Concerned About Unconventional Mental Health Interventions?

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

Wednesday, March 18, 2015

The Harris Case: Attachment,Trauma, Ambiguity, and Investigation

Unless you read only the New York Times (which hasn’t mentioned a word of this), you are probably aware of the Arkansas case of Justin Harris, a state legislator, and his wife, who adopted two little girls, exorcised them, treated them with harsh “parenting” methods, and passed them along privately to another family, where one was sexually abused. The most recent discussion of this case and its background is at www.arktimes.com/arkansas/harris-therapy-controversial/Content?oid=3755237). Before writing this article, Leslie Peacock, an Arkansas Times editor, talked at length to me and to Jean Crume, a DHS social worker, as well as doing a great deal of reading and considering the testimony of the babysitter who took care of the little girls for a period while they lived with the Harrises.

When Leslie and I started our discussion, one of the first issues that came up was what some terms meant. If the Harrises were using “attachment therapy” with the girls—a method that Jean Crume says she sometimes uses—exactly what did that amount to? We looked back at the 2006 APSAC-APA Division 37 Task Force Report, and saw that in 2006 the authors had stated, “The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions.”  This continues to be true a decade later, and in my opinion this is the reason why conventional treatments focusing on parent-child relationships are usually called “attachment-focused” or “attachment-based” therapies, or words to that effect, rather than “attachment therapies”. For myself, I would define “attachment therapy” as a form of intervention derived from the older Holding Therapy, and popularized at the time in the early 2000s  when the dangers of Holding Therapy were being publicized. I would add to this that “attachment therapy” is based on a conflation of child attachment with child obedience and compliance, and on the belief that re-enactment of posited infant experiences in later life causes a child to become emotionally attached to an adult caregiver.

I don’t know whether these would be Jean Crume’s definitions of the “attachment therapy” that she considers suitable in some cases. I do know, though, that as the Arkansas Times pursues its proposed investigation of DHS, terms must not be allowed to go undefined. “Attachment therapy” is an especially problematic term, because for many readers, “attachment” sounds good, and “therapy” must be good, so “attachment therapy” is definitely more than acceptable—even though some practices associated with that label would probably be rejected if they were called “isolation treatment” or “no-toys intervention”. The investigation of DHS must clarify this point.

But of course “attachment therapy” is not the only problem word. Jean Crume is quoted as calling Nancy Thomas methods “controversial”. What do people mean or understand to be meant when they use this word? My big old Webster’s says it means “debatable”, which seems not to be much of a description, as most things more complicated than the time of day are open to debate. It seems to me, however, that in fact the principles and practices of “attachment therapy”, including the “parenting” techniques, are not at all debatable. On the contrary, there are a large number of psychologists and other mental health professionals who would regard those beliefs and practices as totally wrong and unacceptable. Opposed to those thinkers are a small number of persons with various backgrounds who claim not only that “attachment therapy” is effective, but that conventional methods exacerbate children’s problems, and that even the most basic conventional ideas about attachment are incorrect. There is no debate here. These ideas are mutually exclusive. If the conventional attachment theory and treatment methods are right, “attachment therapy” approaches cannot be right, and vice-versa—if “attachment therapy” views are correct, 75 years of research on attachment must be overturned and forgotten.  Where is the controversy? Could it be that Jean Crume and others really mean, “A lot if people don’t like these ideas, but I think they’re all right, and there’s no law against the practices unless somebody really gets hurt”? If that is not what they mean by “controversial”, I can’t guess what they might mean. But I think it would be essential for any investigation to be sure what is intended.

Toward the end of Leslie Peacock’s article (linked earlier) a DHS spokesperson says that the agency is working toward educating foster parents about trauma and its role in determining children’s later behavior. She noted the focus on a “trauma informed” approach and the intention to use Trauma Focused Cognitive Based Therapy, an evidence-based treatment for children who have been sexually abused or hurt by domestic violence. But the spokesperson goes on to say. “Training has also been provided to a number of foster parents. We think a trauma-informed approach is critically important and we’ll be working…on how we can accomplish training for all foster parents.” So, investigators--  what is going on here? TF-CBT is indeed an evidence-based method, but it is taught to and used by qualified professionals. The foster parents are not going to become psychotherapists in the professional sense. What are the foster parents being taught about trauma, about what experiences have traumatic effects, on the behavioral outcomes for children, and on what methods can be helpful? I ask this question not out of general suspiciousness, but because the term “trauma” has “crept” to a much wider meaning than it originally had, just as happened years ago with “attachment”; trauma is now sometimes used to mean practically any bad thing, just as attachment came to mean all good things when present, all bad things when absent. Just a few days ago, I published a post on this blog on the subject of an adoption agency in Ontario whose website baldly stated that all adopted children have been subjected to extensive trauma because of the separation from the birthmother, to whom, it was claimed, they had developed a powerful emotional attachment during their gestation—an idea completely at odds with established research on attachment, but certainly popular with Nancy Thomas and “attachment therapy” advocates . What are the foster parents being taught? The term “evidence-based” seems to be intended to describe their training as well as the professional training, but I don’t see how that can possibly be. Investigators need to explore this, because the attitudes and expectations of foster parents are a good deal more likely to affect children than their occasional visits to therapists.

