from the beliefs and thoughts of the facilitating adult, not the child. The website makes this clear, but does not note the harm done to a number of families when a facilitating adult used the keyboard to accuse a family member of sexual abuse of the child, causing a criminal investigation with all its associated stress and mutual distrust in the family.

The ASAT website lists under unsupported and untested treatments two associated therapies, one under the name “bonding (attachment ) therapies “ and the other under the name “holding therapy”. The first covers both holding therapy and “gentle teaching”, although holding therapy appears again under its own name. Egregiously, neither of the references to holding therapy gives a complete description of how it is done and the potential for physical and psychological harm inherent in this coercive restraint treatment, although the first description does use the word “forcibly” and warns parents against covering the child with blankets as part of this method. The first description also notes that autism is not a bonding or attachment issue, so a therapy that is posited to increase attachment is in any case irrelevant. Both descriptions end with the idea that well-designed and implemented research on holding therapy is needed. None of the risks, child injuries, or deaths associated with holding therapy are mentioned. The pain and fear experienced by children undergoing this treatment are well established and are frequently discussed by adults who went through holding therapy on a closed Facebook group called “Attachment Therapy Is Wrong”.

I find it quite disturbing that a website stressing a scientific approach should omit well-known information about the potential for harm shown by some treatments. The risks associated with holding therapy have been understood for over two decades. A scientific approach must examine both risks and benefits of a treatment, even one for competent adults--  when the patients are autistic children who cannot make their own choices, the information give to parents must be particularly concerned with the potential for harm. 

I'm going to add to this post a statement made by an English man with autism, Les C., now an adult, about his childhood experiences with holding therapy: 


My life experience as a undiagnosed autistic/ aspergers child.

