A New and Essential Book About Holding Therapy

Some readers of this blog already know what Holding Therapy is, but I’d better describe it briefly before I talk about an important new book. Holding Therapy is an unorthodox method of treating posited childhood emotional disorders and is physically and emotionally intrusive; documented deaths and injuries to children have been associated with it. Practitioners of Holding Therapy restrain children physically and prod them in the underarms and torso while demanding that the child gaze into their eyes and shout statements like “I want to kill my mother!”. Between lengthy sessions of holding, the children are often kept in “therapeutic foster homes” where they are given limited diets and required to do tedious, unnecessary work. Proponents of Holding Therapy attribute childhood behavior problems, especially in adopted or foster children, to a failure of emotional attachment and believe that their treatment will cause attachment and [therefore, they would say] solve behavioral difficulties. Holding Therapy is an “alternative psychotherapy”, equivalent to the medical procedures often called “CAM” (complementary and alternative medicine). It is based on highly unconventional beliefs and assumptions and lacks a foundation in supporting empirical evidence. In addition, Holding Therapy has been described as a potentially harmful treatment and has been rejected in statements of a number of professional organizations, including a task force report of the American Professional Society on the Abuse of Children and a position paper of the British Association for Adoption and Fostering. (A more detailed description of Holding Therapy and its background in the U.S. can be found in Attachment Therapy On Trial [Mercer, Sarner, & Rosa,2003; Westport, CT: Praeger].)

Most of the information we have about children’s experience of Holding Therapy comes from training videotapes and published descriptions of the procedure by proponents of the treatment. A small number of individuals have come forward in adulthood to report their earlier experiences, but in most cases they have been exceedingly reluctant to be identified publicly. Some of them were legitimately concerned that they would be sued for defamation by their former therapists if they were to name names and describe methods. Others were fearful that their reports would not be believed, and even that those they spoke to would say that their statements were nothing more than proof of the mental illness for which the treatment was used. Some simply wanted to forget the whole thing, while others, who had received little schooling during the course of their treatment, were shy and inarticulate. Of those who sought legal recourse against Holding Therapy practitioners, most were told that a statute of limitations prevented them from bringing charges more than a year or two after legal adulthood.

But a new book, Invisible England: The Testimony of David Hanson  (http://www.amazon.co.uk/Invisible-England-Testimony-David-Hanson/dp/1478205938/ref=sr_1_1?s=books&ie=UTF8&qid=1346093165&sr=1-1)  gives us for the first time a detailed account of Holding Therapy as experienced and recalled by a victim. Now a young man and the father of two children of his own, David Hanson, with the help of an advocate who has had to use a pen name, has told  in his own words the story of his years of repeated Holding Therapy treatments in a “home” run by a leading British child and family service organization. I’ll quote a brief passage to give you the flavor of David’s description of the treatment in which he was physically restrained:

“ One other adult usally one of the unit residential staff   had to lie down feet on the one adult who would then hold the feet down on the top half one hand behind the therapist back been held by the person sat next to her one hand place on my chest held down my the therapist and constant forced eye to eye contant if I looked way my head would have been pinned in the direction of the therapist and if I tried to say no another hand would firmly clasped over my mouth which would send me into a fit of rage all this was also backed up with a lot of shouting and swearing the therapist would say things like is this what your fucking birth mum did to you did she and the hand would come of my mouth for a responce this seemed to go on for ages”--  and in fact it did go on for hours at a time, weekly or more often, for many years.

Yes, this is Holding Therapy, the same procedure rejected by APSAC, by the British Association for Adoption and Fostering, and by a number of other professional groups--  the same procedure that even David’s advocate had thought “couldn’t happen here”. For the first time, we have a published first-person account that clearly counters claims that children receiving these treatments within the last ten years gave their informed consent to the therapists. It is also made abundantly clear that the children do not express their own feelings, but instead are required to parrot the therapists’ statements. For these essential contributions, I want to thank both David and his anonymous advocate for their courageous publication.

Why is the advocate anonymous? As Invisible England shows, it is not safe to criticize major organizations that can easily pull strings to destroy the livelihood of whistle-blowers. This sad old story is told once again as David’s narrative is embedded in the account of professionals’  efforts  to make visible the secret use of Holding Therapy.

