A kind invitation from APLA, the Czech organization
for parents and professionals working with autistic children, gave me a chance
to travel to Prague this month, to see the city’s beautiful buildings and meet fine
people, and to take part in extensive discussions of alternative
psychotherapies for autism. Partly for fun and partly to ward off jet lag
before lecturing in Prague, I first spent some days in England, where as luck would
have it I had two hours of discussion of Holding Therapy with a British
psychologist and a Member of Parliament who is concerned about the practice.
(Not knowing the politics of this situation, I think I will not name either of
them here—but I do want to thank the MP for his time and attention and for a
tour of the House of Commons.)
Both the Czechs and the British are concerned about
the use of Holding Therapy, but the types of HT in use in the two countries are
not identical. In the UK, HT methods resemble the American “rage-reduction”
version, with the child restrained while held in the therapist’s lap and
provoked to angry resistance. In the Czech Republic, the method is that
proposed by the U.S. child psychiatrist Martha Welch (who now uses the term
Prolonged Parent-Child Embrace or PPCE) and the Czech psychologist Jirina
Prekopova (whose method is abbreviated in Czech as TPO, or “hard hug therapy”).
The Welch-Prekopova method has small children sit on the mother’s lap, facing
her and restrained by her arms, and has older children lie supine with the
mother prone on top of them, while both are coached by the therapist to“express
feeling” until exhausted. In both cases, the child’s resistance or distress is
interpreted as showing the need for further treatment of the same kind.
Although most people in Britain assumed that HT use
had stopped long ago, it turns out that it has not, and according to the MP
there are at least three children still being given this treatment, although
the plan is to stop soon. Revelations about ongoing use of HT have followed the
coming forward of two young men who were given the treatment by a well-known
child welfare organization in the 1990s. It is impossible to tell how many more
young adults were subjected to HT as children, and if the British experience is
like the American, most of them will be unwilling to make public statements. The
National Health Service, and through it the Child and Adolescent Mental Health
Service, have initiated a movement toward the use of evidence-based treatments,
and therefore should be inclined to refuse payment for non-evidence-based HT,
no matter what reports from former patients are made public. However, a
legislative ban would be necessary to prevent HT from being done and paid for privately,
and such a ban would be difficult to enforce.
Children in the UK who have been subjected to “rage-reduction”
style HT have generally been adopted or fostered and stated to suffer from “attachment
disorders”. However, I recently had a contact from another British man who
reported a history of HT done in the manner of Welch and Prekopova. (He wrote a
description of his experiences which I will be posting on this blog in the near
future.) In his case, although he was adopted, the treatment focus seems to
have been on symptoms related to autism or to sensory problems, which he has
been diagnosed with as an adult; these included an aversion to touch that made
the holding treatment agonizing for him. The HT therapist mistakenly considered
these symptoms to indicate a lack of love between the child and his adoptive
parents. It is well-known that Martha Welch traveled through England on a book
tour for her 1989 publication Holding
time, and that she supervised groups of mothers restraining autistic
toddlers at that time. It would be surprising if there are no other people who
had these experiences, but most of them will probably not want to come forward.
The man who contacted me does not want to be identified, although I hope he may
change his mind about that.
The situation in the Czech Republic is a different
one and is in some ways in flux. The primary Czech practitioner of HT, Jirina
Prekopova, began in the 1970s to regard autism as a problem of lack of
attachment which she believed could be repaired by intensive re-enactments of
some experiences that might naturally occur between mothers and infants. (In
taking this viewpoint, she followed an earlier perspective on autism which is
contradicted by the present understanding that 90% or more of the cause of
autism emerges from genetic problems.) Working in Germany, Prekopova stressed
the existence of a scientific basis for her methods and published several weak
studies claimed to support HT. Criticism of her methods developed, and there
was an attempt to prosecute her in Stuttgart in 1996, but this could not be
accomplished without charges being made by families (https://vikas.de/DOKUMENTE/Goldner%20-%20Festhaltetherapie.html).
She returned to the Czech Republic not long after this and dropped the
scientific claims she had once made, instead taking a spiritual/religious view
based on the system of the spiritualist family therapist Bert Hellinger.
Prekopova has continued to present HT as a treatment for autism (hence the
concern of APLA) but has added oppositional behavior as a reason for HT.
Possibly because of concerns expressed about HT,
Prekopova has stopped referring to her method as a psychotherapy and presents
it as a “lifestyle” that fosters family love and that counters factors in
modern life like screen use, factors which she believes cause autism and other
mental disorders. In spite of this claim, Prekopova seems to have started “clinics”
in a number of other countries. It would appear that she now recommends the use
of HT in schools and institutions; this recommendation may put HT in the reach
of legal attacks that are impossible when the practice is confined to private
family situations.
Banning HT in the U.S. has proved difficult because
of the reluctance of professional groups to be involved, the differences in
powers of federal and state governments, and the large number of states that
need to be dealt with individually. But after my European trip I am feeling
cautiously optimistic that some countries will take the lead in this matter and
the U.S. may even follow.
P.S. My best thanks to APLA and its members,
especially Alena Bilkova, Andrea Kralova, Katerina Slaba, and Katerina Thorova
for their kind invitation and the good care they took of me in Prague and
Samechov!
