Thursday, December 12, 2013
Everybody knows that medical and surgical treatments can be frightening, humiliating, and painful to undergo. When there’s evidence that they are effective, though, we grit our teeth and make ourselves go through with them. Parents may have to make decisions to put young children through very distressing treatments, without being able to explain the reason to them, and as an article in the most recent issue of Zero to Three points out, the experience may be traumatic for the child.
But let’s suppose that the treatment we are talking about is not medical or surgical, but psychological or behavioral. If those treatments are frightening, humiliating, or painful, is that acceptable? The German psychologist Michael Linden recently wrote that such experiences created additional “emotional burdens” for patients, and that if there were an effective treatment that was not frightening, humiliating, or painful, it would be completely unethical for a therapist to impose those burdens. Where some degree of fear is likely to be experienced, as in desensitization treatments for anxiety, therapists do their best to offer support and make the experience bearable for the patient. Humiliation and pain are not normal parts of most mental health interventions, and painful aversive treatments are expected to be used only when a behavior is uncontrollable and dangerous enough to justify deliberate causing of pain.
There seem to be a lot of rules about not distressing adult psychotherapy clients-- but many clinicians of various disciplines seem much less concerned about frightening or hurting children. In fact, there seems to be a whole school of thought that holds that pain and fear are needed to cause psychological and behavioral change, or at least that they are harmless byproducts of such change. I’ve repeatedly referred to the various schools of “holding therapy” as having this position, but it appears that there are a number who share these attitudes among professionals whose focus is not on mental health.
Ute Benz’s edited book Festhaltetherapien notes a similar viewpoint among occupational therapists in Germany. In Benz’s chapter in that book, she describes how she was contacted by a number of teachers and others who were disturbed by hearing about occupational therapists doing a form of holding therapy, KIT or Koerperbezogen Interaktions-Training (body-related interaction training). According to one commenter, in KIT the child is ultimately forced under the control of the mother by physical and emotional contact; he goes on to say that for many children who could trust no one, this method gives a helpful lesson in the persistence of love. The commenter also notes how much sincerity it takes to restrain a child who fears or hates you, who screams, curses, complains, cries, scratches, bites, pees his pants in self-defense and despair. I would point out that such last-ditch defense behavior is unlikely unless a child is frightened or hurt, and that fear and pain are apparently tools of the “sincere” KIT therapist.
Authors in Benz’s edited book also refer to the “Vojta method” which had been [happily] unknown to me. This method was originally developed for treatment of the spasticity resulting from disorders like cerebral palsy, but is now promulgated for a range of other problems, including those of children and even newborn babies. The website www.vojta.com notes that “The therapeutically desired activated state often expresses itself during treatment in newborn babies as crying. This understandably leads to parents feeling concerned, and makes them assume that it is ‘hurting’ their child. At this age, crying is an important and appropriate means of expression for the little patients, who react in this way to unaccustomed activation. As a rule, after a short familiarization period, the crying is no longer so intense, and in breaks from exercise as well as after the therapy, newborn babies calm down immediately. In older children who can express themselves in speech, crying no longer occurs.” However, the following clip of treatment of a three-year-old, who is old enough to talk, appears to contradict this claim [N.B. This is quite a distressing display-- please do not watch it while children can hear or see]: www.youtube.com/watch?v=GrtF415N3Gc.
Yulia Massino kindly sent me materials about advertisement in Russia of the Vojta method and the collection of funds for parents who want to take their children to Germany or the Czech Republic for treatment (e.g., http://forum.sibmama.ru/viewtopic.php?t=830157-- in Russian,so please use a translation service if you need to). Vojta therapy is also advertised in English, but apparently not in the U.S.
Yulia also sent information about Elena Fokina’s method of treating children, including young infants, by repeatedly plunging them into cold ocean water, as well as by throwing them around in the infamous “baby-yoga”. Here is an account of Fokina’s “swimming” methods by an observer: http://www.liveinternet.ru/users/nianfora_n/post220258301 (again, in Russian). There is no recording of screaming here, but I warn you that this account disturbed me considerably even though I spend much of my time reading about horrible treatments.
Can these frightening and painful treatments be effective therapies for any childhood problem, physical, neurological, or psychological? They do not offer anything but anecdotal evidence to support their claims. However, as a general rule, sensitive and responsive parenting methods have been shown to nurture good development, and rough, insensitive treatment to have the opposite effect. Psychotherapies for children are often (whether correctly or incorrectly) thought of as operating in analogy with good parenting methods. There seems to be no rationale for inverting this analogy so that good therapy would imitate bad parenting methods. The obvious conclusion is that neither research nor theory supports the use of methods that frighten and hurt children. On the contrary, these methods involve an “emotional burden” (as Linden had it) that can be expected to exacerbate old problems and create new ones.
What sources can such actively harmful treatments have? KIT and Vojta therapy appear to share with the often-rejected American method of “patterning” the view that imitation of early behavior and events will cause those aspects of development to “re-wind” and re-play in a more typical fashion. In both cases, and in other methods pushed by the Association for Pre- and Perinatal Psychology and Health (APPPAH), crying in pain is either dismissed as “expression” or encouraged because of the belief that it erases memories of earlier distress. In these and similar techniques, there may also be a metaphoric glance at exorcism, where a fight with demons, and the distress of the possessed person, are necessary before healing can occur.
Fokina’s cold-water plunges and baby-yoga are more difficult to comprehend. Are these simply the sadistic acts of a woman whose personal charisma attracts the adulation of people who are desperate for a guru and supernatural guide? Is it all just the culmination of a commercial enterprise? I’m at a loss to say, but there seems to be no shortage of parents who will pay someone to tell them to do cruel and pointless things to their children.
