Quite a while ago, on March 18, 2012 to be exact, I posted on this blog a piece called “Attachment Therapy: Where Are the Testimonials From the Children?” I was hoping to hear from people who had experienced or observed various kinds of holding therapy as children and to learn what they remembered about what happened. I have had a few responses over the years, but not long ago, and again yesterday, I heard from someone who had experienced Martha Welch’s “holding time” version of this treatment and had seen and heard her autistic brother as he was put through a brutal form of holding. This correspondent made a suggestion that I had never thought of (doh!) and led me to look at the Amazon reviews of Welch’s 1989 book “Holding Time”, which recommended daily holding of screaming, resisting children, both as a treatment for autism and just for ordinary parenting purposes. Looking over those, I came upon a reference to a book I had never heard of, which amazingly turned out to be on the shelf in my town library.
Let me hear your voice: A family’s triumph over autism was published in 1993 by Catherine Maurice (I see elsewhere that this name was a pseudonym, so I am not at all sure how to reach her for further information—like what happened to her children later). Maurice had a typically-developing son, followed by a daughter and another son, both of whom began by developing typically and then showed many signs of the regressive type of autism. Both also recovered a typical developmental trajectory, a recovery that Maurice attributed to Applied Behavior Analysis (ABA), a behavior modification program that has research support.
This beautifully-written book is a candid account of the actions and feelings of parents dealing with first one, then another autistic child while trying to keep their daily lives somewhat intact. It includes an appendix with specific information about the treatment and gradual changes in each child. As such, it offers a great deal to parents who need some hope and understanding about how a treatment may proceed.
From my point of view, however, the great value of Maurice’s book is its exposure of Martha Welch’s proposed treatment for autistic children. Welch visited Evergreen, Colorado in the heyday of the town’s existence as home of the attachment therapy cottage industry. She absorbed the idea of physical restraint and the power of parental authority to force changes in children as the parent wished them to occur. However, in creating her own method, Welch added the seductive element of “mother love” as a cure for childhood mental illness. She proposed that all holding had to be done by a child’s mother, and indicated that this was a cure for all emotional problems of concern to parents—including aloofness or ingratitude in typically-developing children. In instructional videotapes, Welch presented her son Bram as an example of what could be achieved by daily holding of a resisting child until he or she relaxed and became accepting and affectionate. For many years, the great selling point for Welch’s method was her claim that it cured autistic children, but by 2006 she had altered this to presenting the treatment, now called Prolonged Parent-Child Embrace (PPCE) as a therapy for children with Reactive Attachment Disorder and oppositional behavior; autism was no longer a focus by that time.
Maurice openly admits how she “fell for” Welch’s approach and explanation of autism. Autism, according to Welch (and her mentors Elisabeth and Niko Tinbergen, the latter a Nobel laureate), was caused when a mother and child failed to “bond”. This failure caused the child to be terrified of the world and of people, whom he or she avoided. Inside each autistic child, according to this view, is a typically-developing child who is simply too frightened to speak or look at anyone. Holding therapy forces the child and mother to bond, the child loses his fears, and voila’, the concealed development is demonstrated to be there. Welch’s charm and air of authority convinced Maurice that she must be right, and indeed anyone who watches Welch’s instructional tapes can see how this attractive, warm, caring person would appear to answer the needs of any wretched, frightened, exhausted parent who saw a child deteriorating before their eyes. Of course, from a safe, objective distance, it is much easier to discern in Welch the deep conviction and enthusiasm of what Freud called the furor sanandi – the “lust for curing”.
With respect to holding therapy, Maurice’s story concentrates on how she and her husband responded to Welch. Catherine initially saw Welch as the savior she was looking for, although from the beginning she was concerned about the idea that something had happened to prevent a bond between her daughter and her self. Welch suggested that such an event could occur when a baby of a few months overheard her mother say something negative, or even when an unborn baby was in some way exposed to its mother’s thoughts and opinions. Catherine Maurice doubted this to begin with, and over the months began to question Welch’s views more seriously (although even after she broke with Welch, she seemed to feel that holding did something positive). Her husband was not pleased with Welch from the start, wanted information about the outcomes of the treatment which he did not get, but decided to go along with his wife’s wishes.
