Attachment therapy
Attachment therapy is a pseudoscientific mental health intervention intended to treat attachment disorders in children. During the height of its popularity, the practice was found primarily in the United States; much of it was centered in about a dozen locations in Evergreen, Colorado, where Foster Cline, one of its founders, established a clinic in the 1970s.
The practice has resulted in adverse outcomes for children, including at least six documented child fatalities. Since the 1990s, there have been a number of prosecutions for deaths or serious maltreatment of children at the hands of "holding therapists" or parents following their instructions. Two of the most well-known cases are those of Candace Newmaker in 2000 and the Gravelles in 2003. Following the associated publicity, some advocates of attachment therapy began to alter views and practices to be less potentially dangerous to children. This change may have been hastened by the publication of a task force report on the subject in January 2006, commissioned by the American Professional Society on the Abuse of Children, which was largely critical of attachment therapy. In April 2007, ATTACH, an organization originally set up by attachment-based therapists, formally adopted a white paper stating its unequivocal opposition to the use of coercive practices in therapy and parenting, promoting instead newer techniques of attunement, sensitivity and regulation.
Attachment therapy is primarily based on Robert Zaslow's rage-reduction therapy from the 1960s-1970s and on psychoanalytic theories about suppressed rage, catharsis, regression, breaking down of resistance and defence mechanisms. Zaslow and other early proponents such as Nikolas Tinbergen and Martha Welch used it as a treatment for autism, based on the now discredited belief that autism was the result of failures in the attachment relationship with the mother.
This form of treatment differs significantly from attachment-based therapies, as well as talking psychotherapies such as attachment-based psychotherapy and relational psychoanalysis.
Theory
Attachment therapy is a treatment used primarily with fostered or adopted children who have behavioral difficulties, including disobedience and perceived lack of gratitude or affection for their caregivers. The children's problems are ascribed to an inability to bond to their new parents, because of suppressed rage due to past maltreatment and abandonment. Attachment therapy involves a child being firmly held and/or lain upon by therapists or parents. Through this process of restraint and confrontation, therapists seek to produce in the child a range of responses such as rage and despair with the goal of achieving catharsis. In theory, when the child's resistance is overcome and the rage is released, the child is reduced to an infantile state in which he or she can be "re-parented" by methods such as cradling, rocking, bottle feeding and enforced eye contact. The aim is to promote bonding with the new caregivers. Control over the children is usually considered essential, and the therapy is often accompanied by parenting techniques which emphasize obedience. These accompanying parenting techniques are based on the belief that a properly bonded child should comply with parental demands in a manner "fast, snappy and right the first time" and should be "fun to be around". These techniques have been implicated in several child deaths and other harmful effects.This form of therapy, including diagnosis and accompanying parenting techniques, is not scientifically validated, nor is it considered to be part of mainstream psychology. The form described as "attachment therapy", despite its name, has theoretical foundations inconsistent with those of attachment theory and its guidance is incompatible with the norms of attachment-based therapy.
Treatment characteristics
The controversy, as outlined in the 2006 American Professional Society on the Abuse of Children Task Force Report, has broadly centered around "holding therapy" and coercive, restraining, or aversive procedures. These include deep tissue massage, aversive tickling, punishments related to food and water intake, enforced eye contact, requiring children to submit totally to adult control over all their needs, barring normal social relationships outside the primary caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge. Variants of these treatments have carried various labels that change frequently. They may be known as "rebirthing therapy", "compression therapy", "corrective attachment therapy", "the Evergreen model", "holding time", "rage-reduction therapy", or "prolonged parent-child embrace therapy". Some authors critical of this therapeutic approach have used the term Coercive Restraint Therapy. It is this form of treatment for attachment difficulties or disorders which is popularly known as "attachment therapy". Advocates for Children in Therapy, a group that campaigns against attachment therapy, give a list of therapies they state are attachment therapy by another name. They also provide a list of additional therapies used by attachment therapists which they consider to be unvalidated.Matthew Speltz of the University of Washington School of Medicine describes a typical treatment taken from The Center's material as follows:
According to the APSAC Task Force,
The APSAC Task Force describes how the conceptual focus of these treatments is the child's individual internal pathology and past caregivers rather than current parent-child relationships or current environment. If the child is well-behaved outside the home, the child's doing so is seen as successful manipulation of outsiders rather than as evidence of a problem in the current home or current parent-child relationship. The APSAC Task Force noted that this perspective has its attractions because it relieves the caregivers of responsibility to change aspects of their own behavior and aspirations. Proponents believe that traditional therapies fail to help children with bonding problems because it is impossible to establish a trusting relationship with them. They believe this is because children with bonding problems actively avoid forming genuine relationships. Proponents emphasize the child's resistance to bonding and the need to break it down. In rebirthing and similar approaches, protests of distress from the child are considered to be resistance that must be overcome by more coercion.