My parents have always said that my problems started when I started school. At age 4 I went to playschool with my mam, so I was never left with other children, until my first day at primary when I was 5.
I was very upset, and I could not understand why my mam had gone home and left me, so during most of the day I sat crying and saying I wanted to go home and I didnt like being with other children who just got on with it. After break time when the whistle was blown, all the other children lined up ready to go back inside, while I ran the other way onto the field and rolled on the grass. I vaguely remember doing this and maybe because I thought it was funny to get the teacher to run after me.
The head teacher had said to my mam that my behaviours were not acceptable and that I could end up in borstal if something was not done. In a later year, I found out that I was the only one in the class that was adopted when someone in the class mentioned it, but I didnt know what it meant, and the other children seemed to treat it like a joke that I didnt have natural parents. My mam explained to me what it meant and at first I felt left out, but I didnt have a problem with it, but my parents started to think that I did.
Over the years I never mixed or made friends like others did, and had many problems at home and at school. My parents found my behaviour very alien and badly behaved. I was born in the 70s when in them days some parents punished with shouting and slapping. I was also taken to see numerous  child psychologists and councillors, where my parents would do the talking, while for me I could not communicate. My mam had read some information on autism which was very little at the time, and mentioned the possibility to a psychologist of me being autistic, but they said no and that I was just a very naughty attention seeking child. My autism has affected me differently to how it has other people. I see and feel things differently to others. I could not help the way I behaved, and my parents could not cope and were getting to their wits end. For me I had a high sensitivity of being physically touched in childhood. I was fine with my parents holding my hand to go out or being asked for a light hug, but anything more than that was uncomfortable and distressing if pushed over my limit.
If my mam came and touched me or to put her arms around me, I would resist and push her away. To a parent, that may seem perfectly natural and comforting, but to me it was not, but as a child I couldn't think of a way to explain it. The times when I was slapped for something wrong, and what is just a little tap to a parent, was like a big bash over the head for me, so I naturally went berserk, and retaliated and all hell breaks loose. I wondered when are they going to get the message that its painful for me to be touched.
Every so often I had to go to hospital appointments to see a orthopaedic doctor about my legs because they were not growing right along with my weight issue. Again I hated these appointments because of the touching, so I was probably being awkward. The doctor included in the medical notes that I was out of control and disturbed in some way. When the time came that they felt I needed to have surgery, which I didnt want and still wish I had not, because I wasnt unhappy with the way things were. My parents were concerned about my mobility in case I ended up disabled, so I didnt get listened to, and was taken to hospital, which I thought was a good way to get off school because I was bullied with no friends, and I was early years at the big school now. I was pressurised into having it done. The nurses were horrible to me, they treated me like I was some sort of a freak, and didnt care about my pain until I asked for painkillers. I hated them touching me to remove my stitches and dressings. My leg was stiff, they told me to bend it, or they would get the physiotherapist onto me. The physio came and she was great with the other children on the ward, but she was nasty and brutal with me while the others watched me scream, cry and shout in pain.
I assumed the nurses told my parents everything that happened, but they had not, and they would not have allowed this if they did. It sounded like the psychologist I was under at the time told my parents and the hospital staff not to listen to me. Time off school for another traumatic experience of pain and physical touch, I was no better off.
Sometime later after that, I decided I wanted to spend some time on my own away from home and school. I had bath, got into my favourite clothes and left with my savings book without saying anything. I was found by the police and brought home, and they all wanted to know why I did it.
I did this on 2 occasions, and the 2nd time, 2 nice policemen brought me back and said if I went missing again I would be taken into a home.
My parents thought that I did this because I was adopted, so again I was taken to see a doctor who introduced me to a lady that I could see and talk to and go out and do things with, and that she was adopted too. I did not want this because I didnt really have a problem with it.
Then later my mam read something in a magazine about holding therapy, or someone that had told her about a lady that did it. She did not know what it was or what it was all about, but she told me that we were going to see a lady that could help. A lady who learnt from Welch, unknown then.  As usual, I would just be sitting listening to my parents tell her about everything including our rows, being pushed away and that I was adopted. Surely with experience with others, she should know that I have a resistance to being touched. So what sounded very nice and loving to my parents was agony to me. The distress I have had with unwanted physical touch was bad enough. My parents were desperate for a solution, so they listened to whatever she said to do a hold no matter what I was to say or do to get away from this prolonged uncomfortable painful touch.  A week later, after it had happened 3 more times at home, including the lady coming to our home where another session took place, and seeing her doing this on a TV documentary with others, I was lucky that my dad put a stop to this because he couldnt see how it would solve anything, and he did not like the atmosphere, and for me this had greatly pushed my limits of touch over the top to torture.  My grandparents at the time were told about this, and they agreed that my dad did the right thing. After this last resort, my parents just had to accept the way I was.
END.
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Friday, August 24, 2018

Refusing to Visit a Divorced Parent: Reasons Other Than "Parental Alienation"

There is no question that some children and adolescents in divorced families refuse to visit one of their parents. It’s also very possible that some of these reluctant kids have been influenced by the attitudes or even the insistence of their preferred parent. What’s not so likely is that all cases of resistance or refusal on the part of children, unless they are connected with abusive treatment, are matters of “parental alienation” deliberately brought about by the preferred parent’s campaign of denigration against the other parent.

Very few human attitudes or behaviors are determined by single factors in the way proposed by parental alienation (PA) proponents. That’s why psychologists tend to be suspicious when they come across single-factor theories or theories limited to a very small number of factors but used to explain complex situations. Unfortunately, single-factor theories—so easy to explain, and apparently, to understand—are all too easy to introduce into legal decision-making, while more complex and realistic views may be excluded.

The PA view has been that there are only two categories of children who resist or refuse contact with one parent. One group has been physically abused by that parent, and the abuse has been documented, so their reluctance is seen as rational. The other group, with no documented history of physical abuse, have only  “irrational” explanations for their aversion to one parent, and therefore must have been intentionally alienated by the parent they prefer. A range of bad consequences for the children are predicted if they remain with the preferred parent, and a complete change of custody is demanded.

