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Concerned About Unconventional Mental Health Interventions?

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

Monday, February 19, 2018

Is Attachment Therapy "Controversial"?

A newspaper in Greeley, Colorado has once again incorrectly referred to Attachment Therapy as a “controversial” treatment. AT is not controversial, not are its associated beliefs and adjuvant treatments like Nancy Thomas parenting. They are not controversial because there is no controversy here. No one who has any understanding of child development would enter into any controversy on these ideas and practices, which are clearly wrong, unfounded, and potentially harmful. There is no need to argue the point, as would be done if something were genuinely controversial.

Attachment Therapy is an alternative psychotherapy, the parallel in the psychology world of complementary and alternative medicine (CAM). It can be identified as an alternative treatment because it is implausible, incongruent with what is known about child development, and lacking both an evidence basis and a possible mechanism by which it might work. The same points can be made about the alternative developmental theories and adjuvant treatments associated with AT. Arguments in favor of the AT principles and practices are based on a completely mistaken definition and theory of emotional attachment and use terms related to attachment in obfuscatory ways rather than for clarification.  

There are many other alternative belief systems that are completely wrong, but not controversial, because no knowledgeable person would enter into serious controversy about them. For example, the belief that the earth is flat rather than spherical, as promulgated by the Flat Earth Society (https://www.tfes.org), is wrong, but there is no controversy about it in serious circles. We do not see geographers applying for grants to demonstrate that the earth is a sphere, or writing learned books arguing on philosophical principles that the flat earth view is wrong. Like AT beliefs, the Flat Earth view is a mistaken alternative belief, but not the subject of controversy.

So, why did the Greeley newspaper say AT is controversial? One reason is that lots of other people have said this and it seems like an exciting idea. (And it would be extremely exciting if any evidence were advanced to support AT beliefs, because if they are right, that would mean that almost all established facts and principles about child development have to be abandoned!) Using the word “controversial” also lets the reporter off the hook with both AT proponents and conventional psychologists, by implying that no stand is being taken—although mentioning these ideas at all, when they are so little known in the world of professional psychology, actually is taking a stand. Describing AT as controversial and giving space to differing ideas about attachment and attachment disorders provides the pseudosymmetry, or equal weight for well- and poorly-supported ideas, that passes as “fair treatment” in present-day journalism. Using the “controversial” word  about AT also gives lots of chances to talk about horrible children and the need for adult domination, topics that are bound to attract interest.

Are there controversial ideas and treatments in psychology, as opposed to alternative psychotherapies? Yes, of course. A good example is Eye Movement Desensitization and Reprocessing (EMDR), a treatment claimed to treat anxiety and other emotional discomfort by having the patient imagine the frightening situation while moving the eyes in a pattern. There are lots of controversies here, and lots of people attempting to investigate EMDR empirically. Is EMDR effective in reducing emotional discomfort? If it is effective, what is the mechanism—do the eye movements really make any difference, or is the effective component simply exposure and desensitization as they are used by other treatments without planned eye movements? Because there is genuine controversy here, you will see many articles on these in peer-reviewed professional journals. People who know a lot about the topic disagree on EMDR and seek to test their beliefs by finding new evidence. None of this is true about AT, which is an alternative (CAM) treatment, not a subject of controversy.

If there was ever real controversy among professional psychologists over AT, it died down in 2006 when the joint task force of the American Professional Society on Abuse of Children (APSAC) and the American Psychological Association’s Division 37 rejected out of hand the use of attachment therapy, of adjuvant treatments, of the related views of attachment disorders, and of the alternative theory of child development on which all of these are based. So what keeps reporters and the public talking about these ideas? I would say that it is in part the wholehearted commitment of the public to the idea of attachment as the central theme of human life, coupled with a considerable misunderstanding of what attachment is. “Everybody knows” about attachment so it’s very comfortable for readers and viewers to encounter. Really, however, we need to keep in mind that although attachment (the actual process) is important, it’s not the only thing that’s important in development.

And, there's a difference between controversy and unsupported claims about alternative treatments.

Friday, February 16, 2018

Alternative Therapists Pounce on Florida School Tragedy

Alternative therapists must have been waiting impatiently for an adopted person to commit a tragic school shooting. Now that this has occurred in Florida, various proponents of alternative belief systems have jumped onto the fact , which they claim supports their unsupported equation: adoption=feelings of loss and rage=attachment disorder=violent actions. And, they hope, this horrible situation will give them an entry into the national discussion, fame and fortune.

