Girl:Flower

Attachment Therapy
Child Abuse by Another Name




The abuse of individual dignity, self-determination, rights, bodies, and minds of mental patients by those entrusted with their treatment and care has a long, sad history in 20th century psychotherapy. The public has been subjected to wholesale, unvalidated practices that violate the “first, do no harm” dictum, e.g. lobotomies, the blaming of mothers for autism (“refrigerator moms”), and the suicides and break up of families as a result of false memory syndrome.

Fortunately, with the application of scientific methods to mental-health treatment, coupled with the integrity to go only where the facts lead, many past abuses have been acknowledged and addressed by the caring professions. Unfortunately, high standards are not universally upheld. As a consequence, there is a certain recidivism that requires constant vigilance against the re-introduction and use of abusive practices.

With the advent of the 21st century, another psychotherapy scandal has been brewing for decades. Just as in many of those that have come before, it involves the humiliation, degradation, abuse and exploitation of patients and of their families. This time it has a particularly shocking aspect — the intentional physical and mental torture of
children, primarily adopted and foster children. As before, there are needlessly ruined lives, injuries, and deaths. The practice is known as Attachment Therapy or as we will refer to it, Attachment Therapy/Parenting (AT/P).

The Problem

A large fringe element of pseudoscientific psychotherapists — Attachment Therapists — have invented the dubious, unrecognized and catch-all diagnosis called “Attachment Disorder” (AD) and its cure. AD is thought to be a child’s inability to form a close, loving relationship with his caregiver, typically because of early childhood abuse or neglect. Many, if not most, undesirable behaviors seen in childhood supposedly stem from AD.

Adopted children, many from overseas or minority groups in the USA, are often the targets of Attachment Therapists. Using scare tactics, these therapists offer parents their unvalidated, abusive, and potentially dangerous therapy for AD — practices distinguished by the use of coercive restraint, boundary violations, and harsh parenting techniques. A number of deaths, cases of near-starvation, and breakups of families have been linked to AT/P.

Numerous adjunctive therapies, equally unvalidated, with safety and efficacy unestablished, are frequently employed to supplement AT/P, depending upon the practitioner. To name just a few that have gained great popularity among AT/P practitioners, and are openly embraced at AT/P conventions:

  • Tomatis and Samonas Sound Therapies

  • Cranial-Sacral Therapy

  • Therapeutic Touch

  • Visceral Manipulation

  • Eye-Movement and Desensitization Reprocessing (EMDR)

  • Neurolinguistic Programming (NLP)

  • EEG Neurofeedback Therapy

  • Feldenkrais

  • Brain Gym

  • Video Reflections [freeze-frame analysis for “psychic leaks”]

  • Integrated Awareness

  • Sensory Integration


See Clips of Attachment Therapy
video

What is Attachment Therapy Like?

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. These are known as “holding” and “compression” therapies, respectively, though many other names have been employed for them over the years (see below). Sometimes a child is immobilized inside a blanket or sheet, which is often called either a “mummy,” “burrito,” or “angel” wrap.

While in control of the child, therapists and/or parents attempt to produce enough discomfort and terror so that a child becomes so enraged, fearful or in pain that he struggles against the adult(s). If the restraint alone does not cause a strong enough reaction from a child, other noxious stimuli may be added, such as knuckling or elbowing the ribs, relentless tickling, covering the child’s mouth, jerking the head, or licking the child’s face.

Verbal abuse during Attachment Therapy includes: belittling, taunts, threats of abandonment by the parents, profane and hateful statements made to the child, requiring the child to repeat similar sentiments over and over, and ignoring the child’s voluntary statements and requests. The therapist frequently holds his face inches from the child’s, yelling like a drill sergeant.

While precise methods may vary from therapist to therapist, the underlying beliefs about child development, as well as the character and goals of the practices, are similar in important respects.

Dubious Claims of Therapeutic Effect

Many Attachment Therapists aim to “disturb the disturbed” child and claim that any close physical contact, not just that of coercive restraint, will cause a welling up of “repressed” memories of abuse sustained in infancy, in utero or during the “trauma of birth.”