Given that it’s possible that the PA claims are true in some cases, can we list some other possible reasons for children’s avoidance of a parent in the absence of a history of physical abuse? Of course we can, and I am far from the first to mention this. Children and adolescents may prefer to exercise their developing autonomy; to stay in the house they call home rather than having to go back and forth; to be in easy reach of their friends; to spend their time with friends’ companionship rather than having to devote time to a parent; to avoid criticism or demands from a parent or emotional abuse; to manage to ignore a parent’s disturbing sexual or romantic relationship with one or more new partners; to avoid a step-parent, step-siblings, or parents’ boyfriends or girlfriends; to arrange school, sports, or social activities as they prefer; to escape from questioning about the preferred parent.

 Any or all of these issues may have very different impacts on children at different ages, so the child who at age 8 was indifferent to a parent’s romantic life may at age 14 find any evidence of such excruciatingly embarrassing. A child who at age 12 was delighted to spend a weekend camping may at age 16 want only to socialize with peers. In addition, individual differences in temperament may make one child easily distressed by unsought changes, while a brother or sister of different temperament can accept changes with equanimity.

When we examine psychological and behavioral issues that are not well-understood, one useful strategy can be to find some analogous events that are easier to study. Given that there are so many factors that can help to explain a child’s avoidance of a parent, it seems to be a good idea to find some parallel situation that may give insights into this kind of avoidance. Are there other things children avoid with intense emotion and resistance? Yes, and one of them is not uncommon: school refusal. About 35% of children sometimes  refuse to go to school without a “rational” explanation--  some do this infrequently, while others may manage to avoid school most days for long periods of time. Children who refuse school not infrequently fight against going to school each morning, plead stomachaches, even vomit, scream and have tantrums. The great majority of their parents do not like this, want the child to go to school, fear the consequences for their own work responsibilities, and are disturbed about the social and educational outcomes for the child.  (Parents who actually want the child to stay at home have the option of homeschooling, after all.) The parents don’t know what to do to get the child to go to school, and it is noticeable that they are rarely if ever accused of alienating the child from school.

In a 2009 article in Child Development Perspectives (Pina, Zerr, Gonzales, & Ortiz; “Psychosocial interventions for school refusal behavior in children and adolescents”, Vol. 3, pp. 11-20), the authors discuss children’s motivations for refusing school. I will list these, and in each case state in brackets a possible parallel with refusal to visit a parent:

1.      1.To avoid school-based stimulation like bullying that provokes negative emotion such as anxiety and depression [A child avoiding a parent may also be distressed about parental behavior that is anxiety- or depression-triggering, such as criticism of the child or the other parent, demands for more time or attention, poor parenting skills, insufficient attention paid to the child when he or she is present, or issues that have to do with the parent’s home, friends, or partners and their children]

2.      2. To escape aversive social or evaluative situations like difficulty in making friends or public exposure for lack of school achievement [A child avoiding a parent may find it difficult or awkward to have social interaction with that parent, especially a parent who lacks social or parenting skills, or may feel exposed to criticism for failures to perform scholastically or athletically to the parent’s expectations]   

3.      3. To get attention from significant others such as parents and concerned teachers [A child avoiding a parent may find his or her behavior rewarded by the attention of one or both parents who have been distracted, perhaps for several years, by their own marital situation]

4.      4. To pursue reinforcing events outside school, like playing or shopping [The child avoiding a parent may enjoy his or her own devices, toys, and books and “own room”, as well as familiar foods and routines, a parent who is easier to be with, and the availability of siblings and friends]

In addition to this list of motivations with their possible parallels in avoidance of a parent, Pina et al noted characteristics of children who refuse school, such as poor social skills, social isolation, high levels of family conflict, and a poor sense of self-efficacy in stressful situations.

