Concerned About Unconventional Mental Health Interventions?

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

Tuesday, January 8, 2013

More on the International Problem of Holding Therapy: Nancy Thomas in Russia


Yulia Massino, a Russian blogger, has called my attention to the visit of Nancy Thomas, an advocate of Holding Therapy, to Russia in 2012. Yulia is especially concerned about the possible influence of Thomas because little of the  U.S. criticism of Thomas’ methods has been translated into Russian. Unless Russian parents are fluent in English and have access to professional and other publications, they are unlikely to be aware of the existence of serious concerns about Thomas’ claims.

Thanks to Google translate, it’s possible for non-Russian-speakers to have a good look  at http://attach2me.ru, a web site offering material by Nancy Thomas and other proponents of Holding Therapy to a Russian audience. Like other advertisements for the Holding Therapy belief system, this one begins with an unusual definition of attachment as a desire and ability to prolong emotional intimacy with another person, rather than one of the more common definitions, like a preference for being near a person when uncomfortable or threatened. It proceeds to describe a mental health diagnosis called Reactive Attachment Disorder as including failure to make eye contact except when lying and an interest in blood and gore---  none of which are part of Reactive Attachment Disorder as defined by DSM-IV-TR or by ICD-10.

In a move typical of Holding Therapy proponents, http://attach2me.ru lists a peculiar mixture of books that are all said to be “about attachment”. These include an important volume by John Bowlby, the major theorist of attachment, and one by Bowlby and Mary Ainsworth, his collaborator  and creator of the idea of differing  qualities of attachment. (Articles listed in another section are also primarily by Bowlby.)  In addition, however, the book section includes translations of works by the Holding Therapy advocate Nancy Thomas and by Gregory Keck and Regina Kupecky, authors well-known to support a belief system that shares with Bowlby’s conventional system no more than a handful of vocabulary words. Also listed is a translation of a book whose senior author is Foster Cline, the erstwhile leader of the “rage-reduction therapy” movement of the 1980s and 1990s, and like his colleague Thomas a promoter of an attachment theory quite unrelated to Bowlby’s.

Two questions present themselves: What are the differences between the Thomas/Keck/Cline view of the attachment and the conventional attachment theory formulated by Bowlby? And, given that the two approaches are mutually contradictory, why would proponents of one want to mention the other approvingly?

The first question requires more details but is in fact simpler to answer than the second. Here are some basic differences:

  1. The basic nature of attachment. For the Holding Therapy (HT) group, attachment is an emotional transformation something like religious conversion. Once done, it is difficult to undo or change, but shapes relationships through life by determining not only trust and intimacy, but obedience and gratitude to others. Disturbed attachment results in psychopathic behavior, serial killing, and sexual inappropriateness.
From Bowlby’s viewpoint, attachment is the formation of an early preference for familiar caregivers and sense of security in their presence. As cognitive and emotional development proceeds, existing attachments change toward  more mature relationships, and new attachments are formed. Early attachment experiences are one of several factors that determine later social relations.  Bowlby argued that poor early attachment can result in delinquency, but did not relate early experiences to later severe behavior problems.

  1. The timing of attachment processes. The HT group considers attachment to exist prenatally as a result of some form of communication between birth mother and unborn infant, but also to continue to develop later. Newborns are thought to have a strong attachment to their birth mothers and to suffer grief and rage if separated (e.g.by adoption).
Bowlby’s theory of attachment focuses on social interactions with a small number of caregivers in the second half of the first year as critical to attachment, but assumes that new attachments can develop in the second year and later. Newborns (that is, infants in the first month after birth) are not thought to have attachment or to experience suffering if separated from their birth mothers.

