Nancy Thomas' Inaccurate Statements About Children and Mental Health

Usually I avoid looking at Nancy Thomas’ website, www.attachment.org, but I was reminded of it the other day and had a look—several looks. And of course, having looked, I want to point out a few of the flaws therein.

Let’s start by looking at Thomas’ comments about Attachment Therapy (www.attachment.org/what-is-attachment-therapy/), which, she says, consists of eye contact, touch, smiles, and the “sharing of sugar between the mother and child”. Yes, folks, it appears that Thomas is still committed to the idea she put forward in the 2000 book edited by Terry Levy (and published, to its shame, by Academic Press). She suggested there that attachment can be created by hand-feeding caramels to a child. Logical? You bet, if you can accept Thomas’ premises. These are 1) that attachment normally occurs soon after birth, 2) that breastfeeding contributes to attachment, 3) that because human milk is slightly sweeter than cow’s milk, milk sugars play a role in attachment, 4) that caramels, which contain milk and sugar, are analogous to human milk, 5) that when a woman hand-feeds caramels to a child, the effect on the child is like that of being breastfed. Of course, attachment does not begin shortly after birth, nor is it especially related to breastfeeding. Although it’s true that human milk is sweeter than cow’s milk, there is no reason to think that its sweetness has more to do with an emotional effect on the child than its protein or calcium contents or the individual flavors that come from what the mother has eaten (and anyway, as I just said, there is no particular connection between breastfeeding and attachment). In fact, this whole argument is simply based on sympathetic magic mixed with the assumption that a mother’s early positive feelings toward her infant are immediately mirrored by similar feelings on the part of the infant.

Attachment Therapy, as discussed by Thomas, requires, in addition to sugar, a “release of rage” over a period of several hours. Thomas’ hero Foster Cline supposed that children in this kind of treatment are angry because of the loss of the birthmother and that their rage blocks the development of a new attachment. He used a hydraulic analogy to suggest that when the children express rage, they then become able to form an attachment. This belief unfortunately contradicts research evidence that expression of anger actually intensifies the anger rather than diminishing it. In addition, the belief that a newborn separated from the birthmother will be angry is in contradiction to everything known about early cognitive and emotional development. On this topic, of course, we need to ask how the “release of rage” would be brought about, and the most likely guess is that it is to be done by physical restraint, shouting, and terrifying the child, as per the rage-reduction therapy of the ‘90s. Although Thomas does not define Attachment Therapy directly in this way, she provides enough cues to convey what she is actually talking about, and allows us to guess what she does in her camps when she takes a child aside for a “tune-up”.

The same page reveals two other incorrect assumptions--  unstated, as presumably the wished-for reader already agrees with them. One is that unwanted behavior of children is of necessity associated with difficulties of attachment--  difficulties that, we are told, can be fixed with caramels and other equally likely methods. The second is that the diagnosis Reactive Attachment Disorder  means that a child is manipulative, aggressive, untruthful, exploitative, and so on. Neither of these positions is correct. Certainly children who show risky behavior may have had few opportunities for attachment, but the same kinds of behavior can appear in children with a good attachment history and clear attachment behavior in earlier life. Also, certainly there are children who are manipulative, etc. etc., and they may have at one time also shown symptoms of Reactive Attachment Disorder (although there is no clear method for diagnosing that disorder in school-age children), but the various undesirable behaviors named are not symptoms of Reactive Attachment Disorder.   

Thomas also repeats a claim that was common among members of Cline’s group in Evergreen in years gone by. She proposes that “traditional therapies” are not only ineffective but actually harmful in cases of undesirable child behavior. On another page, www.attachment.org/therapy-goals/ , Thomas states that “Non-directive play therapy, traditional talk therapy, and sand tray therapy have been proven to either be ineffective with children with RAD or make them sicker.” This is, of course, completely untrue with respect to any usual use of the term “proven”. In order for such proof to exist, someone needs to have systematically compared the outcomes of Attachment Therapy with those of the methods Thomas references, and I can assure you that this has not been done. Indeed, there has never been a systematic study of the outcomes of Attachment Therapy alone. Thomas’ argument is not based on the existence of systematic research, but instead on her belief that if a possible mechanism for an effect can be named, this is as good as having found evidence that the effect occurs. She states on both pages the unsupported belief that being alone with a therapist enables a child to become more manipulative, etc., and thus “sicker”, and that the presence of the mother is essential to prevent this. These assumptions are put forward as evidence that the claimed outcomes occur.

It’s a bit mind-boggling to try to unravel the logical and factual mess presented on www.attachment.org. Unfortunately for their children, those who can’t bear a bit of mind-boggling may fall for the claims of this purveyor of snake oil. And just as regrettably for all of us, reporters who hastily copy Thomas’ claims can and do spread these misconceptions and give free advertising to Attachment Therapists.