I recently published an article in the Child and Adolescent Social Work Journal,
under the title “Evidence of Potentially Harmful Psychological Treatments for
Children and Adolescents”. Interested people can read this paper at the
following link: http://rdcu.be/nRB3.
However, assuming that most readers won’t be quite
that interested, I’m going to summarize the article here and add a few
comments.
The point of this paper is that there is clear
evidence that certain psychological treatments that have been used for children
have been harmful, and that in fact it would have been possible to predict these
harms beforehand by careful examination of the principles and practices of the
treatments themselves. Evidence for harm done by certain treatments goes back
to the 1960s, so no one should be surprised to find that this is a possibility.
Nevertheless, specific discussion of potentially harmful psychological
treatments goes back only to 2007, and even then there was little emphasis on
potentially harmful treatments for children. An important publication in 2007
assumed that harms can be identified through systematic research evidence,
whereas in fact anecdotes and journalists’ reports may be the first line of
information to warn of us of harm to children.
My paper proposes that potentially harmful treatments
for children may be identifiable – before harm is done—by several
characteristics that make them unusual in comparison to most childhood mental
health treatments.
One of these is
that they create an emotional burden for
the child, making him or her feel distressed by the treatment. Although it has
been claimed that people in psychological treatment must feel uncomfortable so
they can be motivated to change, this idea is not evidence-based, and the great
majority of child treatments focus on comforting the child as he or she tries
to master issues like anxiety resulting from trauma. Treatments that are
distressing for a child run the risk of re-traumatizing rather than helping.
A second characteristic that is proposed for
potentially harmful treatments for children is derived from the Adverse Childhood Experiences (ACE)
study, currently underway and revealing that problems of both mental and
physical health in adulthood are associated with increased numbers of adverse experiences of painful and
disturbing experiences in childhood. There are ten ACE questions used for
research purposes; of these, the four following questions are most relevant to
potentially harmful psychological treatments for children.
- A parent, another adult in the household, or a therapist often
or very often swore at the child, insulted the child, put the child down,
or humiliated the child, OR acted in a way that made the child afraid that
he or she might be physically hurt.
- A parent, another adult
in the household, or a therapist often or very often pushed, grabbed,
slapped, or threw something at the child, OR at some time hit the child so
hard that he or she had marks or was injured.
- The child often or very often felt that no one in the family
loved him or her, and that no one, including the therapist, thought him or
her important or special.
- The child often or very
often felt that he or she didn’t have enough to eat, had to wear dirty
clothes, and had no adult protector.
I propose that when a childhood mental health
treatment features these ACE events, this fact helps to identify the treatment
as potentially harmful
The third characteristic I suggest for identification
of potentially harmful treatments for children is drawn from the fourth National Incidence Study of Abuse and
Neglect (NIS-4). NIS-4 identifies for research purposes a list of adult
actions that are to be considered abusive to children. The following table
shows adult behaviors that are relevant to the identification of potentially
harmful psychological treatments for children.
Behaviors coded as physical neglect Behaviors coded as
physical abuse
Refusal to allow needed care for diagnosed Hit with hand
condition or impairment Hit
with object
Unwarranted delay or
failure to seek
Push, grab, drag, pull
needed care
Refusal of custody/abandonment
Illegal transfers of custody
Inadequate nutrition
Inadequate personal hygiene
Inadequate clothing
Inadequate shelter
Behaviors coded as educational neglect Behaviors coded as
emotional abuse
Permitted chronic truancy
Close confinement: tying, binding
Failure to register or enroll Close confinement: other
Other refusal to allow or provide needed
attention Verbal assaults and
emotional abuse
to
diagnosed educational need Threats
of other maltreatment
Behaviors coded as emotional neglect
Inadequate nurturance/affection
Exposure to maladaptive behaviors and environments
Other inattention to
developmental/emotional needs
I propose that treatments that include these
behaviors are identifiable as potentially harmful to children.
Having established these criteria for
potentially harmful psychological treatments for children, I examined five
psychological treatments for children to see whether they met the criteria:
aversive conditioning using electric shock, holding therapy/attachment therapy
adjuvant treatments associated with holding therapy/attachment therapy (Nancy
Thomas parenting), “holding time” (Festhaltetherapie),
and conversion therapy for change of sexual orientation. In practice,
although not necessarily in theory, each of these treatments met all or most of
the criteria for potentially harmful treatments for children. Two of the
treatments, aversive conditioning using electric shock and holding therapy/attachment
therapy, have over many years moderated their practices, but their potential
for harm remains. Interested readers can look at the paper for many more
details about these five treatments and for the sources I used in writing the
paper..
I certainly do not mean to suggest that these
five treatments are the only child mental health interventions that have the
potential for harm. I would have liked to include an analysis of various
treatments for children displaying “parental alienation” by rejecting and
avoiding one of their parents, but there is little systematic evidence either
about the effectiveness of these treatments or about their potential for harm.
There is no question that they cause an emotional burden to the children. In
addition to this, there is anecdotal evidence that these treatments may be associated
with frightening experiences with youth transportation services, and with
threats to send an uncooperative child to residential care or to wilderness
programs where the child cannot communicate with anyone outside the treatment
program and may be at the mercy of staff members.
,
No comments:
Post a Comment