Concerned About Unconventional Mental Health Interventions?

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

Thursday, October 14, 2010

On "The Road to Evergreen"

For anyone with an interest in adoption, or in the complementary-and-alternative treatment “attachment therapy”, Rachael Stryker’s recent book The Road to Evergreen is a must-read-- although it’s also a must-criticize, with plenty to concern developmental scientists, clinicians, adoptees, and adoptive parents. Although published in 2010, The Road to Evergreen is based on a doctoral dissertation completed in the early ‘00s and approved by a committee which included Nancy Scheper-Hughes, author of the remarkable participant-observer narrative, Death Without Weeping. Stryker, an anthropologist, followed some of her mentor’s approach, but applied it to a complex topic that lacks the fascinating generalizability of the Scheper-Hughes book. It’s important to note that The Road, though published in book form in 2010, is based on observations and interviews done in the late ‘90s. The book thus gives us a detailed picture of events a decade and more ago, and it is arguable to what extent the practices described are still current. (Proponents of attachment therapy usually say they are not; critics like me cite evidence that they are ongoing.)

Stryker’s interest in her subject matter began with investigation of institutions and adoption in Russia following the collapse of the Soviet system and the beginnings of systematic adoption of Russian children by Westerners. Subsequently, the author became intrigued with the functioning of adoption agencies and the behavior and motives of prospective and actual adoptive parents. These interests led her to the small town of Evergreen, Colorado, then, as now, operating a cottage industry for treatment of children whose behavior and attitudes were uncomfortable for their parents. Most of the children in treatment in Evergreen were adopted, and the intervention most likely to be used with them was “holding therapy” or “attachment therapy”. This physically-intrusive technique was claimed to remove the emotional attachments of adoptees to their birth parents, to create attachments to adoptive parents, and (it was argued,”therefore”) to make the children obedient, respectful, cheerful, and grateful.

Stryker is probably the only person other than attachment therapists, adoptive parents, or children to have witnessed attachment therapy sessions. Other information about these practices has come from descriptions by therapists and adult memories of treated children (see http://stopchildtorture.org), from news reports’ films of children in treatment, and from the 30 hours of videotape showing the treatment that ended in the asphyxiation of the ten-year-old patient Candace Newmaker in 2000 (see Mercer, Sarner, and Rosa, Attachment Therapy on Trial). Stryker’s description matches the other information and confirms the general accuracy of previous descriptions of attachment therapy.

Stryker’s real contribution is in her interviews with adoption staff and adoptive parents. She was able to establish rapport with those individuals, who presumably trusted her as they would not have trusted critics of attachment therapy methods. The material Stryker collected led her to a conclusion that may trouble many, although for different reasons: that the strongest motive for adoption was for the parents to feel like a family, and to be able to play the honored role of parents. In return for the care and material goods offered by the adoptive parents, the children had the job of behaving in ways that supported the adults’ actions and affirmed that they were respected and successful members of the adult community. Attachment therapy at Evergreen offered an assurance of bringing about this desired end in one way or another. If a child did not “improve” or “heal” to the point of going back to the adoptive home, he or she was placed in some other form of care, and this was described as “loving at a distance”. Whatever the outcome for the child, the adoptive parents were guaranteed support for their perceived position as parents of a family.

Stryker presents three cases, with one child “reunited” and the others placed for care outside the family. These families and their treatment are described in some detail. However, some important information is missing. At the time of this study, as today, children receiving attachment therapy were often placed in a “respite family” who provide a milieu reflecting the beliefs behind attachment therapy. The respite home experience includes complete control by adults over the child’s food, drink, and toilet access. Bedrooms are stripped of most furniture and decorations and have an alarm on the door. Children are required to sit immobile for long periods and to carry out tedious, unnecessary tasks like moving stones from one side of the yard to the other, and back again. But Stryker gives little description of these methods or their goals.

Although developmental scientists and clinicians would be interested to see Stryker discuss the poorly-designed outcome research that has examined the effects of attachment therapy, it’s obvious that such topics have no real place in her participant-observer work. However, given the time that passed between the initial observations and publication of The Road, Stryker would have done well to follow up her three reported cases and to note whether there were long-term differences between the “successful” and “unsuccessful” cases. The memories and beliefs of the now-adult adoptees would also have provided a rich source of further investigation.

My great hope, on picking up The Road, was that Stryker would examine any changes in attachment therapy beliefs and practices that followed reports of a number of associated child deaths, the most dramatic being that of Candace Newmaker at the hands of her therapists. The organization ATTACh (Association for the Treatment and Training of Attachment in Children) followed that tragedy within a couple of years by policy statements rejecting physical restraint for therapeutic purposes unless the child is willing (and of course it is highly arguable whether a child can give informed consent to such a procedure).However, some practitioners of attachment therapy apparently continue to use physical restraint, and no practitioner has stepped forward to provide a rationale supporting the change or explaining whether an entire belief system has altered.