For a better understanding of why some children refuse to visit a parent, we might do well to examine these aspects of school refusal and see whether the behaviors are analogous in more than a superficial way. PA proponents have not gotten very far in terms of basic science by insisting on a single factor operating in cas

Friday, August 17, 2018

Choosing Residential Treatment Centers with Family Engagement (When It's Necessary)


A year or so ago I commented on the real shortcomings of some residential treatment centers (RTCs) focused on child and adolescent behavior and mood problems, especially those associated with the CALO group (https://childmyths.blogspot.com/2017/07/calo-and-transferable-attachment-love.html). As we have seen repeatedly for many years now, residential treatment in the form of psychotherapeutic programs or of “specialty schools” can feature cruel, unsafe, and ineffective practices that aggravate existing problems—sometimes by forcing young people to “confess’ to behaviors that never occurred, or by using isolation and restraint as punishment.

In more than a few cases, the problems that cause a child to be placed in a RTC are ones that can be overcome by treatment of the family as a group and especially by training of parents in management skills. But often families do not realize the difficulties that are developing with a child’s behavior until adolescence is upon them and they are faced with a large, strong, defiant individual who is able to act out sexually and whose aggressive actions can have serious outcomes. When children become involved with drugs and gangs, when they threaten their parents or siblings, when they are frightening to school and neighborhood contacts, when the police are summoned, there may be few choices open except residential care.

The question is, does a RTC simply incarcerate the young person, or does it provide treatment that will make possible a return to society and a normal developmental trajectory for education and work?  How can a family decide which RTCs will provide this help, and which will simply keep the child off the streets for the time being?

Peter Gillen, writing in the September 2018 Brown University Child and Adolescent Behavior Letter (a very useful source!) notes the challenges presented by children with severe emotional disorders who present chronic safety issues in their homes, as well as in their schools and communities. He describes a “roller coaster” of treatment successes and failures that lead to continued needs for mental health care, and the revolving door of services that cuases children to think of themselves as “bad kids”. Gillen also points out the real criticisms of RTCs such as “the significant costs, the lack of empirical evidence demonstrating their clinical effectiveness, the potential iatrogenic effects from exposure to others’ maladaptive behaviors [potentially both those of other children and of staff members—JM], the disruption to the caregiver-child attachment bond, and the poor maintenance of post-discharge progress” (p. 6). As a result of these criticisms, Gillen comments, a workgroup has recommended a set of principles with shared values that should govern what they call “therapeutic residential care” (TRC).

An important principle suggested by the workgroup is “building a strong partnership with families and engaging them in a meaningful way throughout the residential process”. Family involvement and contacts appear to lead to more successful completion of treatment and better outcomes for the children. Examples of family involvement are “integrating caregivers [parents and family members] into the daily routines of the residential programming, considering caregivers as the experts of their children’s needs, and improving the overall family’s functioning”, including sibling relationships as well as relationships between parents and the child in treatment.

In an exemplary program at Bradley Hospital in Providence, RI, families participate in weekly family therapy, have phone contacts updating them on issues like schoolwork, and have home visits. At a weekly Family Night, “families are invited to attend a one-hour family-style dinner with a free meal for all, followed by a one-hour caregiver support group with free child care fro siblings. Family Night brings families together with a focus on practicing the real-world skills of sitting and talking together as a family”—without cellphones.

Gillen notes about the Bradley Hospital program that one of its ways of partnering with families is to recognize and discuss their ambivalence about the decision to place a child in a residential program. These families recognize on the one hand the safety issues of keeping a child in the home and community, but on the other hand feel sadness and guilt about what they perceive as their failure, as well as concern that the child will feel unwanted and unloved as a result of the decision.

Historically, many RTCs have fostered the view that families need to deliver a challenging child to the ministrations of staff, need to stay out of the picture except for paying the fees, and can expect to receive the child back at some point (perhaps age 18), “fixed” or otherwise. Certainly some RTCs severely limit children’s contacts with family members other than parents, particularly if their programs claim that they are focused on child attachment issues. Gillen’s article notes the lack of evidence for effectiveness of programs with these positions, and I would point out the strong possibility that such programs can be part of the “school to prison” (or other institution) pipeline.  

