Attachment Therapy - Treatment Characteristics

Treatment Characteristics

The controversy, as outlined in the 2006 American Professional Society on the Abuse of Children (APSAC) 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 (apparently a replication of the program at the Attachment Center, Evergreen) as follows:

"Like Welsh (sic)(1984, 1989), The Center induces rage by physically restraining the child and forcing eye contact with the therapist (the child must lie across the laps of two therapists, looking up at one of them). In a workshop handout prepared by two therapists at The Center, the following sequence of events is described: (1) therapist 'forces control' by holding (which produces child 'rage'); (2) rage leads to child 'capitulation' to the therapist, as indicated by the child breaking down emotionally ('sobbing'); (3) the therapist takes advantage of the child's capitulation by showing nurturance and warmth; (4) this new trust allows the child to accept 'control' by the therapist and eventually the parent. According to The Center's treatment protocol, if the child 'shuts down' (i.e., refuses to comply), he or she may be threatened with detainment for the day at the clinic or forced placement in a temporary foster home; this is explained to the child as a consequence of not choosing to be a 'family boy or girl.' If the child is actually placed in foster care, the child is then required to 'earn the way back to therapy' and a chance to resume living with the adoptive family."

According to the APSAC Task Force,

"A central feature of many of these therapies is the use of psychological, physical, or aggressive means to provoke the child to catharsis, ventilation of rage, or other sorts of acute emotional discharge. To do this, a variety of coercive techniques are used, including scheduled holding, binding, rib cage stimulation (e.g., tickling, pinching, knuckling), and/or licking. Children may be held down, may have several adults lie on top of them, or their faces may be held so they can be forced to engage in prolonged eye contact. Sessions may last from 3 to 5 hours, with some sessions reportedly lasting longer... Similar but less physically coercive approaches may involve holding the child and psychologically encouraging the child to vent anger toward her or his biological parent."

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 this 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 attachment problems because it is impossible to establish a trusting relationship with them. They believe this is because children with attachment problems actively avoid forming genuine relationships. Proponents emphasize the child's resistance to attachment 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 he or she has 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 attachment 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 countertherapeutic, in contrast with accepted theories of attachment.

According to Advocates for Children in Therapy,

"Attachment Therapy almost always involves extremely confrontational, often hostile confrontation of a child by a therapist or parent (sometimes both). Restraint of the child by more powerful adult(s) is considered an essential part of the confrontation." The purported correction is described as "... to force the children into loving (attaching to) their parents; ... there is a hands-on treatment involving physical restraint and discomfort. Attachment Therapy is the imposition of boundary violations – most often coercive restraint – and verbal abuse on a child, usually for hours at a time; ... Typically, the child is put in a lap hold with the arms pinned down, or alternatively an adult lies on top of a child lying prone on the floor."

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 traumatised 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.