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Concerned About Unconventional Mental Health Interventions?

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

Saturday, June 16, 2018

Is Facilitated Communication a Potentially Harmful Treatment for Children?


Not long ago, I published an article about potentially harmful psychotherapies for children in  Child and Adolescent Social Work Journal. I was more than happy to receive the message below. You can read the article itself for free by clicking on the link and then on the box that says Social Sciences.
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 In the article, I argued that although most people think of any “therapy” for children as beneficial and certainly as safe, there are some treatments still in use that have the potential for doing harm rather than good. Some of these treatments have even caused child deaths, though obviously not all the children undergoing the treatments die or even sustain injuries. I proposed in the paper that rather than waiting until after children are hurt, we may be able to identify potentially harmful treatments for children (PHTCs) by looking at certain characteristics they share. As a group, PHTCs are implausible—they involve weak logic and are not in agreement with things that are well-known about child development. They use methods that resemble abusive actions like isolating or terrorizing a child. They are also lacking in any systematic research that supports their effectiveness and safety.

If children (or families) have already been hurt by a treatment or method, that piece of evidence should draw our serious attention to the cause of the injury. Researchers nowadays are told to report adverse events related to the methods they are investigating, but of course it is much more difficult to study these relatively rare events than to look at whether a treatment is effective. Some practitioners will reject reports of harm to treated children as “anecdotes”, but it has been pointed out that the anecdote is the first line of defense for maintenance of treatment safety. Reports of harm are the canaries in the therapeutic coal mine and deserve attention and analysis.

When I wrote about PHTCs in that article, I did not even think about including Facilitated Communication (FC) as an example of a PHTC. I thought FC, a method claiming to let children who cannot speak or communicate in other ways with the help of a keyboard and a helper who guides the child to say what he or she wants, had been rejected years ago! I thought this because of various canaries in the coalmine in the form of reports that FC was driven by the helper, and not the child’s intentions, and had resulted in unfunded accusations of abuse against parents, and resulting family disasters. But no, not at all, FC is apparently still around. The following newspaper article describes a conference advocating FC at the University of Northern Iowa and the distress with which this has been met by people who understand the FC facts:

Is FC a PHTC? Certainly, attention has been drawn to the method by reports of FC-created, unfounded abuse accusations and their adverse effects on accused parents, with subsequent impacts on the children who are already severely affected by their disabilities. These reports indicate that the canaries have stopped singing and we had better see what the problem is, so let’s look at the other issues involved with PHTC status.

Is there evidence from systematic, well-designed, well-implemented research that facilitators enable communication-disabled children to make their thoughts and wishes known?  No, on the contrary, when children have seen one thing and their helpers another, the answers about what they have seen reflect what the adult saw, not what the child saw. FC keyboarding shows what the adults think, and what they assume the child thinks—sometimes correctly, no doubt, but always with a strong chance of being wrong.  

Is FC a plausible method? Is it logical and congruent with what we know of child development? No, it is not. There is no reason why the introduction of a keyboard would make an adult especially sensitive to a child’s thoughts. If the adult knew what the child thinks, he or she could speak for the child, but this does not happen. The keyboard is simply a distraction from the fact that the adult is creating the communication, just as a person with a Ouija board is causing a sequence of letters to be chosen.

Is FC in itself a harmful method, as some child psychotherapies have directly harmful components? No, it is not in any serious sense directly harmful for an adult to manipulate a keyboard together with a child. We might even look for some psychological benefits of the added contact and interaction. In terms of communication benefits, however, there may be distinct opportunity costs--  the loss of family time and resources, as well as the failure to use more effective methods when they exist.

What does the real harm is FC in the hands of some volunteers or practitioners, who use their position to accuse innocent parents of abuse and thus create situations in which a parent may not be allowed near the child (who must be distressed at the disappearance of a familiar person) and may potentially go to prison if not exonerated. Even exoneration will not make up for loss of jobs, friends, even the marriage, as well as disruption of the relationship with the child. Why are such accusations made? Is it some extreme form of “rescuing” the child or a way to commit hostile acts against the parents? This is not clear, but what is evident is that FC, a method associated with harm, implausible, and rejected on the basis of strong evidence, is potentially harmful to many if not all children and should not be taught or practiced anywhere.

When the canaries are quiet, the rest of us had better speak up.


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