Most parents who feel they need RTC care for a child will ask questions about the physical facility and about the experiences the child will have. Gillen’s comments suggest that the time has come for parents to explore carefully the role they themselves will play in residential treatment.  The idea of family engagement has been an important part of preschool education philosophies for many years, and it is associated with improved outcomes for children. It may well prove to be an equally important factor in residential therapeutic care for children and adolescents.


Thursday, August 16, 2018

Are Parental Alienation Organizations Cult-like in Nature?


In the litigious atmosphere of the modern United States, it is common for personal, professional, or financial allegations against someone to be brought into the courtroom as ways for another party to achieve a goal. Divorce courts and family courts frequently see arguments based on such allegations, deployed for financial or other gains. An increasingly common allegation by one parent against another is parental alienation—generally defined as the refusal of a child to have contact with one parent, in the absence of rational objections (usually limited to a history of substantiated physical or sexual abuse), and as the result of a campaign of denigration and “brainwashing” by a favored parent. When parental alienation (PA) is successfully argued in the courtroom, the consequences for the accused parent may be dire, involving prohibition of contact with the child and financial responsibility for treatments offered by PA proponents. This continues despite the absence of evidence supporting the PA diagnosis or the safety and effectiveness of the treatments used.

The question I want to raise in this post is whether some organizations promoting PA concepts and treatment methods are in fact similar to cults.

Let me state at the beginning that I am far from claiming that PA cannot happen. I have no doubt that this parental behavior and child outcome do sometimes occur. However, I am equally far from accepting that the behavior and resulting outcome are present in most of the cases where PA allegations are made. The burden of proof for a claim to that effect is on PA proponents, who have not provided evidence either for their diagnostic approach or for the treatments they advocate.

Given that no adequate evidence has been provided, and that organizations nevertheless strongly support PA views, the obvious question is how and why people are persuaded that claims about PA are valid.  Do the  practices of  PA groups resemble those of cults?

The  Wikipedia definition of cults says this: “The term cult usually refers to a social group defined by its religiousspiritual, or philosophical beliefs, or its common interest in a particular personality, object or goal. This broad definition would include the Boy Scouts, the Green Party, and the Pennsylvania Association for Infant Mental Health, because of their common interests and goals, and presumably PA advocacy groups also fit here. But most uses of the term imply or say overtly that a group called a cult is potentially harmful in some way, to its members or even to society in general. To match that aspect of the meaning of the term, various checklists of cult characteristics have been offered.

For example, material at https://www.theguardian.com/commentisfree/belief/2009/may/27/cults-definition-religion, proposes that cults have these characteristics:

·         Absolute authoritarianism without meaningful accountability.
 No tolerance for questions or critical inquiry.
 No meaningful financial disclosure regarding budget or expenses, such as an independently audited financial statement.
 Unreasonable fear about the outside world, such as impending catastrophe, evil conspiracies and persecutions.
 There is no legitimate reason to leave, former followers are always wrong in leaving, negative or even evil.
 Former members often relate the same stories of abuse and reflect a similar pattern of grievances.
 There are records, books, news articles, or broadcast reports that document the abuses of the group/leader.
 Followers feel they can never be "good enough".
 The group/leader is always right.
 The group/leader is the exclusive means of knowing "truth" or receiving validation, no other process of discovery is really acceptable or credible.


Here is another checklist of cult characteristics, from
http://www.anandainfo.com/cult_checklist.html (an excerpt from the book "Captive Hearts, Captive minds", by Madeline Tobias and
Janja Lalich adapted from information compiled by Dr. Michael Langone). The introduction to the checklist makes it clear that cults are to be identified when they have many characteristics from this checklist; a small number may be found in non-cult organizations, and an actual cult may not check every box.

                           Checklist of Cult Characteristics


1) The group is focused on a living leader to whom members display excessively zealous, unquestioning commitment.

2) The group is preoccupied with bringing in new members and/or making money.

3) Questioning, doubt, and dissent are discouraged.

