Saturday, March 16, 2019
When Arguments for Alternative Psychotherapies Cite Chemotherapy
Alternative psychotherapies (APs) are psychological treatments that are unconventional, are without any systematic empirical evidence about their safety and effectiveness, and in many cases are implausible in terms of psychological theory or established facts about child development. Some APs for children are directly harmful, and in the absence of evidence of their effectiveness we can consider all these treatments to be at least indirectly harmful-- for example, to use up families’ resources that would be better spent in other ways.
One possible harm done by APs for children is the infliction of discomfort either physical or emotional, sometimes with real pain and sometimes with the infliction of serious fear. Holding Therapy/Attachment Therapy, sometimes targeting adopted children and aiming at child obedience, gratitude, and the appearance of love for adopted parents, clearly involves both physical and mental discomfort caused by therapists. Nancy Thomas parenting (NTP), although it is not presented as a therapy by its advocates, is intended to bring about attitude and behavior changes like those that are goals of psychotherapy, and it too includes unpleasant, painful, and frightening experiences like being required to sit without moving for periods of time and having food limited in quantity and variety. Conversion therapy, a form of AP argued by its proponents to change same-sex orientation to heterosexuality, sometimes shares characteristics of holding therapy, and according to those who have experienced it, involves intense and disturbing efforts to change the nature of the treated person, in part through threats of eternal damnation.
Treatments for “parental alienation”, like Family Bridges and High Roads, are APs, as they lack empirical evidence of safety and effectiveness and are implausible as well as being unconventional. Like the other APs just mentioned, they depend on threats and fear to bring about certain changes in behavior. Children and adolescents given these treatments have reported not only distressing experiences during treatment, but also terror and discomfort when taken from their homes or schools or even from a courtroom by youth transport service workers who sometimes use handcuffs to restrain their charges.
How do proponents of APs justify the discomfort and fear experienced by children and adolescents receiving treatment—especially given that these methods are without evidence of effectiveness? An argument given by practitioners of Holding Therapy for many years has been that the treatment was analogous to chemotherapy for a child with cancer. Of course chemotherapy is painful, frightening, and distressing, but without it your child will die. The parallel suggested by these practitioners is that Holding Therapy is painful, frightening, and distressing, but without it your child will… perhaps not die, but become a serial killer (if male) or a prostitute (if female; these fates are apparently considered comparable), or will kill you, or will go to prison for some or all of the above. This, of course, is thorough abuse of an analogy, because although many children with untreated cancer do die, and although chemotherapy has been demonstrated to prevent many of those possible deaths, the same does not hold for Holding Therapy for treatment of childhood mental illness, antisocial behavior, or dissatisfaction of adoptive parents. First, although many serial killers have been shown to have had disturbed childhoods, it has not been shown that that childhood behavioral disturbances in general are of necessity followed by serial killing in later life. Second, it has certainly not been shown that children who receive Holding Therapy or other APs become less likely to have serious problems later—in fact, one might well predict that such children become even more likely to have emotional disturbances because of the resemblance of some AP techniques to other adverse childhood experiences.
Discussion of “parental alienation” treatments is beginning to focus on the distress and discomfort experienced by children and adolescents who undergo them. Advocates of these treatments argue that the untreated outcomes would be so bad that the discomfort is completely worth the benefits achieved. They claim, on the basis of very little evidence, that mental illness will result if a child is alienated from a parent and has no contact with that person. They argue also, without evidence, that children and adolescents who avoid one parent already have cognitive problems and disordered critical thinking.
I have yet to see practitioners of “parental alienation” treatments bring up the very faulty chemotherapy analogy as advocates of other APs have done, but no doubt someone will bring it up soon.