Monday, November 26, 2012
They Don't Do That Any More: Attachment Therapy/Holding Therapy
Everybody knows the story of the tippler who declared that he didn’t drink any more. Caught with a bottle of beer in his hand, he explained: “I don’t drink any less, either!” That seems to be the possible position of the Association for Treatment and Training of Attachment in Children (ATTACh). Following the deaths of Candace Newmaker and other children in situations associated with holding therapy, ATTACh announced early in the 2000 decade that its members would no longer use coercive methods or physically restrain children in treatment. By the present year, 2012, we would expect all practitioners who consider themselves to be doing “attachment therapy” to have gotten this message-- if indeed it is being sent. (The continuing presence at www.attach.org of misinformation about Reactive Attachment Disorder raises questions about exactly what is being communicated.)
Nevertheless, here we are seeing the same old same old story being told in the blog http://adoptingspecialneeds.wordpress.com. This blogger has apparently spent her adult life adopting extremely difficult children and now has, among others, a 6-year-old who bites and fights. With this child, the adoptive mother is following the advice of the attachment therapy guru-ess, Nancy Thomas, and also displays a table of “facts” about Reactive Attachment Disorder that looks quite official but is in fact not based on any genuine information about that disorder as it is described in DSM (see p. 17 of her blog). Adoptive Mother has also sought an “attachment therapist” who will do an intensive treatment, many hours a day, with a method that is only vaguely described but appears to involve coercive restraint and other “holding therapy” techniques.
Adoptive Mother identifies herself with the Trauma Mamas (other adoptive mothers of children from severely traumatic backgrounds) and believes that she and they are a special breed whose experiences and qualities no one else can understand. One of the reasons Adoptive Mother and others seek out “attachment therapists” is that such practitioners encourage the view that only people with similar experiences can “get it”, and that conventional therapists are critical and rejecting of parents and simply “make the children worse”. These parents may also welcome a belief system that stresses escalation of intrusive parental control-- whether they welcome it or not, they buy into it when they choose a method that emphasizes coercion. Someone has said that “attachment therapy” is a way for parents to have children punished without doing it themselves, and this may be the reason we see Adoptive Mother writing “While Hope is clearly RAD, and I am committed to her without reservation, there are too many times when I simply do not like her” (but I quote this remark in full awareness of the genuine ambivalence that may cause some of the intensity of parental love).
How do I know that the treatment Adoptive Mother has sought is a coercive one? Not having been in the treatment room, of course, I don’t. Adoptive Mother mentioned wanting to find an AT (attachment therapist) trained by Daniel Hughes, and Hughes, in spite of his earlier admiration of holding therapy, has stated that he does not use coercion. However, Adoptive Mother does refer to children who have died in the course of holding, and states that she and her husband are present in the treatment room and would not permit anything abusive to happen, so it appears that she recognizes at least some element of coercion. In addition, the treatment she describes involves insistence on eye contact, and how this would be achieved without some degree of coercion or intimidation is not clear to me.
In addition to her choice of therapists, Adoptive Mother comments frequently on the use of physical force in dealing with the child. This ranges from the “strong sitting” demands advised by Nancy Thomas to a physical takedown and pindown to the use of a papoose board, a padded wooden restraint board used in painful or frightening medical and dental procedures, the use of which by professionals should receive documentation. (She notes 30 minutes of restraint of the child on the papoose board at one point.)
It appears that in spite of the claims of ATTACh that they "don't do it any more", “attachment therapy” in its “holding” form is alive and well and maintaining its position in the forefront of unconventional psychotherapies for children.
Not surprisingly, Adoptive Mother is also attracted to other alternative, unorthodox treatments. She is enthusiastic about having a chiropractor treat a child for bed-wetting. She employs a “tapping” technique (see http://childmyths.blogspot.com/2012/11/fun-with-thought-field-therapy-why-some.html) with one of her other children. She refers to the use of “sensory activities” and of “therapeutic holding”, both approaches with little or no evidence supporting them. She seems to be an easy sell for the AT practitioner who tells her that her child is in terrible shape, but that a tiny “spark” remains in spite of all. Wouldn’t it be nice if screening of adoptive parents looked into their ability to detect snake oil? But, until caseworkers can detect it themselves, I don’t suppose such screening is about to happen.