What happens with these treatments is not, as the Vojta method author says, “hurting”. It’s hurting with no quotation marks. And therapy for children should not hurt, unless there’s a very good reason.
Monday, December 9, 2013
I happened to be reading The great derangement by Matt Taibbi, the Rolling Stone contributing editor, with an eye to seeing his comments about how Congressional rules have changed-- when I saw that he also included an account of being an “undercover atheist” in a weekend encounter group/retreat run by the Texas Cornerstone Church. As I mentioned in my last post about a German therapy weekend, these things all follow a predictable pattern, even though details about family constellations or speaking in tongues may be different. But Taibbi interested me by speaking of a concept put forward by the minister leading this weekend, one Philip Fortenberry.
I’m about to say how Taibbi described this concept, but I must note that I have only his description to go on. The Cornerstone Church website alludes to it slightly, but my search of the Internet has not revealed any other information about it. The basic idea, however, is identified in this way by Taibbi: “The program revolved around a theory that Fortenberry quickly introduced us to called ‘the wound’. The wound theory was a piece of schlock Biblical Freudianism in which everyone had one traumatic event from their childhood that had left a wound. The wound necessarily had been inflicted by another person, and bitterness toward that person had corrupted our spirits and alienated us from God. Here at the retreat we would identify this wound and learn to confront and forgive our transgressors, a process that would leave us cleansed of bitterness and hatred and free to receive the full benefits of Christ” (pp. 70-71). Identification of the wound was apparently carried out by recounting personal stories in small groups, and cleansing proceeded on the final day through a service in which people spoke in tongues and vomited up demons.
The connection between being wounded and filled with hate and having to get rid of indwelling demons may not be obvious to non-charismatics, but there is a logic when the omissions are filled in. Cruel actions and hatred or pain attract demons, who in turn prevent the afflicted person from being filled with the Holy Ghost (I am referring here not to Taibbi’s account, but to various materials about charismatic thinking.) Being cleansed of the demons, it seems, causes one to be cleansed of the aftereffects of the ‘wound’, including the hatred and bitterness that attracted the demons to begin with. (I am not sure where forgiveness comes into the picture, but in the “family constellation therapy” I mentioned in the previous post, hurt people are asked to beg the forgiveness of those who have hurt them; this includes sexually-abused children, who are to beg the forgiveness of the abusing adult, and, no, I don’t have this backward.)
The parallel with Nancy Verrier’s “Primal Wound” is easy to see. For Verrier, the important “wound” is the one she believes to take place when an infant is separated from its birth mother, to whom (according to Verrier) the child has already established a prenatal bond. Adoption by another family is accompanied by the ill effects of the separation wound and makes it impossible for adopted individuals to be truly happy. Verrier recommends that all the details of the separation and adoption be discussed in order to have a good developmental outcome, but does not suggest any therapeutic approaches that could support this (and indeed she has been criticized by otherwise-accepting authors for her failure to offer guidance on this point).
How does the PW compare to “the wound”? It’s a specialized form of wound, occurring under specific circumstances, and not to be found in most of the population. However, it otherwise parallels the “wounds” posited by Fortenberry. It occurs in early life and hangs on, accumulating ill feelings, and interfering with ordinary happy life. According to advertisements for Verrier’s other book, Coming home to self, people with childhood traumas feel they are living “unauthentic” (sic) lives, just as those with Fortenberry’s “wounds” feel they need to “know the truth” and “be set free”. If Verrier did not base the PW on the “wound”, or vice-versa, the two must be descendants of the same belief system. And of course they both resemble closely the Scientological practice of “clearing engrams” acquired before birth and in early postnatal life.
One more interesting point about the PW: charismatics too give adoption a privileged position as a cause of emotional distress. For them, the circumstances behind adoption-- lust, unwanted pregnancy, accident or illness, infertility, or death of a parent-- all attract demons to the adopted person as well as to those around him. There may even be generational curses at work, so the actual adoption, lust, death, etc. may have occurred many decades ago (coming full circle back to Bert Hellinger, it seems), but affecting someone living today.
Who started this, I’d like to know? Whoever it was, it’s clear that all these stories are versions of religious beliefs. That’s why it’s so repugnant to the believers to attempt to argue in terms of observable events--- even when their stated beliefs are presented as if they come from the observable.
I’ve been reading further in Ute Benz’s edited book Festhaltetherapien, which examines various aspects of holding therapy as promulgated by Jirina Prekopova in Germany and the Czech Republic and by Martha Welch in the United States. Today I want to discuss Marika Sommerfeldt’s chapter on a weekend of family constellation and holding therapy in Prekop’s style. Once again, I have to say that I have not asked permission to translate or to post any of this material, so I will summarize most of it and translate only a few passages. This translation, by the way, is my own and my dictionary’s, and to paraphrase Mark Twain, it was “clawed into English by unremitting toil.”
Sommerfeldt signed up for a therapy weekend as one who had read about it and wanted to know more, but as an excuse for her participation she invented a fictional grandchild who cried a great deal and was difficult to comfort. The story she tells of this weekend is strongly reminiscent of any “encounter group”, church-sponsored retreat, or (for those who remember this) the National Training Labs events of the late ‘60s and ‘70s. Each person has a story to tell and “shares” his or her difficulties with others, a proceeding managed by several qualified and student therapists. These self-revelations are followed by various group rituals and by individual therapy sessions intended to ameliorate the problems.
Sommerfeldt seems to have brought to the weekend a genuine willingness to observe, and a real interest in her fellow weekenders, combined with common sense and a delicate sarcasm. To amuse herself when on her own, she also brought a copy of Bulgakow’s The master and Margarita, a novel in which “madness” and its treatment play primary roles-- very appropriate for the milieu in which she found herself. As advised, she packed comfortable clothes in the expectation that participants would be sweating.