Once again, I consider The Road to Evergreen a must-read for people interested in adoption and the attachment therapy issue, or indeed in many aspects of parenting and of complementary-and-alternative mental health interventions. But readers will be disappointed if they expect the book to give an up-to-date picture of attachment therapy or to outline the tortuous history of this unconventional practice.

8 comments:

  1. "remove the emotional attachments of adoptees to their birth parents, to create attachments to adoptive parents, and (it was argued,”therefore”) to make the children obedient, respectful, cheerful, and grateful."

    I just can't comprehend how anyone would think there was anything good about this.

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  2. The thing is, people who believe it's sinful for a child to be disrespectful are really attracted to the idea. And of course Stryker suggests other motives as well, although not really admirable ones.

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  3. Yeah, it's amazing what the fear of a god can make people do. I tried to talk with a lady who was struggling with being told to spank for religious reasons. She seemed unsure about being able to control herself once she got started and just seemed to me not thrilled about "having to" spank. It's an old thread but I check back from time to time to see if "liz" has returned. I do NOT endorse this blog or it's owner's views. I accidentally landed on it when reading about parenting. I've inserted a space between brent and riggs in the link.

    http://www.brent riggsblog.com/2010/01/parenting-in-2010/comment-page-1/#comment-595

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  4. As one of the children who witnessed attachment therapy first hand, I have some very specific views on the subject. I do not believe it did anything but harm my mental state during my three years in Evergreen, CO. away from my family. I was not adopted and while I remember children there who were adopted, I cannot think of any non-american who was there during my stay at Forest Heights Lodge in the late 80's.

    They practiced "holding" therapy. Restraining the movements of a child and asking difficult questions until the child reached the point of rage. I read that the thought is/was that after this rage is expressed, other issues can be dealt with. All I remember is that it taught me to think about what the therapist wanted to hear vs reality. If I answered truthfully, I was placated and the restraint continued. Not until I acted completely enraged and lied to them would I be allowed to be let go. More often than not, this was a 2-3 hour process. It defiantly hurt my ability to trust and be close to others throughout the last 20+ years. To be clear, the counselors there were very kind and I still think of many with kind regards, it is the therapy sessions/therapists and the overall theory behind attachment therapy that I find flawed.

    As to the article above and I gather the books assertment of total control of food, drink, and toilet access combined with sparse living conditions, that was not what I experienced. While I came from a wealth family and was used to fairly high standards of living, conditions were what I would access as normal "middle America" rural Colorado standards of living. We had fun quite a large amount of the time. Normal stuff, skateboards, flag football, skiing.

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  5. Thanks so much for your comments, fashionwelder. I'm hoping that the Evergreen book will bring more personal reports like yours, and help me and others understand exactly what the experience was like for children. It's especially interesting that you did not seem to get the "rough" foster home experience that was later recommended by Nancy Thomas. I wonder whether this was a change over time, or just a difference in the practices of various therapeutic foster parents? Any ideas? And are you in touch with anyone else from that period?

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  6. I'm not sure about what is recommended by Nancy Thomas. I had actually never heard of her until Googling the Evergreen subject last week.

    From what I understand the facility where I was remains fairly unchanged from my time there. It houses about 20-25 boys in Evergreen, CO. Several rooms were 2-6 boys in bunk beds and whatnot. Thinking about it, I don't think I ever had more than just one roommate. It was considered a privilege to have a solo room and I did for most of my stay. The room was fairly normal and not much different than what I experienced later in Northeastern boarding schools and college dorms.

    I don't think it was a difference between therapists, but my assigned therapist was known as one of the "tougher" ones. There were four therapists if I remember correctly.

    I haven't had contact with anyone from there since probably around 1989.

    Here is a link to the facility. http://www.forestheightslodge.org/

    Strangely enough, there is a Facebook group for "alumni" as well.
    http://www.facebook.com/group.php?gid=44119321946

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  7. It's my impression that the Nancy Thomas methods were more associated with the Attachment Center at Evergreen. Rather than being a long-term residential center like Forest Heights, ACE used "therapeutic foster parents" in "respite homes" where children stayed while not in treatment sessions. The foster parents were instructed to use methods like limitation of food that were claimed as supportive of emotional attachment. It's very interesting to know that those methods were not used at Forest Heights, at least while you were there. It may have been different by the early '90s, though.

    I looked at the Facebook page you mentioned (thank you for that), but didn't see any comments that seemed to provide information about this topic. Have you seen any?

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