Concerned About Unconventional Mental Health Interventions?

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

Monday, October 15, 2012

Holding Therapy as an International Problem


Some readers of this blog will be aware of my years-long concern about Holding Therapy (also called Attachment Therapy, Z-therapy, soul therapy, rage-reduction therapy, etc.). Holding Therapy, which I’m going to abbreviate as HT, is an alternative psychotherapy---  the psychological version of  complementary and alternative medicine (CAM). By this I mean that it is based on implausible assumptions, at odds with conventional understanding of personality and early development, and is also without a systematic evidence basis with a foundation of randomized controlled trials or well-designed nonrandomized trials. HT is used primarily with children, although some of the “sexual conversion” proponents have employed it, and its practitioners are more often social workers or licensed mental health professionals than they are psychologists or physicians. Child injuries and deaths have been associated with HT.

When most people see the word “psychotherapy”, they assume that the treatment in question is some form of talking therapy. They may think of highly-directed cognitive therapies or of psychodynamic approaches that seek basic motivations and may explore memories of early life, but they have in mind an intervention that relies on discussion between the therapist and the client. Even when people consider treatment of young children, they expect psychotherapies to focus on communication, perhaps through play methods rather than through speech.

HT, however, is a talk therapy only in the most minimal sense. It has strong physical components, including physical restraint of the child, demands that the child kick on command or do push-ups or jumping-jacks, and painful grasping and prodding of the child’s body. Children in treatment are required to shout statements like “I hate my mother! I want to kill her!” at the command of the therapist. The originator of this treatment, one Robert M. Zaslow, a California psychologist whose professional license was revoked after he injured an adult patient, suggested that clients sign a waiver noting that bruising was to be expected from the treatment.

Discussions of HT have often attributed the practice to a sort of American backwoods mentality, associated with religious fundamentalism and an approval of the use of force to achieve desired ends. In fact, people outside the United States have essentially said “it can’t happen here”.

But in the last few years it has become plain that although HT is not common, it does happen in England, as has been described at http://invisibleengland2.wordpress.com and in the book Invisible England. In fact, HT has a long history in Great Britain, as I have described in a paper recently accepted by the British journal Adoption & Fostering.

A recent e-mail from the Czech Republic alerted me to the fact that the HT practitioner Jirina Prekopova , who had practiced for many years in Germany, has returned to her homeland and is advocating and practicing HT. Here are two videos of the proceedings:
http://www.youtube.com/watch?v=jqj_mLYKmxo

{Note-- 10/16/12-- these videos now come up as unavailable. If you want to see them, try searching Jirina Prekopova youtube, because there were a number that could be seen yesterday.}

But BE WARNED: THESE ARE VERY DISTURBING! ON NO ACCOUNT PLAY THEM WHEN CHILDREN CAN HEAR THE AUDIO. The language is Czech, but you will get the picture all too well without understanding the words.

One of my correspondents has said that Prekopova uses these methods with children who have tantrums, including, according to her, an infant under a year of age. The correspondent has complained to the Association of Czech and Moravian Psychologists but has received no answer.

Prekopova lectures widely, and groups using her methods have been formed in several European countries and in Latin America.

How Prekopova developed her HT methods, and how she received encouragement, is an interesting story with several clear morals. The story goes back to the 1980s, when the New York psychiatrist Martha Welch visited the town of Evergreen, Colorado--  usually thought of as the nursery of HT—and developed her own version of the treatment, which she initially called “holding time” but today refers to as “prolonged parent-child embrace” (PPCE). Welch’s method involved face to face contact in which a small child was held on the mother’s lap, and older children lay supine with the mother lying on top of them, supporting some of her weight on her elbows. Children resisted this strongly and fought to get away, while the mother shouted and cried in expression of her own negative feelings. Eventually, both were expected to calm down and to express tender affection for each other. Welch originally presented this as a treatment for autism.

