Friday, October 25, 2013
A kind invitation from APLA, the Czech organization for parents and professionals working with autistic children, gave me a chance to travel to Prague this month, to see the city’s beautiful buildings and meet fine people, and to take part in extensive discussions of alternative psychotherapies for autism. Partly for fun and partly to ward off jet lag before lecturing in Prague, I first spent some days in England, where as luck would have it I had two hours of discussion of Holding Therapy with a British psychologist and a Member of Parliament who is concerned about the practice. (Not knowing the politics of this situation, I think I will not name either of them here—but I do want to thank the MP for his time and attention and for a tour of the House of Commons.)
Both the Czechs and the British are concerned about the use of Holding Therapy, but the types of HT in use in the two countries are not identical. In the UK, HT methods resemble the American “rage-reduction” version, with the child restrained while held in the therapist’s lap and provoked to angry resistance. In the Czech Republic, the method is that proposed by the U.S. child psychiatrist Martha Welch (who now uses the term Prolonged Parent-Child Embrace or PPCE) and the Czech psychologist Jirina Prekopova (whose method is abbreviated in Czech as TPO, or “hard hug therapy”). The Welch-Prekopova method has small children sit on the mother’s lap, facing her and restrained by her arms, and has older children lie supine with the mother prone on top of them, while both are coached by the therapist to“express feeling” until exhausted. In both cases, the child’s resistance or distress is interpreted as showing the need for further treatment of the same kind.
Although most people in Britain assumed that HT use had stopped long ago, it turns out that it has not, and according to the MP there are at least three children still being given this treatment, although the plan is to stop soon. Revelations about ongoing use of HT have followed the coming forward of two young men who were given the treatment by a well-known child welfare organization in the 1990s. It is impossible to tell how many more young adults were subjected to HT as children, and if the British experience is like the American, most of them will be unwilling to make public statements. The National Health Service, and through it the Child and Adolescent Mental Health Service, have initiated a movement toward the use of evidence-based treatments, and therefore should be inclined to refuse payment for non-evidence-based HT, no matter what reports from former patients are made public. However, a legislative ban would be necessary to prevent HT from being done and paid for privately, and such a ban would be difficult to enforce.
Children in the UK who have been subjected to “rage-reduction” style HT have generally been adopted or fostered and stated to suffer from “attachment disorders”. However, I recently had a contact from another British man who reported a history of HT done in the manner of Welch and Prekopova. (He wrote a description of his experiences which I will be posting on this blog in the near future.) In his case, although he was adopted, the treatment focus seems to have been on symptoms related to autism or to sensory problems, which he has been diagnosed with as an adult; these included an aversion to touch that made the holding treatment agonizing for him. The HT therapist mistakenly considered these symptoms to indicate a lack of love between the child and his adoptive parents. It is well-known that Martha Welch traveled through England on a book tour for her 1989 publication Holding time, and that she supervised groups of mothers restraining autistic toddlers at that time. It would be surprising if there are no other people who had these experiences, but most of them will probably not want to come forward. The man who contacted me does not want to be identified, although I hope he may change his mind about that.
The situation in the Czech Republic is a different one and is in some ways in flux. The primary Czech practitioner of HT, Jirina Prekopova, began in the 1970s to regard autism as a problem of lack of attachment which she believed could be repaired by intensive re-enactments of some experiences that might naturally occur between mothers and infants. (In taking this viewpoint, she followed an earlier perspective on autism which is contradicted by the present understanding that 90% or more of the cause of autism emerges from genetic problems.) Working in Germany, Prekopova stressed the existence of a scientific basis for her methods and published several weak studies claimed to support HT. Criticism of her methods developed, and there was an attempt to prosecute her in Stuttgart in 1996, but this could not be accomplished without charges being made by families (https://vikas.de/DOKUMENTE/Goldner%20-%20Festhaltetherapie.html). She returned to the Czech Republic not long after this and dropped the scientific claims she had once made, instead taking a spiritual/religious view based on the system of the spiritualist family therapist Bert Hellinger. Prekopova has continued to present HT as a treatment for autism (hence the concern of APLA) but has added oppositional behavior as a reason for HT.
Possibly because of concerns expressed about HT, Prekopova has stopped referring to her method as a psychotherapy and presents it as a “lifestyle” that fosters family love and that counters factors in modern life like screen use, factors which she believes cause autism and other mental disorders. In spite of this claim, Prekopova seems to have started “clinics” in a number of other countries. It would appear that she now recommends the use of HT in schools and institutions; this recommendation may put HT in the reach of legal attacks that are impossible when the practice is confined to private family situations.
Banning HT in the U.S. has proved difficult because of the reluctance of professional groups to be involved, the differences in powers of federal and state governments, and the large number of states that need to be dealt with individually. But after my European trip I am feeling cautiously optimistic that some countries will take the lead in this matter and the U.S. may even follow.
P.S. My best thanks to APLA and its members, especially Alena Bilkova, Andrea Kralova, Katerina Slaba, and Katerina Thorova for their kind invitation and the good care they took of me in Prague and Samechov!