4) Mind-numbing techniques (for example: meditation, chanting, denunciation sessions, or debilitating work routines) are used to suppress members' doubts.

5) The group's leadership dictates how members should think, act, and feel (for example: members must get permission from leaders to date, change jobs, or get married;) leaders may determine types of clothes to wear, where to live, how to discipline children, and so forth.

6) The group is elitist, claiming a special, exalted status for itself, [its] leader(s), and members (for example: the leader is considered the Messiah or an avatar; the group and/or the leader has a special mission to save humanity).

7) The group has a polarized we-they mentality that causes conflict with the wider society.

8) The group's leader is not accountable to any authorities (as are, for example, military commanders and ministers, priests, monks, and rabbis of mainstream denominations).

9) The group teaches or implies that its "superior" ends justify means that members would have considered unethical before joining the group (for example: collecting money for bogus charities).
10) The group's leadership induces guilt feelings in members in order to control then

11) Members' subservience to the group causes them to give up previous personal goats and interests while devoting inordinate amounts of time to the groups’.

12) Members are encouraged or required to live and/or socialize only with other group members.

We can look at a parental alienation advocacy organization and evaluate the number of characteristics it shares with the stated cult characteristics. Some examples can be drawn from the website of the 501 c(3) organization Simply Parent, https://www.simplyparent.org.
Simply Parent invites persons who feel they have been victimized by PA to join a Parent Speak meeting. Here are some questions addressing the appropriateness of such meetings for individuals who may be interested:
 a society free of parental alienation, where good parenting is protected in its diverse genesis, forms and colors
 Do you struggle to recognize yourself in self-help books or common parenting stories?
Have you withdrawn from your support networks because they cannot relate to what you are going through?
Do you feel mocked by others’ responses or advice?
Then, states the website, “ Parent Speak meetings are for you. Completely anonymous, these meetings are by and for parents like you because you deserve to be supported, nurtured and uplifted.”
 At https://www.simplyparent.org/working-groups, the website invites interested parents to join the “movement” and its working groups. Acknowledging that people may have different motives for joining, the page answers the question “What’s in it for you?” in several ways. Possible rewards for the joiner may be:

1.      1. Retribution, on behalf of all those whose darkest hour is brought on by biased, archaic, and inhumane systems intended to serve them

2.     2. Network of leading thinkers across research, professional practice, media, policy, and more…

3.      3.Exposure to the cutting edge of a force that will shortly affect millions of people and redefine professions

4.     4.  Influence over an emerging public health and social justice frontier

5.    5.  Kudos—both personal and professional—for not only being on the right side of an emerging movement, but for having the foresight, expertise, and commitment to shape it.

[A note at the bottom of this list again assures readers that they may remain anonymous, though it is not clear how personal kudos is to be enjoyed by anonymous people.]


Without at all wanting to claim that these lists are perfectly accurate or reliable, I want to consider the question of how much do these things overlap--  the cult characteristics or checklist, and the questions and statements of Simply Parent?

Let’s look first at the questions posed to potential members who may feel isolated, mocked, etc. These questions appeal to a we-they polarized mentality that places members in opposition to the wider society. They suggest unreasonable fear about the “outside world”, including the possibility of conspiracies that work against these individuals. It is implied that the group has a special status and mission. These questions alone show that the organization shares some characteristics with cults.

The “what’s in it for you?” section reveals other cult-like characteristics, including an emphasis on adding new members:.

1.     1. “Retribution…”: Again, a we-they polarized view is shown. A special mission of the organization is suggested. The group is not only unaccountable to authority, but planning to take steps that will control and shape outside authority.

2.     2. “Network of leading thinkers…”:  The group is shown as the means of finding truth, is always right, and is the source of absolute authority drawn from credentialed persons who agree with the group.

3.     3. “Exposure…”: The special mission of the group is shown here, with predictions about dramatic social changes to be created in the form of what the website calls a “battle plan”.

4.      4.“Influence…”: Again, there is a special mission in which interested people are invited to take part.

