Friday, July 21, 2017
CALO and the Transferable Attachment: Love Your Dog, Love Me
From time to time I see advertisements for a residential treatment center known as CALO (www.caloteens.com), or for programs apparently related to this model. The programs provide residential treatment for children and teenagers who, the proprietors claim, are difficult to parent because they suffer from Reactive Attachment Disorder. RAD is said to make them lonely and miserable, unable to “bond” with others, uncooperative, poor school achievers, etc., etc. As occurs all too often, these proprietors note their belief that adoption even at birth is likely to result in these undesirable outcomes.
Let’s have a look at one CALO website, where “our proprietary treatment” is described at www.caloteens.com/message2.html. I want to note first that “proprietary treatment” is a term generally reserved for methods whose details are considered to be trade secrets, statements about which are protected as commercial speech in the United States. Unlike information about research-validated, evidence-based treatments, for which details are easily available if you know where to look, proprietary treatments are difficult and usually quite expensive to learn about-- as a rule, you have to sign up for workshops or seminars or buy material from a suggested reading list sold only through the proprietors.
Material at caloteens.com suggests that a major CALO concern has to do with a rivalry with behavioral modification programs. As is typical of non-evidence-based, commercially driven proprietary treatment programs, the CALO discussion argues that behavior modification, which is seen as a rival, replicates harmful situations that have already affected the children, and that recovery from childhood problems must begin “with the heart” and be followed later by behavior change. It is not stated with any clarity how any “heart” changes can be detected before they are followed by behavior change, and therefore it is far from clear how CALO’s claimed (but unlisted) research basis could have been established.
The CALO website also stresses the need for specialized treatment of childhood mental health problems, and notes that their staff are specialists in treatment of attachment and trauma disorders, as described and trained by groups like ATTACh and the Attachment & Trauma Network. These comments are red flags for the possibility of two difficulties often associated with proprietary treatments.
One is the assumption that some single factor, such as attachment, is the single most important cause of a wide range of developmental and emotional problems; like the bed of Procrustes, this assumption compresses or stretches problems caused by combinations of biological and environmental problems so that they “fit” the chosen bed—in this case, the attachment bed. As has been pointed out by the British psychologists Woolgar and Scott, this sort of single-factor explanation opens the door to choices that ignore not only complex causes, but even simple factors that differ from the chosen cause.
A second red flag has to do with the assumption that the details of a CALO program are of necessity essential for treatment. However, serious work in clinical psychology has for years focused on general or shared factors that contribute to good outcomes achieved through treatments that are different in details. In some cases, such as EMDR, specific details (like eye movement) may have nothing to do with positive outcomes, which probably result from general helpful factors like empathic responses. The CALO claim to uniqueness of its program is thus not likely to be a strong argument for people with training in understanding therapeutic approaches—but it is quite likely to appeal to worried parents.
However, let’s go on to my favorite bit of the CALO website. This is the part about golden retriever therapy and the transfer of “attachment lessons” learned from dogs, to human relationships. Kids in CALO programs take care of dogs; they are said to “learn trust” from the dogs, therefore to understand attachment, and therefore (with some additional, undescribed help) to transfer the attachment they have learned from the dog to a human being. This is quite an interesting idea, but one that makes a common but mistaken assumption about emotional development, and also one that betrays considerable confusion about how attachment works and what an attachment relationship is.
The first issue here is one that I have often termed “ritual reenactment”. The basic idea is that if certain events lead to a positive outcome for infants and young children, those events, reenacted in some way in later life, will recapitulate normal development and correct any problems that occurred when they were wrongly experienced earlier on. This belief has appeared in many forms from Sandor Ferenczi’s “babying” of patients to the methods of Frieda Fromm-Reichmann as fictionalized in I Never Promised You a Rose Garden to Nancy Thomas’s insistence on bottle-feeding older children. None of these methods has ever been shown to be effective, but somehow the thought of a “do-over” continues to have a strong appeal to the public.
But-- suppose that just for the sake of argument we accepted the idea of the “do-over”, would caring for a golden retriever be a way to do this? A comparison of the ordinary and the “treatment” situations says it would not. In typical early development, a child is cared for by a consistent and responsive small group of adults. The adults care for the infant physically, but they also spend much time showing their positive feelings about him or her, working toward communication of child to adult and adult to child, and enjoying play and social interactions that bring pleasure to both adult and baby. The outcome of these experiences is that the toddler stays close to the familiar adult if anything is scary or distressing, can be comforted by the adult hen distressed, and explores new things best if allowed to have contact with a familiar person at will. (This set of behaviors has been summarized as “trust” or as “attachment”, although those terms really apply to a hypothesized inner state that guides the behavior. ) Well before school age, children put their social experiences to work to build a set of ideas about how people interact socially, sometimes called an internal working model of social relations (IWM). The IWM continues to develop, sometimes along new lines, as the child grows and has new social experiences.
How does that set of events compare to caring for a dog? First of all, the roles are reversed. The human being acts as the “parent” and the dog as the “child”. If the boy or girl does a good job of nurturing and playing with the dog, the dog will develop trust in the boy or girl—but certainly not an exclusive trust, especially if the dog is a very sociable golden retriever. The CALO website says that the child learns empathy for the dog and therefore becomes more empathic toward his or her parents, but it is far from clear how either of these things could happen. If a child is a callous, unemotional individual, in what way will doing the work of caring for a dog teach or motivate empathic skills? And, if the child did become able to empathize with a dog, read the dog’s signals, become aware of the dog’s usual needs, even realize that any golden will convey that he needs yet another roast beef sandwich because there really wasn’t any meat in the one you just gave him—how do any of these skills relate to the more complex needs and messages of human beings, the facial expressions, the body language, and all the other factors that influence empathic responses? How do any of these enter into the IWM’s further development? Indeed, if trust and attachment were transferable, there would presumably be no attachment disorders in adopted children, as all (according to the CALO website) must have been attached to adults in the past, even at birth, so they ought to be able to hand that attachment package over to a new caregiver, just as they are claimed to “transfer” attachment from a dog to a human.
Since the relatively new developmental trauma disorder fad came on the scene, I’ve been expecting to see fewer extravagant claims about attachment, but it seems that CALO and similar groups are getting all the juice they can out of the mythology of attachment. And, of course, therapy dogs, emotional support animals, etc. are now in fashion, so why not bring in the golden retrievers too?
Perhaps we’re lucky that they haven’t decided to create attachment through pot-bellied pigs.