Once again I must thank Yulia Massino for pointing
out a claim that needs refutation. In a tweet, Dawn Teo says “Traumatized kids don’t
respond to traditional treatment. They need assistance from specialized
clinicians.” This claim has been put forward by attachment therapists since the
‘90s, although initially they said not only that the children did not respond—they
added that conventional treatment actually made the children’s conditions
worse.
It’s hard to know where to begin to parse these
statements. They provide not only an embarrassment of riches, but a good deal of
embarrassment that people claiming to be mental health professionals would say
such things. But we can begin with the simple fact that although attachment
therapists have made these claims repeatedly, and have even provided lengthy
rationales for why the claimed event might occur, they have never provided the
slightest empirical evidence to support their statements. They have stated a
hypothesis that is quite testable through systematic outcome research: that is,
that when children with similar problems are assigned randomly to conventional
treatment or to “specialized” attachment treatment, the latter group will have
significantly better outcomes. They have not tested this hypothesis, but have
simply asserted that the results of such a test are already known. This form of
argument is common among alternative practitioners, who “already know” that
their methods are effective and don’t feel the need to examine or allow for
their own biases. For the rest of us, however, that approach is not adequate.
The burden of proof for the statement is on the attachment therapists. (I would
point out, by the way, that when parents pull their children out of
conventional treatments because the therapist asks them to consider how they
are contributing to a problem, this is not the same thing as the treatment “not
working".)
What is “traditional treatment”, anyway? Does this
mean a Freudian psychoanalytic approach, or Reichian character analysis? If so,
no doubt it is true that these will not be very helpful for children (not that
this means that attachment therapy is effective, of course). There are excellent evidence-based treatments
for children who are struggling with trauma, however. One of these, Child-Parent
Psychotherapy, focuses on the needs and problems of preschool children who have
endured traumatic experiences like seeing violent attacks on their mothers. Perhaps
Dawn Teo and her colleagues do not regard evidence-based treatments as “traditional”?
There would be a good deal of truth to that, historically speaking, of course,
but her statement seems a bit different when we make it “traumatized kids don’t
respond to evidence-based treatment”, so my guess is that this isn’t what she
meant—but what she did mean, I am not sure.
Now, how about “traumatized kids”? There is a lot
being said about trauma these days; in fact, trauma is the new fad word taking
the place of attachment. This is not to deny the real importance of a
trauma-informed view for those working with children’s disturbed moods and
behaviors. But not everything is about trauma, any more than everything was
ever about attachment. When children have actually experienced traumatic
events, they need trauma-informed care—but undesirable behavior or moods do not
necessarily show in and of themselves that they are caused by trauma. There are
plenty of other factors that are possible causes of childhood disturbances,
including genetic and prenatal problems, poor nutrition or exposure to toxic
substances, delayed cognitive and language development, visual or hearing
impairments, and physical illness. “Traumatized” is not a word to be used as
shorthand for “adopted” or “Reactive Attachment Disorder” or “not behaving to
parents’ standards”, nor does it mean the same thing as conduct disorder. If
Dawn Teo was using the term in this shorthand fashion, her statement is not
meaningful; if she really meant that there are no evidence-based treatments for
traumatized children, she is simply wrong.
What about the “specialized clinicians” Teo
references? Since she also alludes to an article from Forrest Lien’s Institute
for Attachment and Child Development website, I can only assume that she means
people like Lien and his staff, who were for many years involved with the
alternative psychotherapy called attachment therapy by its practitioners (not
the same thing as attachment-based therapies, by the way). They have been committed for a long time to
non-evidence-based treatments and have never published any reports on the
outcome of their methods—in addition, as Rachel Stryker pointed out in her book
The road to Evergreen, this group has
defined long-term residential care as being a successful way for a family to “love
at a distance”, so outcome measurements might have some unusual definitions.
Lien and similar practitioners have made much of
their “specialization”, and this goes over well with the public. After all, if
you have a Sears refrigerator, you call a Sears repairman; if you have gum
disease, you go to a periodontist, so wouldn’t you seek a specialist for your
child’s problems? The big difference is that although you can tell if your refrigerator
isn’t working, and your regular dentist can tell you if your gums are in
trouble, you, as the parent, are not likely to know which among many possible
factors (some including your own behavior) are causing your child to be in
difficulty. Indeed, you may not be able to ascertain on your own whether there
actually is a problem or whether you are defining a normal child behavior as
pathological simply because it is a nuisance. All this means that if you seek a
“specialist”, you may be doing so on the basis of a misunderstanding of the
child or family issues, and that “specialist” may define all problems as resulting
from and treatable by aspects of his or her own “specialty”, like the little
boy with the new hammer. In fact, contrary to Teo’s advice, parents who are
concerned about child mental health need a person with broad general training
in child development and clinical work with children, who will explore and
consider all of the child and family factors that may contribute to a problem.
That person may have been trained in an evidence-based treatment method, but he or
she will never say that ALL other methods are ineffective, because there can be more than one effective method for a problem. (The person may, of course say that SOME methods are ineffective or even potentially harmful.)
What does this all add up to? Dawn Teo’s statement
and those of all the others who have said the same thing over the years, are
false.
Up next: a look at the IACD claims mentioned by Teo.
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