Monday, September 19, 2016
When Threats Substitute for Therapy
Changing oneself through legitimate psychotherapies can be hard work – work of the kind that adults can decide to do, but work that most children and even adolescents are not mature enough to manage. Child psychotherapies usually offer gentle though concentrated guidance in the direction of changes that adults think will be good for the child. The child does not necessarily think the changes are needed and may not really understand change processes, so treatments must be pleasant to experience, and any hard work must be encouraged and thoroughly supported by the therapist.
Of course, people can be made to change their behavior in ways other than their own hard work or gentle guidance. They can be threatened with punishment or unpleasant experiences unless they straighten out. If a person is capable of changing voluntarily, threats can be an effective change agent, and they work that way in most of our everyday lives. I’m looking for a parking place-- there’s a good one-- but there’s a sign that threatens me with having my car towed away if I park there. The threat makes me change my planned parking behavior. Or, I don’t want to take time to go to the doctor and get a flu shot—I’d rather go for coffee and gossip. But I had flu once, and the threat I perceive of catching it again is enough to change my behavior. Even preschool children can respond to clearly-stated threats of unpleasant experiences in the near future: “If you hit your sister, you will get a time-out”.
Do threats make up any part of normal therapies? No, they don’t, and therapists generally are uneasy about situations where there is an implicit threat to a client-- for example, a court order to seek treatment. But there are unorthodox treatments for children where threats are used, and those threats may bring about behavior change if the child is able to make such a change voluntarily.
The classic case of threats as part of an unconventional treatment is “holding therapy”. Children receiving this treatment were (and perhaps still are) threatened that if they do not “work hard”, their parents will abandon them and simply leave them at the treatment facility. The children do not know that such an action would be child abuse and would create serious legal repercussions for the parents; even voluntary legal termination of parental rights is quite difficult and subject to continuing financial responsibility for the child. Children in holding therapy may also be assured that if they do not change in some way, they will end up by killing someone and will spend their lives in prison. Adults may know that these are not realistic threats, but children do not know that and are terrified of the outcome, especially if they do not know how to change or even what needs to be changed.
I recently received a long email from a young woman I’ll call Polly. She is 17 years old, has finished high school, and recently went to court to become legally emancipated. But her emancipation petition was not Polly’s first experience with the courts. Her parents, who are divorced, have become locked into an accusation of “parental alienation”—the idea that Polly and her sister, who preferred to live with their father and avoid their mother’s household and her boyfriend, must have this preference because their father had “brainwashed” them into believing bad things about the mother. (Proof of this claim was that the girls insisted that it was their own decision!)
Polly’s mother contacted a California therapist whose psychology license had been revoked but who said he could practice a “psychoeducational” method called Family Bridges. As is the case for many proprietary treatments, it is not easy to find a description of Family Bridges. However, Polly has described what happened to her and to her younger sister when a judge ordered the girls to travel from their home state to California and to participate in Family Bridges.
According to Polly’s report, when the girls tried to refuse, they were taken away from the courthouse by employees of a “youth transport service”. (These “services” and the little regulation they undergo were discussed by Ira Robbins at www.americancriminallawreview.com/files/7714/0539/9315/Robbins.pdf.) The transporters responded to Polly’s crying and lying down on the ground by telling her that her father would go to jail if she didn’t go, and hinting that she herself would be confined in a residential treatment center. The two girls were taken to a town in California, where they were met by their mother, the mother’s boyfriend, and several psychologists, who met them in a hotel room and apparently do not have an office. The plan was to provide the girls with treatment that would convince them that their father had made them think that their mother was abusive.
The treatment, or “psychoeducation”, consisted of watching and discussing a number of video presentations. These included material about visual illusions, about how people may express opinions that are not really their own because of social pressures, and about the well-known study by Milgram in which participants who believed they were giving other people serious electric shocks often continued to do so when ordered by an authoritative experimenter. The implications of these presentations were apparently that the girls should understand that opinions they thought were their own had actually been created in their minds by their father—a plan with its own logic, perhaps, but not one based on any evidence that deeply emotional beliefs can easily be changed, nor indeed on any evidence that they had been influenced in their opinions by the father.
At almost 18, Polly was almost four years past the age when adolescents are normally given the chance for informed consent to medical or other therapeutic procedures. Instead, threats were used to force her cooperation, and her concerns and opinions were ignored. The threats came into the picture when Polly continued to be resistant and to speak rejectingly to her mother in spite of this “treatment”. According to Polly, one of the psychologists told her, “If you continue that behavior, you will be sent somewhere else. You seem like you need more help than we can give you”—superficially an offer of help for a vulnerable person, but in essence a threat of further disruption to her life. Arrest was threatened if she did not mind her mother, and for several days both girls were told that if they did not cooperate they would go to a treatment facility for juvenile offenders or to wilderness therapy-- these both being situations where teenagers are held incommunicado, have no opportunity to report abuse, and live in austere, even dangerous conditions. Back at the mother’s house, too, incarceration in a residential treatment center was the threat used to obtain obedience.
If Polly had not succeeded in her emancipation petition, or if she had been much younger, no doubt her behavior would have continued to be manipulated by threats-- and perhaps some of the threats would even have been acted upon. What if her behavior had changed in response to those threats? Would that have indicated that the “treatment” was effective—or simply that people respond at least temporarily to sufficiently serious threats?
One other question: when people are trained to do interventions that in practice include threats, are they trained in effective threatening?