Most Attachment Therapists also claim, erroneously, that raging done by a child during a holding helps rid him of dangerous infantile anger. They further claim that as a child becomes exhausted from struggling against restraint, the child enters an “infantile state,” a developmental stage that they alone think can be “redone” to forge a close attachment to his current parents. This attachment is demonstrated most strongly, say many Attachment Therapists, by “eye contact on the parent’s terms.” Additional measures are swaddling, bottle-feeding, and speaking in baby talk to the child, even if an older teen.

Varying Nomenclature

While the practice of Attachment Therapy (AT) is just now coming to light, it actually has been around for almost thirty years. Here are some of the names used for it:

  • Z-therapy

  • Rage-reduction therapy

  • Theraplay

  • Holding Therapy

  • Attachment Holding Therapy

  • Attachment Disorder Therapy

  • Reattachment Therapy

  • Holding Time

  • Cuddle Time

  • “gentle containment”

  • Holding-Nurturing Process

  • Emotional Shuttling

  • Direct synchronous Bonding

  • Breakthrough Synchronous Bonding

  • Therapeutic Parenting

  • Dynamic Attachment Therapy

  • Humanistic Attachment Therapy

  • Corrective Attachment Therapy

  • Developmental Attachment Therapy

  • Dyadic Attachment Therapy

  • Dyadic Developmental Psychotherapy

  • Dyadic Support Environment

  • “affective attunement”

  • Prolonged Parent-Child Embrace

Sometimes AT/P deliberately co-opts mainstream terms, such as (a) therapeutic holding, which is used by pediatricians and others to describe emergency restraint used only during therapy for the purpose of securing immediate personal safety; (b) affect regulation, which is used by many mental-health professionals to describe a person’s control over the outward display of emotions and behavior; (c) ordeal therapy, which is a label for some approaches that seek to block or cut short problem-maintaining behaviors; and (d) trauma therapy, which generally seeks to treat individuals suffering from post-traumatic stress disorder.

(Note may be taken that the list above does not include “rebirthing” or “rebirthing therapy.” This is a label that the press and others put on the procedure that Connell Watkins and Julie Ponder supposedly used to kill
Candace Newmaker. Watkins and Ponder were trained in the approaches of Douglas Gosney, an Attachment Therapist practicing in California, who taught that re-enactment of the birth process might be a useful script for some holding sessions. That script he and others called “rebirthing” for short.)

“Attachment Therapy” is not a precise term and, indeed, is not even a universally accepted term among those who practice it. Because a person may be described as an Attachment Therapist (on this website or in other places) does not mean that the person uses each and every technique ascribed to AT/P, or even subscribes to each and every belief that underlies AT/P. But it would be a disservice to the public to try to engage in a discussion about these practices without trying to give some overall guidance as to what is being discussed. It is reasonable to expect that the reader can be discerning when trying to apply generalized statements to specific circumstances and individuals. (See also
What Makes a Proponent of Attachment Therapy?)

For our purposes, we have identified several distinguishing characteristics, any one of which qualifies a practice to be called Attachment Therapy/Parenting:
  • Practices, teaches or recommends restraint (or other violations of interpersonal boundaries) for an allegedly therapeutic purpose. The things mentioned are often deliberately confrontational and intrusive.

  • Principally treats, or is concerned with, a condition of “Attachment Disorder” (distinct from the DSM-recognized diagnosis of Reactive Attachment Disorder), and assesses for that condition using unvalidated diagnostic tools, or uses no tools at all for objective assessment.

  • Practices or recommends treatment based on a belief in the efficacy of any of the following: re-traumatization; catharsis, especially through expression of rage, fear, sadness, or other “negative” emotion; recapitulation (re-enactment, re-living, or “re-doing”) of stages of development; or repatterning of the brain.

  • Adheres to unvalidated notions about child development or attachment, especially the so-called “Attachment Cycle” (aka Bonding Cycle, Need Cycle, Rage Cycle, Soul Cycle). Though reference may be made to the Attachment Theory, pioneered by John Bowlby and Mary Ainsworth, Attachment Therapy shares very little with that empirical work (and indeed runs counter to it in almost all important respects).