There is much more to the story than I have told here. It’s very much worth reading for anyone who is concerned about the lives of at-risk children and families. And, just a little note for the future: it’s my impression that the organization that subjected David Hanson to Holding Therapy has recently signed on to provide services to children in another country. The problem is not resolved, although David’s account may help us move in that direction.

A Vicious Effort to Scare Parents Away from Vaccination

Don’t read the material at this link if you’re not already in a calm, reflective mood: http://sanevax.org/a-parents-guide-what-to-do-if-your-child-dies-after-vaccination/   --- because after you read it you may be too furious to speak anyway.

Here’s the deal: this outfit, “sanevax”, wants to dissuade parents from protecting their children from contagious diseases by means of immunization. They show this in the first paragraph by referring to “severe reactions in previously healthy infants, toddlers, or teenagers, many of whom succumbed after either 1. receiving vaccinations, or 2. experiencing protracted adverse effects due to vaccinations.” This sentence appears to state that many infants, toddlers, and teenagers die following vaccination, which of course is very far from the truth. Perhaps the author meant that of the very few children who have adverse events following (not necessarily because of) vaccination, a large proportion die? This would be a great deal closer to the truth, but it’s not at all clear whether that was intended to be the statement…  and, not so incidentally, the author fails to state what proportion of children die or suffer severe handicapping conditions when they contract the diseases against which vaccination would protect them.   

So far, “sanevax” repeats the usual anti-vaccination statements in their usual muddled form, encouraging the belief that vaccination regularly kills children, but not making this statement so clearly that they can be confronted with the lie direct. However, the document then proceeds to describe to parents what scientific evidence and legal proceedings they must demand if their child dies. Lists of tests and tissue samples are provided, with the addendum that because the parents will be so shattered at the time (which no doubt they would naturally be), they must already have arranged with friends and relations to carry out these instructions. In other words, the parents are not only made to imagine the necessary proceedings following their child’s notional death, but they are encouraged to create a network of sympathetic helpers who can be brought to share their fears and beliefs. “Sanevax” thus suggests the development of what we might call a mini-cult of believers who will support each other’s assumptions and buffer the parents from the influence of objective evidence. The social group of supporters and sympathizers can then emphasize information that argues against vaccination, and thus make it less likely that the parents will overcome their fears, seek good evidence and think in terms of probabilities, and choose to protect their children against the possible devastating effects of contagious diseases.  

Why should parents prepare to demand full investigation of a child’s death? The whole community should be grateful to parents who managed to do this, because this detailed evidence could help assure others that the death was caused by something other than vaccination. But this is not the reason given. “Sanevax” suggests full investigation in order to bolster parental claims for reimbursement under the National Vaccine Injury Compensation Program--- and while there is practical value to this information, the reference to the program in this context, and without historical background, implies that there must be serious reasons for fearfulness, or no such program would exist.

Then “sanevax” proceeds to the real crux: the threat that parents whose children die in unexplained ways may be accused of having brought about Shaken Baby Syndrome.  The document warns that emergency room personnel are not trained to recognize vaccine effects and that therefore “it is common practice for child abuse/neglect, or Shaken Baby Syndrome (SBS) legal charges to be filed against parents of children who die from vaccine damage to the brain, especially if there are no visible trauma marks on the child’s body”.  This statement begins with the broad claim of “common practice” without indicating the source of this information--- or indeed dealing with whether it is possible to say what “commonly” happens under circumstances of such exceeding rarity, even non-existence, as “vaccine damage to the brain”. “Sanevax” omits to say that there are physical signs of SBS (subdural hematoma and bilateral retinal hemorrhage) rather than “no visible trauma”. The document also omits the fact that suspected cases of child abuse receive investigation, and legal charges may follow if the investigation seems to justify such a decision. This omission, and the collapsing of a lengthy sequence of events into charges against the parents right in the ER, creates a vivid and frightening image that in fact does not correctly describe the steps that might (but usually do not) lead to indictment. Once again, the lie direct cannot be given, but we seem to have gone as far as what Shakespeare’s Touchstone called the “lie circumstantial”.

Where did “sanevax” get the idea that parents are charged with child abuse when (and if!) this kind of child death occurs? One source appears to be the Australian Viera Scheibner, whose claims can be seen at www.bibliotecapleyades.net/salud/esp_salud33d.htm.  Scheibner commented in a piece written some years ago, “I was told by a social worker in the United States that many foster parents are rotting in US prisons. First, they are forced to vaccinate their charges, and then, when side effects or death occur, they are accused of causing them.” Scheibner did not, of course, say what she meant by “many” foster parents or indicate the sources of this social worker’s information.