5.    5.  “Kudos…”: A we-they polarized view places members in a superior position to those outside the group and identifies the group as the source of knowledge about the mission and ways to achieve it.

While Simply Parent’s website shows some overlap with identifying characteristics of cults, there are some characteristics that are absent or for which no information is available. For example, it is unknown whether people ever leave the group, what pressures they may find themselves under, or whether there is criticism or punishment for those who go. Nothing suggests that members are confined to socializing with other members (although if they feel isolated and mocked by outsiders, they may tend to do so). Clothing and other everyday concerns do not seem to be issues, although certainly the entire PA concept stresses a single way of handling specific child behaviors and attitudes as the primary focus of the group and the reason for the existence of the organization. Whether group members feel they can behave unethically in order to achieve their goals is not stated, though in my own experience another PA group was willing to use subterfuge in order to have an exhibit booth at a psychology conference. There is no living leader mentioned as an absolute authority on the Simply Parent website, although the PA proponent Craig Childress seems to take this position on his own website, as he claims a complete reformulation of developmental changes in attachment.

The cult characteristics lists that I gave earlier do not mention some items that I see in the Simply Parent material. One is a “come the revolution” approach with goals and promises of changing laws and social attitudes, which is not characteristic of small “end of the world” or “guru” cults, but is seen in larger groups like the Scientologists. A second is a sense of grandiosity, as in claims that millions of people will soon be affected by the work of the organization. A third is the apparent appeal to narcissism, as members are invited to join with persuasive statements about the advantages of the organization for individuals who have been “mocked” but will now attain power and even participate in retribution against those who have rejected them. These two items are of particular interest because PA proponents claim that those they accuse of “campaigns of denigration” are grandiose and narcissistic and will cause the alienated children to develop those problems as well. Whether grandiosity and narcissism are common elements in cult-like organizations is not clear, although certainly such characteristics, if not excessively blatant, would be advantageous for a cult leader, and might well make an organization attractive to those whose own personalities were reflected in that of the leader.

One final comment: the absence of one factor is painfully evident in the Simply Parent material, as far as I can see. This is any statement of concern about the needs of the children whose welfare is the supposed concern of PA advocates. If this is a cult-like organization, it is one whose mission involves “simply” parents and not children.     



How
Hs lists overlap accompanying exam.

Monday, August 13, 2018

Of Pigs, Parlors, and Unconventional Views of Attachment Disorders



On a number of occasions I’ve pointed put how Christian fundamentalists have attributed mental illness to demonic possession, and demonic possession in turn to some malfeasance, not just of the possessed person, but perhaps of a near relative or parent. I’ve felt a little guilty about making this connection and citing (for example) Pigs in the parlor, a book originally published in the 1970s but reprinted more recently. Maybe (I’ve said to myself) I’m not being quite fair to present-day fundamentalists—maybe they have dropped these ideas and I just don’t know about it.
But, no. My finger-pointing was fair. The pig-in-parlor analogy is still at work. For example, see the following article: Owen, C. (2017). Obscure dichotomy of early childhood trauma in PTSD versus attachment disorders. Trauma, Violence, & Abuse. https://doi.org/10.1177/1524838017742386.  I can’t quite figure out what is going on here, but this article may originally have been published under a different title in 2016 in Fidei et Veritas: The Liberty University Journal of Graduate Research. This is not a veiled accusation—I have only found this at ResearchGate, and the sources are not easy to follow.

