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Concerned About Unconventional Mental Health Interventions?

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

Sunday, July 28, 2013

Naming the Sources: Where People Get Their Ideas About Attachment and Mental Health

Recently, I published in the Brown University Child and Adolescent Behavior Letter (a monthly publication) a piece entitled “Giving parents information about Reactive Attachment Disorder: Some problems” (CABL, 2013, Vol. 29, August; p. 1, 6-7). I was responding to a parent-education handout on the subject of  RAD that CABL had provided a few months previously. The handout briefly referred to the existence of misunderstandings about RAD, but did not examine what these beliefs might consist of or the ways parents might acquire them. I was concerned that parents who were already committed to mistaken beliefs might not pay attention to an accurate handout, or, worse, might decide that a practitioner who used such a handout was ignorant of the facts and would make their child’s condition worse. In my CABL piece, I pointed out sources of misunderstandings on the Internet and in print media, where journalists all too often repeat incorrect statements about children and attribute harmful behavior to RAD.

Shortly after this article came out, someone called to my attention the following: In this description of a difficult--  and badly mishandled—adoption, a psychiatrist is quoted as attributing the child’s difficult behavior to Reactive Attachment Disorder, which is said to be “common among children who were abused as infants before bonding with their parents”. A most curious statement, it seems to me--  is there a different problem that occurs if they are abused as infants after bonding to their parents? And what exactly does either the psychiatrist or the journalist mean by “bonding”, which, as I pointed out a few days ago, is a term generally applied to the feelings of parents for their infants, not the reverse?

But, be all that as it may, the article goes on to attribute to Reactive Attachment Disorder this child’s behaviors of urinating and defecating around the house, sleeping problems, eating problems, manipulative behavior, and cruelty to animals. Yes, these are challenging behaviors with respect to which the adoptive mother needed much guidance and support; no, these are not symptoms of RAD as described by anything but one of the non-evidence-based checklists promulgated by various “attachment therapists”. Yet, here they are, large as life and twice as natural, displayed in a newspaper for all to see and learn from, without the slightest indication that they should be questioned with respect to their cause.

The Portland article then proceeds to throw in yet another unsubstantiated belief: that children diagnosed with RAD are bright but don’t seem to learn, and don’t learn from discipline (undefined, but presumably equated with punishment). This idea would appear to be derived from the position of “attachment therapists” that obedience is the result of attachment, and that noncompliance is a symptom of an attachment disorder. Once again, the journalist has repeated a belief about attachment and mental health problems that is likely to be accepted by the average reader, and once learned, to interfere with well-supported material describing children’s attachment-related behavior.

So, do people actually absorb various misunderstandings about attachment, mental health, and challenging behavior by children? An article by Sara McLean, an Australian social worker, and her colleagues, suggests that they do (“Challenging behavior in out-of-home care: Use of attachment ideas in practice.” Child and Family Social Work, 2013, 18, 243-252). McLean and her group interviewed foster parents about children’s behavior and the effect of attachment. They found four beliefs that influenced the way foster parents responded to challenging behavior.

First, children showing difficult behaviours were thought of as either unable to form attachments or as wanting not to form attachments. These children were thought to have been permanently damaged and made unlike other children by their early experiences. Aloof or self-reliant children were thought to be better placed in a residential group situation than with individual foster parents with whom they would “fail to attach” and be rejected. McLean pointed out the dangers of assuming that a child’s observable behavior accurately reflects the inner state, an assumption that can lead to giving up on a child.

Second, McLean and her group found through their interviews that foster parents believed that children have a limited potential for attachment, and that unless an adult was to function as a ”primary” attachment figure, a child’s attachment to that person should not be encouraged. People with whom the child had developed relationships felt that they should “get out of the way” if the child had the opportunity to form a relationship with someone who could be a permanent primary figure. McLean pointed out that part of the problem here is a confusion of attachment with dependency on another person. (This confusion is evident among “attachment therapists” who require children to ask adults for everything they need in the way of food, drink, or toilet use, and punish them if they attempt to help themselves in age-appropriate ways.)

McLean and her group also found that many of the foster parents thought of attachment, as a close, trusting relationship with behaviors expressing intimacy. Children who behaved in difficult ways were seen as lacking in trust and therefore unable to give up their need for challenging behaviors. The foster parents expected children to improve their behavior only if they entered into an intimate and affectionate relationship with the adult. Changes in parenting techniques were seen as less important as ways to improve child behavior (and, although McLean did not mention this, the belief stated earlier, that children with attachment disorders cannot learn or respond to discipline, might also be relevant).

Finally, McLean and her colleagues mentioned the belief that attachment is “transferable”, that if a child has developed an attachment to one adult, he or she has essentially learned a skill and can do the same thing readily with the next caregiver. This belief may serve as justification for disrupting placements or for limiting contacts with people who have become important to a given child.

McLean’s article did not attempt to identify the sources of these misunderstandings about attachment. However, looking attentively at the Internet and the media helps to identify at least some of the origins of the mistaken beliefs. How do we go about correcting the situation? That’s a difficult question, and apparently an international one, as we see problems of misunderstanding in the U.S., Canada, the U.K., Australia--  and of course all the places in which holding therapy is presently fashionable.



  1. Are you saying that a child cannot bond with new caregivers?

    1. No, of course not. But I am saying that when new attachment occurs it does not follow the pattern proposed by McLean.

      I don't use "bond" to refer to children's emotions at all,and neither should you.