Attachment Therapy

Attachment therapy is the most commonly used term for a controversial category of alternative child mental health interventions intended to treat attachment disorders. The term generally includes accompanying parenting techniques. Other names or particular techniques include "the Evergreen model", "holding time", "rage-reduction", "compression therapy", "rebirthing", "corrective attachment therapy" and Coercive Restraint Therapy. It is found primarily but not exclusively in the United States and much of it is centered in about a dozen clinics in Evergreen, Colorado where Foster Cline, one of the founders, established his clinic in the 1970s. This article describes this particular set of interventions although in clinical literature the term "attachment therapy" is sometimes used loosely to mean any intervention based, or claiming to be based, on attachment theory, particularly outside the USA. Attachment therapy as described in this article should not be confused with other schools of therapy which are more empirically-based and which aim to address problems stemming from disrupted attachment to caregivers.

Attachment therapy is a treatment used primarily with fostered or adopted children who have behavioral difficulties, sometimes severe, but including disobedience and perceived lack of gratitude or affection for their caregivers. The children's problems are ascribed to an inability to attach to their new parents, because of suppressed rage due to past maltreatment and abandonment. The common form of attachment therapy is holding therapy, in which a child is firmly held (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 attachment 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 attached child should comply with parental demands "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 scientifically unvalidated and is not considered to be part of mainstream psychology or, despite its name, to be based on attachment theory, with which it is considered incompatible. It is primarily based on Robert Zaslow's rage-reduction therapy from the 1960s and '70s and on psychoanalytic theories about suppressed rage, catharsis, regression, breaking down of resistance and defence mechanisms. Zaslow, Tinbergen, Martha Welch and other early proponents 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.

It has been described as a potentially abusive and pseudoscientific intervention that has resulted in tragic 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 "attachment 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 (APSAC) which was largely critical of attachment therapy. In April 2007, ATTACh, an organization originally set up by attachment 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. Some leading attachement therapists have also specifically moved away from coercive practices.

This form of treatment differs significantly from evidence-based attachment-based therapies, talking psychotherapies such as attachment-based psychotherapy and relational psychoanalysis or the form of attachment parenting advocated by the pediatrician William Sears. Further, the form of rebirthing sometimes used within attachment therapy differs from Rebirthing-Breathwork.