Open Letter to ATTACh
by Jean Mercer, PhD,
Professor of Psychology
Richard Stockton College
Pomona, New Jersey
The Association for Treatment and Training in the Attachment of Children (ATTACh) is a self-described “international coalition of professionals and families dedicated to helping those with attachment difficulties by sharing our knowledge, talents and resources.” (www.attach.org) It also is a leading proponent for Attachment Therapy and as such has been a target of criticism by Advocates for Children in Therapy.
Recently, Professor Jean Mercer, who is also President of ACT’s Board of Professional Advisors, sent an Open Letter to the President of ATTACh outlining her — and ACT’s — concerns about the nature of ATTACh and its activities. We reprint that letter here with some slight editorial revisions.
As of this posting, Professor Mercer reports no receipt of a response from ATTACh’s president or anyone else purporting to speak for ATTACh.
March 10, 2006
Mr Todd Nichols President, ATTACh
Dear Mr Nichols:
This is an open letter that I hope you will share with members of ATTACh. I address it particularly to you because its writing was instigated by some remarks of yours at the 2005 ATTACh conference. I have learned that you spoke of me in the following way:
Jean Mercer, who has been a longtime critic of ATTACh and the various therapies — and one of the critics that will not listen to anything I have to say, or anybody else from this room or organization…
I make no objection to your statement, and I freely admit that I regard material from ATTACh with considerable suspicion. However, learning of your remarks gave me occasion to consider why I feel the way I do about ATTACh, and what ATTACh would need to do in order to earn my respectful attention and that of others like me. I have outlined my thinking below and am sending it to you to consider and discuss with other members of ATTACh.
I propose a 12-step program that would move ATTACh into a position of much greater professional integrity. If these steps were followed, I would be very willing to accept the statement that coercive holding (i.e., psychologically or physically enforced restraint of voluntary movement), age regression, and the various adjuvant treatments and parenting methods are neither practiced nor approved by ATTACh members, if such a statement were still made.
ATTACh needs to disengage from members who have supported or engaged in coercive holding and who have never provided a rationale for changing their practice, or to persuade such people to explain why they no longer support their previous techniques. ATTACh has a number of members who are well known to have practiced coercive holding and who have themselves published statements describing their use of coercion and their beliefs in its appropriateness as a treatment for children. These people need to make public the reasoning or experiences that led them to change their approach. Until they do so, their involvement in ATTACh and ATTACh conferences makes the stance of the organization very ambiguous indeed. (Naturally, the same concern would apply to members who have practiced Coercive Restraint Therapy and have not changed their practices.)
ATTACh needs to disengage from members who have relinquished their professional licenses following disciplinary proceedings. ATTACh continues to support the contributions of individuals who have behaved in ways far outside the requirements of professional ethics. Professionals outside ATTACh cannot help wondering how many members have had serious ethical problems.
ATTACh needs to disengage from members who present false or deceptive credentials or whose degrees are from nonaccredited institutions. ATTACh has members whose degrees are from diploma mills, and quite a few from nonaccredited institutions. ATTACh also has a number of members whose claim to professional success is based on belonging to membership organizations such as the American Psychotherapy Association. These members lead outsiders to question the training of other persons connected with ATTACh.
ATTACh needs to require members to adhere to ethical standards as they exist for conventional practitioners in the helping professions and as they are required by national professional organizations such as the American Psychological Association and the National Association of Social Workers. ATTACh members are currently violating such standards in specific ways. For example, ATTACh presently has members who advertise on the Internet that their treatment methods are better than those of other practitioners, and who use “testimonials” on websites in disregard of concerns about evidence of effectiveness. Inspection of material on the Internet also shows that some ATTACh members are remarkably cavalier about the issue of informed consent; while consent may be documented, the information given to the client makes the difference between informed and uninformed consent. Many ATTACh members appear to an outside observer to be practicing outside their competence, especially with respect to developmentally appropriate practice. These actions are all contrary to the ethics codes of the national professional groups. (However, there does seem to have been a reduction in the number of statements that conventional treatments are harmful, which is certainly an improvement.)
ATTACh needs to require members not to use Internet links to or recommended readings from material that encourages coercive holding or age regression techniques. A number of ATTACh members have web sites that refer clients to material by members of the authoritarian, coercive “old guard” who founded ATTACh. The presence of this material strongly implies approval, whether or not a “disclaimer” statement is included.
ATTACh needs to require members not to present diagnostic “checklists” of the type historically associated with coercive treatment. Checklists that encourage clients to do their own diagnosis give the impression that the practitioner is simply doing a type of advertising. Parent who use these checklists are encouraged to believe that their children have serious emotional problems. The checklists are especially dangerous in that they omit any consideration of developmentally appropriate differences in behavior or mood. Diagnosis by telephoned checklist is a particularly reprehensible practice.
