Concerned About Unconventional Mental Health Interventions?

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

Monday, November 26, 2012

Branding Cures and Attachment Therapy: A Little History and Discussion



Writing in the New York Times Magazine on Nov. 25, 2012, Lori Gottlieb, a professional psychotherapist, talked about a modern trend in her article “The Branding Cure: My So-Called Career as a Therapist.” Gottlieb’s comments about the behavior of psychotherapists in general have a remarkable relevance to the existence of psychologists, social workers, and others who call themselves “attachment therapists”--  and for the appeal that title has to many parents.

Gottlieb’s article addresses the response of psychologists to the fact that there are too many psychotherapists for the number of possible clients. For a lot of reasons, including the availability of psychotropic medications and limitations of insurance coverage for talk therapy, psychotherapists are finding that all their training may not put them in the position of making a living. What to do? One solution that has been suggested is to “brand” themselves by stating a narrow specialty on which they can be consulted--  weight loss, for example, or parenting discipline methods.

Here is what a “branding consultant” told Gottlieb on this point: “Nobody wants to buy therapy anymore… They want to buy a solution to a problem….[People come in] because they wanted someone else or something else to change” rather than seeking deep changes in themselves. Gottlieb reported, also, that people wanted to choose a therapist on the basis of personal characteristics of the practitioner, often emphasizing experiences or background shared by the client. This means that psychotherapists  who want enough clients to support themselves may need to provide some personal information about themselves, perhaps on a blog.

 People like me who are old enough for emeritus status notice a remarkable contrast between this advice to present-day therapists and ethical standards for professionals several decades ago. In the past, it was not only not customary for professionals to advertise in more than the most discreet way (“Dr. X has opened a new office at 999 Chestnut Street and is available by appointment”), but advertising was in fact prohibited by professional codes of ethics. In the 1970s, two cases decided by the Supreme Court re-defined advertising as a part of commercial speech that is protected under the First Amendment. One of these, Virginia State Pharmacy Board v. Virginia Citizens Consumer Council, 1976, permitted pharmacists to advertise drug prices for competitive purposes. The other, Bates v. State Bar of Arizona, 1977, decided that an attorney was permitted to advertise his services in spite of the ethical guidelines of his state professional organization which forbade such advertising.

After those two decisions, it was only a matter of time until law firms used billboards to attract people who had been in car accidents or had other legal problems; the traditional ambulance-chasing gave way to advertising that was seen daily by potential clients who might not yet be in any trouble. Psychologists and other professionals followed suit. Of course, with the advent of the Internet, both obvious advertising and “informational” blog or website presentations became ubiquitous. Ethical guidelines for psychologists (www.apa.org/ethic/code/index.aspx?item=8 ) do not forbid advertising, but require that public statements of any kind not be false or deceptive. (However, attempts to get the American Psychological Association to enforce this guideline are not likely to meet with cooperation, in my own experience.)

It was only at the point when information could be placed on the Internet that psychotherapists were in a position to “brand” themselves by announcing a specialty, and quite a few now do this. The public should know, however, that a licensed psychologist or social worker has almost invariably received a general training in psychotherapy at the accredited (we hope) university that granted the degree. Although there are continuing education classes that focus on specialties like weight loss or parenting, these were not the focus of the practitioner’s professional education, nor do they have anything like the rigor of a serious training program. A psychotherapist may have sought extensive training in the “brand” he or she presents--  or, possibly, not. There is no mechanism for preventing a person from saying that his or her specialty is birth trauma if that is the “brand” chosen, even if there is really no such thing as formal training in that specialty.

What does all this have to do with “attachment therapy”? This treatment is a “brand” selected and fostered by the organization Association for Treatment and Training of Attachment in Children (ATTACh; www.attach.org). Although there are many academic programs that focus on research into the development of emotional attachment and its consequences for later attitudes and behavior, few if any “attachment therapists” have studied at one of them. Although there are also many academic programs providing training in psychotherapy for children, and all of them consider the role of attachment in the development of personality, mood, and behavior, few if any teach a form of psychotherapy that aims specifically to alter attachment status. (They may, however, teach methods of work with parents that can alter the adults’ responses to children’s communication of attachment cues.)