In any case, Owen begins by objecting to the 2013 descriptions of Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in DSM-5. She insists that these descriptions fail to include many symptoms she ascribes to RAD, such as lack of conscience, destruction of property, pathological lying, food hoarding, etc., etc., combined with superficial charm. These symptoms and behaviors, which have never been considered to be aspects of RAD except in an alternative, fundamentalist-influenced belief system, are the ones described by Hall and Geher (2003), whom Owen cites. For example, Owen states that “Some of the typical RAD behaviors (such as deliberate enuresis/encopresis) are designed as self-defense measures to repulse caregivers and make them back away from the childthus insulating the child from further rejection and trauma” (p. 3)..Hall and Geher picked up this list, including this quite unsupported claim of intentional wetting and soiling-- from an obscure paper by Reber (1996), in which the author stated firmly that these are symptoms of attachment disorders—without referencing any empirical work or even speculative peer-reviewed material to support his claims. Owen sees DSM-5 as omitting full descriptions of RAD, rather than realizing that the symptoms she lists have never been associated with RAD by any of the mainstream researchers like Zeanah whom she also cites. Some, but not all, of them have been described as aspects of PTSD, but it is not, as Owen suggests, inexplicable hat they are not included as part of RAD. They may be part of problems that are co-morbid with RAD, but they are not part of RAD—by definition.

Owen’s paper continues with a vivid, not to say histrionic. account of an adopted child who was extremely uncooperative, screamed, bit herself, ran away, and made her family’s life difficult, despite “intensive” treatment, including holding therapy (which Owen interestingly classes as a fringe therapy even though she appears to accept many of the beliefs behind the use of this treatment). The child’s treatment at the time of Owen’s writing was in a residential program described as a “non-profit ministry”.

Owen’s treatment plan for the child contains elements of family therapy, of psychoeducation, and of TF-CBT, but also sets as a treatment goal “Train the child up in the ways of the Lord without inadvertently retraumatizing her”. This goal is of interest first in its acknowledgement that this kind of training may be retraumatizing, but also in its emphasis on religious authority as a source of decisions about needed behavior change.

Owen goes on to search for religious argument about the causes and cures of mental illness, and she finds it in the work of the Texas Christian  University psychologists David Cross and Karyn Purvis.  Using Scripture, Cross and Purvis defined the nature of evil, the nurture of evil, the roots of evil, and the pathology involved. In the end, they concluded ‘with some degree of certainty, that although not all maternally deprived (or psychologically abandoned) individuals will become antisocial, virtually anyone who in fact becomes antisocial will have been maternally deprived’ (p. 77). Thus, it is clear that ‘maternal deprivation may actually be the root of all evil’ (Cross & Purvis, 2008, p. 77)”[typos corrected-JM]. Owen thus accepts a convoluted argument about the existence and causes of evil as a substitute for consideration of the complex causes of antisocial behavior, omitting, in particular, the factors that would have to exist in addition to maternal deprivation in order for the Cross and Purvis statement to have a possibility of accuracy. But presumably shifting codes from the psychology of early development to a statement of religious belief has been taken by Owen as a good way to avoid either empirical evidence or strictly logical argument.

Toward the end of her article, Owen abandons the pretence that the discussion is about identifiable trauma or about treatments like TF-CBT.  Instead, she says this: “ Christians need to be aware of and vigilant against the dark spiritual forces that undergird these children’s behavioral and emotional disturbances (Eph. 6:10-18). Above most other disorders, the dynamic of the conflict in children with PTSD from ECT [early childhood trauma] and their new caregivers has a particularly demonic element to it. Many of the night terrors, for example, include emission of a deep, guttural-growl that sounds non-human. The level of rage and cold, calculating revenge that these children can inflict (i.e. evidence of deprivation, according to Cross and Purvis,2008) defies rational explanation ….Competent counselors in full armor who recognize a child with PTSD from ECT as rooted in fear and work to overcome the dark, spiritual influences that threaten to destroy the family, can help bring hope and healing to these families in a way that those treating for RAD/DSED cannot” (p. 16).

If I interpret these last sentences correctly, the claim seems to be that for full religious authority and therapeutic power, practitioners need to accept the argument that the RAD/DSED categories are wrong, and that they are wrong because they do not fit into the belief system shared by this author and other Christian fundamentalists. Acceptance of a scientific view that excludes supernatural causes and demon possession makes good therapeutic outcomes impossible, Owen implies.

The pigs of yore seem to have been moved out of the parlor and into the clinic.