"Faux-RAD" and the ABC 20/20 Video: Some Progress

There has been some interesting progress with respect to the letter to 20/20 I included in a post two days ago. I received a phone call from Miguel Sancho, a 20/20 producer, and another from his assistant Lynn Redmond. They plan to modify the video that caused so much concern, and to do this with the help of Dr. Anne Marie Albano of Columbia University, a clinical psychologist and one of the signers of the letter.

In talking to Sancho and Redmond, I realized how easy it is for people to assume that if an approach to childhood mental illness or problem behavior does not use holding therapy, it must be all right. Naturally I am pleased when the dangerous and physically-intrusive techniques of holding therapy are abandoned, but I continue to be concerned about the use of related methods without evidentiary foundations. There are a number of these methods that were historically associated with holding therapy and have persisted on their own as holding therapy has diminished. These methods include demands for “strong sitting”, assertion of adult authority by requiring children to ask an adult for permission to do anything they need (including toilet use), making sure that a child is within the line of sight of an adult at all times, and the assumption that physical contact between child and adult has a therapeutic value of its own.  These methods are not likely to do direct harm to the child, but they add to what Michael Linden has called the emotional burden of therapy, and because they are ineffective may cause indirect harm by keeping the child out of effective treatment.

I have been trying for years to find a term that will describe not only these methods, but the related diagnostic efforts, and the unconventional theory that supports the whole can of worms. I recently encountered the expression “faux-RAD”, which I think conveys the disparity between these beliefs and practices and those of the conventional, evidence-based practice of psychotherapy. Michael Shermer years ago referred to the suffocation of Candace Newmaker  by her therapists as “death by theory”, and I consider that insight to be essential to the understanding of faux-RAD. It is faux-RAD theory that allows the replacement of one harmful or ineffective treatment with another that is based on the same assumptions.

To deal with the faux-RAD problem, as exemplified by the 20/20 video, we need to understand the tenets of the theory. I am going to state them here in simple form:

1. Emotional attachment normally begins before birth and is present in basic form in newborn babies.
2. Children separated from their biological mothers are filled with rage and grief even if the separation is immediately after birth.
3. Rage and grief prevent development of attachment to new caregivers, as do later experiences of abuse and neglect.
4. Normally, in non-separated children, attachment advances in two stages during the first and second years.
5. In the first year, attachment to caregivers progresses because the child comes to recognize that the caregiver is the source of all satisfactions of needs. The repeated experience of need followed by satisfaction given by a parent (called an “attachment cycle”) establishes the authority of the caregiver.
6.  In the second year, the caregiver sets limits on the child’s behavior, further establishing authority and therefore attachment.
7. Children are obedient, compliant, and grateful when parental authority has been established in these two ways, and they are said to be attached.
8. Children who are disobedient, noncompliant, and ungrateful are not attached but have attachment disorders, and they do not recognize parental authority. This situation may occur because of persisting rage and grief, and/or because of the absence of the attachment cycle.
9. To make children obedient, compliant, and grateful, they must express their rage and grief and achieve catharsis; then, they must experience re-enactments of the attachment cycle which involve complete dependence on adults for food, drink, etc. This treatment causes obedience by establishing attachment.
10. Because infants need touch experiences, children in treatment also must experience re-enactment of frequent adult touch; this must be given at the decision of the adult and not at the request of the child, and indeed may be against the child’s wishes.
11. Children who are not attached (have attachment disorder) by faux-RAD criteria are filled with hatred and the desire for violence; if treated by conventional psychotherapies, they will get worse; if untreated, they will grow up to be serial killers or prostitutes.

The tenets of faux-RAD described here are at odds with everything known about attachment, about parent-child relationships, about sources of violent behavior, and about effective psychotherapy, as well as with established definitions of Reactive Attachment Disorder. The confusion of attachment and authority is especially noxious, as it opens the door for practices that are distressing and potentially harmful to children.

Regrettably, a look at doctoral and master’s theses written in U.S. social work schools in recent years reveals that faux-RAD ideas are sometimes taught and accepted. This  fact, together with the state-sponsored faux-RAD trainings of adoption workers in Georgia and Utah some years ago, means that the undercurrent of these potentially harmful beliefs is still very real and may have been exacerbated by the 20/20 video. However, I look forward to correction by ABC and to increased awareness of the issues on the part of psychologists, social workers, parents, and teachers.