In other words, there are no “attachment therapists” in the sense of persons trained in an accredited educational setting to  do treatment that alters a child’s attachment to specific adults. The idea that there are such people is purely a matter of “branding” by ATTACh, which offers certification for people who have been through its educational programs and maintains a list of “registered” therapists. I have to admire the chutzpah with which ATTACh has declared itself the source of training in a posited therapy and the final judge of what is or is not “attachment therapy”. This has been done in the face of a complete absence of evidence that the problems to be treated even exist in the declared form, or that the treatments used alter personality or behavior at all. A “brand” has been  invented by ATTACh, it’s out there on websites and blogs, and the market niche this brand requires has been opened. ATTACh built it, and they have come, but unfortunately their attendance at this baseball game is not necessarily therapeutic.

How was the “branding” of AT carried out? Looking at what’s on the Internet, we can see how beautifully the actions fit with the trends described by Gottlieb. First, there was a definition of a variety of real or potential difficulties as due to a single problem factor, attachment. This provided potential clients with a problem whose solution they could seek from practitioners whose name, ”attachment therapists”, gave the evidence that they were the right people to do this job. Second, AT practitioners stated that no deep change in the parents was required. It was, as Gottlieb quoted, a matter of wanting “someone else or something else to change”, and AT blogs and websites said that this could be done by correct treatment (while also warning against the dangers of pursuing conventional treatment outside the “brand”.) Third, ATTACh and its associates emphasized personal characteristics of practitioners and provided unusual amounts of personal information in various ways like blogs and self-published books; this permitted clients to choose a therapist on the basis of adoptive parenthood (for example) rather than on general training at a respectable institution or on breadth of experience with childhood mental health problems. AT clients found this appealing, especially in contrast with the professional reticence of most conventionally-trained psychotherapists--  which those who chose AT often perceived as aloofness or even disapproval.

Did the Supreme Court make the right decisions back in the ‘70s? I think not. Advertising and “branding” by professionals is good for the professionals’ bank accounts--  but surely those should not be the first consideration for the community.



  

2 comments:

  1. I had an interesting, somewhat tangential experience today. A local private/non-profit post-adoption support organization (Adoption Journeys), funded by the state of Massachusetts, advertised support groups for teens dealing with issues related to identity as an adoptee.

    I thought it might be helpful for one of my daughters, so I emailed for more information---specifically the name, schooling, licensure, and years of experience of the group leader. What I got back was a request that I call the organization to complete a preliminary intake ("pre-screening," their words) to see if we qualified. What? You're offering a professional service, for which you're getting paid (albeit by a third party), but you won't provide basic details about the professionals who might be working with my children? We're supposed to be petitioners, instead of astute consumers? I think not. I feel sorry for those families who are so desperate for post-adoption support that they'll cooperate with such a stance.

    I responded back that most professionals are happy to provide their credentials immediately, and if I can receive that information from them, I might call. Doubt I'll hear back.

    Coincidentally, or not?, the same organization runs a group for parents about attachment (though the attachment group description does not appear in the organization's official parent guide, available here: http://child-familyservices.org/wp-content/uploads/adoption-jouneys-booklet.pdf). Again, pre-screening of the families seems to be the relevant issue at this stage of offering a service, instead of providing details about the service and the professionals providing it. Checking to see the level of compliance of the parents first, perhaps?

    "Parents of Children with Histories of Attachment Trauma (P-CHAT): a support
    group specifically for parents raising children with Reactive Attachment Disorder. This group is facilitated by a clinician and meets quarterly. If interested, please call for pre-group interview."

    This group needs a mole. (I can't fake enough accommodating behaviors to do it.)

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  2. I don't know why people don't demand the credentials of psychologists/social workers/counselors, or why such professionals don't provide them up front as dentists,vets, and lawyers usually do. Perhaps part of the problem is that even well-educated people sometimes don't know the difference between a psychologist and a psychiatrist, much less all the other types of MH licensees who have been invented over the last 20 years. But that fact should give an impetus for patient education, not for ignoring the issue.

    Then of course we have the people who provide lengthy presentations of their credentials, but they ain't necessarily so!

    What we seem to need is a consumer movement that will demand information from these organizations rather than trying not to offend them-- or perhaps trying to avoid the good old accusations of denial, repression, avoidance, and self-injury that are not unknown when middle-management mental health staff are confronted.

    Any volunteers?

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