Coercive techniques, such as scheduled or enforced holding, may also serve the intended purpose of demonstrating dominance over the child. Establishing total adult control, demonstrating to the child that they have no control, and demonstrating that all of the child's needs are met through the adult, is a central tenet of many controversial attachment therapies. Similarly, many controversial treatments hold that children described as attachment–disordered must be pushed to revisit and relive early trauma. Children may be encouraged to regress to an earlier age where trauma was experienced or be reparented through holding sessions. Other features of holding therapy are the "two-week intensive" course of therapy, and the use of "therapeutic foster parents" with whom the child stays whilst undergoing therapy. According to O'Connor and Zeanah, the "holding" approach would be viewed as intrusive and therefore non-sensitive and counter-therapeutic, in contrast with accepted theories of attachment.
According to Advocates for Children in Therapy,
Psychiatrist Bruce Perry cites the use of holding therapy techniques by caseworkers and foster parents investigating a Satanic Ritual Abuse case in the late 1980s, early 1990s, as instrumental in obtaining lengthy and detailed alleged "disclosures" from children. In his opinion, using force or coercion on traumatized children simply re-traumatizes them and far from producing love and affection, produces obedience based on fear, as in the trauma bond known as Stockholm syndrome.
Parenting techniques
Therapists often instruct parents to follow programs of treatment at home, for example obedience-training techniques such as "strong sitting" and withholding or limiting food. Earlier authors sometimes referred to this as "German Shepherd training". In some programs children undergoing the two-week intensive stay with "therapeutic foster parents" for the duration or beyond and the adoptive parents are trained in their techniques.According to the APSAC Task Force, because it is believed children with bonding problems resist bonding, fight against it and seek to control others to avoid bonding, the child's character flaws must be broken before bonding can occur. According to proponents, their idea of attachment parenting may include keeping the child at home with no social contacts, home schooling, hard labor or meaningless repetitive chores throughout the day, motionless sitting for prolonged periods of time, and control of all food and water intake and bathroom needs. Children described as attachment-disordered are expected by attachment therapists to comply with parental commands "fast and snappy and right the first time", and to always be "fun to be around" for their parents. Deviation from this standard, such as not finishing chores or arguing, is interpreted as a sign of attachment disorder that must be forcibly eradicated. From this perspective, parenting a child with an attachment disorder is a battle, and winning the battle by defeating the child is paramount.
Proper appreciation of total adult control is also considered vital, and information, such as how long a child will be with therapeutic foster parents or what will happen to him or her next, is deliberately withheld. Attachment parenting expert Nancy Thomas states that attachment-disordered children act worse when given information about what is going to occur because they will use the information to manipulate their environment and everyone in it.
In addition to restrictive behavior, parents are advised to provide daily sessions in which older children are treated as if they were babies to create attachment. The child is held in the caregiver's lap, rocked, hugged and kissed, and fed with a bottle and given sweets. These sessions are carried out at the caregiver's wish and not upon the child's request.
Attachment-based parenting is the widely acknowledged to be the opposite of what holding therapy proponents describe. Attachment is an affectionate, mutually satisfying relationship between a child and a caregiver that serves the purpose of making the child feel safe, secure, protected from danger, and comforted especially after exposure to danger. In addition, bonding and attachment involve overlapping concepts but describe different phenomenon.