  1. How attachment occurs. The HT theory of attachment holds that this emotional commitment of the child increases through the first year insofar as caregivers can satisfy the child’s needs. (Infants with serious health problems are thought to fail in attachment if caregivers cannot comfort them.) The experience of need followed by gratifications presented by caregivers is referred to as the “first-year attachment cycle”, a concept absent from conventional views of attachment. Attachment is thought to be advanced and perfected during the second year of life when caregivers set limits on children’s behavior.
Bowlby’s theory of attachment focuses entirely on pleasant social interactions with familiar caregivers as the cause of attachment and the related sense of security with familiar people. Attachment is more difficult if caregivers are indifferent or unpleasant, or if the child has too many changes of caregiver.

  1. How attachment problems are thought to be treated. The HT approach is based on the assumption stated in the last paragraph, that attachment occurs because of satisfaction of physical needs and because of limit-setting. HT methods, especially those sometimes referred to as “Nancy Thomas parenting”, aim at re-enacting the events HT advocates believe are responsible for early growth of attachment to caregivers. In order to satisfy a child’s physical needs, it is essential to be sure that these needs exist and can only be gratified through the intervention of the caregiver or proposed attachment figure. Children are forbidden or prevented from efforts to help themselves in age-appropriate ways like preparing food or using the toilet at will. The child’s diet is limited in amount and variety (one Russian adoptee in the U.S., Viktor Matthey, was apparently fed on uncooked grains), leading to malnutrition and weight loss; he or she may be made to sleep in a cold room; and toilet use is available only with the stated permission of the caregiver. Along with actual “holding” treatment, these methods are thought to prepare the child for a new attachment, which is cemented by means such as extended mutual gaze, rocking and cuddling of older children as well as younger, and hand-feeding of milky sweets in apparent imitation of the provision of  milk from the breast. As all behavior problems are thought to be based on poor attachment, these methods are expected to help with all difficulties.   
Conventional child psychotherapies based on Bowlby’s theory, such as Robert Marvin’s “Circle of Security”, focus on increasing parents’ and children’s communications with each other, so parents become more aware of children’s cues showing that they need comfort and security, and children in turn have improved social experiences. Specific problem behaviors  like speech delays are treated in conventional ways and are not linked particularly with attachment history.  

  1. Safety and effectiveness. A number of cases of harm to children have been associated with HT and “Nancy Thomas parenting”, but no such association has occurred with conventional treatment. HT methods have no foundation in systematic evidence, but several conventional methods are evidence-based.


It is abundantly clear that the HT approach is vastly different in its assumptions about attachment than the conventional attachment theory developed by John Bowlby. Why, then, would http://attach2me.ru list together a series of books that contradict each other? The best explanation appears to be that the HT group wish to gain acceptance by “riding the coattails” of a major conventional psychological theory and associating themselves with a name that has been heard by every introductory psychology student for the last 40 years or so. Not guilt, but respect, by association is the goal of the promulgators of http://attach2me.ru. They’ve tried the same thing in the United States, but here they have met again and again with critical rejection by major professional groups. What a new frontier Russia must be for them--  a Promised Land where few have yet heard about the reality of HT, and most can’t read the endless criticisms of the method! Let’s hope that Pavel Astakhov takes note of what may be happening to Russian children in their own country.

N.B.  I believe I’ve heard that Jirina Prekopova is also making some approaches to Russia. What a Battle of the Titans that might be---  NT versus JP--- which can restrain the other longer?  
  

12 comments:

  1. Dear Dr. Jean Mercer! Thank you for your attention to the problem of the beginning of "Nancy Thomas parenting" promulgation in my country. I shall translate your post into Russian and publish it in my blog as well. I also shall find the ways with the help of my friends to report this information to Pavel Astachov. It seems that he is not informed that this dangerous psyhocult began to spread in our country as well. And I noticed that "holding" therapy has been already widely advertisised in russian Internet as the "widespread modern method" to "cure autism" (without mentioning the critics of this method in USA or UK). But "Nancy Thomas parenting" is an " innovation".

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    1. In Russia, has the holding therapy for treatment of autism been associated with Jirina Prekopova? And is the Nancy Thomas treatment claimed as a treatment for autism, or for Reactive Attachment Disorder, or what?