Speaking of encountering another mother who was devoted to Welch, Maurice noted: “In this woman, as in other holding therapy disciples, I was beginning to see something I didn’t like—something I recognized in myself: blind faith, idealization of human individual, unwillingness to admit we can make mistakes about what is right for our children….Before my relationship with Dr. Welch ended, I was to understand what it might be like to be seduced and drawn into a cult. To those who are frightened enough and desperate enough, it becomes harder and harder to hold onto sense and intelligence, reason and objectivity. Cast into an unknown land, uncertain of our bearings, we parents at the Mothering Center took enormous solace from the calm assurances, the sweet promises, of our savior.” However, over time Maurice realized that although she could see the positive results of the ABA treatment her daughter was also receiving, Welch consistently told her how harmful it was. She also came to understand that she had never seen any of the “cured” children Welch claimed to have come out of holding therapy. One case, published in Life magazine rather than in a professional journal, did not seem to Maurice to have had anything like the successful outcome claimed for it.
Maurice and her daughter visited a group in which holding therapy was being done by mothers with autistic children and were terrified by the screaming and the shouts of mothers “expressing” their rage that the children were not paying attention to them. Among other things, she saw a mother restraining her severely impaired three-year-old son; when the child accidentally bumped his head, the mother asked for ice, and an aide told her, “Mary… that bump is insignificant compared to the damage you will do if you don’t get a resolution from this child” – a resolution being a change in the child’s behavior from screaming resistance to cuddling. The aide went on to say that the reason she could not “get a resolution” was that her husband was not supportive enough. All these things were concerning to Maurice, but the final straw was that when she was asked to speak about holding for a BBC production on the treatment, her attempt at a balanced presentation, speaking of the various treatments that were being used for her daughter, was edited so that only holding was recommended.
Maurice’s discussion of her attraction to Welch’s method and her gradual loss of faith is a real, though sympathetic, object lesson to parents who find themselves devoted to an “alternative psychotherapy”. The impact of the misguided treatment on her family may have been as serious as the challenges presented by autistic children. At the time this book was written, Maurice’s children were still too young for their thoughts and memories to be articulated very well, so we really do not know how they experienced Welch’s treatment or any other treatment they received. I know Maurice has continued her concerns about autism, because, still using her pseudonym, she more recently co-edited a book with two well-known professionals in the field. Could she tell us now how her grown-up children are doing? Could the children tell us what they remember or think about their experiences? I wish she, and they, would round off the understanding she supplied in her 1993 book with that additional information.
Some autists feel that ABA therapy was abusive. What do you think about that?ReplyDelete
When aversives are used in ABA, it certainly can be done abusively. In addition, Ivar Lovaas, the developer of ABA, stopped using them after a few years because he felt they were ineffective. Except for one or two holdouts, I would say that aversives are hardly ever used today except when the alternative of allowing the child to self-injure seems much worse. Even in cases of self-injury, there is much work going on to develop effective methods that do not use aversives.ReplyDelete
All that being said, it is of course possible to use any treatment technique in at least an emotionally abusive way, by shouting at the child, behaving in an intimidating way, and handling the child roughly. It's also true that even when the therapist is by no means abusive, autistic children may cry and resist in the first sessions. However, they subsequently become engaged with the treatment and seem happy to participate. How many sessions of crying should make us define this treatment as abusive? I am not at all sure. I know it's all too easy to compare uncomfortable psychological treatment to uncomfortable medical treatment, and by analogy to say that if uncomfortable chemotherapy is worthwhile when it cures cancer, uncomfortable [fill in the blank] psychological treatment is equally worthwhile. Whether that conclusion is correct or not really depends on all the details-- how uncomfortable, how long, and how effectively does it correct the original problem?
I do not know how to answer these broader questions and would like to hear other people's opinions.