Concerned About Unconventional Mental Health Interventions?

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

Tuesday, June 12, 2012

"Adoption Today" and the ATTACh Belief System

The June 2012 issue of the magazine Adoption Today is available for free at (It’s supposed to be available at the magazine web site, too, but I wasn’t able to make the pages turn when I went there.) It’s worth looking at under a strong light--  in a discouraging kind of way.

This issue contains no articles by people with advanced professional research backgrounds, or by anyone usually considered to be an outstanding researcher or clinician in adoption or related fields. (It has an advertisement by someone who has claimed his methods are evidence-based, but that’s a whole ‘nother story.) That situation may not be too surprising in a publication that’s aimed at adoptive parents, of course—but it is surprising to see that many of the articles are by leading members of the Association for Treatment and Training of Attachment in Children (ATTACh), an organization that has its own belief system about attachment and has shown little interest in the realities as demonstrated by systematic investigation. Those who doubt this statement may want to go to and look at the list of behaviors that are claimed to be indicative of disorders of attachment; compare those with the actual definition of Reactive Attachment Disorder in DSM-IV-Tr, and note the absence of any other “attachment disorder” in that volume, and you’ll see what I mean.

Adoption Today, at least in this issue, is a vehicle for advertisement of the books, videos, and services offered by a small number of practitioners. But it also includes articles under the bylines of many of the same people, and some of these deserve closer attention as they reveal how the authors follow the “party line” rather than evidence-based material about either attachment or adoption. Incidentally, the last page of the issue contains a “CEU quiz” for pre-adoption preparation, although it acknowledges that most states have no requirement for this type of training.

Starting on p. 14, an article by Lark Eshleman, who I believe is an educational psychologist, discusses attachment in terms borrowed from ATTACh. (Eshleman apparently worked with the Craver family who were recently convicted in the death of their adopted child, as I discussed at In her article, Eshleman provides a definition of attachment quoted from ATTACh: “Attachment is a reciprocal process by which an emotional connection develops between an infant and his or her primary caregiver.” Let’s give this some consideration.
First, is attachment actually a reciprocal process? Its foundations are in reciprocal behaviors, but attachment itself is not reciprocal. Attachment is the name given to a motivational change in a young child, one which leads him or her to show preferences for familiar people (not just the primary caregiver, by the way). Attachment is shown most often as an attitude, or readiness to behave, in which social preferences are acted upon when threat or discomfort is present, not all the time.

To say that attachment is a reciprocal process implies mutuality and suggests that the caregiver is experiencing the same motivational changes as the child, which is certainly not the case; if it were, mothers with headaches would rush to be with their children, rather than hoping for some quiet time alone. If the process were reciprocal, there would be no sad cases of young children grieving over their removal from the homes of neglectful or abusive parents who show little sign of caring about the kids.

It is true that attachment develops in the context of social interactions with other people. But infants are so ready to form attachments that they need relatively little encouragement or reciprocity from adults to do so--  in fact, many adults would much rather that their toddlers showed less attachment behavior, and rather than encouraging the behavior may actively discourage it (but without successfully altering it).

It’s also true that adult caregiving and infant bids for care  (the usual context of attachment development) are reciprocal. Students of parental behavior used to use the terms epimeletic (meaning caregiving) and etepimeletic (meaning soliciting caregiving) to emphasize the interactions between these two types of behavior. And most social interactions take place in the caregiving situation, so attachment is developed in association with reciprocal actions--  but that is not the same as saying attachment is reciprocal. When the claim is made that attachment is reciprocal, it’s easy for adoptive parents to feel that “something is wrong” when an adopted child does not share the parents’ excitement, pleasure, and love.

Incidentally, the focus of the ATTACh definition on the "primary caregiver" is problematic. Attachment to several familiar people (even those who are sociable but not caregivers) is a feature of toddlers' lives. We can see this because toddlers can use people other than the primary caregiver as secure bases for exploration and also can turn to those people when threatened or uncomfortable. The ATTACh approach turns on the theory that the mother is absolutely central to the child's emotional development, as originally assumed by Bowlby, later dropped by Bowlby, and shown to be unlikely in this age of LGBT etc. families.

So Eshleman is pushing a concept created by ATTACh which is in fact not in line with the realities of attachment as systematic research has shown them to be, and Adoption Today is presenting this idea as reliable thinking about attachment. What else can we find in this issue, other than advertising for Eshleman’s services and publications? Ah—let’s look at this article by Mershona Parshall, starting on p. 18. (Parshall was the business partner of Elaine Thompson, an “attachment therapist” who was involved in the case of the caged Gravelle children in Ohio; Parshall was not accused in that case nor as far as I know was she involved in the treatment of the Gravelle children.) Parshall’s article describes the use of “neurofeedback” for treatment of severe behavior problems in an adopted boy. Over a period of two years, the boy received the treatment (usually described as “possibly efficacious”), and his behavior improved, an outcome that Parshall attributes to neurofeedback rather than to maturation. Parshall states that apparent regressions in behavior are to be expected at the beginning of the treatment and that it is critical not to increase medications, but actually to decrease them, at this point--  a potentially dangerous statement if there are serious biological reasons for the problems, and one which Parshall makes without explanation.

Interestingly, on p. 24, we see an article (and accompanying advertisement) by Terry Levy and Michael Orlans, founding members of ATTACh and formerly attachment therapists involved with Evergreen, CO (the home of holding therapy), and still listing an Evergreen address. Levy was the editor of a 2000 book published by Academic Press that featured a chapter by Nancy Thomas, the “therapeutic foster parent”, who advised removing furniture from children’s rooms and placing alarms on their doors, requiring them to ask for all “privileges” including use of the toilet, limiting the quantity and variety of their food, and insisting on periods of “strong sitting” without motion or speech. Thomas also advocated withholding information from children in treatment, including answers to their questions about when they would see their parents again (these, of course, were children who were said not to be attached to the parents they were asking for).

Speaking of Nancy Thomas, the piece by Julie Beem on p. 30 seems to be on the same page with the Thomas philosophy. A sidebar lists “therapeutic parenting” programs as suggested by Thomas, by Heather Forbes, by Katherine Leslie (all fans of the restrictive approach), as well as by the Love & Logic company, headed up by Foster Cline, one of the originators of holding therapy and related approaches.

Have I said enough to show what’s going on here? I could, but won’t, go on to discuss the numbers of therapists listed at the end of the issue who have been associated with potentially harmful treatments for children and with the less harmful but not demonstrably effective approaches now sponsored by ATTACh. I do not see on that list the names of respected, evidence-oriented clinicians like Mary Dozier or Sheila Eyberg!

Adoption Today, can’t you do better than this? Adoptive parents need information that is both reliable and accessible. A magazine that functions as the house organ of ATTACh and as an advertising medium is not living up to its responsibilities.

1 comment:

  1. The "Adoption Today" April 2011 issue has more of the same. You can see a bit of the issue online:

    I would love to see what they list as "Attachment Resources" on page 32.