In the early ‘80s, Welch  met Elisabeth Tinbergen, the educationalist wife of Nikolaas Tinbergen who had received the Nobel Prize for Medicine or Physiology in 1973, together with Konrad Lorenz and Karl von Frisch. Tinbergen’s work involved instinctive responses of animals to specific stimuli, and in his Nobel speech he attempted to bridge that work to work on human behavior and especially on the problem of autism. Mrs. Tinbergen introduced her friend to the Nobelist, who was impressed with the connections between “holding time” and his own ideas about early development and autism. The Tinbergens wrote a book about autism and holding, and although they noted that there was no systematic evidence to show that Welch’s method was effective, they also included a lengthy appendix by Welch, with many photographs. The support from the famous Niko Tinbergen was one of the factors that led to the publication of Welch’s own book, Holding time, and her tour of Great Britain, publicized by the BBC in films that show her guiding groups of mothers to restrain their crying autistic children. (One of the morals here is, just because a person gets the Nobel prize for one thing, that doesn’t mean he knows a whole lot about other things--  cf. Linus Pauling and vitamin C.)

Jirina Prekopova met with Tinbergen and Welch and adopted the Welch method. Apparently also present at this meeting was Bert Hellinger, a German therapist. Hellinger has a method he calls systemic family therapy. Hellinger’s approach includes the idea that one’s soul may be “entangled” with those of ancestors in ways that cause the individual to act out ancestral issues. For example, a boy may be homosexual because of the desires of a deceased sister. Similarly, when incestuous relationships occur, perhaps between father and daughter, both partners are responsible, and the daughter must forgive and respect her father. Prekopova refers to and supports Hellinger’s system, although it is not clear to me in what way she actually uses it.

So, there we are. As a result of various personal contacts, and a lack of guidance from professional and licensing organizations in Europe and elsewhere, HT has spread and continues to do so. Is it not time for an international conference to discuss what can be done about this? “Anya Chaika”, author of Invisible England, what do you suggest?  




9 comments:

  1. Documentary film celebrating Jirina Prekop that is called Mum, Dad, give me a hug, from which are video, (all here http://www.ceskatelevize.cz/porady/10267432237-mamo-tato-obejmi-me/410235100021005/ ) was broadcasted by Czech public television before Christmas 2010 . Jirina Prekop gets in Czech Republic general support from official spots
    Jirina Prekop's wish is "to expand ideas of HT around the world".

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  2. Thank you for this contribution.

    Unfortunately, Prekopova seems to be succeeding in her efforts.

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  3. I think that an international conference on HT would contribute greatly to stopping the spread of these practices. It is clear that HT is used in a number of countries. However, the treatment has often taken root "under the radar" of the organisations that are responsible for its governance. The situation in the Czech Republic is particularly worrying because Jirina Prekop appears to have the support of key establishment figures.

    One way of dealing with these unscientific and abusive treatments is to expose them to rational and evidence-based arguments. Doing this in the context of an international conference would be even more effective

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  4. I wonder whether Edzard Ernst would help by sponsoring a conference. Britain seems like the logical place for it to be, as somewhat central geographically.

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  5. Dear Dr. Jean Mercer, thank you very much for your work. I am from Russia. And I am very anxious that these ideas are now spread by some people in my country as well. In 2012 Nancy Thomas arrived in Ekaterinburg with her lectures. And now one prominent oranization involved in adoption has trabslated her book "When the love is not enough" and is providing it in Internet without charge, (i.e.,http://attach2me.ru/books/kogda_lyubvi_ne_dostatochno/)/ As in general Russian people do not know English well, they can"t, learn critical revews on this issue. I wrote some articles on this topic in my blog, but of course this is is not enough to stop this "virus". I would be very greatful if you consider this aspect as well.

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  6. Dear Yulia-- thank you for getting in touch.I was recently reading your blog,which was recommended to me by "Anya Chaika". Google translate would not translate the whole post, but what I read was very disturbing indeed. In my opinion, the methods recommended by Nancy Thomas are more dangerous than holding therapy itself.

    There are plans underway for a meeting in London on 20 April 2013 of an international group concerned with abuses in child psychotherapy. There will be Czech, British, and U.S. delegates attending. Would you be interested in this meeting-- either in attending or in preparing material for someone else to present?

    Best regards,
    Jean

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  7. Dear Dr. Mercer! Thank you very much for your invitation. I shall do my best to take part in this conference by some kind. I am not sure now wether I would be able to arrive to London, but I can send the materials, by any way.

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  8. Dear Dr. Mercer! Thank you very much for your invitation. Of course, I'll do my best to participate in such important conference, may be not by myself but preparing material for something else to present.

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    Replies
    1. Good! I will keep a place open on the agenda for your report and will present it myself if you like.

      See today's post too--

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