Wednesday, December 4, 2013
Speak Roughly to Your Little Boy, and Beat Him When He Sneezes: More on "Festhaltetherapien", Edited by Ute Benz
A couple of weeks ago, I commented on an on-line sample from a new German book, Festhaltetherapien:Ein Plaedoyer gegen umstrittene Therapieverfahren, edited by Ute Benz. I have now received a copy of the book and am making my way painfully through it-- I began by looking up three words in every paragraph and am now down to two for most paragraphs, and even an occasional paragraph where (I think) I understand everything.
I didn’t begin at the beginning, but wanted to look at a chapter by Ute Benz on the historical development of Holding Therapies (pp. 121-143). (I should emphasize here that the title is in the plural, and that although the book focuses to a considerable extent on the treatment as done by Jirina Prekop and Martha Welch, in fact there are other methods that use restraint on children in almost the same way as Prekop and Welch.) I am going to translate some parts of this chapter, but I do want to note that I have not asked permission to do so. I assume that the short sections I will present, and the fact that I have no commercial interest here, will make this acceptable, but if there are any objections from authors or publisher I will naturally take the post down.
I’ll begin with Benz’s description of Prekop’s holding method, which its proponents recommend for autistic children, for oppositional children, and for “any child who needs it”. “The picture of the classical holding scene looks like this: a boy or girl sits or lies on a mat with the entire body held tightly by adults, the mother and/or father and perhaps a third or fourth helper, so that the child can no longer move, but can only cry out. For the child to scream and cry during the procedure is considered normal and even desirable as the expression of emotion belonging to the method, so crying must be provoked if a child becomes compliant too quickly. This is to dissolve repressions. The child’s crying is much more easily tolerated by the parents when many children are treated and cry simultaneously. If a child immediately becomes still and resigned to his fate or goes to sleep or looks around the room, he is practicing a defense against the treatment and must be provoked in order to break through the defense.”
“When Holding Therapy is done in the home, the parents are warned to close the windows, so that neighbors will not hear the sound of screaming and call the police. Because the delaying tactics of the restrained child may cause him to scratch, bite, hit, or kick, a certain position needs to be taken, so there are no bruises as visible signs of mistreatment. The child must cross his hands and legs in a sort of straitjacket position and sit straddling the lap of the adult. His head must be laid or pressed against the crook of the adult’s neck. … the child must not be let go under any circumstances, such as begging, yelling, screaming , or desperately crying, even if he needs to go to the toilet, his nose runs, or he becomes sick, or when both bodies are bathed in sweat, or when the child trembles from stress or is hungry or thirsty. All these things are done in typical evasive maneuvers [N.B. Benz is describing Prekop’s viewpoint, not her own opinion!] that must be overcome in the course of the process so that the goal of a tractable child is reached.” This goal is shown when the child allows eye contact as the parents wish it, lets himself be caressed, and says things like “I love you” or promises desired behavior. As Benz notes later, this end is thought to justify the means.
Benz, who estimates 10,000 cases of this treatment in Germany and Austria over the last 30 years, also notes people who have contacted her to ask for help or explanations. (She also notes that few German psychotherapists know about Holding Therapy or even know it exists.) In 2004, she was contacted by a divorced father who had custody of a seven-year-old boy; the boy was refusing to visit his mother. The boy told his father that the mother would restrain him while he lay on the floor, would stroke him and whisper “I am your mother, I love you.” Benz was also contacted by a town counselor who was concerned about accusations of mistreatment against a staff member in a children’s home, where there had already been repeated indications of trouble. The accused person had already resigned, but the town council now needed to review over a hundred videotapes although they did not know anything about the theory and practice of Holding Therapy. In 2011 Benz was contacted by a 27-year-old woman from the Netherlands, who had been given intensive Holding Therapy for years as treatment for cerebral palsy. For the first four years holding was done three times a day, which was later reduced to three times a week. At age 20 she had serious problems with being near other people and with physical contact. Her doctor advised her to seek therapy but could not say where to go.
Benz describes a number of similar cases who have contacted her, but as far as I have read does not suggest specific techniques for treating these effects of Holding Therapy, although she does note that practitioners need to explore whether new patients have been subjected to this treatment. As I have noted before, in one case I know in the United States, a young woman who as a child was subjected to treatment of the Prekop-Welch type suffered increasingly severe anxiety attacks in her 20s, but was relieved by desensitization treatment focusing on her memories of the treatment, particularly the screams of other children in the room.
I must say that distressing as I find treatment of this type for autistic children, the idea of trying to apply it to someone with cerebral palsy is really beyond anything I have encountered before. One wonders whether these people would use holding for appendicitis! Surely declarations of intense pain and vomiting could be interpreted as defensive delaying actions, too … and no doubt similar interpretations have been made by some practitioners.
In a later post, I want to go into what Benz has to say about the use of similar techniques by occupational therapists in Germany.