Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, July 3, 2017

Too Little or Too Much: Bringing Complaints About Patterns of Child Maltreatment

Now and then I encounter questions about some abusive practices that are done as part of unconventional “attachment therapies”. Adopted and foster children are often the targets of practices advised by non-mainstream therapists, counselors, and coaches of various stripes. The suggested methods can include all or some of the following:

·         Limiting the quantity and variety of children’s diets
·         Requiring children to “strong sit” tailor-fashion for periods of time without speaking or moving
·         Insisting that children ask permission for everyday actions that are normally handed independently after age 2 or 3, such as using the toilet or getting a drink of water
·         Punishing children who eat or drink without permission by forcing eating or drinking of large quantities
·         Confining children to a bedroom or a basement for many hours, sometimes providing only a bucket for sanitary purposes
·         Placing alarms on bedroom and cupboard doors
·         Removing all but minimal furniture from the bedrooms where children spend much of their time

These methods are claimed to be directed at creating parent-child attachment and preventing children from becoming murderers in later life—claimed goals that would certainly get the attention of most parents and make them likely to work zealously to do as they are told.

The first problem, of course, is that these methods have nothing to do with creating attachment, attachment has nothing to do with murder, and thus the methods do not treat either mental illness or criminal tendencies a child may have.

The second problem? Well, this is what I want to get at. I hear from worried people who tell me they have seen a sister or neighbor or someone else who seems to be using methods like those above. Sometimes they have reported to child protective services, sometimes they haven’t but wonder if they should—don’t want to get anyone in trouble unnecessarily but don’t like the looks of the situation, etc. What would happen if they reported?

Generally speaking, nothing would happen.

Unless a child is injured or killed as a result of an adult action, using methods like the list above is not illegal. Research definitions of child abuse contain categories that most of those items would fit into, but laws about child maltreatment do not. Like most laws, those laws have the goal of covering as much territory as is needed without getting into too many details.  We don’t have laws that say not to lock the child in a bedroom, because such a law could easily be evaded by locking the child in the basement, woodshed, broom closet, or garage instead. A law can’t include all the possible places a child could be locked up. And, we don’t want a law that will punish parents for child abuse if they accidentally shut a door and leave a child locked in until they hear him yelling five minutes later. Many of the things on that list are actions that a parent might carry out unintentionally or in a very mild form. (“You took that extra pancake that your sister wanted, now I want you to eat it!”)

Because we do not have such very detailed laws about child abuse, and because most parents might occasionally do something that was a bit like the items on the list, it would generally be assumed that any parental act that would be considered abusive must pass a pretty high bar--  one that could not be met by insisting someone eat the pancake he swiped or ask permission before eating something specially prepared for a party. As a result, a complaint about one incident of a listed action  would not—and probably should not—be given much attention by a child protection agency. Even a set of complaints about many items on the list would probably not contain any one item that would reach that high bar. The items on the list would not even be picked up by a checklist of adverse childhood experiences (ACEs) that are known to be associated with problematic developmental outcomes.

Each item is too little to trigger official action, but many repetitions of many items  are likely to form a pattern of experience that includes too much adversity to foster good development. Just as an accumulation of small injuries can lead to untoward physical consequences, it seems possible that repeated psychological injuries can have an outcome that is greater than the sum of its parts. Unfortunately, there is usually no way for a concerned observer to report a pattern of problems; an outsider sees only the occasional event and has no way to know what happens between times. Even if the pattern were carefully recorded, child protective staff may have no mechanism for interfering when each incident, standing alone, looks unpleasant but minor. The parent’s actions may not be “best practice”, but which of us can claim that we always make the best choices? There is plenty of evidence that we just need to be “good enough parents”, and we do not really have clear standards about what is “good enough”.

I would like to propose that agencies and organizations move toward recognizing the patterns of multiple, apparently low-impact, possibly cumulative, but risky, parenting behaviors. At the least, such an approach could prevent some of the child deaths from slow starvation and exposure that crop up in the news with relentless regularity. At the most, such an approach, coupled with parent education and supervision, could improve the chances of excellent developmental outcomes for large numbers of children now at risk.


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