Saturday, March 16, 2013
Warnings From the Attachment Industry: Examining Online Material About Attachment Therapy
Looking over the details of attachment therapy web sites is always interesting and revealing. Somehow, laborers in the attachment biz seem to make the same mistakes repeatedly. Maybe they never read anything that contradicts their viewpoints-- but of course that would mean omitting a great deal of relevant material, without which an educated perspective is impossible.
Today, I notice that at www.instituteforattachment.org, mouthpiece of the Institute for Attachment and Child Development in Colorado, includes a message called “Beware of Attacks on Attachment Therapy”. The author, Forrest Lien, provides a mixture of truths, half-truths, and errors to support his argument that people like me are mistaken in their concerns about attachment therapy.
Lien distances his organization from the lady formerly known as Connell Watkins, but also describes Watkins as having “wrapped a child up in a blanket which affected her breathing and she died”. This description seems to me to parallel the statement that Jesus was in an upright position with his arms extended, this influenced his health, and he passed away. Both are true, but a bit incomplete. Lien’s comments about Candace Newmaker may appeal to those who have seen the related “Law & Order” episode, in which the scriptwriters avoided the issue by having the child’s death due to an allergic reaction to the blanket. But the reality is that Candace suffocated because of pressure exerted against her immobilized body by a number of large adults who believed they were imitating the experience of childbirth and that this would cause Candace to be the “real” attached child of her adoptive mother. Silly and pointless as it may be, rebirthing should not be fatal. It was fatal in this case because of the factor Michael Shermer has called “death by theory”. That is, Watkins and her fellow-therapists were convinced of the basic tenet of attachment therapy, promulgated by Foster Cline, that a display of power and authority was necessary in order for a child to become attached to a parent. Watkins persisted in her actions for 70 minutes, ten times longer than the usual rebirthing session-- 70 minutes in which the child initially begged for release, vomited, defecated, and for the last 30 minutes was silent. It was not the blanket that affected Candace’s breathing; it was the deep conviction of the therapists that in order to be successful they must ignore the child’s “lies” and force her compliance.
Lien is perfectly correct in saying that rebirthing is not holding therapy, and it is wrong to equate the two. This error on the part of a Congressional resolution and of the American Psychological Association has caused a great deal of trouble, although it pleased holding therapists, who were happy to point the finger at rebirthing and away from their own principles and practices. In fact, rebirthing is quite unlikely to do either harm or good-- unless it is intensified to a dangerous level by beliefs like those Watkins held.
Interestingly, Lien notes that his organization stopped using holding therapy in 2006 (even though, as they state, it was not the same thing as rebirthing). Six years after Candace Newmaker’s death! Several years after a number of publications pointed out other child deaths associated not only with the therapy, but with the belief system that equates obedience with attachment! Can we believe that people who took that long to drop a particular practice have also dropped all of the harmful mistaken beliefs that supported the practice? I find it difficult to believe, and my difficulties are confirmed by the rest of the www.instituteforattachment website.
As usual, some of the principles that make attachment therapy dangerous are seen in the list of symptoms of Attachment Disorder given on this site. There we are, at “What is Attachment Disorder?” -- the same old same old claimed symptoms, totally different from the characteristics of Reactive Attachment Disorder as described in DSM. Manipulativeness, lack of conscience, remorse, or empathy, inability to give or receive love, lack of cause and effect thinking (ever wonder how they can be so manipulative without this?), lying, destructiveness, cruelty, and of course superficial charm. But Reactive Attachment Disorder is officially characterized by either excessive clinging and dependency on caregivers or by a lack of normal preference for familiar people. Where did the IACD Attachment Disorder list come from? It’s a combination of a number of old checklists, including one that’s supposed to identify psychopathy. How did this list get associated with Reactive Attachment Disorder, the term used at several places on the website? Do the website authors hold that Reactive Attachment Disorder is the same as Attachment Disorder? If not, what is the evidence that there is a distinct disorder called Attachment Disorder? If www.instituteforattachment.org is not sure what problem it’s treating, it seems a bit arrogant to declare that the treatment is a safe and effective one.
Given the apparent confusion about the problems being treated, perhaps, it’s not surprising that www.instituteforattachment.org features among “research articles” a piece on the Randolph Attachment Disorder Questionnaire, which makes many of the assumptions noted in the last paragraph. The RADQ is an instrument that has never been published in a peer-reviewed journal and one whose efforts at validation involved having the same person administer questionnaires to parents and make diagnostic decisions, a pretty sure way to create bias in the results. It’s not clear on the rest of the site whether IACD even uses the RADQ, and indeed they should not, because not only is the instrument poorly validated, its author states perfectly clearly that it is NOT an assessment for Reactive Attachment Disorder, but for “something else”—Attachment Disorder. This does raise the question, though-- if IACD does not use the RADQ, why do they post information about it? Is the answer that they actually do use it, or is the presence of the RADQ on the site simply a code that communicates to some readers the real belief system at work here?
I didn’t come here to argue that IACD uses directly harmful methods, that they killed Candace Newmaker, etc. I do believe that some psychotherapeutic methods are indirectly harmful, in that they are ineffective but delude parents into avoiding more effective treatments. This problem points up questions about the effectiveness of the treatments used by IACD. Exactly what these are is not obvious, of course; however, some of the articles and other materials give us an idea. For example, there is a piece by Sebern Fischer touting neurofeedback, a method that has never been supported by adequate outcome research. An article by Victoria Kelly claims that physical contact and eye contact are important factors in treatment of childhood emotional disorders-- a claim that has never been supported by evidence, and that in fact has been tested only by proponents of holding therapy.
There are some other questions that the web site put into my head, but did not answer. Why does www.instituteforattachment.org state in a testimonial that a child diagnosed with PDD was successfully treated with their methods? Is this a claim that PDD is caused by the same factors that appear to create RAD? Is it that, as someone commenting on this blog remarked the other day, that all but clearly genetic early mental health problems are due to attachment difficulties? And what would be the ground for making these claims?
Another question: children treated at IACD are apparently sent to “therapeutic foster homes” for periods of months. If the goal is to create emotional attachment to their parents, what would be the rationale for this separation? Do Forrest Lien and his staff believe, like the old holding therapists, that they can create an attachment in a child and then transfer it from one attachment figure to another? How would that work, when attachment is a matter of a relationship, not some entity inside the child?
And finally: is it true that IACD uses the Attachment Disorder diagnosis? When seeking third-party reimbursement, do they use that term, or do they claim DSM code 313.89, Reactive Attachment Disorder? It’s my understanding that public funds are received by IACD, and surely there is a problem if in applying for such funds the organization substitutes an acceptable diagnosis for one that is not evidence-based.
Until IACD and other organizations can correct their misinformation and answer these questions, I will continue to hold the position that attacking attachment therapy is not only an appropriate action in terms of the evidence-- it is in fact a professional responsibility.