As I often do, I received an email message from Heather Forbes, former colleague of Bryan Post (a  smooth “plausible fellow”, well-known for his store-bought doctorate), and present ruler of the Beyond Consequences mini-empire. There is a link to the message at https://www.facebook.com/BeyondConsequences/posts/10155982520430256, but let’s look at what she had to say:
“As I watched the news on last night and this morning, all I saw was discussions about gun control, active shooter school policies, mental health, and proper law enforcement protocol. While these are all valid issues to discuss, I believe the most important issue continues to be overlooked. We aren't looking at our students from a social/emotional, heart-centered perspective. This shooter's history was rampant with experiences of rejection. He was adopted and then lost BOTH his adoptive parents. Then he was expelled from school. That is three experiences of severe rejection and loss: 1) the loss of his birth family, 2) the loss of his adoptive family, and 3) the loss of his school family. As humans, we are a social species....we are designed to live in families, especially as children… 
 I can only see that there is no coincidence that this horrifying event took place on Valentine's Day--the day we celebrate love and relationships. “ (Heather then proposed that she be a spokesperson to the nation on these issues and asked her followers to suggest her to various news outlets.)

So, let’s examine Forbes’ thinking under a strong light. What we see is the usual “proof by assertion”.
First, she equates rejection with loss, implying that the sadness and grief of loss are accompanied by equal amounts of the resentment and anger that stem from rejection. While no one can deny that we human beings often feel some anger toward those who have left us, even when they did this unintentionally, the feelings and effects of rejection and loss are not the same, and conflating them confuses the issue. As is the case for most pseudoscientific explanation, the misused terms obfuscate rather than clarifying the discussion.

Second, Heather Forbes states that the loss of the birth family is an experience of severe rejection and loss. There is no evidence that this is the case for children who are adopted early in life, especially those who are adopted before the age of 8 or 9 months when emotional attachment to familiar caregivers may have begun. The idea that adopted children are enraged and full of grief because they have been separated from a birth mother is not based on any observations of children; instead, it is implausibly based on beliefs that mother and child are genetically attached or that attachment occurs prenatally—all these ideas being fostered by alternative groups like the Association for Pre- and Perinatal Psychology and Health (APPPAH). These beliefs are worth their weight in gold to those who offer their guidance to adoptive families and adult adoptees, and who do so by creating unnecessary anxiety about the future for people who are doing very well.

Third, Heather Forbes points to losses in the adoptive family, and I will not try to argue that these may not have contributed to emotional disturbance, although the adoptive status is irrelevant here. Losses in any family act as adverse childhood experiences (ACEs) and may contribute to disturbed emotions and behavior—although they are even more likely to create later physical disorders than mental illness, and are not thought to be a major factor in serious mental illness.

Fourth, Forbes points to the loss of the “school family”, apparently reversing cause and effect. The shooter was expelled from school because of disciplinary problems, so this loss followed rather than caused his disturbed behavior.

Finally, let me note the twisted argument Forbes presents about Valentine’s Day, just as  a further example of the cherry-picking of evidence and illogical conclusions drawn in her statement. According to Forbes, it is “no coincidence” that the shooting happened on Valentine’s Day, so it should be attributed to loss of love as the triggering factor for the shooter. But it was also Ash Wednesday, the beginning of Lent—can Forbes not parlay this fact into a further non-coincidental connection? Was the shooter disturbed by seeing people with ashes on their foreheads, reminding him of life’s ultimate end and therefore his losses? Was the anticipation of giving things up for Lent too much for one who felt he had been robbed of his rights? Sorry, Heather Forbes, but if you use one fact to support your argument, you can’t ignore the other facts, whether they are about attachment or about holidays.

Not surprisingly, our old friend Nancy Thomas has chimed in, recognizing this tragedy as a way to advance her brand. She says, at https://www.facebook.com/ntparenting/posts/1579834535464320 Yes, it is possible this young man may have demonstrated many of the characteristics of RAD when he was younger. The more likely outcome at this point is he may receive a diagnosis of Conduct Disorder. That is usually the go-to dx for adults who have been or should have been diagnosed with RAD when they were children. For those who worry this is where their child is headed we have this. There is always hope as long as they are breathing. Those who have a diagnosis of RAD are not automatically killers.

Well, what a relief Thomas has given us here! Children diagnosed with Reactive Attachment Disorder will not necessarily grow up to be killers. However, she suggests, killing allows us to detect that the killer did as a child have Reactive Attachment Disorder. Presumably this means not Reactive Attachment Disorder as indicated by sadness, lethargy, and disengagement from social interaction, but instead the alternative version in which children are liars and thieves and manipulate or harm others—and, saliently, in which it is predicted that children who show no symptoms are simply too cunning to be caught, but still need an alternative treatment so they will not become either serial killers or prostitutes, depending on gender. (And I’ve always been fascinated by the equation of these two forms of misbehavior.)