  • Claims that AT practices are safe and efficacious when there is a near complete lack of scientific support.

  • Practices or teaches harsh parenting and respite methods, based principally upon combinations of deprivation, isolation or humiliation for the child.

  • Uncritically recommends materials (such as websites, books, videos, lectures, and conference presentations) which do any of the above.

“Attachment Disorder”

AT/P purports to treat children who are thought to be unable to “attach” to their present caregiver (often an adoptive mother). Advocates believe that disruption of the “need cycle” in infancy is responsible for chemical changes in the brain and for the child’s inability to show affection to his present caregiver. AD also purportedly leads a child to being unable to trust, to feel pain, accept discipline, develop cause-and-effect thinking, demonstrate self-control, have a conscience, or accept responsibility for one’s own actions. As a direct consequence of these, AD then purports to explain a plethora of other undesirable behaviors, including but not limited to: lack of eye contact, torturing and killing pets, firesetting, bullying, preoccupation with fire and gore, frequent and prolonged tantrums, poor academic performance (though intelligent), deliberate property destruction, obstreperousness, “crazy” lying, and superficially charming with strangers.

AT/P advocates claim that AD is an extremely serious problem, and, left untreated, AD children can maim, kill and torture without conscience or feeling. They say that children with AD grow up “to be such persons as Ted Bundy, Charles Manson, Adolph Hitler, [and] the teenagers who shot up Columbine High.” (Kasbee, 2001)

Accepting Freudian notions about repressed emotions and memories, AT/P advocates attribute development of AD to bad experiences as an infant, at birth, in the womb, or even at conception. What they consider to be memorable experiences reflect highly unorthodox ideas. For example, if a pregnant woman considers having an abortion, those “negative thoughts” are conveyed to the fetus and become the basis for an “attachment disturbing” experience which remains with the child after birth and into adulthood. The trauma of being born is supposedly another attachment-threatening experience. The “trauma of conception,” — when drunken sperm attack an egg — is still another such threat.

Disturbing the Disturbed

AT/P claims to know exactly how to treat every Attachment-Disordered child. Every such child is believed to be “filled with rage” towards their biological mother, for her early neglect and abuse, but instead takes it out on the adoptive mother, often to the exclusion of any others. (Blaming the biological mother can certainly serve to make this intervention more attractive to adoptive parents.) Every disturbed child has supposedly learned, in the womb or in infancy, that the world is not a safe place and has developed dysfunctional “survival skills” as a result, such as refusing to make eye contact or allowing anyone who matters to “get close.” Not trusting anyone, especially the present caregiver, an Attachment-Disordered child is characterized as needing to be in control of every situation, fearing he will die if he gives up that control. Even infants are alleged to be motivated by this fear of dying.

Attachment Therapy often treats Attachment Disorder by “disturbing the disturbed,” as some advocates put it. It is designed to create conditions that supposedly release pent-up rage, which usually means deliberately enraging and terrifying a child, or turning a trantrum or outburst into a more prolonged
“holding” session. Playing on the belief that the child has an allegedly pathological need to be in control and to avoid physical contact, the child is held (restrained) by a parent and/or therapist.

The process predicted by Attachment Therapy goes as follows:

  • The child struggles to get out of the hold, and the holder matches all resistance (bruising is not uncommon).

  • When the child fails to free himself, he feels he is dying, and panics; fear and frustration turn into anger.

  • In time, the real target of the anger (the biological mother) is identified.

  • The child “gets out the anger” (a popular, but mistaken, notion).

  • After hours of struggle, the exhausted child is thought to have regressed to an “infantile” state. Then hugs, rocking, eye contact, swaddling, and feeding with a baby bottle are employed to provide needed nurturing.

  • The therapist leads the adoptive mother and child through a “re-do” of this early developmental stage, rejecting the biological mother’s abuse and neglect and transferring his “attachment” to the current caregiver.


