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Child Psychology Blogs

Concerned About Unconventional Mental Health Interventions?

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

Monday, October 8, 2018

The Demand for Obedience: How Two Alternative Psychotherapies for Children Resemble Each Other

Discussions of non-evidence-based medical treatments often use the term CAM—complementary and alternative medicine. The idea is that such treatments can be used in two ways. They may be complementary to evidence-based medicine, as when yoga or nutritional components are added to conventional cancer treatment. Or, they may be used as alternatives and substituted for evidence-based treatments, as when substances made from apricot pits are used to treat cancer rather than radiation or chemotherapy.

Non-evidence-based treatments also exist in psychotherapy, but they are usually used as alternatives rather than as complementary additions to evidence-based treatments. Because of that, I usually call them alternative psychotherapies (APs) rather than using CAM or CAP to describe them. APs are not just treatments that lack a good evidentiary foundation; there are psychotherapies that are still in the process of data collection that are not APs in spite of their relatively small evidentiary support. APs are different in that they are not plausible, because they employ faulty logic or because they are not congruent with things we know about human beings. APs for children and adolescents are noticeably out of step with established information about child development, for instance. APs also have potentials for causing harm to clients, sometimes serious harm, sometimes harm in the form of opportunity costs as families expend resources on ineffective treatments.

APs for children and adolescents may resemble each other even though the theories behind them and the practices they employ are quite different. This is especially the case when the focus of the treatment is on compliance and obedience to adults. 

My original interest in APs involved Attachment Therapy, a treatment for children that stresses obedience and considers compliance to be the indicator that children have formed emotional attachments to adults. This is implausible for many reasons, but especially because it assumes a single factor at work to determine complex behaviors that are based on both maturation and experience. Advocates of Attachment Therapy have published descriptions of their practices and discussions of their rationales for limiting children’s diets, requiring tedious and difficult manual labor, and threatening children that they will never go home if they do not cooperate. Members of groups like the Facebook closed group Attachment Therapy Is Wrong have disclosed their experiences in this form of AP.

More recently, I have identified some treatments for “parental alienation” as APs. These treatments purport to correct children of divorced parents who strongly prefer one parent and resist visiting the non-preferred parent. The children are thus disobedient to the non-preferred parent, and if they have been ordered by a court to visit they may also be failing in compliance to the court and its officers. Parental alienation treatments have been described by their advocates as involving multiday workshops in which children may not contact the preferred parent, must spend time with the non-preferred parent, and must watch educational videos and engage in “fun” activities followed by a required vacation with the non-preferred parent. Some of the programs maintain separation from the preferred parent for 90 days or more and make communication with that parent contingent on complying with rules for desired behavior toward the non-preferred parent. The children have no money or phone allowed to them and are often a great distance from home.

 Although as far as I know there is no social media site where adolescents or young adults have described their past experiences with parental alienation treatments, over the last year I have seen a number of accounts of the proceedings as experienced and recalled by those who have been through them. These accounts have some details in common. One is that the children (I am going to include adolescents in this category) were taken from school or home to the place of treatment by youth transport services workers. The transporters in some cases applied handcuffs to the children before transporting them by car or plane. Money and phones were taken away, so although some children were told that they could leave the treatment rooms if they liked, and that they were not being forced to do anything, in reality they had little choice except to find themselves alone on the streets of a strange city. Cooperation was also obtained  by means of threats—for example, if a child would not eat when given food, he or she might be told that this was very unhealthy and it would be necessary to place the child in residential treatment for his or her own good. Wilderness therapy programs were often mentioned, with emphasis on the impossibility of escaping or communicating with anyone on the outside. Other threats involved manipulation of concerns about the preferred parent, for example that he or she would go to jail or be fined a large amount if the child did not cooperate, watch the videos, play the games, and talk to and make eye contact with the non-preferred parent.

The common themes of Attachment Therapy practices and those of parental alienation interventions are evident. The children are essentially held captive by practitioners. They have in many cases experienced physical restraint—handcuffs for the parental alienation cases, “take-downs” for the Attachment Therapy situations. Although in theory they may be able to leave the premises, in practice this would mean going into a frightening milieu that they are not prepared to handle. In both cases, descriptions by victims include constant intrusive supervision and demands for compliance with unnecessary assignments, whether cutting the grass with nail scissors in one case or watching videos and discussing them in the other. Victims of both methods have reported practitioners’ laughter at the children’s discomfiture. Threats of abandonment or of more intense seclusion and isolation are in both case used to manipulate children’s behavior. In both therapies, children learn to comply to whatever extent they are able  in order to escape from the pressure and constant demands they experience. Only children who for physical or mental reasons cannot comply will not show the temporary behavior changes required of them, and as a result advocates of both methods claim that their treatments are effective.

I don’t discount the importance of some degree of obedience and compliance in children and adolescents. Their own safety may well depend on established habits of attending to adult advice. However, when a psychotherapy focuses entirely on compliance as an indication of mental health, and especially on compliance to an adult’s demands for affection and gratitude, a mistake is being made. This is particularly true when an intrusive treatment is directed toward older school-age children and young adolescents, whose normal developmental trajectory is moving them away from their relationships with parents and toward relationships with peers, romantic connections for the future, and cooperation with friends, teachers, and employers.

Finally, I want to point out that treatments involving parent-child relationships need to involve changes in both child and adult, without which the relationship itself cannot really change. In infant mental health circles, one important principle is that treatment must be treatment of the dyad, and this is true in a more complicated way of relationships between parents and older children too. Yet the APs discussed in this post focus on making the child change. Why? Presumably this is because a) the child can’t get away, and b) the adult is paying the bill. It’s certainly not because there is evidence that this approach is effective, or even that it is consistent with the ideas of family systems that are so often and so nonchalantly invoked.

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