ATTACh needs to require members not to use the Randolph Attachment Disorder Questionnaire for diagnostic or research purposes. As I have discussed in detail elsewhere, the RADQ was poorly developed and inadequately validated. It is also based on the belief system inherent in coercive practices. When I see that a practitioner uses the RADQ, I assume that he or she is either influenced by the belief that restraint is therapeutic, or is ignorant of important issues.
ATTACh needs to require members not to state that they can diagnose an “Attachment Disorder” categorized other than by the DSM 313.89 code, and not to state that any type of attachment disorder or problem is either common or associated with violent behavior at the level of serial killing. There is no evidence for any of these claims, and practitioners who make them are inviting criticism.
ATTACh needs to encourage members to publish material in peer-reviewed venues and in books put out by professionally-edited publishing houses. Subsidy publishers and house publications may be quick ways to get into print, but they raise eyebrows among knowledgeable observers. With respect to publication, it would be a good idea for ATTACh members to slow down on the controlled clinical trials work which is probably premature, and instead to provide some complete case studies with narratives describing treatment protocols. No reader can correctly interpret the results of a CCT study without knowing what the treatment actually consisted of. At present, outsiders have no way of learning about techniques advocated by ATTACh members, other than attendance at ATTACh training events. While this situation may be of financial benefit to ATTACh, it is not the way work in the helping professions is usually done.
ATTACh should abandon the goal of “registering” attachment therapists while operating as a freestanding association. The credentialing efforts made by ATTACh in the last couple of years are alarmingly self-referential. They appear to involve people trained by ATTACh members who were also trained by ATTACh members, without regard to the work and standards of any professional credentialing organization. If ATTACh wants to be involved in the work of credentialing, it would be wise to join a professional group that can assess and validate ATTACh credentials. Otherwise, ATTACh simply joins the number of self-declared commercial credentialing groups such as the American Psychotherapy Association.
ATTACh should make serious, well-publicized, good-faith efforts to meet the standards discussed by the APSAC Task Force. Of matters addressed by these standards, the use of “age regression” techniques is of particular concern. An important related question is whether “affective attunement” through physical contact should be considered an age regression technique. In my opinion, it is such, because the type of contact involved is culturally acceptable only for infants and toddlers, and children know this very well. Perhaps you, as a member of the APSAC Task Force, accepted the idea that such physical contact was included under the category of age regression; perhaps you considered the term “age regression” to cover only techniques like bottle-feeding and caramel-offering. If ATTACh members do not consider their techniques to involve age regression, they need to state this publicly and offer their reasoning on the subject. Otherwise, outsiders will not consider ATTACh to be in compliance with the APSAC conclusions.
[Editor’s note: APSAC stands for the American Professional Society on the Abuse of Children, which empaneled a Task Force on Attachment Therapy that recently returned a report, endorsed by a unit of the American Psychological Society, highly critical of many AT practices.]
Finally, ATTACh should have a president who is a licensed professional child psychotherapist with an earned doctorate from an accredited (not “approved”) university (not a freestanding institution with a single narrow focus). While I certainly accept that you, Mr Nichols, have a real interest in the work of ATTACh and some organizational skill, members of other professional organizations expect a president to be someone with personal achievement in the area the organization deals with. In the case of ATTACh, the president should come from a background that has emphasized not only clinical skills, but professional ethical standards and the evaluation of research evidence. The president should be competent to understand the relevant literature and to convey it accurately to members of the organization; I bring up this point because of a misinterpretation I see in your current statement. In this memo, you state that ATTACh’s influence is seen in the adoption of the term Coercive Restraint Therapy as a replacement for Attachment Therapy, as seen in my recent Medscape paper (“Coercive Restraint Therapies: A Dangerous Alternative Mental Health Intervention,” Medscape General Medicine. 2005;7(3); posted 08/09/2005) and elsewhere. In reality, the term CRT was adopted in an attempt to accomplish two ends:
To create a a general term that would include a variety of terminology for methods used by ATTACh adherents, including some trademarked names, and
To apply a term that rejects the preemptive redefinition of the word “attachment” so common among ATTACh members, as well as operationalizing the treatment in question rather than defining it with respect to its alleged purpose.
I believe that ATTACh has some real challenges to face before it can become a recognized professional group that is qualified to make training and credentialing decisions. My list of issues could continue beyond these 12 steps, and if continued would include my concerns with ATTACh’s support for unsubstantiated methods such as neurofeedback. However, I will be convinced of your good intentions if you will simply address the points I have made here. I hope that during your remaining time as ATTACh president you will be able to persuade your members that they have serious matters to discuss.
I also hope that members of ATTACh will not regard this letter as a “scathing” one. I write out of a very real concern with children and families whose needs I hope to see better served, and I have received too many e-mails from families who complain of harm by the work of some ATTACh members for me to feel indifferent to the present situation. I would like to see ATTACh become able to make a real contribution, but I feel this is impossible until the steps I have outlined are followed.
Jean Mercer, PhD
Past president, New Jersey Association for Infant Mental Health