Introductions over and stories told, with tears in several cases, the first day of the workshop began with a ritual farewell to accompanying children, who would be taken to be cared for by young people who were students of special education or of theater [! JM]. All sang a song about a mouse who was going on a trip around the world and all the things he packed. (Sommerfeldt noted at this point that the organizers addressed everyone in the familiar form, as if they were relatives or close friends.)
Further stories were told by the adults, some of them having to do with marital conflict. Sommerfeldt noted “I was always asking myself, how the others and I got to this level of intimacy. Perhaps this is usual in group therapy. I don’t know, but I found it misplaced. The speakers lost all restraint-- they cried and sobbed. The therapist tried to calm them, but it seemed to me a mistake to advise ‘deep breathing’ or ‘putting both feet on the floor to be grounded’. My first impulse was to take these crying women in my arms and comfort them, but perhaps this was also the wrong reaction. We were asked by Ralf [a therapist] to explain what we expected from the weekend. The hopes were very great.”
A later ritual for the adults was to form two circles, with men and children in the inner circle, women in the outer circle, singing in alternation. The children sang the song about the mouse again, following Jirina Prekop’s dictum that “children need rituals”.
An organizer then began a description of Bert Hellinger’s family constellation therapy, without mentioning his name. She explained the family hierarchy and the order of places of father, mother, children, and grandparents. The father is always at the top of the hierarchy because he determines the descent of the children. For example, she said, if a mother is from Saxony and a father is French, their daughter will also be French. Sommerfeldt commented, “It’s never occurred to me in this way. The father of my children is of Saxon background, but he considers himself a Berliner, because he was born in Berlin. My children will not be too pleased when they hear that after this workshop they are no longer Berliners.”
The organizer also stated that the order of relationships remains the same even if the parents divorce. If the order is broken, the child feels unprotected and becomes oppositional and tyrannical. If the mother has conflicts with her own mother, the child will take over and display the conflicts. Indeed, it was said, there is a “seventh sense” and an instinct by which when the child sees her own mother in her child, the child cannot love her. Sommerfeldt commented, “this speech seemed to me completely confused, I simply couldn’t understand it.”
Now Sommerfeldt had to give a more complete story of the fictional crying grandchild. “No, mother and child were not separated after birth, and the mother showed very affectionate concern for the child, so ‘Philip’ was not suffering from a maternal deprivation syndrome, and no, the family’s relationships were not disturbed. Nor did the child go to day care. The rest of the extended family was somewhat odd.” The therapist Maximilian created a family tree, then he explained. “My problems obviously came from my father’s first wife, who had never been welcomed by the family and who died a long time ago. I understood that my grandchild cried a lot because my father never talked about his first wife and she no longer belonged to our kindred. Confusion had been brought into the family order. My mother, my sister, and I had profited from the abandonment of the first wife and must thank her for this and bow before her sad fate. … I was happy when my therapy hour was at an end.”
Subsequently, Sommerfeldt asked with some trepidation (brave woman!) for holding therapy. This was presented as being done in a modified form, and was done by several therapists rather than by a person with whom she was at odds [this seems to me contrary to what Prekop advises, but I suppose the arrangements are made to suit each case. JM]. It was done in her bedroom at the conference hotel, and a point was made of doing the holding on an extra bed, not on the bed she slept in. She was asked to sit leaning against a woman therapist, with her head on the other woman’s shoulder, and was advised that she should not talk and question and that her failure to understand with her heart was a cause of problems. Memories stored in the body were also mentioned. Rather than lasting to exhaustion, as seems to be recommended for children, the holding sessions stopped after about an hour.
The weekend continued with various ritual performances, such as pretending to be hedgehogs in a nest, and concluded with a candle-lighting ceremony in which candles were to be dedicated to those each person loved. Sommerfeldt commented that she found the ceremony ludicrous, but others found it calming and good to do.
Sommerfeldt was left with affectionate feelings toward the other participants and felt she would like to stay in touch with some. “When I left, my daughter was already waiting at the exit. She immediately asked me how it had been. By this time I really had holding therapy and constellations or whatever they’re called up my nose. I told her, I don’t want to talk about it now-- and didn’t stop talking until we got to Berlin.”
There are many more details that I’ve skipped, and this chapter is a real contribution to understanding of holding therapies and of the involvement of Hellinger’s ideas in the Prekop system.
Wednesday, December 4, 2013
Speak Roughly to Your Little Boy, and Beat Him When He Sneezes: More on "Festhaltetherapien", Edited by Ute Benz
A couple of weeks ago, I commented on an on-line sample from a new German book, Festhaltetherapien:Ein Plaedoyer gegen umstrittene Therapieverfahren, edited by Ute Benz. I have now received a copy of the book and am making my way painfully through it-- I began by looking up three words in every paragraph and am now down to two for most paragraphs, and even an occasional paragraph where (I think) I understand everything.
I didn’t begin at the beginning, but wanted to look at a chapter by Ute Benz on the historical development of Holding Therapies (pp. 121-143). (I should emphasize here that the title is in the plural, and that although the book focuses to a considerable extent on the treatment as done by Jirina Prekop and Martha Welch, in fact there are other methods that use restraint on children in almost the same way as Prekop and Welch.) I am going to translate some parts of this chapter, but I do want to note that I have not asked permission to do so. I assume that the short sections I will present, and the fact that I have no commercial interest here, will make this acceptable, but if there are any objections from authors or publisher I will naturally take the post down.