Perhaps the “sanevax” group realized that they had mentioned no checkable facts, because in the end they turned to the use of a red herring in the form of a link to a PLOS article. The linked article reported an experimental study in which mice which received repeated immunizations developed autoimmune tissue injuries which resembled lupus. “Sanevax” quoted a statement from this paper’s conclusion which noted the possibility that excessive exposure to antigens might cause autoimmune responses. They did not, however, quote the previous sentence, which  said: “Living organisms are constantly exposed to a broad range of environmental antigens, as exemplified by the recent re-emergence of measles virus infection among a subpopulation of Japanese young adults who were not vaccinated against the virus.” “Sanevax” picked the cherry that appeared to support their position, but did not notice--  or perhaps expect others to notice--  that the study authors were in fact concerned with all types of antigen exposures, not just with vaccines.

“Sanevax” appears to have designed an anti-vaccination argument that is based entirely on an approach of low cunning, focused on parents’ greatest anxieties about their children and themselves. The “sanevax” fearmongering abandons all effort to deal with evidence for or against vaccination practices, but concentrates on terroristic threats that obscure and distract from realistic health concerns.  I would characterize this type of persuasion as vicious, because—in a move comparable to any vice---  it avoids a calm, open consideration of fact and favors instead an emotion-charged way of thinking which is apparently addictive and certainly unhealthy.

Nothing said by “sanevax” contradicts or even challenges the fact that immunization against disease is good for children and for all of us. In their lengthy article, they actually said nothing but “BOO!”

Nursing Babies and Eye Contact: Who Said It? And What Did He Mean?

Readers of this and other blogs have gone around in circles about the claim that nursing babies gaze into their mothers’ eyes. This assertion turns up in many an Internet site and many a book, and those who make the claim often add the suggestion that the mutual gaze causes attachment and/or bonding. However, experienced nursing mothers usually say, “Sure, sometimes they do--  but sometimes they don’t.” They also note that babies younger than about 6 weeks don’t reliably make eye contact at all, much less allow themselves to be distracted from voracious feeding in order to socialize.

I’ve been looking for a source for this claim about eye contact, and I think I’ve found one in the work of Rene’ Spitz  (sorry, I don’t know how to make that acute accent properly on my keyboard). Spitz was a psychoanalytically-trained physician who suggested the term “anaclitic depression” to describe the distress of infants and toddlers abruptly separated from familiar caregivers and cared for in institutions. In the 1940s and later, he used careful observations and  filming techniques to demonstrate the young child’s response to separation. Spitz spent some time at the University of Colorado Medical Center and was the mentor of the eminent infancy researcher Robert Emde.

Spitz’s 1965 book, The first year of life, focuses on the shaping of personality by very early experiences--  and I should point out that, interestingly, the word “attachment” does not appear in the index at all. I should also point out that Spitz emphasizes the interaction of experiences with biological characteristics and notes that personality developments may emerge from previously existing forms as a result of maturation, just as limbs grow spontaneously from  primitive forms during embryonic life, without being triggered by experience.

Here’s what Spitz says about the gaze of nursing infants: “We have observed that in the majority of cases the breast-fed baby stares at the face of his mother unswervingly throughout the act of nursing without turning his eyes away until he falls asleep at the breast…; in bottle-fed babies this phenomenon is neither consistent nor reliable”. Overleaf (p. 52), Spitz shows a photograph of a nursing baby and mother who appear to be making eye contact. The caption reads “During Nursing the Breast-Fed Baby Stares Unwaveringly at His Mother’s Face.”

Now I ask you, are those two statements the same?   “In the majority of cases the breast-fed baby stares at the face of his mother unswervingly” and “During nursing the breast-fed baby stares unwaveringly at his mother’s face”? No, the first one says that sometimes, in at least 51 % of cases, the baby stares at his mother’s face. The second one appears to be saying that all breast-fed babies stare all the time, but in fact it may have been intended to say that in this particular picture, the baby was looking at his mother at the time the picture was taken. It’s not exactly clear what the photo caption means, but in either case it’s different from the text statement.