      Thank you for your work in getting this to the attention of Pavel Astakhov. A person who knows a lot about it already is Konstantin Semin, the TV anchorman. He interviewed me some years ago when he was working in the U.S.

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  2. Dear Dr. Jean Mercer! In Russia Internet and also in the introduction to russian translation of Nancy Thomas book ("When love is not enough") Nancy Thomas is claimed to be "a great specialist" of "global level" in growing up "difficult" (i.e., adopted) children with "RAD" and treating practically all mental health deseases, even the most serious (autism, bipolar disorders and others). But mainly her book and lectures are suggested for parents of adopted children. Also, those who recently published her book in Moscow wrote in their blog that they were going to bring these books to social workers! And for her lectures in family center "Aistenok" Ekaterinbourg there were invited the workers of Health department, social workers and so on, besides the present and future parents of adopted children. "Holding therapy" for autism treatment seems to be promulgated in Internet independently, as the "effective" method "invented by Martha Welth". I could not find any connection with Prekopova yet. Also I don't know the attitude of our official medicine to "holding therapy" in autism treatment, because I am a biologist (PhD in the field of hybridama technology, immunochemistry and etc), not a specialist in mental health. But I am going to elucidate this question as well. Yulia Massino.

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  3. Dear Dr. Jean Mercer! In Russia Internet and also in the introduction to russian translation of Nancy Thomas book ("When love is not enough") Nancy Thomas is claimed to be "a great specialist" of "global level" in growing up "difficult" (i.e., adopted) children with "RAD" and treating practically all mental health deseases, even the most serious (autism, bipolar disorders and others). But mainly her book and lectures are suggested for parents of adopted children. Also, those who recently published her book in Moscow wrote in their blog that they were going to bring these books to social workers! And for her lectures in family center "Aistenok" Ekaterinbourg there were invited the workers of Health department, social workers and so on, besides the present and future parents of adopted children. "Holding therapy" for autism treatment seems to be promulgated in Internet independently, as the "effective" method "invented by Martha Welth". I could not find any connection with Prekopova yet. Also I don't know the attitude of our official medicine to "holding therapy" in autism treatment, because I am a biologist (PhD in the field of hybridama technology, immunochemistry and etc), not a specialist in mental health. But I am going to elucidate this question as well. Yulia Massino.

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    1. I didn't realize your name was actually Massino-- sorry for calling you "Mass".

      Are you aware of any Russian laws that would prohibit people from making these unsupported claims-- laws about commercial speech or trades description acts?

      This is all extremely disturbing.

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  4. This is like exporting chemicals found to be too dangerous for domestic use by U.S. regulatory authorities and dumping them on unsuspecting consumers in developing nations, solely for a profit, with no regard for human life. Frightening. Immoral. Malicious.

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    1. Your analogy is a good one. And I wonder who (other than NT) gets the profit here?

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  5. Dear Dr. Mercer! Thank you very much for your important explanations concerning scientific attachments theory and HN dangerous tales. As to the law - I do not know the exact answer to ths question now and have to discuss this issue with an advocate.

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    1. Thank you. Please do let me know what you find out.

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  6. Yulia Massino-- could you please get in touch with me or Anya Chaika to let us know whether you will be able to contribute a presentation to the
    April conference?

    Thanks,
    Jean

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  7. I find it interesting that in an attempt to regress a child they withhold toilet privledges. I only have 2 kids, but I'm fairly certain neither of my children used the bathroom on command or requested permission in the first year of life. I'm also pretty certain that general wisdom is that infants should be "fed on demand" and not put on a specific schedule. Of course there are different theories and opinions in regards to this, but I believe most experts agree.

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    1. Of course if you look at the old "Babywise" books they recommended strict scheduling-- but then they had babies hospitalized with failure to thrive, so they re-thought that a bit.

      That is an interesting thought about infants--"permission to pee, please Mom?"

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