One more of these, though I am sure they are multitudinous: http://www.teapartytribune.com/2018/02/15/guns-dont-kill-people/ by a person somewhat disturbingly called Bill the Butcher, who states that guns don’t kill people—psychiatrists kill people. Bill the Butcher states that his granddaughter has Reactive Attachment Disorder and as a result “ripped the ears off a small dog to get its bows for her hair”. This kind of claim is often made by people who are devoted to the alternative view of attachment and of causes of mental illness, but anyone who has jointed and skinned a chicken (a dead one, I mean!) knows that tearing flesh apart with your bare hands is not readily accomplished. I would suggest that this story is a myth related to various alternative therapists’ stories of children who have torn the heads off puppies.  By use of this myth, the child is identified as a powerful, hostile, evil being, and, as Bill the Butcher suggests, incarceration is the only legitimate response. According to B the B, mental health professionals and teachers cause school shootings by attempting to help disturbed children, and responsible people must simply lock the children up.

As most killings are not committed by adopted people (who are only about 2% of the population), it has taken awhile for  alternative therapists to get their chance to claim that mass shootings are related to adoption and to attachment disorders. But their opportunity has finally come and they are taking advantage of it as best as they can. Let’s hope that media outlets do not act in haste to accept, Forbes, Thomas, or B the B as spokespersons for the role of mental health in these tragedies.   

Tuesday, February 13, 2018

T. Berry Brazelton's 100th, and "Touchpoints"

The great pediatrician T. Berry Brazelton’s hundredth birthday will be celebrated April 23, 2018, at a symposium at the Boston Marriott hotel in Newton, MA. A stellar group of speakers will be there and people in the Boston area may want to attend. It is expensive though—so for my part I am going to offer here some reminders about Brazelton’s concept of “touchpoints” as a way for parents to organize their childrearing work.

Brazelton’s various “touchpoints” books, and his work together with Joshua Sparrow and others, focused on times of developmental changes in the lives of babies and young children, and the way those changes can disrupt family life and create parental anxiety (see www.brazeltontouchpoints.org). Guidance about these times of change and disruption can help parents keep calm and work through expectable disruptions.

It’s a big flaw in human thinking that we tend to expect things to stay the same as they are at any moment. If something doesn’t go well, we imagine that there will never be any improvement and are deeply discouraged about the future and life in general. If everything is fine, we dismiss the possibility that anything less desirable could happen, and expect smooth sailing ever after. Learning that life—and parenting—has ups and downs is quite difficult, but this lesson, if learned, helps everyone to weather difficult times. Brazelton’s “touchpoints” approach suggested that if parents can anticipate times of disruption, they will deal with those times more comfortably when they do come.

People other than Brazelton have considered this issue in terms of events in early development. Anna Freud, for example, suggested that there were natural times of what she called “regression”—periods when an infant or child who had been easy to care for became temporarily more difficult, cried a lot, had tantrums, slept or ate poorly, for no apparent reason. It’s interesting that she used the term “regression” for this behavior, because that implies that the child has gone back to acting as he or she did earlier. Actually, though, periods of “difficult” behavior may mean that a child has progressed, not regressed. A 4-month-old is not afraid of strangers and does not fuss when approached by new people, but a 10-month-old, with more advanced cognitive and emotional development, is likely to cry and try to hide, and may be much distressed when introduced into a new environment with new caregivers. Increased maturity of a child can go with greater care difficulties from the parent’s viewpoint, but it can be hard for a parent to see things that way, and when other people express annoyance or concern about developmental steps they do not recognize as progress, parents’ lives are made even harder.

Arnold Gesell and Frances Ilg, who in the 1940s and ‘50s published books for parents and teachers about developmental changes, talked about “interweaving” of negative and positive changes during infancy and the preschool period. The idea again was to anticipate and prepare for events rather than being startled and badly disrupted by them.

Brazelton’s real contribution to the idea of “touchpoints” is that children’s developmental steps—the same ones that may make parents anxious or angry—can be reframed and reinterpreted as evidence of good development. Just as parents look forward to developmental milestones like sitting alone, walking independently, the first word, they can be guided to recognize what Anna Freud called “regressions” as developmental progressions. Because some of these developmental steps are fairly predictable, parents can be encouraged to anticipate them and find them delightful as well as possibly problematic. (I’ve always thought that if I could design a greeting card, I would do one that says, “Congratulations! Your child was afraid of a stranger for the first time today! Her development is going very well!”)

