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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

Tuesday, December 7, 2021

Alternative Psychotherapies Include Some Parental Alienation Interventions


Since the 1990s, the movement toward evidence-based medicine has been associated with a term for medical practices that are not evidence-based. These are often referred to as complementary and alternative (CAM) methods. Complementary methods are those that are used together with conventional evidence-based treatments; readers can no doubt figure out that alternative medical practices are used on their own. CAM approaches are without clear evidence of safety or effectiveness—if that evidence were present, they would just be medicine, not CAM.

Similar terminology for psychological treatments has lagged. People do not usually speak of complementary and alternative psychotherapies (“CAPs”). One real reason for this is that unconventional psychological treatments are rarely used in a complementary fashion together with conventional treatments. Unconventional treatments are generally put forward as alternatives to conventional therapies. As a result of this situation, I suggested in a book published some years ago (“Alternative Psychotherapies”, Rowman & Littlefield, 2014) that we simply use the term alternative psychotherapies (or therapies, or treatments, or interventions) to describe unconventional treatments that lack clear evidence of safety or effectiveness. Alternative psychotherapies are of particular interest because they can do both direct and indirect harm to clients. We see, for example, that “conversion therapies” intended to change sexual orientation can do direct harm by increasing depression and suicidality, and indirect harm by using up family resources that could be used better in other ways.

Having spent years looking at alternative psychotherapies for children like Attachment Therapy (AKA Holding Therapy), I am interested in what all of these treatments have in common. I notice, certainly, that proprietary treatments for parental alienation (a child’s rejection of one divorced parent in circumstances thought to indicate persuasion by the preferred parent) meet requirements to be called alternative psychotherapies. Interventions like Family Bridges or Turning Points for Families have never presented adequate evidence of effectiveness and have shown little or no concern about safety issues. But Family Bridges and Holding Therapy are vastly different in most ways. Are there points they share as alternative psychotherapies?


I am going to describe some characteristics that I think are shared by various alternative psychotherapies, including those directed at parental alienation. Please note, though, that I am taking the opportunity to use this blog as a way to speculate on points that are not yet clear to me. Some of what I mention here does not come from the published work of parental alienation proponents (for example), but from organizations that serve to popularize certain viewpoints. For Attachment Therapy, an example would be For parental alienation therapies, the organization Family Access—Fighting for Children’s Rights has become very active in the last year or so and is moving from webinars into a subscription television service.

I.                   Proponents of alternative psychotherapies state that conventional treatments exacerbate children’s problems. Such exacerbation may be attributed to the vulnerability of conventional therapists, who believe lying children or allow themselves to be manipulated by children or parents.

II.                Proponents of some alternative psychotherapies have argued that children’s experiences of distress during treatment were minimal when compared to the predicted negative outcomes of remaining untreated or treated only by conventional methods.

III.             Proponents of some alternative psychotherapies warn against attention to children’s statements or wishes, on the grounds that mental health problems will be worsened if children are allowed to exercise autonomy; children are also characterized as liars who must be called to account.

IV.             Proponents of alternative psychotherapies predict serious long-term consequences for children who do not receive their recommended treatments. Proponents of Attachment Therapy have long claimed that untreated children will be violent in childhood and will grow up to be serial killers (Ted Bundy has often been cited as an example). In a recent email, Family Access claimed that children who did not receive parental alienation interventions as recommended would be sociopaths in adulthood.

V.                Proponents of alternative psychotherapies may create alternative diagnostic categories and announce them as “not yet” in DSM-5 or ICD-11, implying that these diagnostic manuals will eventually accept the categories.

VI.       Proponents of alternative psychotherapies claim that only people they have trained can carry out their methods, and that extensive conventional training is not needed, or that the treatments are not actually mental health treatments so no licensure is required.

VII.             Proponents of alternative psychotherapies may claim scientific evidence for their methods when in fact there is no evidence that meets the usual standards required for support of psychological treatment.

VIII.          Proponents of alternative psychotherapies may respond to criticism by personal attacks rather than by discussion of evidence or of planned systematic outcome research.

It’s my impression that alternative psychotherapies share these as well as other characteristics. I would be interested in hearing others’ comments about additions to or deletions from this list.


NYT Lets “Relinquishment Trauma” Pass


Every adoption is simultaneously a triumph or a tragedy for most or even all of the particpnats. The New York Times op-ed by Elizabeth Spiers demonstrates this fact (“I was adopted. I know the trauma it can inflict.” E. Spiers, Dec. 6, 2021, p. A23). Whether there would have been greater tragedy without the adoption of a child is something we can only guess at, and out guesses are different for different individual cases.

Spiers tells her story and describes her own emotions about her childhood and her adult meeting with her biological mother. No one else can possibly know her experiences  and her emotional reactions, and I would not dream of arguing about what she feels. (What would be the point of doing that, anyway? I only bring it up because there will be some people out there who castigate me for what they see as denying lived experience.)

However, there is one part of Spiers’ narrative that is not a description of her experiences and feelings, but a speculation on why she feels as she does. I had hoped that this particular speculation had fallen under its own weight when deployed in the past, and I am shocked to see it printed in the New York Times.

The speculation I refer to is the idea that babies “bond” to their biological mothers during gestation, and as a result they later suffer from “relinquishment trauma” if adopted or fostered. This idea was put forward in the 1990s, not by “researchers” as Spiers suggests, but by authors like Nancy Verrier, whose book “The Primal Wound” has served to distress many adopted individuals and adoptive families. Verrier, and her colleagues at the Association for Pre- and Perinatal Psychology and Health (APPPAH) have held that separation of a child from its biological mother, even on the day of birth, causes an intense and lingering sense of loss and difficulty with social relationships.

This speculation, repeated by Spiers in  her NYT piece, contradicts much that is known about emotional development. It also fails to consider alternative explanations for cases where adopted individuals do suffer from a sense of loss, loneliness, and difficulties with relationships. These facts and the existence of alternative explanations need to be considered before anyone accepts the idea of a “relinquishment trauma” affecting adopted individuals.

Here are some specific points that contradict Spiers’ claims about “relinquishment trauma”, a factor which, if operative, would presumably affect all adopted children:

I.                    The great majority of adopted children do very well.

II.                 When there are problems that can reasonably be associated with adoption these are usually seen in late-adopted children. Much research on this point was done after the closing of the notoriously dreadful Romanian orphanages in the 1990s.

III.              Attachment behaviors, in which infants and toddlers show their preference for familiar people and seek them when distressed or frightened, are not apparent until at least six months after birth. Newborn babies have been shown to recognize the smell of their mothers’ milk, but they do not show fear and distress when cared for by other people, as they will do in later months.

IV.              Feelings of loss and distress in adopted individuals can be explained without appealing to “relinquishment trauma”. Most adopted people will learn at some time that they are adopted and will either learn or imagine the circumstances of the adoption. Those circumstances are never pleasant and may range from the deaths of one or both biological parents to extreme youth or poor health or drug involvement of the biological mother to abandonment of the mother by the father and her own parents. It is possible, though less likely, that the biological mother simply did not want any children or had reason to reject this one as a child conceived through rape or incest.

Learning (or imagining) and processing any of these possibilities can place a serious psychological burden on adopted individuals. Feelings of loss and the need for comfort are likely to follow—especially if adoptees are told that they must be affected by “primal wounds” or “traumas” that are offered as explanations for feelings that have much more evident causes. Mental health professionals who stress “relinquishment trauma” as a reason for adoptees’ psychological distress should consider iatrogenic effects they may be creating. The New York Times opinion editors might also give some thought to this problem.