Attachment Therapy Goes to Russia

For quite a long time now, most of my posts have been about “parental alienation”. There are so many current PA events that it has been hard to ignore what’s happening there. However, there are a lot of potentially harmful treatments for children, and one of them is our old friend attachment therapy, AKA holding therapy. It has by no means disappeared.

Please do note that I am not talking about conventional attachment theory or about the thousands of research articles on the topic of developmental changes in social relationships. Attachment therapy (AT) is a fringe practice based on a couple of spurious ideas. One is that most behavioral problems in children, including disobedience, stem from a failure of emotional attachment in infancy and the toddler period. A second idea is that adopted children are most likely to display attachment problems, even if they were adopted on the day of birth and have never experienced problematic separations. Third, children who are noncompliant and aggressive are said to have Reactive Attachment Disorder, even though this real diagnosis has much different symptoms. Fourth, children said to have Reactive Attachment Disorder are supposed to be effectively treated by methods that include physical restraint, the restraint being thought to create attachment through a display of adult power and authority. These are the major tenets of what we might call the “attachment therapy belief system” (ATBS), a set of ideas that has existed on the fringes of mental health treatments since the 1970s.

Although professional organizations in the United States and elsewhere have officially rejected ATBS, nevertheless some practitioners go right on using and teaching it. My Russian colleague Yulia Massino tells me that ATBS is presently being taught in Russia by a group led by an American, Kenneth Frohock of the Attachment Institute of New England in Worcester, Massachusetts. Frohock and his followers have posted a number of YouTube pieces that give some insights into the kind of misinformation they are providing to adoptive parents and others in Russia.  Their presentations are apparently supported by a Russian government grant.

At various places among the presentations, Frohock states the need for holding (physical restraint) as a way to treat adopted children whose parents are concerned about their behavior and development. He suggests that holding may be required for children of all ages. As there has never been any empirical evidence that holding therapy is effective as a treatment for any childhood mental disorder, and as the safety of holding procedures is very much in question because of some past fatalities associated with it, I can say unequivocally that this is a mistaken  position for Frohock to take, and that it is regrettable that he is spreading misinformation to other countries.

His support of holding as a therapy is not the only problem in evidence in the YouTube presentations. My long-term colleague Linda Rosa kindly transcribed one of the presentations for me to use in discussion here. This presentation is at https://www.youtube.com/watch?v=9YPRHNRCV_Y.  In this presentation, Frohock describes his way of “reading” a child.

 First, he rejects the idea that the expression of the mouth is of value. The mouth, he says, indicates what a person wants you to think that they feel, rather than what they actually do feel. He attributes to children the ability to have enough cognitive empathy to understand how another person will respond to a given facial expression, and enough acting ability to change the expression to indicate some feeling that the child wants to convey to the observer. This would seem to be a tall order, especially for younger children, and Frohock does not indicate why he thinks they can do this.

Frohock goes on to say how he knows what the child is really feeling. He asserts that the eyes are important indicators, and the larger, rounder, and more infantile they are, the more they show a source of trouble that occurred early in development. Why this should be is not made clear, but perhaps we are looking at a concrete representation of the idea of fixation at or regression to an earlier stage—of course, I am only guessing at Frohock’s thinking. With respect to the eyes, Frohock also states that where the pupils are small, fear is indicated. It may well be that children in this form of treatment have good reason to be frightened, but ordinarily dilation of the pupils goes with fear (dilation  allows more light into the eye and may be helpful in a threatening situation).

Frohock also claims that kids can cry only on one side, the side being significant, and that they can “suck: back a tear that has brimmed over. Further, he associates shoulder posture with specific feelings--  “straight across” means that the child is scared, “slanted” means sad or shamed. Frohock remarks that he was not taught this, which indeed I can well believe, but figured it out for himself when working with addicts and gangs.

In this video and elsewhere, we have evidence that Frohock’s work jibes with the ATBS. He stresses adult authority as exemplified by holding and the focus on the child rather than a family system. He focuses on adopted children as likely to have attachment problems, to which he ascribes any later difficulties. In addition to these non-evidence-based claims, he thinks he has the ”art to find the mind’s construction in the face”—which he did not learn from anyone but invented for himself. Like other AT proponents, he presents himself as the only one who knows how to do these things—and like other pseudoscientific “alternative therapists”, warns that conventional treatment simply worsens problems.

There is a good deal more to be said about this Russian venture and I will comment further in the next few days.

N.B. The question is sure to arise: is what Frohock does actually holding therapy in the usual sense? The website of the Attachment Institute of New England mentions holding as a treatment. Frohock in his Russian presentations refers to "loving embraces" using language similar to that of Dyadic Developmental Psychotherapy. It would seem that these "loving embraces" must be enforced, as Frohock refers to continuing or threatening to continue the treatment for many hours. In my opinion, however good the intention, an artificially initiated embrace in which one person  is reluctant, however "lovingly" it is done, is not the same thing as a genuine loving embrace and has much in common with physical restraint in the form of holding. On the other hand, I have no reason to think that Frohock uses painful poking or tickling as part of the treatment, or that he shouts and demands that children shout, as was the case for the holding therapy prescribed by Foster Cline.