Concerned About Unconventional Mental Health Interventions?

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

Sunday, August 11, 2013

When Attachment Therapists Don't Understand Attachment Theory, Bad Decisions Are Made


In several posts in the last few months, I’ve mentioned “Eve Innocenti”, a mother who has not been allowed contact with her children since they were brought to an attachment therapy clinic in Colorado, apparently at the desire of a stepmother. These school-age children were said to suffer from mental health problems that were attributed to their early experiences with their mother, although no inappropriate experiences were ever documented. Like little boys with hammers, attachment therapists are inclined to see attachment problems everywhere, and especially focus on attachment when children have been separated from early caregivers. Attachment therapists also believe that they have methods that can cause children to become attached, or to transfer their attachments from one person to another. These beliefs are in contradiction to well-established evidence about what attachment is and how it develops and changes with age.

“Eve” has recently shared with me a report made by the county Department of Human Services in preparation for a permanency hearing next week. In it, the foster family organization that is taking care of one child is quoted as saying, “At this time his providers at ____   are not recommending that he have contact with his biological mother [Eve Innocenti]. They believe that considering the history that his biological mother would be disruptive to his attempts to gain in attachment [punctuation sic]. They do not recommend any type of contact including written contact.” With respect to the other child, the attachment therapy organization where he is placed is quoted as saying, “ they would be opposed to contact with his biological mother [Eve Innocenti]. They believe that contact with her would set back _____’s developmental progress. They believe that [Eve Innocenti] is a trigger for concerning behavior and that the confusion she brings into his life would prevent him from forming positive attachments. They do not believe it is likely that [he] would be in a good position to have any kind of contact including written and supervised calls with [Eve Innocenti] during the next six months to a year…. It is this caseworker’s understanding that ____’s therapist is recommending no contact, … due to ____’s developmental stage of attachment…”. Eve’s assigned attorney also told her in an e-mail that the boys were not being allowed to see any other family members than the man who is the biological father of one of them and his present wife.

It is hard to know where to begin commenting on the confusion which these therapists and foster care staff are imposing on the established facts and theory of emotional attachment. The first problem is the conflation of attachment with all of personality development and all of behavior. The children have been said to show conduct disorders and aggressive behavior, but these are not symptoms of attachment disorders. In addition, there is no generally-accepted method for diagnosing attachment disorders in school-age children.

One child is said to be attempting “to gain in attachment” and the other to be potentially prevented from “forming positive attachments”. These are meaningless statements. Attachment is not something a child can attempt to gain, nor is there such a thing as a “positive attachment” as opposed to any other kind. One can only assume that the people making these statements are following the lead of authors like Foster Cline and Nancy Thomas, who hold that cheerful, affectionate obedience is a result of attachment, and its absence a symptom of an attachment disorder. In reality, of course, children who are securely attached can be grouchy, disobedient, and unaffectionate, depending on circumstances and on their age. Attempts to correct these behaviors are sometimes justified, but when they are appropriate, the treatment does not involve attachment per se, although it may well focus on the relationship between child and parent.

The age issue is a very important one, and confusion about this is shown in the report’s reference to one child’s “developmental stage of attachment”. It is true that attachment theory, as formulated by John Bowlby, describes stages of attachment, beginning with many months of acceptance of all caregivers, then proceeding to a period of stranger and separation anxiety and intense grief over lengthy separation from familiar people . As toddlers develop better language and understanding of the world, they can more easily tolerate separation and develop excellent relationships with a larger number of adults; toddlers also begin to resist parents’ wishes and negotiate for what they want. By school age, children and parents ideally have developed a “goal-corrected partnership” in which each will make some adjustments in order to maintain a happy relationship. In describing these stages, Bowlby was considering not only maturation of the child’s abilities, but also the results of learning from experience with other people.

However, I would hazard the guess that the people quoted in the report on Eve’s children are not considering  the stages of attachment as Bowlby described them. Instead, I would speculate, they are thinking in terms of notional stages that were invented by Foster Cline and his colleagues several decades ago. These stages are often referred to as the “attachment cycle” (see http://thestudyofnonsense.blogspot.com/2012/08/parsing-attachment-cycle-fox-terrier-of.html). The “attachment cycle” is said to consist of two stages, one in which the child forms an emotional attachment to a caregiver because he or she is completely dependent on that person for the satisfaction of all needs. The second part of the “attachment cycle” occurs when the caregiver displays power and authority to set boundaries and enforce child obedience, once again equating compliant behavior with emotional attachment. Because neither of these stages is actually a part of the development of attachment, they cannot provide a useful way to think about a child’s “developmental stage of attachment”.

In reality, attachment develops because of pleasurable social interaction between a baby and an adult. And, because attachment is a very robust developmental phenomenon, it can and does occur even if pleasurable interactions are relatively few, and even if there is some abusive treatment.  It is important for young children to understand boundaries and rules, and to comply under certain circumstances, but these things have nothing to do with attachment. As children develop attachment, they also learn some things about what to expect from other people, and they may be securely attached to one adult caregiver while insecurely attached to another. As they develop further, they learn more about relationships with other people and may move from insecure to secure attachment or the other way around.

One of the real problems shown in the report on Eve’s children was that attachment was somehow thought of as developing independently of the rest of the child’s development, and being capable of being treated in some independent way. In fact, all aspects of development move ahead in a linked way. Children do not remain “stuck” at an early stage of development, nor can they be made to return to such a stage and rework it by regression and recapitulation. Eve’s son cannot be at some stage of attachment development that is characteristic of a toddler; things just don’t work that way. He may, for all I know, be grumpy or disobedient or worse, but these are not attachment issues. Even children who actually do have concerns associated with attachment need to be treated at their real developmental level, not at a level posited as part of an alternative theory of attachment.