I’ll begin with Benz’s description of Prekop’s holding method, which its proponents recommend for autistic children, for oppositional children, and for “any child who needs it”. “The picture of the classical holding scene looks like this: a boy or girl sits or lies on a mat with the entire body held tightly by adults, the mother and/or father and perhaps a third or fourth helper, so that the child can no longer move, but can only cry out. For the child to scream and cry during the procedure is considered normal and even desirable as the expression of emotion belonging to the method, so crying must be provoked if a child becomes compliant too quickly. This is to dissolve repressions. The child’s crying is much more easily tolerated by the parents when many children are treated and cry simultaneously. If a child immediately becomes still and resigned to his fate or goes to sleep or looks around the room, he is practicing a defense against the treatment and must be provoked in order to break through the defense.”
“When Holding Therapy is done in the home, the parents are warned to close the windows, so that neighbors will not hear the sound of screaming and call the police. Because the delaying tactics of the restrained child may cause him to scratch, bite, hit, or kick, a certain position needs to be taken, so there are no bruises as visible signs of mistreatment. The child must cross his hands and legs in a sort of straitjacket position and sit straddling the lap of the adult. His head must be laid or pressed against the crook of the adult’s neck. … the child must not be let go under any circumstances, such as begging, yelling, screaming , or desperately crying, even if he needs to go to the toilet, his nose runs, or he becomes sick, or when both bodies are bathed in sweat, or when the child trembles from stress or is hungry or thirsty. All these things are done in typical evasive maneuvers [N.B. Benz is describing Prekop’s viewpoint, not her own opinion!] that must be overcome in the course of the process so that the goal of a tractable child is reached.” This goal is shown when the child allows eye contact as the parents wish it, lets himself be caressed, and says things like “I love you” or promises desired behavior. As Benz notes later, this end is thought to justify the means.
Benz, who estimates 10,000 cases of this treatment in Germany and Austria over the last 30 years, also notes people who have contacted her to ask for help or explanations. (She also notes that few German psychotherapists know about Holding Therapy or even know it exists.) In 2004, she was contacted by a divorced father who had custody of a seven-year-old boy; the boy was refusing to visit his mother. The boy told his father that the mother would restrain him while he lay on the floor, would stroke him and whisper “I am your mother, I love you.” Benz was also contacted by a town counselor who was concerned about accusations of mistreatment against a staff member in a children’s home, where there had already been repeated indications of trouble. The accused person had already resigned, but the town council now needed to review over a hundred videotapes although they did not know anything about the theory and practice of Holding Therapy. In 2011 Benz was contacted by a 27-year-old woman from the Netherlands, who had been given intensive Holding Therapy for years as treatment for cerebral palsy. For the first four years holding was done three times a day, which was later reduced to three times a week. At age 20 she had serious problems with being near other people and with physical contact. Her doctor advised her to seek therapy but could not say where to go.
Benz describes a number of similar cases who have contacted her, but as far as I have read does not suggest specific techniques for treating these effects of Holding Therapy, although she does note that practitioners need to explore whether new patients have been subjected to this treatment. As I have noted before, in one case I know in the United States, a young woman who as a child was subjected to treatment of the Prekop-Welch type suffered increasingly severe anxiety attacks in her 20s, but was relieved by desensitization treatment focusing on her memories of the treatment, particularly the screams of other children in the room.
I must say that distressing as I find treatment of this type for autistic children, the idea of trying to apply it to someone with cerebral palsy is really beyond anything I have encountered before. One wonders whether these people would use holding for appendicitis! Surely declarations of intense pain and vomiting could be interpreted as defensive delaying actions, too … and no doubt similar interpretations have been made by some practitioners.
In a later post, I want to go into what Benz has to say about the use of similar techniques by occupational therapists in Germany.
Wednesday, November 27, 2013
I hate the term Parental Alienation Syndrome (PAS). Of course a parent can do and say things that encourage children to feel alienated from the other parent (just as a parent can do or say things that alienate children from himself or herself). Children can be alienated to a greater or lesser degree by many factors, and I would hazard the guess that all children at all times have some preference for one parent over the other, although the preference may change with age and events. When parents separate or divorce, it would be virtuous for both of them to remember what they used to like about the other parent, and to encourage the children to maintain a positive relationship. Some people do the opposite, but their actions and the children’s responses are not part of a “syndrome”, a term that tries to sound as if there is solid scientific evidence behind the use of the PAS label.
A lot of people other than myself have also rejected the PAS concept. As a result, instead of accusing a divorcing co-parent of causing the children’s alienation, there may be an accusation of failing to promote the children’s relationship with the other parent. When the accused parent denies that this was the case, the conclusion may be that he or she is “in denial” and must go into therapy in order to acknowledge the actions and understand the reason for them. It may be ruled that until this is accomplished, there can be little or no contact with the children.( I am wondering, by the way, whether a request that the other parent have supervised rather than unsupervised visitation may be enough to trigger the accusation.)
This does not leave much of an option for a person who actually did not fail to promote the relationship, does it?
I have in mind two cases that almost exactly followed this pattern, and one other that has some similarities. All are cases where a parent denies having done what she is accused of (they all happen to be “she”), and is sent for therapy to enable her to “confess”, and, I suppose, be shriven. If she really did wrong, of course, this speaks badly for her character, so she should not have much contact; if she says she didn’t, that means she’s lying, confused,or mentally ill, so again she should not have much contact. To be accused is to be convicted, it would appear.
In one case in Canada, the parents separated when the children were about one and two years old. The mother asked for supervised visitation with the father, who sought the help of a psychotherapy group. Father’s attorney claimed Parental Alienation Syndrome and full custody was given to the father, with the order that mother must undergo psychotherapy in order to acknowledge her alienating behavior and treat whatever problem caused it. Until this is done she is not to have contact with the children, nor may her parents see them. Mother denies having caused alienation and argues that if the children are alienated, it is father’s own behavior that has done this. The costs of psychotherapy are in any case impossible for her to pay.