Holdings typically take two hours, with the child “raging” much of that time. Some “breakthrough” holdings last one or two days. Many holdings are typically required before a child is thought to make real progress. And parents are typically warned that the child’s behavior will likely get worse before it gets better.

During the holding process, the holder tries to get the child to face what the therapist believes is the original source of his rage. To do this, the holder yells at the child, just inches from his face; the child is told what to think and what to believe, and often to repeat it back, over and over, also by yelling. Sometimes, a therapist engages in “emotional shuttling,” where the therapist alternates yelling with soft, soothing speech, to keep the child off-balance and uncertain (though some claim it is used to train the child to handle his emotions). The child is required to maintain eye contact with the holder at all times; if the child refuses eye contact, the holder roughly grabs or squeezes the child’s face to force it.

All of this is often in an environment of loss or separation for the child, who has been isolated from family and familiar surroundings. The therapist’s threats to make the isolation permanent are completely believable to the child in the circumstances. Panic and despair — helplessness and hopelessness — are the targeted emotions.

AT has thus been defined by some experts as trauma bonding, as in the Stockholm Syndrome. “You could use a cattle prod and get the same thing. And if you’re telling me it works and the kid minds, that’s not impressive,” says longtime AT critic Beverly James, LCSW.

A trauma bond is made by a captive with the tormentor. In the case of AT, this would be the child with the holder (therapist, AT “parenting specialist,” or the mother). If a “breakthrough” occurs when the therapist (or parenting specialist) is doing the holding, the child will form a trauma bond to the therapist. This is apparently counter-productive, since the stated objective of AT is to achieve attachment with the caregivers (almost always the mother). But AT theorists explain away this troublesome outcome by claiming that the child’s attachment is routinely
transferable from the therapist/specialist to the mother!

“Bottle
“Reparenting”
[Photo: Orange County Register]

Reparenting

After a successful holding session, a child is supposed to be ready to accept affection from his mother — and her authority over him. The now-passive child is treated as an infant, sometimes swaddled and fed with a baby-bottle, and spoken to as if a baby needing reassurance. Bottle-feeding is done with all ages of children, even teens. The child is expected to gaze long and lovingly into his mother’s eyes. Following Jungian ideas about regression, he is at this time thought by therapists to be “re-doing” the initial stage of attachment, or at least AT/P’s idea of it.

Therapeutic Parenting

AT/P is a total immersion experience for children. After enduring Attachment Therapy sessions, children are subjected to its harsh parenting methods while at home, while staying with respite workers, or when living with “therapeutic foster parents.”

Parents are advised to maintain control over a child with “firm and continuous pressure,”
i.e., strict discipline, as if the child was hemorrhaging to death. When a child isn’t enduring more holding therapy at home, many additional “parenting” techniques are used to show the child that his mother is in complete control:

  • Isolation. An objective is to have a child’s only contact be his mother until he has sufficiently formed a primary attachment with her. Commonly, a child is kept away from siblings and friends, and out of school for “long vacations.” (Education, by the way, is considered a privilege that must be earned and not a right.) He may also be kept away from extended family members.

  • Excessive exercising. If a child does something the wrong way — e.g., answers a question with an “I don’t know” — he will be assigned push-ups or jumping-jack exercises, supposedly to get adequate levels of oxygen in his brain.

  • Pointless chores. Tasks are assigned for their maximum unpleasantness, repetitiveness, and uselessness. Shoveling manure is often mentioned. Adult survivors describe having to wash every dish in a kitchen if a spot is found on a single glass. Several report having to move a woodpile from one place to another and back; one had to pick up dog feces and leaves with her fingers.

  • Inadequate diet/starvation. Many children are maintained on peanut butter sandwiches or cold oatmeal for weeks or months at a time. One AT/P “parenting specialist” recommended “soup kitchen” food — something the child should be told he’ll need to get accustomed to. Ingestion of sugar, considered a “bonding food,” is strictly controlled, dispensed not as a reward but as a control mechanism.