The boys’ therapists apparently believe that they can act as if the children are infants, and by following some rules about how early attachment develops, they can create powerful new attachments. Presumably, this is why they want to exclude from the children’s experience adult contacts other than those with the parents-designate. (Do the foster parents and other caregivers avoid eye contact and so on, as advised by various attachment therapists, so the children don’t accidentally “attach” to them?) They presumably also believe that, like infants or toddlers, the children will grieve over and forget their lost biological mother, and be ready to attach to (i.e. , they mean, love and obey) the persons provided for them. But…  these boys are not infants or toddlers. They understand human relationships in a much more mature way, and although they may develop new and satisfying relationships, they will not forget their mother, but instead will be tormented by their belief that she could contact them but does not want to. Rather than helping them, their present treatment, with isolation from many familiar people and occasional “therapeutic” meetings with the designated parents, simply reminds them of the fearful specter of abandonment, a child’s greatest anxiety.

So far, all decisions about Eve’s children seem to have been made on the recommendation of their therapists. Soon, I hope, an actual judge will consider the facts. I only hope that he or she will have sought some understanding of attachment as it is considered in the world of mainstream psychology and psychiatry, not in the alternative universe of attachment therapy.  


11 comments:

  1. My opinions follow:

    Alas, I fear that Eve's experience is not unique in Colorado.

    In 2009, social worker Forrest Lien, the clinical director of Institute for Attachment and Child Development, claimed to have pilot programs with four Colorado counties: Arapahoe, Larimer, Saguache, and Denver.

    As well as bullying children into unquestioning obedience, Attachment Therapy actually works at breaking bonds of affection. A training tape made by Lien (2006), for the Institute for Attachment and Child Development, indicates that demonizing the biological parents is a key feature of Attachment Therapy. In one technique, Lien brings in associates who pretend to be the child's biological parents; they act drunk and threaten to physically hurt the child. (This is done even if the child was adopted at birth.)

    Children are advised that they need to denounce their biological parents if they are ever to be considered "family material."

    What is maddening is that there seems no way to hold county and state agencies accountable for subjecting children and families to this therapy which is demonstrably harmful. What to do?

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  2. In some programs of this kind, I know that "therapeutic foster parents" are not supposed to act in ways that are thought to facilitate attachment-- make eye contact, be affectionate, etc. This makes me wonder whether Eve's children spend most of their time being stonewalled by their caregivers. Unfortunately, although some attachment therapists have made training videos and so on, there is very little information available about the conduct of the caregivers with whom the children spend most of their time-- except for various injunctions about controlling food, toilet "privileges",etc.

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  3. Again; there has to be something someone can do. This is maddening! Does "Eve" have someone (a therapist, an expert on attachment, someone?) who can go with her and testify on her behalf and the behalf of the childern? Where are the guardian ad litems? Are they just as crazy? Seriously, there has to be some logical, rational, somewhat intellegent person NOT lacking in common sense working in CO! This case makes me so angry!

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    1. Hurray! I've just learned that a hearing is scheduled and there will be testimony to support Eve and the children, as well as to support the decisions the therapists have made. This won't occur for some weeks, but I'll definitely comment on how it works out.

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  4. I can't reply directly to you for some reason so I had to add a new comment.
    I hope it goes well. I don't know how she copes. I would go insane, I think, if someone kept my kids from me.

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  5. I stumbled on a blog posting that discusses RAD and the constellation of other disorders that "attachment therapists" like to call RAD, which makes a whole lot of sense to me. I wonder what you think about it, Jean, especially the discussion of genetics and inheritability--not a popular topic in adoption circles, I'm afraid. I guess every child (especially adopted children) are supposed to be blank slates. Anyway, I haven't read this person's blog before and don't know anything about him, so if he's a quack, pardon me! It's just so rare to see a discussion of genetics with respect to "attachment disorder" (sic) that I'm intrigued.

    Here's the link: http://drgrcevich.wordpress.com/2013/06/13/dsm-5-rethinking-reactive-attachment-disorder/

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    1. Thanks so much for sending this. I think the blogger is right on the money, and he has certainly been braver than I have been in addressing the genetic factors that nowadays are very possibly involved in a child's separation from birth parents. In past decades there were many more children who were adopted because of parent deaths from disease or accident, and of course that can still happen, but today it is more likely that the adoption occurred because of parent personalities and behaviors (like risk-taking) that can have strong genetic components. Attachment itself has not been clearly shown to have a genetic component, but of course it's not all about attachment, and as drgrcevich says, the disturbing behaviors sometimes reported are not related to attachment disorders.

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  6. Hard to discuss this---really, really hard---with parents of newly adopted children who believe that their "nurture" will cure all of "nature." I keep my comments gentle and hope they'll continue to love their children forever, even if they can't ever "cure" them.

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    1. It is difficult-- and I think there are particular problems for adoptive parents who have their identities wrapped up in the evidence that they are "good people/good parents" which they want the children to provide. Of course birth parents can have similar problems, but people who have adopted because of infertility may be seeking to repair a damaged sense of self anyway, and that can compound the problem.

      I'm not sure what the situation is for people who have adopted as part of a religious obligation (the Great Commission)-- does the fact of adoption in itself fulfill their obligations, or does the child have to show they've done right, by being "good"?

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  7. Do you think you could write about this case? It's getting a lot of attention and I see a lot of red flags.

    http://www.nydailynews.com/news/world/u-s-couple-jailed-qatar-staving-daughter-article-1.1418610

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  8. I am trying to find out more about it before shooting off my keyboard.Yes, there surely are red flags, but there are also unusual events. If you find more please send it along-- I am looking, too.

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