Thursday, January 28, 2016
Caveat Emptor: Looking Further at Claims by the Institute for Attachment and Child Development (IACD)
In my last post, I examined some assertions put forward by supporters and members of the Institute for Attachment and Child Development, a Colorado organization with a long history of various versions of attachment therapy. Today I want to spend some time examining the claims made by IACD at www.instituteforattachment.org/join-our-mission/end-the-stigma/. (N.B., the page actually says www.institutefor attachment.ong, but I don’t see how that will work.)
The IACD page expresses concern about the “stigma” associated with attachment therapy. This term, of course, has an emotional appeal, as we all know from Erving Goffman and others that stigmas are bad, unfair, and especially in the case of mental illness should be fought and contradicted by all right-thinking individuals. In the case of attachment therapy, however, it is hardly the case that there is a “stigma” attached to it. To reject something is not to stigmatize it. Most mental health professionals have never heard of attachment therapy, and those who have have made clear public statements rejecting it on logical and evidentiary grounds as well as in terms of its potential to harm children. The 2006 Chaffin et al task force report which advised strongly against the use of attachment therapy is a case in point. A negative task force report is not a stigma, any more than the current deep concerns of psychologists “stigmatize” torture during interrogations.
The IACD page references as a source of the claimed “stigma” the unintentional killing of a child by a Colorado therapist in the course of a “rebirthing” session in 2000. This, it is argued, somehow caused “respected therapists” to be blamed. The two therapists involved, of course, were Connell Watkins (AKA C.J. Cooill) and Julie Ponder, who were assisted by a number of helpers. The child was Candace Newmaker, who had been brought by her mother for a course of attachment therapy sessions, with the “rebirthing” just a frill that was added because an itinerant rebirther, Doug Gosney, had recently passed through the area offering training sessions.
As Michael Shermer cogently argued a few years later, Candace’s death was a “death by theory”. It would have been harmless, though silly, to play out the rebirthing drama with this child, as had been done with other children in episodes lasting only a few minutes. But Watkins and Ponder were deeply committed to the attachment therapy belief system promulgated by Foster Cline, and they believed that the child’s reported difficulties were simply resistance. For therapeutic success, they had, they thought, to force her to acknowledge the authority of adults by obeying their instructions to emerge from the flannel sheet that wrapped her. It was this set of beliefs, long associated with the alternative developmental theories of attachment therapy, that caused them to ignore her 40 minutes of pleas for help, her vomiting, and finally 30 minutes of unresponsiveness during which Watkins and Ponder leaned on her wrapped body and discussed real estate (as clearly shown in the session videotapes). Watkins and Ponder killed Candace because of what they believed, not because of the specific techniques they chose. It is perfectly disingenuous to attribute this death to rebirthing, but of course this was the position taken by many who wished to weaken legislation that tried to prohibit potentially harmful treatments.
Let’s go on to look at a later part of this IACD page, the purported history of attachment therapy. First, let’s examine the statement that attachment disorders were discovered in 1972 by persons in Evergreen, Colorado. I am afraid this does not hold up under a strong light. John Bowlby in the 1930s was already looking at connections between disturbed early relationships and later delinquent behavior, and following World War II wrote extensively about the effects on young children of separation from parents associated with evacuation from British cities during bombing. Anna Freud did the same, and Rene’ Spitz focused on the depression and physical illness of babies grieving over separation. At a far less respectable level, Robert Zaslow, a California psychologist, began in the 1960s to use a form of holding therapy to create attachment, whose absence he considered the cause of autism and schizophrenia. After losing his license following a serious injury to an adult patient, Zaslow traveled the country giving demonstrations (one person who was present has reported to me that these included a 12-hour holding session with a young schizophrenic man). He encountered Foster Cline, a physician, in Colorado and recruited him to the attachment therapy doctrine. Cline later surrendered his Colorado medical license as part of a disciplinary proceeding after a child was injured. Cline preached that “all bonding is trauma bonding” and that physical restraint and authoritarian methods were the essence of child mental health treatment. (Zaslow went to Germany, where he published his new theory of the “Medusa complex” and the power of eye contact.)
Meanwhile, beginning in 1980, DSM had listed a syndrome called Reactive Attachment Disorder of Infancy and Early Childhood. This was a problem of babies and toddlers, and involved apathy and disengagement; it was seen as a feeding disorder, of concern because the children were not thriving physically. Later versions of DSM suggested that the real issue had to do with inappropriate social engagement on the part of toddlers and preschool children. Cline and his group quickly picked up this term-- indeed, Zaslow had years before based his views on a mélange of Bowlby’s early, ethological attachment theory, and on the claims of Wilhelm Reich. By 2000, the checklist by which Cline’s followers diagnosed Reactive Attachment Disorder had been formalized by Elizabeth Randolph (N.B. license also revoked) into the Randolph Attachment Disorder Questionnaire, whose manual plainly stated that the problem was not RAD, but something else that they were calling just “attachment disorder”. (This issue about what is RAD and what isn’t also comes up on the IACD website, but I will save that discussion for later.)
The IACD “history” proceeds to say that in the early 1990s, the organization ATTACh (Association for Treatment and Training of Attachment in Children) had already begun to be concerned about Cline’s “rage reduction” therapy. I do not believe this is true, although obviously I am not privy to all of the discussions that went on in ATTACh at this time, and I would be most interested in any substantiated correction. ATTACh materials up until about 2004 continued to list the names of therapists who certainly were using Cline-like treatments (in fact, it would appear that some of these are still listed). Only after Candace Newmaker’s 2000 death, and more importantly her therapists’ 2001 conviction and imprisonment, did ATTACh make public statements that rejected coercive treatment of children. This was in spite of the fact that the social worker Beverly James had already, in a 1994 book, expressed outrage and concern about the methods being used by this group.
One more rather interesting point about the IACD “history” (which seems to have been shaped to position Forrest Lien as the great leader of treatment for unhappy parents, and perhaps incidentally, their children): the page states that holding therapy “should consist of: essential components that include eye contact, appropriate touch, empathy, genuine expression of emotion, nuturance [sic], reciprocity, safety, and acceptance, While a variety of holding positions can be used, the physical safety of the client is the primary consideration” (italics removed). (Does it not boggle the mind, by the way, that any psychotherapist, far more one treating children, would have to state explicitly that he or she will avoid physically harming the patient? ) This statement appears to omit any consideration of either demonstrated effectiveness of the method (an outcome checklist seems to be in use, but no outcome research has been published), or, just as importantly, of emotional harm. Children who have experienced abuse or been engaged sexually by adults, or who are in treatment at the behest of adoptive parents, may experience being held as threatening and overwhelming, especially if they are past the preschool period when physical holding by parents is culturally acceptable. The burden of proof is on IACD and its supporters to show that these techniques do not result in later emotional disturbance such as depression and suicidal thinking or actions. A discussion of the nature of informed consent for children, and the extent to which children who are under the control of adults are able to exercise this, would be most relevant here.
Curiously, the lengthy IACD statement about the nature of holding therapy is followed by the assertion that no form of holding is now used there, but no details of the actual treatment are provided, other than a reference to “revisiting the attachment cycles” by therapeutic foster parents. I’ve followed a number of links that purport to tell me more about the IACD treatment model, but they all end up with the same vague discussion.
And there’s more: we’ll look on another day at IACD claims about what RAD is, and, most interestingly, about the idea that therapists are dealing with a :brain disorder”.