  • Restricted environment. A child’s bedroom is kept mostly bare, with locks or alarms on the door and windows. One survivor claims several AT/P establishments in Colorado have “scream rooms” in their basements — locked, windowless rooms with no toilet — where children may spend days or weeks locked away in isolation.

  • “AT/P Paradoxical Techniques.” Parents are supposed to act unpredictably and irrationally with a child in order to keep him “off balance,” i.e., unable to “manipulate” situations. Another AT paradoxical practice is making a child gorge on any food he may have been caught sneaking.

  • Demonizing. Children are belittled and taunted outside of therapy. Since much, if not all, of a child’s behavior is suspected of stemming from evil motives or being cunningly manipulative, even good behavior by a child is frequently dismissed. Complaints of ill health are deliberately ignored as mere attention-getting. Indeed, some children have gone without needed medical attention for serious conditions until they become emancipated at age 18. Children treated this way are believed to be insensate to pain, while super-sentitive to light touch. They supposedly injure themselves so that abuse charges might come against their caregivers. A leading AT parenting specialist claims that she doesn’t allow Attachment-Disordered children to pray, because she can’t be sure who they are praying to, implying Satanic affiliation on the part of the child.

  • Compliance training. Children are expected to comply with all adult request with alacrity: “fast and snappy, and right the first time [just the way mom wants it]” is the refrain. Orders are to be obeyed unquestioningly. For example, should a child fail to close an upstairs door, he may be ordered to do it — fast and snappy — hundreds of times. As a gauge of a child’s unquestioning obedience, he may be frequently asked to repetitively flush an unused toilet. One session with a child was observed on videotape, where she was put through what the “Therapeutic Foster Parent” (TFP) called “your basic German Shepherd” — repeated, rapid commands of come, go back, sit, stand.

  • “Strong sitting.” Resembling the old standby of “standing in the corner,” strong (or power) sitting, is not used for just punishment. At frequent times during a day, a child is required to sit, tailor-fashion, utterly motionless for 10-30 minutes at a time. A required length of time is set at the beginning (usually 3 minutes, plus one minute for each year of age), but the time does not start to run until the child has gone completely motionless and is staring straight ahead, so the actual sitting can run into hours.


“Strong
“Strong Sitting”
[Photo: Orange County Register]

Because these techniques are abusive on their faces, parents who use them fear discovery by others who “will not understand.” They develop almost cult-like behaviors of defensiveness and secrecy.
Children, for their part, appear to react as
hostages would. Therapeutic Parenting has been likened — even by some advocates — to brainwashing.

“I know what you're doing to these kids — you’re brainwashing them,”
Foster Cline, an early leader of the AT movement, told Robert Zaslow, the inventor of Z-Therapy, back in the 1970’s. To which Zaslow responded by putting an arm around Cline and telling him, “Foster, these kids’ brains need to be washed.” Cline agreed that “their thinking was massively cleaner when he [Zaslow] was finished” with them.

Children subjected to Therapeutic Parenting often grab at emancipation as soon as possible. By that time, however, they are often poorly prepared for independent living. There is often no high school diploma (much less a chance of higher education), lingering effects from the abuse they have endured (such as poor social skills and some medical problems), and bitter estrangement from their parents. If the children weren’t troubled in the first place, the adults they become often are. AT/P practitioners and parents steadfastly blame the child for that.

Therapy Goes On for Years

AT/P must be continued until successful. It frequently involves an expensive ($7,000-$10,000) “two-week intensive” at an Attachment Therapy center, with the child going through Holding Therapy in the morning and staying the rest of the day with “therapeutic parents,” practicing chores and obedience. During those two weeks, the child typically sees little of his parents, the people to whom he’s supposed to be attaching.

It appears that children rarely achieve dramatic breakthroughs during two-week AT/P intensives. Few get to return home immediately afterwards, though parents are warned that their behavior may worsen for awhile. Many, however, stay on at the treatment center, living in allied “therapeutic homes,” for an average of 3-6 months. Some children prove “incorrigible” and spend the remainder of their childhood and adolescence in such places. The charges for such extended treatment have been known to reach $5,500 per month or more.

