Attachment Therapy - History

History

Matthew Speltz of the University of Washington School of Medicine states that the roots of attachment therapy are traceable to psychologist Robert Zaslow and his "Z-process" in the 1970s. Zaslow attempted to force attachment in those suffering from autism by creating rage while holding them against their will. He believed this would lead to a breakdown in their defense mechanisms, making them more receptive to others. Zaslow thought attachment arose when an infant experienced feelings of pain, fear and rage, and then made eye contact with the carer who relieved those feelings. If an infant did not experience this cycle of events by having his fear and rage relieved, the infant would not form an attachment and would not make eye contact with other people. Zaslow believed that creating pain and rage and combining them with eye contact would cause attachment to occur, long after the normal age for such developments. Holding therapies derive from these "rage-reduction" techniques applied by Zaslow. The holding is not used for safety purposes but is initiated for the purpose of provoking strong negative emotions such as fear and anger. The child's release typically depends upon his or her compliance with the therapist's clinical agenda or goals. In 1971, Zaslow surrendered his California psychology license following an injury to a patient during rage-reduction therapy. Zaslow's ideas on the use of the Z-process and holding for autism have been dispelled by research on the genetic/biologic causes of autism.

Zaslow and his "Z-process", a physically rough version of holding therapy, influenced Foster Cline (known as the "father of attachment therapy") and associates at his clinic in Evergreen A key tenet of Zaslow's approach was the notion of "breaking through" a child's defenses—based on the model of ego defenses borrowed from psychoanalytic theory, which critics state has been misapplied. The "breaking through" metaphor was then applied to children whose attachments were thought to be impaired. The clinic, originally called the Youth Behavior Program, was subsequently renamed the Attachment Center at Evergreen.

In 1983, ethologist Nikolas Tinbergen published a book recommending the use of holding therapy by parents as a treatment or "cure" for autistic children. Tinbergen based his ideas on his methods of observational study of birds. Parents were advised to hold their autistic children despite resistance and to endeavor to maintain eye contact and share emotions. Tinbergen believed that autism related to a failure in the bond between mother and child caused by "traumatic influences" and that enforced holding and eye contact could establish such a relationship and rescue the child from autism. Tinbergen's interpretations of autism were without scientific rigor and were contrary to the then growing acceptance that autism had a genetic cause. Despite the lack of a sound theoretical or scientific base, holding therapy as a treatment for autism is still practiced in some parts of the world, notably Europe.

Speltz cites child psychiatrist Martha Welch and her 1988 book, Holding Time, as the next significant development. Like Zaslow and Tinbergen, Welch recommended holding therapy as a treatment for autism. Like Tinbergen, Welch believed autism was caused by the failure of the attachment relationship between mother and child. Mothers were instructed to hold their defiant child, provoking anger and rage, until such time as the child ceased to resist, at which point a bonding process was believed to begin.

Foster Cline and associates at the Attachment Center at Evergreen, Colorado began to promote the use of the same or similar holding techniques with adopted, maltreated children who were said to have an "attachment disorder". This was replicated elsewhere such as at "The Center" in the Pacific Northwest. A number of other clinics arose in Evergreen, Colorado, set up by those involved in or trained at the Attachment Center at Evergreen (renamed the Institute for Attachment and Development in about 2002). These included one set up by Connell Watkins, formerly an associate of Foster Cline at the Attachment Center and its clinical director. Watkins was one of the therapists convicted in the Candace Newmaker case in 2001 in which a child was asphyxiated during a rebirthing process in the course of a two-week attachment therapy "intensive". Foster Cline gave up his license and moved to another state following an investigation of a separate attachment therapy related incident.

In addition to the notion of "breaking through" defence mechanisms, other metaphors were adopted by practitioners relating to the supposed effects of early deprivation, abuse or neglect on the child's ability to form relationships. These included the idea of the child's development being "frozen" and treatment being required to "unfreeze" development. Practitioners of holding therapy also added some components of Bowlby's attachment theory and the therapy came to be known as attachment therapy. Language from attachment theory is used but descriptions of the practices contain ideas and techniques based on misapplied metaphors deriving from Zaslow and psychoanalysis, not attachment theory. According to Prior and Glaser "there is no empirical evidence to support Zaslow's theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children's behavior."

Cline's privately-published work Hope for high risk and rage filled children also cites family therapist and hypnotherapist Milton Erickson as a source, and reprints parts of a case of Erickson's published in 1961. The report describes the case of a divorced mother with a non-compliant son. Erickson advised the mother to sit on the child for hours at a time and to feed him only on cold oatmeal while she and a daughter ate appetizing food. The child did increase in compliance, and Erickson noted, with apparent approval, that he trembled when his mother looked at him. Cline commented, with respect to this and other cases, that in his opinion all bonds were trauma bonds. According to Cline, it illustrates the three essential components of 1) taking control, 2) the child's expression of rage; and, 3) relaxation and the development of bonding.

In addition, proponents believed that holding induced age regression, enabling a child to make up for physical affection missed earlier in life. Regression is key to the holding therapy approach. In attachment therapy, breaking down the child's resistance by confrontational techniques is thought to reduce the child to an infantile state, thus making the child receptive to forming attachment by the application of early parenting behaviors such as bottle feeding, cradling, rocking and eye contact. Some, but by no means all, attachment therapists have used rebirthing techniques to aid regression. The roots of the form of rebirthing used within attachment therapy lie in primal therapy (sometimes known as primal scream therapy), another therapy based on beliefs in very early trauma and the transformational nature of age regression. Bowlby explicitly rejected the notion of regression stating "present knowledge of infant and child development requires that a theory of developmental pathways should replace theories that invoke specific phases of development in which it is held a person may become fixated and/or to which he may regress."

According to O'Connor and Nilsen, although other aspects of treatment are applied, the holding component has attracted most attention because proponents believe it is an essential ingredient. They also considered the lack of available and suitable interventions from mainstream professionals as essential to the popularization of holding therapy as an attachment therapy.

In 2003, an issue of Attachment & Human Development was devoted to the subject of attachment therapy with articles by well-known experts in the field of attachment. Attachment researchers and authors condemned it as empirically unfounded, theoretically flawed and clinically unethical. It has also been described as potentially abusive and a pseudoscientific intervention, not based on attachment theory or research, that has resulted in tragic outcomes for children including at least six documented child fatalities. In 2006, the American Professional Society on the Abuse of Children (APSAC) Task Force reported on the subjects of attachment therapy, reactive attachment disorder, and attachment problems and laid down guidelines for the future diagnosis and treatment of attachment disorders. The APSAC Task Force was largely critical of Attachment Therapy's theoretical base, practices, claims to an evidence base, non-specific symptoms lists published on the internet, claims that traditional treatments do not work and dire predictions for the future of children who do not receive attachment therapy. "Although focused primarily on specific attachment therapy techniques, the controversy also extends to the theories, diagnoses, diagnostic practices, beliefs, and social group norms supporting these techniques, and to the patient recruitment and advertising practices used by their proponents." In 2007, Scott Lilienfeld included holding therapy as one of the potentially harmful therapies (PHT's) at level 1 in his Psychological Science review. Describing it as "unfortunately" referred to as "attachment therapy", Mary Dozier and Michael Rutter consider it critical to differentiate it from treatments derived from attachment theory. A mistaken association between attachment therapy and attachment theory may have resulted in a relatively unenthusiastic view towards the latter among some practitioners despite its relatively profound lines of research in the field of socioemotional development.