Attachment Therapy - Claims

Claims

According to the APSAC Task Force, proponents of attachment therapy commonly assert that their therapies alone are effective for attachment-disordered children and that traditional treatments are ineffective or harmful. The APSAC Task Force expressed concern over claims by therapies to be "evidence-based", or the only evidence-based therapy, when the Task Force found no credible evidence base for any such therapy so advertised. Nor did it accept more recent claims to evidence base in its November 2006 Reply.

Two approaches on which published studies have been undertaken are holding therapy and dyadic developmental psychotherapy. Each of these non-randomized studies concluded that the treatment method studied was effective. Both the APSAC Task Force and Prior and Glaser cite and criticize the one published study on holding therapy undertaken by Myeroff et al., which "purports to be an evaluation of holding therapy". This study covers the "across the lap" approach, described as "not restraint" by Howe and Fearnley but "being held whilst unable to gain release." Prior and Glaser state that although the Myeroff study claims it is based on attachment theory, the theoretical basis for the treatment is in fact Zaslow.

Dyadic developmental psychotherapy was developed by psychologist Daniel Hughes, described by the Task Force as a "leading attachment therapist". Hughes' website gave a list of attachment therapy techniques, repeated by the APSAC Task Force from an earlier website, which he stated do not or should not form part of dyadic developmental psychotherapy, which the Task Force took as a description of attachment therapy techniques. Two studies on dyadic developmental psychotherapy have been published by Dr. Becker-Weidman, the second being a four-year follow up of the first. Prior and Glaser state Hughes' therapy reads as good therapy for abused and neglected children, though with "little application of attachment theory", but the advocacy group ACT and the Task Force place Hughes within the attachment therapy paradigm.

In 2004, Saunders, Berliner and Hanson developed a system of categories for social work interventions which has proved somewhat controversial. In their first analysis, holding therapy was placed in Category 6 as a "Concerning treatment". In 2006 Craven and Lee classified 18 studies in a literature review under the Saunders, Berliner & Hanson system. They considered both dyadic developmental psychotherapy and holding therapy. They placed both in Category 3 as "Supported and acceptable". This categorization by Craven and Lee has been criticized as unduly favorable, a point to which Craven and Lee responded by arguments in support of holding therapy. Both Myeroff et al.'s study and Becker-Weidman's first study (published after the main Report) were examined in the Task Force's November 2006 Reply to Letters and were criticized as to their methodology. Becker-Weidman's study was described by the Task Force as "an important first step toward learning the facts about DDP outcomes" but falling far short of the criteria necessary to constitute an evidence base.

Some studies are still being undertaken on coercive therapies. A nonrandomized, before-and-after 2006 pilot study by Welch (the progenitor of "holding time") et al. on Welch's "prolonged parent-child embrace therapy" was conducted on children with a range of diagnoses for behavioral disorders and claimed to show significant improvement.

In March 2007, attachment therapy was placed on a list of treatments that have the potential to cause harm to clients in the APS journal, Perspectives on Psychological Science. Concern was expressed about methods that involve holding and restraint, and the lack of randomized, controlled experiments showing the effectiveness of the treatment.

In 2010 a modest social work study and "invitation to a debate", based on interviews with the deliverers and recipients of a therapeutic intervention incorporating non-coercive holding at one centre in the UK, called for further consideration of the use of this type of intervention. The intervention was not described as "holding therapy" but as using a degree of holding in the course of therapy. Although recipients were generally positive about the therapy received, the holding aspect was the least liked. The authors call for research and a debate on issues of what constitutes "coercion" and the distinctions between the different variants of "holding" in therapy.