In a second case in the U.S., the parents separated when the children were almost two and almost 4, following revelations of father’s use of prostitutes. Father did not want to divorce. Mother asked for supervised visitation because father had allowed one child to play with an electronic device on which father had downloaded pornography. Mother took the children to her family’s home in Canada, while father petitioned a U.S court for custody. Mother has just been told that custody is to be given to the father because she failed to promote the father-child relationship during the separation, and that she must go into therapy so she can acknowledge and work through the problem. The children must go to their father by Jan. 1, giving them one month to prepare for this major change. If mother stays where she is, she may see the children once a month and Skype with them every other day (a decision that ignores the usual recommendation for overnights equivalent in number to the child’s age in years); if she follows the court’s directive and also moves to the father’s chosen city, she may have 50/50 custody. She denies that she failed to promote the relationship.
The third case is different, and I have written about it here before (http://childmyths.blogspot.com/2013/01/kafka-again-more-on-capture-of-child.html). In this case, the mother asked a couple (the man being the father of one of her children) to care for two preschoolers for some days. When she returned, the couple refused to give them up. Years have passed in a legal battle over this which has taken all of mother’s savings. The children have been in an unconventional form of therapy and one is in residential treatment against mother’s wishes. The therapists say, and the courts agree, that the mother must have been abusive, because the children are in problematic mental health; nothing in their early medical or educational records indicates this. The mother denies that she was neglectful or abusive, and this is interpreted as evidence that she must have been so. The plan at this point appears to be to terminate her parental rights and to “free” one of the children for adoption by an as yet unknown family.
Do all these cases remind anyone of anything? For me, they are quite reminiscent of the Recovered Memory Therapy scandal of the ‘90s, in which failure to remember sexual abuse was counted as evidence of abuse, as heavily or more so than memories. Accused parents who denied abuse were also told that they certainly could not see their children unless they confessed their misdeeds; those who confessed falsely out of desperation (or were convinced that their lack of memory meant they were guilty) could still not be with the children and often lost their jobs and other resources as well.
It’s time that the courts dropped the ‘70s pop psychology belief that denying something is evidence that it’s true. Honestly, life isn’t all in our unconscious minds and motivations. And a reality-based request for supervised visitation is not alienation, in any case.
Last weekend, my husband and I visited friends in another state, a family that has one 9-year-old child, a boy adopted from Latin America when he was 11 months old. On Monday morning, I saw an interesting little scene: before young Phineas (which I’ll call him because it’s pretty obvious that it isn’t his name) was about to leave for the school bus, his mother called him to give goodbye kisses to my husband and me, because we were about to go home, and then she wanted a hug and kiss for herself. Phineas came to her and let her put her arms around him, but he turned his face away with a blank, withdrawn expression and did not participate.
I was struck by the resemblance between Phineas’s behavior and the failure to be affectionate “on the parent’s terms” that proponents of Attachment Therapy regard as a symptom of Reactive Attachment Disorder (or of their notional entity, Attachment Disorder). And of course there were various other cherries that could be picked to build support for this diagnosis: separation from the birth mother very early; care by a foster family, then separation from them for placement with his adoptive parents. He even had to be told not to be quite so rough with the dog on Sunday afternoon.
So,shall we jump to the conclusion that Phineas is a sad case of RAD, or AD? Let me offer some alternative explanatory factors.
First, let me point out that nine is an age when most children begin to look outward from the family and concern themselves less with their parents and more with their peers. The hugs and kisses that they used to like so much now become more formalized, except perhaps at bedtime. Rough-and-tumble play is very much part of their lives, and they may need to be reminded that pets don’t communicate in the same ways their friends do.
In addition, Phineas’s life has had some bumps in it over the last two years. His developmental pathway had been very smooth in every way, until two events occurred a couple of years ago. The first was that his mother, who is a medical professional, developed an allergy to latex that was of life-threatening proportions. If Phineas had touched rubber bands or latex balloons and then touched her or kissed her, she had a reaction that required a visit to the emergency room, often, of course, with Phineas in tow. Even a visit to a store that had a display of latex balloons could do this, and Phineas became a balloon-detecter, looking around him carefully as they entered each new place. On a couple of occasions, balloons at Phineas’s school meant that his mother had to leave quickly, and there was much correspondence as the mother asked school staff to help her by excluding latex balloons . If the balloons were there, she could not go to the school for classroom visits or parties or many of the events other parents attended (and Phineas’s father’s job rarely gave him the chance to do these things).
At that point, Phineas received a head injury in a playground accident and suffered from post-concussion syndrome that continued over more than a year. He could not tolerate loud noises or crowds, cried easily, and was afraid of another blow to his head. His school attendance had to be managed carefully. And of course this was all complicated by the fact that his mother could not go with him to a doctor’s office unless she knew it was latex-safe, so even his medical care had additional complications. (He also had a medical problem involving a mass on a testicle, which fortunately resolved without further treatment.)
Last summer, just as the effects of the concussion finally seemed to be over, two elderly, much-loved members of the family died, and Phineas’s maternal grandmother had two heart attacks. To help deal with this, his mother went away for two weeks at a time to the neighboring state where her mother lives, leaving Phineas with his father-- the best possible situation for him, but also the first real separation he had had from her.
A week ago, Phineas’s school started a new fund-raising project, making and selling necklaces made of stretchy bands-- latex, of course. His mother told him she would be fine if he did that as long as he changed his clothes when he came home and put them in the washer so she did not have to touch them. But on the school bus he had to sit next to a boy who tends to bully, and when the boy pulled out his rubber bands, Phineas told him “don’t touch me with those, I don’t want to get latex on me. It makes my mother sick. She might even die.” The other child, not surprisingly for him, took this as provocation and rubbed the bands all over Phineas’s shirt, saying “I’m killing your mother!”. Phineas got off the bus in a storm of tears and told his mother “I don’t want you to die! Please don’t die!”