Success is considered achieved when a child gives eye contact and affection to a parent “on the parent’s terms” (when and how
they want it, and not just to meet the child’s desires for affection or reassurance). For example, only the parent determines the time and place for a hug, and where the arms are to be placed. Also, previously observed bad behaviors must significantly abate or disappear. A successfully treated child is, AT/P advocates say, “respectful, responsible, and fun to be with.”

In fact, there are few successes with AT/P. Though AT/P advocates have many anecdotes of success (made by parents), there is no scientifically valid evidence in support of its efficacy. As even their own anecdotes reveal, every apparent short-term success in treatment is almost always followed by apparent relapses. When an AT/P center was asked once to produce a favorable testimonial from a former child patient who is now an adult, it couldn’t or wouldn’t do so.

Experts think that short-term successes are in most cases a consequence of the “trauma bonding,” discussed earlier. Trauma forms a dysfunctional bond at best, and also only a temporary one (hence the “relapses”). The cycle of success and relapse tends to keep a child perpetually in AT/P, if financially feasible. Those children treated and claimed to improve over time with AT/P are, in the opinion of child-development experts, more likely to have done so due to changes wrought by the normal maturation process, or for other reasons totally unrelated to AT/P.

AT/P can and does become a way of life, but invariably it is a long, difficult, time-consuming, tiring, and
unhappy time for all involved. The concept of respite care becomes an essential one as parents, indeed the entire family, become weary and stressed by the constant effort and harshness of their own actions toward the child. Many families struggle or collapse financially as result of the substantial costs of AT/P. Some families may break up as a result of AT/P; AT/P therapists reinforce the victimhood and high value of the mother in AD, often at the expense of the father. Some families have abandoned AT/P out of necessity — and report that their quality of life immediately improved.

Children subjected to AT/P for prolonged periods are literally robbed of their childhoods, and many grow up resenting it and their families. There is a growing number of people who now identify themselves as “adult survivors” of AT/P (see “
A Search for Survivors” website.)

Three Decades of Unimpeded Growth

AT/P has existed as a movement for over 30 years. Though it has not exactly been “underground” in all that time, it has been spreading quietly. It is traceable mainly through book publications, conference presentations, and lately the internet. Each of the leading proponents has tried to make his or her own mark on the progression of ideas in AT (or set himself somewhat apart). But because the movement was never centralized (it was not until the late 1980’s that an organized affiliation even arose), there was never an enforced orthodoxy among proponents or practitioners. Occasionally, they would even challenge each other (for example, therapy sessions with holdings done by a therapist vs. by a parent). Nevertheless, their similarities appear greater than their differences. They all appear to have a certain “family resemblance,” which involves confrontational and intrusive treatment of the child by the therapist, or taught to custodial parents, or both. Treatment performed or recommended typically includes violations of interpersonal boundaries, often involving some form of physical restraint with an alleged therapeutic purpose.

The family tree of Attachment Therapy can be traced back to Wilhelm Reich (best known for Orgone Therapy), Jackie Schiff (Transactional Analysis and Reparenting) and Robert Zaslow (Z-Therapy) in the 1970’s. They were followed by
Foster Cline (Rage Reduction), Martha Welch (Holding Time), Vera Fahlberg (Attachment Holding Therapy), and Ann Jernberg (Theraplay) in the 1980’s. The 1990’s saw the rise of Nancy Thomas and Deborah Hage (Therapeutic Parenting), Terry Levy (Holding Nurturing Process/Corrective Attachment Therapy), Elizabeth Randolph (Humanistic Attachment Therapy), Gregory Keck (Holding Therapy), and Ronald Federici (Adults Only) in the 1990’s; and finally the emergence of Daniel Hughes (Dyadic Attachment Therapy/Developmental Attachment Therapy/Dyadic Developmental Psychotherapy) and Bryan Post (Dyadic Support Environment) in this decade.

From its beginning, Attachment Therapy has been largely ignored by the mental-health professions, including state regulatory boards. Until recently, it had not been taught in any form at accredited universities. Instead, AT/P techniques were developed and widely disseminated through word-of-mouth, “training” videotapes, privately published books, adoption agencies, and lately the internet. Parents introduced to AT/P in this way are ushered into deeper involvement through seminars, conferences and parent-support groups.