Let’s see what else Spitz says in The first year of life. Maybe that will help figure out what he meant to say about nursing babies and their mutual gazes with their mothers. Here are some relevant statements: “The infant’s inability to perceive his surround lasts for a number of weeks. Toward the beginning of the second month an approaching human being begins to acquire a unique place among the ‘things’ in the baby’s surround… If you approach the hungry, crying baby at the hour of feeding, he will become quiet, open his mouth or make sucking movements…. In this second month, the infant reacts to the external stimulus only when it coincides tith the baby’s interoceptive perception of hunger… Two or three weeks later, we note a further progress; when the infant perceives a human face, he follows its movements with concentrated attention.”

In other words, it would appear that Spitz would not have expected infants of less than 6 weeks to pay attention to faces at all. So his claim about an unwavering mutual gaze would seem to apply only to babies older than perhaps 6 or 8 weeks.  Were the “majority of cases” all among babies who were older than that? Or did Spitz count the younger babies in the group that was less than the majority? He doesn’t say, but it does seem pretty clear that he did not expect neonates to gaze into anyone’s eyes.

More recent research, like that of Melzack and Moore, does indicate that even newborns can pay attention to people’s faces and show us they do by imitating facial expressions. Like other researchers of his period, Spitz believed that many developments appeared at later ages than we now have seen demonstrated. But  imitating a person sticking out his tongue is quite a different matter from sustaining a mutual gaze, and we can’t reason from one to the other; to conclude that one ability is related to the other, we would have to have evidence of nursing infants involved in mutual gaze at a very early age, and we don’t have that.  

The idea that the gaze has a power to influence others people is quite an old one, and it’s not surprising that young mothers can easily be unnerved by claims that their babies must look into their eyes, especially now that everyone is terrified of autism. But the fact is that even babies who are old enough to make eye contact only do this about half the time while nursing, even according to Spitz, and this does not indicate any problem about their development. And, by the way--   nursing mothers are not always deeply engaged with gazing at their babies. They may find this time an excellent one for cutting the baby’s fingernails or cleaning out the ears without protest, or they may talk on the phone, eat a sandwich, have a cup of tea, or read to an older child while the baby does his thing. Breast-feeding only takes one of your hands--  that’s one of its great advantages.

That Old Basic Trust Concept: Peddling the "Attachment Cycle"

NOTE: A more formal and complete version of this post appears at http://thestudyofnonsense.blogspot.com/2012/08/parsing-attachment-cycle-fox-terrier.html.

Over the decade or so that I’ve been looking at Attachment Therapy and other unconventional treatments, I’ve puzzled many times over the idea of a “first-year attachment cycle” that culminates in something called basic trust , followed by a second-year cycle that sets limits for toddlers. The two of these are said to add up to secure attachment. But although conventional developmental psychology certainly uses the concept of attachment and different security statuses, the other ideas are not part of conventional, evidence-based child development studies.

The Attachment Therapist Foster Cline described an “attachment cycle” in some of his work in the 1990s. He apparently picked up the idea from Vera Fahlberg, who was a visitor in Evergreen, CO (home of Attachment Therapy as a cottage industry), and Fahlberg in turn attributed a diagram of the “attachment cycle” to Rene’ Spitz, a psychiatrist who studied young children separated from their mothers and who spoke of anaclitic depression as a result of such separation. According to Fahlberg, the “attachment cycle” involved a child’s repeated experiences of need for food or other care, followed by a parental response. Parents who responded quickly and sensitively fostered the development of secure attachment, while neglectful or abusive parents did not. Somewhere along the line--  and I have yet to figure out where--  someone inserted the idea that secure attachment depended on limit-setting that convinces the toddler that parents are powerful and authoritative, and therefore trustworthy.

This set of beliefs is promulgated in the writings of Foster Cline, Nancy Thomas, and other related authors, and is repeated in popular books about adoption and fostering and on Internet sites advising on those subjects .

Where did these ideas come from? Once again, the “attachment cycle” theory, as described by Cline and others, is not derived from any aspect of conventional developmental psychology. Like many “alternative psychologies”, it shares some terminology and some ideas with conventional work, of course. The ideas that infants and toddlers develop emotional attachment to caregivers and that their attachment serves as the foundation for later social relationships is part of the work of John Bowlby, a British psychiatrist whose approach is a foundation of present-day developmental psychology. The idea that attachment can be secure or otherwise was suggested by Bowlby’s colleague Mary Salter Ainsworth, who in her turn had derived it from the security-focused work of her dissertation adviser. Bowlby associated attachment with the social aspects of caregiving, rather than with feeding and physical care--   and in this he disagreed with Freud’s earlier “cupboard love” theory of attachment as resulting from feeding experiences. However, except in very unusual cases, social aspects of caregiving are combined with physical aspects, and the person who feeds, cleans, and comforts a baby is usually also the one who smiles, tickles, plays peek-a-boo, and so on, so it’s difficult to separate these two factors and see how each influences attachment.