A few days later, Phineas turned his head away when his mother wanted to kiss him goodbye before he went to school. Do we have to look to an attachment disorder to explain this? I think not! This child is intensely attached to his mother, and not unrealistically afraid of losing her. What can he possibly do to feel better about this? His only option is to try to avoid the vulnerability he feels-- or at least to try to act as if he isn’t vulnerable. To interpret this behavior as meaning a lack of attachment would be absurd, and to attempt to treat it by placing him in “therapeutic foster care” would simply exacerbate his fear.
Am I saying that there is no such thing as Reactive Attachment Disorder? Not exactly; I think there are behaviors of quite young children that stem from disturbed attachment relationships. But when we see years of typical development, and then “aloofness” in family relationships, I believe we do well to examine these in the context of all the child’s experiences, both early and recent. Most contextual factors may not be as obvious as they are in Phineas’s case, but they need to be searched for before we assume that attachment is the problem.
Monday, November 18, 2013
When I was commenting on Kathryn Joyce’s Slate article about the terrible life and death of Hana Williams last week, I was struggling to think of a reason why adoptive parents would try to care for more children, and more challenging children, than common sense would say anyone could manage effectively. It’s clear, as Kathryn and other writers have frequently pointed out, that fundamentalist Christian beliefs have often driven the growth of “megafamilies”-- although in cases like that of the Schultzes in Tennessee a few years ago, it was not God but Mammon that was probably the motivating factor. Still, there are many fundamentalist Christian families who have adopted some children, but stopped while they were still in control of the situation-- so why do some go on and on? In my earlier post, I speculated that there might be some form of emotional disturbance that would create a powerful, anxiety-based drive for more and more children-- but even in talking about this, I realized that I was trying to separate some aspects of megafamily adoption from religious beliefs, in the hope of identifying some characteristic of potential adoptive parents that could be used to keep their family size within manageable limits.
While reading about the Williams family, I noticed particular statements about the adoptive parents’ emotional reactions to pictures or information about come children-- that their hearts went out to Hana, for example. This stayed in my mind as I went on to read a second article about a megafamily, or, as the author Maggie Jones called it, a “supersize” family (www.nytimes.com/2013/11/17/magazine/god-called-them-to-adopt-and-adopt-and-adopts.html?_r=0). So far, I’m delighted to say, this family has not had a tragic history, although the adopted children come from difficult histories of their own.
According to Jones, the adoptive mother of this family “latched onto the idea of adopting from foster care after hearing an ad on K-LOVE, a [Denver area] Christian radio station, about a new organization… that was helping Christians adopt foster kids… ‘Has God been calling you to adopt?’ the voice-over asked.” Jones also noted that of “the dozens of evangelical and conservative Christian parents I spoke to, many said that church sermons, Christian radio shows or other Christian campaigns, including Focus on the Family’s national foster-to-adopt program, pushed them to adopt.”
Why were these ads and sermons so effective? Presumably, Christian adopters are not more susceptible to persuasion in a general way than other people are—they don’t, I suppose, buy more from catalogs or e-mail ads than most of us. Can it be that there is something in their belief system that makes them more easily persuaded to adopt, and adopt more and more? I think there are a couple of points of belief that do have this impact.
One of the points is institutionalized to some extent because of its appearance in the New Testament. James 1:27 tells Christians to care for distressed orphans and widows. (As others have pointed out, the widows seem to be getting pretty short shrift, but that’s a whole different issue). The form that care should take is not described, and in the past contributions to missionaries and orphanages were generally considered to put a person in compliance with this admonition. Today, as Kathryn Joyce pointed out in The child catchers, care for orphans is conflated with the Great Commission of spreading the Gospel, and for many the child’s conversion to Christianity is as important a goal as relieving physical distress. (One can see why this is the case, given the belief system.)
A second point of belief has become part of one type of Christian belief system over the last hundred years, in spite of the rejection of this idea by mainstream churches. This is the belief that miraculous events, of the types described in the Bible, can still occur today for people who are committed to a system that is variously described as charismatic or Pentecostal. Charismatic believers consider that they can experience or carry out supernatural events like those described as occurring for Jesus’ followers after his death. These include the ability to detect evil spirits and to exorcise them-- an ability to be expected after one is shown to be part of the system by “speaking in tongues”.
Of the phenomena to be expected by a convinced charismatic, a superlatively important one is to be spoken to by God, who will indicate his wishes for a person. The K-LOVE ad literally referred to this: “Has God been calling you to adopt?”
The idea of a direct message from God is a difficult one for nonbelievers to understand, and this is partly because even when joking about this we tend to think of a spoken message of the kind we would receive from another person. Gary Trudeau made much of this idea several years ago in showing his reporter Rick Redfern at a press conference where God spoke to the person being interviewed-- but “only on background. This was not for attribution.”
But charismatics do not necessarily expect a message from God to come in the form of a voice they can hear. It is more likely to be in the form of a “word of knowledge”. According to www.christcenteredmall.com/teachings/gifts/word-of-knowledge.htm, a word of knowledge is “a definite conviction, impression, or knowing that comes to you in a similitude (a mental picture), a dream, through a vision, or by a Scripture that is quickened to you. It is supernatural insight or understanding of circumstances, situations, problems, or a body of facts by revelation; that is, without assistance by any human resource but solely by divine aid.” If I understand this definition, it means that a divine message could come in the form of preoccupation with an idea or text, as well as by intense emotional responses that are experienced as conviction. I don’t understand to what extent self-editing or examination of conviction and impressions is acceptable, and to what extent it would be considered as disobedience to the divine message. It would seem, though, that all that is needed to identify a word of knowledge is a sense of certainty-- or, in the title of Pirandello’s play, Right You Are If You Think You Are.