There is distinctly a dearth of scientific and academic support for the techniques promulgated, but the professional silence to date about AT has given it an apparent legitimacy by default. This appearance of legitimacy has been enhanced by courses about AT that award professionals credits that count toward the continuing-education requirements of their governmental licenses (commonly called
CEU’s). The cachet of professional approval (or at least acceptance) can be a significant factor in getting some professionals to set aside their personal reservations about the practices they see in AT/P.

The low-key marketing and even lower-profile professionalism have permitted AT to avoid, for the most part, any significant oversight by society at large. While a few practitioners came to the attention of state regulators from time to time, none are known to have received any significant sanction or restriction to their practice until the mid-1990’s. (See particularly the cases of
Foster Cline, MD, and Elizabeth Randolph, PhD.) The prevalence of MSW’s and LCSW’s in Attachment Therapy ranks also gave them peer access to caseworkers in adoption agencies and departments of social services, whom they can use to blunt opposition to their practices and invoke adoption-privacy regulations to mask their activities from general notice.

By 2002, there were hundreds of facilities openly practicing AT/P in the United States. These included residential treatment centers (the current name given to in-patient mental-health facilities that are not considered psychiatric hospitals), private clinics, and solo practitioners. There were also an uncounted number of “therapeutic foster homes” which offer AT-related parenting practices, and a similarly undetermined number of Child Placement Agencies specializing in putting children suspected of being at risk for Attachment Disorder into environments (either as adoptions or foster-care placements) where they will receive AT/P.

Finally, there are a number of “tough love” programs around the country that are not strictly AT/P, but which treat children in recognizably similar ways. Arguably the most well-known of these are some so-called “wilderness” programs, where adolescents are given bootcamp-like experiences of physical and emotional stress, with the intention that they “confront” their attitudes which their families find objectionable. These programs share with AT/P the discredited notions of catharsis of “repressed anger,” “disturbing the disturbed,” and age regression to deal with “traumatic events.” The abusive nature of these programs is slowly coming to light and are raising public concern (for example, recent events in American Samoa). Until now, however, the unsophisticated acceptance of such programs by the general public, media, and even by the courts, has given aid and comfort to AT/P practitioners, and even sometimes facilitated their practices (by referring patients).

Targeting Parents

There can be little doubt that there are troubled children who are difficult to raise. AT/P is custom-designed to appeal to frustrated, disappointed parents of such children. It offers a single, holistic explanation for all problematic behaviors — and shifts any blame away from the current caregivers. As an immediate consequence of that simplistic explanation, it also offers a single, one-size-fits-all treatment: overcome the child’s inability to form a stable, loving relationship with his mother and all other problems melt away.

Part of the sales pitch for AT reassures suffering parents that they are not at fault for having a troubled youngster — the child, supposedly still under the influence of his abusive biological parents, is the real problem. (This is also a point made repeatedly to the child while in therapy.) Parenting skills are never questioned, though mothers often readily adopt newly learned AT parenting methods. AT even has a title of honor for every woman who brings a child into AT/P: “Awesome Mom” (co-opting the Old Testament adjective for God). If anything, parents are chided sympathetically for trying too hard, for having put up too long with an abusive child. The #1 rule of AT/P parenting is: “Take care of yourself first.”

The child does not have to be troubled in an obvious way, or even very much at all, to be targeted for treatment with AT/P. All the child has to be is distant, cool, and unresponsive to parental affection, or have normal cultural aversions to direct eye-contact (which AT/P regards as a definitive symptom). These can easily be the case between new parents and an adopted child. But even a toddler suspected of being overly friendly to strangers, or a baby who does not manage eye contact during nursing (a real trick to do!), can be labeled AD.

