Attach-China: What Treatment Methods and Principles Does It Support?

In response to my open letter of a few weeks ago to Mary Landrieu, on the subject of pre- and post-adoption training and services, Lynne Lyon of Lawrenceville, NJ has provided her own open letter intended to contradict my statements, especially in reference to certain organizations ( see http://childmyths.blogspot.com/2013/01/russian-adoption-letter-to-mary.html; scroll down to comments). In this post, I will repeat Lynne’s statements and refute them by referencing material from www.attach-china.org, one of the organizations whose methods and principles I challenged.

Lynne begins her letter with a red herring alluding to outrageous statements about rape. She then quotes part of my original letter, which refers to the belief that “adoptive parents can cause children to become attached to them by displaying their power and authority. In order to display authority, parents must make children completely dependent on them and obedient to them; children may eat and drink only as parents allow them, must not use the toilet without asking, and may be kept in cold or uncomfortable sleeping arrangements, including cages.” Lynne goes on to say that this is poor scholarship and that she herself does none of these things, and that I am wrong about attach-china and other groups.

I am happy to accept Lynne’s statement that she does none of the things mentioned. But I maintain that material on attach-china and other similar websites conveys support for the practices described above.

Why do I say that attach-china and other groups support the belief that adoptive parents cause attachment by displaying power and authority? Let’s begin with the material  called “When the Bonding Cycle is Broken” on www.attach.org. This material begins with a quotation from Terry Levy and Michael Orlans, formerly of the Attachment Center at Evergreen, the original hotbed of “rage-reduction” holding therapy as invented by Robert Zaslow and perfected by Foster Cline (both of whom surrendered professional licenses following injury to clients). The book quoted here, and Levy’s 2000 edited book published by Academic Press (to their lasting shame), both advocate physical restraint and provocation of children as a way to break attachments and create new ones. Levy’s 2000 book also rejoices in a lengthy chapter by Nancy Thomas, in which she advises limitation of children’s diets, isolation in locked rooms, enforced “strong sitting”, and hours of manual work as ways to treat emotionally-disturbed children. (Sylvia Vasquez, who was convicted  of keeping her adopted children in cages with buckets as toilet facilities, claimed that a book by Thomas was the source of her practices.) The quotation of Levy and Orlans’ book by www.attach-china.org conveys to readers an approval of all these people’s publications and claims.

To go on with the same material from www.attach.org: the following section cites the “bonding cycle”, an imaginary process claimed by attachment therapists to be the source of normal attachment in infancy (see http://thestudyofnonsense.blogspot.com/2012/08/parsing-attachment-cycle-fox-terrier-of.html for a discussion of the actual sources of this idea). The “bonding cycle” belief system ignores the evidence that attachment does not develop through experiences of gratified physical needs, but instead involves an interaction of pleasant social exchanges with the naturally-developing fear system in the second half of the first year. Of course, for attachment therapists simply to misunderstand how attachment comes about would be a minor problem--  except that on the basis of this misunderstanding, a commitment to the “pathophysiologic rationale” (the belief that if you know how a problem arose, you can tell how to solve it), and a belief that re-enactment rituals can undo past developmental errors, some practitioners have come to the principle that older children can become attached only if their parents control everything about their lives until the children comply. As is the case for many other mistaken beliefs about child-rearing, this one can become dangerous when parents escalate their efforts by withholding food or intensifying other sources of physical discomfort. Again, the emphasis placed on the “attachment cycle” by www.attach-china.org conveys to readers that statements about the repetition of such a cycle in treatment are somehow legitimate.

Let’s look at another section of the www.attach-china.org site: a Reactive Attachment Disorder Checklist, as usual in no way related to the symptoms of Reactive Attachment Disorder as described in DSM. And this one is of extra interest as having been acquired from Walter Buenning, well-known in past years for power-asserting holding therapy with infants as well as with older children. Although this checklists purports to be for assessment of infants, it includes some of the old goodies from checklists back to Foster Cline and before--  preoccupation with fire, gore, and evil, for instance. None of these characteristics are in fact used in conventional evaluation of Reactive Attachment Disorder, but are  given great emphasis by holding therapists who advise power assertion.

Well, this is entertaining, and we could go on and on, but let’s just look at one more interesting thing--  the www.attach-china.org material about treatment. The site references Martha Welch, whose specialty for many years has been a version of holding therapy in which young children are restrained face-to-face with parents, older children restrained in the supine position with the parent lying on top of them. This goes on for an hour or more while the children fight and scream and the parent shouts her anger and distress about the child. Welch originally proposed this as a treatment for autism, but more recently has called it Prolonged Parent-Child Embrace and focused it on Reactive Attachment Disorder. The site also references Gregory Keck and Regina Kupecky, whose support of physical restraint as a treatment method is well-known.

The section on treatment goes on to discuss neurofeedback, a method without an evidence basis, and to reference with approval its use by Larry van Bloem, a Utah practitioner whose clinic was implicated in deaths and injuries of children, and who himself was under investigation and would have had his license revoked if he had not been killed in a car accident almost ten years ago.

And finally, about the treatment section: curiously, attach-china is willing to state that sand tray therapy and play therapy are ineffective for children with Reactive Attachment Disorder. I don’t dispute this, and would agree that there is little good evidence that they are effective with any child, but I query the implication that if those two methods are not effective, the other ones mentioned must have good evidence of effectiveness. Not only is there no such evidence, but holding therapy and related parenting methods have been associated with serious adverse events as no other child psychotherapies have ever been.

On the basis of the evidence I have just put forward, I stand by my statement that attach-china and other organizations provide potentially dangerous misinformation about attachment and attachment disorders. This misinformation may create expectations and behaviors in adoptive parents that can lead to mistreatment of children, and once again I query the involvement of these factors in the injuries and deaths of children adopted to the U.S. from abroad.

I do not, of course, accuse Lynne Lyon of any of these misunderstandings or inappropriate treatments of children. I would ask her, though: if you agree that the methods and principles I attributed to attach-china are wrong and dangerous, why do you not stand up to rid your profession of therapists who are committed to dangerous advice? Why spend your time complaining about someone who is making an effort to correct potentially harmful practices?