Stopping Holding Therapy Is Not Enough

After Candace Newmaker’s death at the hands of her therapists in 2000, some professional organizations released resolutions condemning various alternative psychotherapy practices. Some, like the American Psychological Association, rejected “rebirthing”, the form of treatment during which Candace died, but did not mention holding therapy. Others stated their rejection of holding therapy, a method that had also been used with Candace and that is known to have caused some injuries and deaths. A task force report by Division 37 of APA and the American Professional Society on Abuse of Children (APSAC) in 2006 also referenced some adjuvant treatments associated with holding therapy, for example, withholding or forcing of food, but even that report was relatively unconcerned with the adjuvant treatments that had been proposed and used by “lay therapists” like Nancy Thomas.

Following Candace’s death and the public criticisms of holding therapy by professional groups, the organization that had been the primary supporter of this treatment changed its position. In position papers in 2003, the Association for Treatment and Training of Attachment in Children (ATTACh) stated opposition to the highly coercive holding therapy and approval of a new method claimed to be more sensitive to children’s needs and wishes. ATTACh did not specifically state rejection of the adjuvant treatments that had often been used with children  receiving holding therapy, but it was noticeable that Nancy Thomas, who had been a major participant in ATTACh conferences, appeared there less and less frequently.

In spite of the occasional criticism of her methods, Thomas, who is a charming and entertaining presenter, retained and continued to build her audience. Her presentations contained and still contain dramatic claims about the number of murdering children she has fostered and treated with such effect that 85% of them are completely cured of the “attachment disorders” she considers them to have. Her advice about treatment of childhood mental illness and behavioral problems continues to include limiting of food choices, confinement to a bedroom, the use of door alarms, and feeding of sweet foods with the intention of creating emotional attachment.

Certainly there is no evidence to suggest that such techniques are helpful for any form of childhood mental or behavioral disturbance, but we can ask in addition whether they are actually harmful and as deserving of rejection by professional organizations and legislators as holding therapy itself. To examine this issue, let’s look at the events surrounding the suspension of a psychologist’s license by the Oregon Board of Psychological Examiners (http://obpe.alcsoftware.com/files/miller.debra%20(kali)%20a.f._559.pdf). The Board gave an Order for Emergency Suspension of the license of Debra Miller, Ph.D., in March, 2014, on the grounds that her continued practice constituted a serious danger to the public health or safety.

In a PowerPoint presentation (www.ohsu.edu/xd/outreach/occyshn/training-education/upload/Reactive-Attachment-Disorder-Handouts-Miller.pdf), Miller made it clear that she supported what I can only call the worst of the worst of holding therapy proponents’ views, using infamously unreliable and unvalidated checklists for diagnostic purposes. And, although holding therapy itself was not mentioned in the pdf  cited in the previous paragraph, she did recommend to parents that they use adjuvant treatments of the type encouraged by Nancy Thomas. In the license suspension document, a description is given of the practices recommended by Miller for the father and stepmother of a 12-year-old boy who later attempted suicide by strangulation, and who when brought for medical care stated his distress over the treatments he had experienced. These included having to sit in his father’s lap while making eye contact and being fed milk from a bottle, crawling on the floor for 20 minutes each day, having to urinate into a jar in his room, being confined to a room with an alarm on the door, and being required to address his stepmother as “Queen”. As is typical of practices of the Nancy Thomas type, the boy was also required to do jumping jacks (these exercises are claimed to bring oxygen to the brain) and to practice “power sitting” or “strong sitting” in a specified position for periods of time. Other “neurodevelopmental exercises” involved somersaults and “log rolling”. The suicide attempt was preceded by a period during which the father was making the boy drink water and then try to urinate into a jar every 15 minutes.

In explaining this license suspension, the Board of Psychological Examiners referred to the statements of APSAC and other groups over a number of years, warning against inappropriate diagnosis or treatment of Reactive Attachment Disorder. In addition, the Board noted that the methods Miller recommended “may actually serve to increase emotional lability”. As they pointed out, “the techniques recommended by Licensee in this case (or taught by unlicensed practitioners that Licensee referred her clients to) created the potential for misinterpretation by the parents and a high risk for physical and psychological damage to the child that could have contributed to [his] feelings of hopelessness, which is a significant predictive factor for suicide.”

As far as can be seen, Miller did not carry out or recommend rebirthing or any version of holding therapy; she only recommended the adjuvant treatments associated with those techniques. Unless a child is harmed, as occurred in this case, it is highly unlikely that such treatments will ever be called to the attention of authorities--  and even if such attention were sought, the relevant authorities are usually not familiar with the practices, and it is doubtful that a serious investigation would occur. Practitioners who use or recommend the methods favored by Miller are usually quite safe from criticism, for these reasons, except in cases where a child’s distress and depression culminate in injury. In addition, these practitioners generally do not carry out the methods themselves, but leave the hands-on treatment to parents, making it difficult to establish the therapist’s responsibility. In the present case, a younger or less articulate child, or one with physical or mental challenges, might well have been unable to tell the story that led to the practitioner’s license suspension.  

It has been an important task over the last 15 years to convince the professions and the public that holding therapy is an inappropriate method of treatment for children (and indeed, not all professionals are yet convinced of this). But as the Oregon case shows, there is further work to be done. Psychotherapists who teach parents to use methods like limiting food or forcing drinking, or even like required bottle-feeding of older children, are very much in the wrong. They can cause direct harm to children and families, as we have just seen. They are almost sure to cause indirect harm by delaying effective treatment and by wasting family resources.

We need to see professional organizations publicly rejecting the adjuvant treatments that have been recommended by holding therapy proponents, and we need to see related education of state licensing boards, not all of which are as knowledgeable as the Oregon group.

ADDENDUM: Another case involving Miller can be seen at www.publications.ojd.state.or.us/docs/A119529.htm. In this case, there was a disagreement between a divorced couple when the father wanted to stop the therapy Miller was doing with his children. The nature of the therapy is not mentioned in this document, but would be interesting to know.