There are a lot of questions to be asked before anyone understands exactly what has been going on in Atkansas, as well as in many other states’ human services departments.

   

8 comments:

  1. I have yet to see a therapist calling himself an "Attachment Therapist" without revealing a tie to the practices and/or beliefs of the infamously abusive Attachment Therapy.

    Perhaps this is because Attachment Therapy, its parenting, and its unrecognized "Attachment Disorder" diagnosis have gotten such bad press over the decades that responsible therapists are careful to avoid association.

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  2. I was a bit surprised that Jean Crume spoke as favorably about Nancy Thomas as she did in the AKTimes piece, after all the recent negative press involving the Harris case. But then again, I shouldn't be.
    Crume has long been associated with Attachment (Holding) Therapy.

    

In a 2002 conference presentation for ATTACh (the trade organization for Attachment Therapists), Crume was introduced as being trained in the “Two-Week Intensive Model” at the infamous Attachment Center at Evergreen, which consists of a child being subjected to 2-3 hours of Holding Therapy everyday, compliance training, etc. Crume then spoke about participating in Holding Therapy at a large RTC in Illinois, although she acknowledged that Illinois DHS personnel:



    “...were vehemently opposed to doing this form of treatment.  In fact, not just with this case.  With any case.  They’re very opposed to the Two-Week Intensive model, and actually told the parents that if they chose to pursue this, they would pull all other funding and support that they were giving the family....”



    Crume went on to describe participating in Holding Therapy: 



    “Therapeutic Holdings were the typical across-your-lap, one-arm-behind-your-back.  And then I was holding his hand and just to kind of get a sense of his body tension....  We also used kicking in the Therapeutic Holdings to get some body stimulation to help him....So, the first thing we’re going to show you is [the child’s] inability to express anger...”



    Crume also noted that “....there’s a lot of compliance that has to occur." 



    More recently, in a 2013 newsletter for Arkansas foster parents, Crume refers to Attachment Therapy’s bogus “Attachment Disorder,” listing its signs: “poor eye contact...appear very mature for her age...defiance, anger retaliation or aloofness....excessive talking, destroys property, lying, anxiety, stealing....”

    

Crume then recommends parents of an attachment disordered child “create a highly structured and nurturing environment...Give chores...If she hurts you, then she has to do something nice for you: give you a hand massage...” This is straight from Nancy Thomas.

    

Jean Crume has been working for DHS, apparently since at least 2012, and alas, she now has a long-term contract with Arkansas DHS 2015-2019. 


    “The contract with Jean Crume, recognized as an expert in the field of Reactive Attachment Disorders, was first specifically set up as a post adoption service for our families, but has expanded to include children not placed in an adoptive home yet.”



    http://humanservices.arkansas.gov/dcfs/dcfsDocs/SFY%202015-2019%20Child%20and%20Family%20Services%20Five%20Year%20Plan.pdf



    Crume’s own words, past and present, should disqualify her from caring for any child, much less being in a position of authority over all of Arkansas’s adoptive and foster children. 


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    Replies
    1. Thanks for posting all this! But am I right in thinking that Illinois' decision was largely because they refused to pay, not because they wanted to prohibit the treatment?

      Amazing how all these people are recognized BY THEMSELVES as attachment experts. It's the selfie credential!

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    2. When I made a transcript of Crume's presentation at ATTACh, I looked it up and saw that Illinois DHS had a policy against "Holding Therapy"on their website.

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    3. I noted in this policy in 2004:

      "Efficacy of specific treatments for RAD has not been established.

      "Multi-modal tx is best option

      "Current tx paradigms:

      "1. Infant-parent Psychotherapy

      "2. Integrative therapy

      "3. Theraplay

      "4. Holding therapy: Is not accepted by DCFS as an appropriate intervention

      "5. Rage reduction therapy: Is not accepted by DCFS as an appropriate intervention"

      https://web.archive.org/web/20041129092247/http://dcfswebresource.prairienet.org/resources/practice_guide.php

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    4. I think the trick is, they said they were not doing HT. HT involves holding the child against his will, and by that time there had been the invention of "attachment therapy" where the child was persuaded to agree to being held. In addition, much of what was recommended and used was probably (as in the Harris case) the "parenting" techniques, which don't actually include holding. People were aware that HT might be fatal in some cases, but did not have the same awareness of nonfatal adverse events connected with the "parenting".

      In addition, I have to wonder whether for "not accepted as an appropriate intervention"we need to read "not paid for", rather than "we'll come after you if you do this."

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  3. I suspect you are right, i.e that Illinois DHS did not come after Chaddock for Holding Therapy and continued to reimburse this center, as well, from what I have read in the press in subsequent years.

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