Concerned About Unconventional Mental Health Interventions?

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

Monday, June 6, 2011

When Child Therapists Promote Coercive Tactics: A Deadly Trickle-Down

The front page of the New York Times today (June 6, 2011) carries a most disturbing story headlined “A Disabled Boy’s Death, and a Troubled System” (http://www.nytimes.com/2011/06/06/nyregion/boys-death-highlights-crisis-in-homes-for-disabled.html?_r=1&ref=dannyhakim). The article reports that “on a February afternoon in 2007, Jonathan, a skinny, autistic 13-year-old, was asphyxiated, slowly crushed to death in the back seat of a van by a state employee who had worked nearly 200 hours without a day off over 15 days. The employee, a ninth-grade dropout with a criminal conviction for selling marijuana, had been on duty during at least one previous episode of alleged abuse involving Jonathan. “I could be a good king or a bad king,” he told the dying boy beneath him, according to court documents. In the front seat of the van, the driver, another state worker…, watched through the rear-view mirror but said little.” The boy was in the face-down restraint position well-known to carry a risk of asphyxiation. When Jonathan stopped responding, the two staff members spent an hour driving around, talking and shopping, with his body in the back of the van.

The article goes on to describe how Jonathan had been losing weight at the state school where he was a resident, and a logbook about his treatment revealed that “the school was withholding food from Jonathan to punish him for taking off his shirt at inappropriate times”. Bruising and other injuries had been part of Jonathan’s school life as well as that of other residents.

Obviously, there was no single cause for this horrible event. Overwork , undertraining, and lack of supervision of staff are important reasons, as is the hiring of individuals with criminal records. But I believe there is another factor: methods proposed by a small number of child psychologists, therapists, and parent educators, which suggest that coercive and potentially dangerous techniques are acceptable ways of dealing with noncompliant children. Those methods are directed toward family use, but I question whether such recommendations do not “trickle down” to use in so-called special education facilities.

Some readers will recall that I have mentioned in earlier posts situations in which parents were advised to withhold food from children in order to force compliance. (I described one case in which the parents who withheld food and kept a child locked up both received prison sentences, but the therapist who advised them suffered no consequences.) Others as well as I have repeatedly discussed the continuing problem of recommendations for restraint of individuals in the prone (face-down) position, and the possibility of asphyxia when this advice is taken.

I would contend that these suggestions do more than put specific home-reared children and their families in danger. The existence of this advice, without response by comment or consequences from professional licensing boards or from national professional organizations, is a signal to those who care for the developmentally disabled. The signal says: withholding food and using dangerous types of restraint are good techniques for families to use; therefore, they are appropriate and acceptable for residential school staff too.

Recently, I spent 90 minutes listening to an audio presentation available at http://www.consequences.com/aggression/audio.html. This presentation was essentially a lengthy advertisement for a $900 weekend training in which parents would be taught methods of restraint declared to be safe by one of the presenters, a person who in his self-published work has recommended face-down restraint as a means of establishing compliance in children.

The weekend was described as providing contact with people to talk to, who would not turn the parents in to child protective services. It was also to include advice about establishing relationships with the police and with protective services staff so they would not take complaints of abuse seriously. Declaring that he didn’t understand “fancy psychotherapeutic stuff”, one of the presenters stated that he was “FBI trained” and that he would personally train and certify parents in restraint methods. The certification would give them credibility with authorities who might otherwise object to their treatment of children. The presenter suggested that single parents needed to recruit outsiders to help them with restraint, and that living in northern Virginia he arranges for Marines from Quantico to do this.

This presenter, and others with similar messages, break no laws when they give this type of advice and suggest ways to evade the attention of authorities who deal with child abuse. Even parents who follow the advice are unlikely to meet legal consequences unless, and until, a child is injured by their actions. As the Times article shows, when that kind of advice trickles down to the residential treatment center level, even harm to a child may receive only the mildest punishment. (In Jonathan’s case, the driver who watched the child being killed “had been fired from four different private providers of services to the developmentally disabled before the state hired him to care for the same vulnerable population”.)

I don’t propose legislation that would prohibit giving bad advice about parenting. There are too many possibilities for any law to cover. I do ask, however, why professional licensing boards and professional groups like the American Psychological Association appear to be indifferent to advice that can mislead parents and harm families, and that may encourage public attitudes that foster ill-treatment of the developmentally disabled. I understand and cherish the First Amendment, but I don’t believe that professional privileges include the right to mislead.

Incidentally, in the audio presentation mentioned above, one of the presenters says that in some states continuing professional education credits may be available for the advertised workshop. If anyone comes across CE units given for such a class, I would very much appreciate hearing from you about it.

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