Brazelton’s work looked at a range of changes in areas of development that can provide “touchpoints” for parents. For example, he noted that at about 4 months, babies’ increasing interest in the environment may make them more difficult to feed, as they stop nursing to look at other people in the room or to explore the mother’s face. By about 9 months, their desire to use their newly-developed pincer grip makes them want bits of food to pick up and decreases interest in being spoon-fed. By 12 months, new skills and an increased need for independence indicate developmental progress. Parents can take pleasure in these changes and work to accommodate them by providing changes in diet and encouragement to move forward—or they can fight the changes, making themselves and the babies unhappy. (If the parents accept the belief of some alternative therapists that emotional attachment occurs when an adult feeds the baby, they will definitely run into anxiety and difficulty on this point.)

The Touchpoints books are very much worth a look for parents of infants and toddlers.

Monday, February 12, 2018

A Letter to Florida About Proposed Use of "Alternative Therapies" for Veterans

The Honorable Dana Young
Chair, Health Policy Committee
404 S. Monroe St.
Tallahassee, FL 32399-1100

Dear Ms. Young:

A Florida colleague has told me about Bill 23-00010-18 and I am writing to comment on the proposed provision of “alternative therapies” to veterans.

Let me note first that “alternative therapies” are by definition treatments that are unsupported by an acceptable empirical evidence basis. If they were supported by evidence of safety and effectiveness, these treatments would simply be called “therapies”. Veterans and all citizens deserve help to insure that their investments of time and resources into treatments are protected by evidence of treatment effectiveness. The only people whose best interests are served by provision of “alternative therapies” are the “alternative therapists” themselves.

The proposed use of “equine therapy” for veterans is a a good example of service to “alternative therapists” rather than to veterans. Treatment by horseback riding was originally used as a means of gentle stretching of contracted muscles for children with cerebral palsy and the sequelae of other diseases like polio. Horseback riding was effective for these purposes and was enjoyable and interesting for the children, which helped them tolerate discomfort they might feel. Within the last 20 years or so, however, enthusiasts of horseback riding began to propose that if riding was good for children with cerebral palsy (who may appear to be mentally limited even though they are often not), it should also be good for autistic children or for children whose disturbances were clearly emotional. One “equine therapist” has even claimed that the horse’s gait is “downloaded” to a disturbed child’s brain, thereby normalizing brain functioning, and that horses can tell whether a person is lying to another person; there is no evidence to support these claims, which are in fact rather bizarre.

The proposal that “equine therapy” be used for veterans’ emotional disorders has simply been generalized from the unsupported claims made about the treatment as it has been used for children. If a veteran has contracted thigh muscles as a result of nervous system or other injury, yes, horseback riding may provide helpful stretching. If a veteran is bored and limited in what he or she can do, horseback riding can be fun and rewarding. But these possible benefits for some veterans do not mean that “equine therapy” is effective treatment for PTSD or any other mental disorder, or that it should be supported or even encouraged by the state of Florida..

I hope you will take these points into consideration with respect to 23-00010-18. I would be happy to discuss these issues further if that would be helpful.

Yours sincerely,

Jean Mercer, Ph.D.
Professor Emerita of Psychology, Stockton University, Galloway, NJ

Wednesday, January 31, 2018

A Facebook Page that May Interest You: About Continuing Education for Psychologists

In the United States, each state has its own regulations about licensure of psychologists, but generally speaking a person may not describe him- or herself as a psychologist or advertise clinical services without being licensed, or being supervised by a licensed psychologist. In addition, it's generally the case that in order to maintain licensure, psychologists must receive continuing education through coursework off- or on-line. Not all courses are acceptable for continuing education credit-- they must be approved by the American Psychological Association (APA) working through entities called "approved providers". An approved provider may be a university, a commercial organization, a non-profit, or a state board of psychology.

 Approved providers are supposed to ascertain that coursework earning continuing education (CE) credit meets some fairly stringent APA requirements. A presentation is acceptable for CE credit only if the content is adequate-- an application must include learning objectives for attendees, professional publications supporting the information provided, background of the presenter, and so on.

The problem? Some approved providers, notably some commercial groups, do not do a very good job of vetting the material before approving APA CEs. And , in spite of disclaimers in conference and lecture brochures, some people continue to think that any content that receives APA CE credit must have been stated to be valid by APA. For one example, a presentation by Nancy Thomas, the self-described foster parent educator, was approved for CE credit a few years ago-- in spite of Thomas's having no professional education at all, and being able to submit no professional publications to support her claims.

Fortunately, there is a clear path to complaints that trigger investigation by APA of presentations that should not have been given CE credit. It takes a while to search for supporting information and to write a complaint, but it can be done-- and these investigations do take place and may lead to cancellation of the CE credit for a questionable presentation. (Although there are certain commercial organizations that have been guilty of these problems more than others, as far as I know, their approved provider status has not been revoked.)

If you are interested in being involved in discussion of some of these issues and learning how to make a complaint, please join us at https://www.facebook.com/groups/161745967794736/. You don;t have to join to comment.