Mr. and Mrs. Williams reported the sense that their “hearts went out” when they saw Hana’s pre-adoption photograph. Did they identify this experience as a word of knowledge or a divine command, I wonder? Similarly, the family Maggie Jones wrote about, when they were reluctant to adopt more children. received an e-mailed picture from an adoption caseworker, which they said “pulled them in”. Did they too identify as a divine message the compassionate impulse that most of us feel toward children in trouble ? If so, perhaps we have an explanation of why some adoptive parents do go on accumulating children, sometimes with obviously tragic outcome, sometimes, perhaps, with unknown impacts on the children and the adoptive parents themselves.
What should we do, then? Can we possibly ask potential adoptive parents if they have charismatic beliefs that might affect how they manage their families? No, of course not, and I don’t think even the most militant atheist would care to countenance such a question and its influence on adoption decisions. (Presumably most of us would not want free-thinking or any other view of life to prevent us from adopting.)
However, we can limit the size of adoptive and foster families as we limit the size of other care groups. For example, in many states, family day care homes (services that care for young children in the caregiver’s residence) are limited in the number of children to be cared for and the age range of those children. In New Jersey, family day care providers may not care for more than three children under a year of age, or more than four children under two years of age, of whom no more than two may be under one year. If one or more children under 6 are present as well as those younger children, a second caregiver must be present as well as the primary caregiver. Interestingly, with respect to the family described by Maggie Jones, the New Jersey guidelines for family day care prohibit leaving children alone with an assistant under the age of 18 except in an emergency, and forbids children under 16 from working so many hours that schoolwork is affected-- whereas Jones’ article describes a daughter now 18 who has been driving siblings to school and changing one child’s tracheostomy dressing, apparently for some time.
Whatever the religious or personal motives for the creation of megafamilies, it would seem that we already have a template for limiting them. Like so many other issues, however, applying the template requires political will, and acceptance of conflict with some adoptive parents-- and, no doubt,some adoption caseworkers.
Wednesday, November 13, 2013
A new book, Festhaltetherapie: Ein Pladoyer Gegen Umstritten Therapie…. (Holding Therapy: An Argument Against Controversial Therapies) was published in 2013, and I thank Mrs. Alena Bilkova for calling it to my attention. I hope to get in touch with the editor, Dr. Ute Benz, but I haven’t managed this yet (maybe LinkedIn will do it?).
Festhaltetherapie is a treatment that resembles American “rage-reduction therapy” and other methods that use physical restraint of children in the belief that these procedures have therapeutic effects on psychological problems. Unlike the “classic” American holding therapy, Festhaltetherapie (or, to give its Czech abbreviation, TPO) does not hold the child in the therapist’s lap, use provocative physical prods, or demand that the child shout slogans about wanting to kill people. Festhaltetherapie involves a parent holding a child tightly while the parent expresses feelings about the child and the child cries and struggles, until both are exhausted. Young children are held on the lap facing the parent (usually the mother), but larger children lie on the back with the mother face-to-face on top of them, restraining their hands with her own. Festhaltetherapie is used with autistic children and those who are oppositional by Jirina Prekopova, the Czech proponent of this treatment, but her American counterpart, Martha Welch, now uses her technique “Prolonged Parent-Child Embrace” for treatment of Reactive Attachment Disorder (although she originally saw it as a treatment for autism).
In the 1980s, Prekopova and some German colleagues presented some weak research purporting to give scientific support to the effectiveness of Festhaltetherapie. Before her return to the Czech Republic, however, Prekopova became acquainted with the spiritualist family therapist Burt Hellinger, and her TPO approach now eschews scientific evidence and bases the treatment entirely on the “flow of love” through non-material channels. Prekopova has adopted Hellinger’s view of a hierarchical, patriarchal family power structure that can be healthy only if the child submits to parents completely-- and, by the way, if wives are submissive to husbands. Prekopova now presents Festhaltetherapie as a “lifestyle”, not a treatment, but others continue to promote it as a treatment for autism.
Dr. Ute Bemz and her colleagues wrote their book on Festhaltetherapie in protest against the use of a treatment that is not only ineffective but painful and distressing to children and to families. I have ordered the book from Amazon, but don’t have it yet-- however, from material at http://www.psychosozial-verlag.de/catalog/product_info.php/products-id/2290 I can see a series of intriguing chapters on this little-discussed topic. Here are some chapter titles, in my own clumsy translation (I am translating Festhaltetherapie as holding therapy):
“Power and authority as a therapeutic principle? Methods and psychodynamics of holding”
“Possibilities and limits of parent-infant-toddler psychotherapy”
“Holding therapy in the market of the education industry”
“The attraction of holding therapy for people in the helping professions with the example of occupational therapy”
“Long-term consequences of holding therapy”
“Unmasked pictures. Prekopova in action”
“Consequences and lengthy healing processes in psychotherapy”
“Critical observations on a faulty theory from an analytic perspective”
“ ‘We meant well. Is there trauma in holding therapy?’ Experiences of holding therapy in professional and family contexts.”
“If parents only want the best. Conversation with a mother who believed in holding therapy.”
Of course I can’t tell the contents of these chapters from their titles, but it would appear that they include something I have never seen published before, information from one or more parents who have experienced holding therapy from the parental side. Although people concerned about these restraint therapies ordinarily concentrate on the painful experiences of the child undergoing treatment, as well as with the later anxiety and post-traumatic phenomena reported by adults who were treated when they were children, it seems probable that some parents carrying out holding therapy may also be traumatized as they are instructed to ignore their child’s patent distress.
I also look forward to reading the comments connecting holding therapy with occupational therapy, a discipline that has offered some extraordinarily helpful techniques for children but has also been prone to theories with little empirical support.