It looks as if proponents of the “attachment cycle” also picked up some ideas from Erik Erikson, a student of Freud, and tutor at one time to Jung’s children. In Erikson’s book Childhood and society he offered a re-framing of Freud’s psychosexual stages of development as  psychosocial stages aligned with the demands maturation and society make on an individual at different ages. In Childhood and society, and later in Identity, youth, and crisis, Erikson offered the idea of a life cycle (not an “attachment cycle”) in which life presents repeated crises (points at which old ways of doing things no longer work) to the developing person, forcing changes in personality and functioning. As discussed in Identity, youth, and crisis, these crises separate stages of personality development that are characterized by specific concerns such as the development of a sense of trust. Earlier stages foreshadow later ones, as Erikson described in a famous table in Identity, youth, and crisis which indicates relationships between infant and adolescent issues as well as the foreshadowing of concerns of later life by adolescent development.

Erikson’s view of basic trust identified trust as a foundation for a healthy personality able to deal with both gratifying and distressing aspects of the world. However, he did not equate basic trust with attachment. On the contrary, he noted the need for an appropriate balance of basic trust and basic mistrust in the world. In addition, he stated the following about adults who show basic mistrust: “a radical impairment of basic trust is expressed in a particular form of severe estrangement which characterizes individuals who withdraw into themselves when at odds with themselves and with others. Such withdrawal is most strikingly displayed by individuals who regress into psychotic states in which they sometimes close up, refusing food and comfort and becoming oblivious to companionship. What is most radically missing from them can be seen from the fact that as we attempt to assist them with psychotherapy, we must try to ‘reach’ them with the specific intent of convincing them that they can trust us to trust them and that they can trust themselves” (Identity…, p. 97). Although Erikson identifies “total rage” as an infant response to frustration and an aspect of mistrust, he does not include rage, interpersonal aggression, or violence as part of adult mistrust--  unlike authors who cite the “attachment cycle” and attribute adult criminality to attachment problems.

What about that “second-year attachment cycle”? Authors who use this concept have claimed that secure attachment is not simply a matter of early experience with sensitive, socially- responsive care, but that secure attachment can result only from setting of limits and the clear identification of caregivers as powerful and authoritative figures on whom the child must depend entirely (and whom, by extension, he had better not offend).  If secure attachment is present and measurable at age 12 months, as Ainsworth and others have reported, it is difficult to see how events in the second year come into the picture. It may be that authors referring to the “second-year attachment cycle” found themselves searching for a rationale for their claim that child obedience was indicative of secure attachment, when in fact the emphasis on obedience emerged from other values (for example, those of American fundamentalist Protestantism, with their sources in early Calvinism).

How does Erikson’s work jibe with the “second-year attachment cycle”? Erikson was of course aware that the toddler period is one in which parents all over the world seek to curb young children’s impulsiveness, keep them and others safe, and begin the task of socializing them into acceptable members of family and society. These parental efforts can and do trigger the resistance so characteristic of this age group. However, Erikson’s concerns were not about periods of resistance, but instead about the potential outcome of toddler experiences, which he saw as a “choice” (to over-simplify) between a sense of autonomy and a sense of shame and doubt about the self.  Erikson, whose personal and political experiences led him to favor individualism, saw a confident autonomy as advantageous to the individual, and a sense of a self threatened by shame and disapproval as disadvantageous to mature personality development. Although both autonomy and shame would be played out in a social context, especially within the family, Erikson did not focus on a need to emphasize parental power or authority during the toddler period, except in the sense that consistency and sensitivity to the child’s needs were critical. (Bowlby, similarly, considered this period as one of negotiation between parent and child rather than of parental power assertion.)

Basic trust, although an important part of Erikson’s theory and a good answer to a lot of exam questions, is by no means the same thing as attachment. Autonomy is by no means equivalent to any posited “second-year attachment cycle”. If you see these assumptions made in any material about attachment, adoption, or child psychotherapy, you may have wandered into an alternative psychology universe. Be sure to read and make choices with care.