A sample of Dr. Benz’s book can be seen at http://www.psychosozial-verlag.de//pdfs/leseprobe/2290.pdf. I’ll translate (again clumsily) a few important remarks:
Bernd Ahrbeck states: “Holding therapy is no safe undertaking. Forcing of attachment on children who have at their disposal no reliable attachment is full of risks. The probability is high that old traumas will be reactivated and new ones established. There should be no illusions about the authoritarian character of holding therapy, even if its proponents are constantly declaring their good intentions and celebrating this treatment as an especially humane method. Anyone who has seen the published videos of holding therapy will not be able to avoid shuddering.
Michael Krentz writes: “The practice of holding therapy, carried on with trivializing ideological-esoteric foundations or camouflaged under veiled terms as ‘supportive and attachment-based pedagogy’ or as ‘attachment holding’ or as ‘reconciliation therapy’, harms the psychological development of the child over the long term.”
If anyone can correct my translations I would appreciate it. I am not sure whether Gewalt in this context should be translated as “abuse” rather than “power”.
Tuesday, November 12, 2013
Kathryn Joyce, the author of The child catchers and other publications about child abuse associated with fundamentalist religious convictions, has published a heartbreaking narrative about the death of Hana Williams, a 13-year-old adoptee from Ethiopia (http://www.slate.com/articles/double_x/doublex/2013/11/hana_williams_the_tragic_death_of_an_ethiopian_adoptee_and_how_it_could.html). The story is truly a dreadful one and involves years of mistreatment culminating in Hana’s death from exposure and hypothermia, for which the adoptive parents have been convicted and given prison sentences of many years.
Hana’s life in a family of nine children had been ruled by the infamous book To train up a child, by Michael and Debi Pearl, which advocates punishments such as thrashing with plastic plumbing supply line from the age of four months (yes, months). The punishments she experienced, which also included being confined in small or isolated spaces and made to shower with the garden hose outdoors, were inflicted for getting homework wrong, standing in the wrong place, cutting the grass too short, and “sneaking” food (this last being a frequent theme in abuse of foster and adopted children). Her death from hypothermia occurred after hours without shelter in drizzly 40-degree F. weather; her adoptive mother, Carri Williams, no doubt was unaware that a person does not have to literally freeze to death, but can die as a result of lowered body temperature at temperatures far above the freezing point. Death caused or facilitated by hypothermia has occurred in other similar cases, like the death of the Russian adoptee Viktor Matthey (or, commonly, the deaths of boaters who fall overboard in cold waters).
Kathryn Joyce’s article connects the Williams’s adoptions, and the abuse of Hana and other children, with the parents’ religious beliefs. As Joyce has pointed out in The child catchers, a movement for adoption has in recent years been part of American evangelical Christian thinking. In addition, some fundamentalist religious groups have emphasized publications recommending parenting that demanded children’s obedience and enforced it with physical punishment. This tendency began with the Baby Wise books in the 1990s (publications later strongly criticized because the rigid regulation of early feeding had harmed some infants), and proceeded to approval of the obedience-producing manual To train up a child (see http://childmyths.blogspot.com/2010/07/child-death-by-thousand-cuts-in.html for another death associated with this book). The enforcement of child obedience as the principle task of parenting dates back to Puritan times in the United States, and belief in this value has always considered intense punishment as regrettable but essential to save the child from danger of hellfire. In most cases, however, the children do not die or even have severe enough injuries that the parents would seek medical attention for them, so we are not likely to hear of them-- and as many of the children in question are homeschooled, there are no teachers, and perhaps no near neighbors, to notice chronic mistreatment.
Joyce also describes the connection between fundamentalist Christian beliefs and multiple adoptions resulting in “mega-families” with 20 or more children. The belief that the “Great Commission” of spreading the Gospel requires adoption of children who would otherwise not be Christians is clearly related to this phenomenon-- if a person believes it is a religious duty to take as many children as possible, clearly only practical barriers will limit family size. As Joyce points out in The child catchers, any care deficits that may occur as a result of having too many children are considered to be outweighed by the spiritual victories accomplished. But any parent or child care provider can testify that having too many children to care for makes it impossible to do a good job, or even to notice the needs of every child. For this reason, state laws and guidelines set limits on the staff:child ratio of day care centers in order to facilitate good individual development. For whatever reason-- perhaps shared faith or personal relationships—not all adoption organizations take these issues into consideration, but instead cooperate with the creation of adoptive families too large to care for effectively. (Yes, the children may help care for each other, but they do not do the job that a committed adult can do with a small number of children.)
I wonder, though, whether in addition to religious beliefs, we may be seeing these “mega-families” formed as the result of a form of emotional disturbance in the adoptive parents. It’s certainly clear that excessive motivation toward some normal activities should be regarded as pathological. Excessive eating and drinking, and “sex addiction”, interfere with normal life and are reasons for psychological treatment. Hypersexuality may even be a symptom of brain damage. Could there, then, be a pathological level of the wish to have children that most (but certainly not all) people experience? Is there some yet undescribed problem we might call “hyperparentalism”, which leads to an inescapable, anxious yearning for more and more children, but does not cause good care for the children when they arrive? If so, can we detect this before adoption-- and can we get adoption caseworkers to regard such urges as pathological rather than admirable?
I throw this idea out as a possible explanation of part of the megafamily phenomenon. I know, of course, that there are plenty of other reasons for this kind of behavior. These may include financial benefits for foster care or adoption. There may be advantages of social respect and honor for women whose religious and cultural milieu does not permit her to be employed or to study toward professional qualifications. There may also be advantages for husbands who would prefer for their wives to stay at home and be as dependent as possible.
When these benefits are mingled with religious beliefs, they seem to offer some explanation of multiple adoptions, and even of cruel treatment. Nevertheless, I have to wonder whether the explanation is complete without some consideration of the more personal motives of adoptive parents who seek more children than they can care for, and maltreat the ones they have.