Again, in AT/P the fault never lies with the current parents or with their manner of interacting with the child (which can just as easily be the real problem). Since it is the parents who make the decision whether to place the child in therapy, AT/P is pitched to the parents as a attractive alternative to the difficult work of conventional family therapy. (Though it should be noted that some Attachment Therapists may suggest separate Attachment [Holding] Therapy for the parents, in addition to that for the child.)

Pseudoscience

Attachment Therapy is an unvalidated psychotherapy, meaning that there is no scientifically acceptable evidence for its efficacy. Moreover, because of its violent nature, it cannot be considered safe. Indeed, there have been deaths from it.

Even the condition for which AT/P is an alleged treatment — Attachment Disorder — is unrecognized outside of AT. There is one relevant diagnosis appearing in the American Psychiatric Association’s
Diagnostic and Statistical Manual (DSM-IV), called Reactive Attachment Disorder (or RAD). The AT community has latched onto RAD as a rationalization for using AT (even calling children “RADishes”), but unjustifiably so. The DSM-IV considers RAD to be “very uncommon” (i.e., rare). The diagnostic criteria are very strict and almost no child labelled RAD (in AT) actually meets those criteria. Moreover, a RAD diagnosis must be differentiated from other more established diagnoses, such as ODD, PTSD, ADHD, PDD, bipolar, and autism. The American Psychiatric Association has recently (June 2002) issued a Position Statement warning against the use of AT in the treatment of RAD, pointing out that all of forms of coercive restraint are contraindicated. The American Professional Society on the Abuse of Children, together with a unit of the American Psychological Association, in 2006 strongly recommended against the use of AT/P methods and approaches, even calling for child-welfare officials to consider them “suspected child abuse.” (There have been many other position statements taken, for which see our Opponents page.)

There is only one study of the efficacy of Attachment Therapy to have been published in a peer-reviewed journal. (
Myeroff, 1999) It involves neither randomized controlled trials nor clinical controlled trials. It is called “quasi-experimental” by its own authors and firm conclusions cannot be drawn from it. Also, the study only measured performance in one dependent variable — aggression, and not “Attachment Disorder,” so it may even be a non sequitur to AT.

There are only a few instruments to diagnose and quantify the severity of Attachment Disorder in children. None of them have been validated. First among them has been the Randolph Attachment Disorder Questionnaire (RADQ), developed by
Elizabeth Randolph, PhD, in the mid-1990’s (apparently at about the same time, or immediately after, she had her psychology license revoked by the State of California). It consists of a questionnaire self-administered by parents, as opposed to one evaluated by disinterested professionals. This is typical of the others as well.

The RADQ was published and sold by a leading AT/P center, The Attachment Center at Evergreen. Despite representations to the contrary by many AT/P proponents, the RADQ is unvalidated; there is no published research to establish that the instrument reliably identifies AD (
i.e., has low rates of false positives and false negatives), much less to determine its sensitivity for quantifying the Disorder’s severity in a child. Without such validation, the instrument is utterly worthless for use in a clinical setting or in research into the efficacy of AT modalities. Yet, the RADQ is extensively used by Attachment Therapists to diagnose AD and to show parents just how bad their child supposedly is (or might become), and even if he needs to be institutionalized. Some therapists use it to show parents that their child has RAD, though the instrument is not even purported to differentiate symptoms from those displayed by other disorders (as required by the DSM-IV for a RAD diagnosis). The checklist-type alternatives to the RADQ are equally undiscriminating and unvalidated.

APSAC Report

In 2006, a task force convened by the American Professional Society on the Abuse of Children issued their report on Attachment Therapy (“Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems,” Child Maltreatment, Feb 2006; 11(1):76-89) This report found the unvalidated practice of Attachment Therapy, its parenting methods and use of the “Attachment Disorder” diagnosis “inappropriate for all children. They further recommended that child welfare workers investigate these practices as “suspected abuse.” The American Psychological Association’s Division on Child Maltreatment adopted this report and its recommendations. It is our opinion that this report makes the practice of AT/P very difficult to defend legally.

Conclusions

With no recognized theoretical basis, no published research, and no validated instrument with which to do research, but with pretentions in the direction of science, AT/P can at best be considered a pseudoscientific enterprise. Add to its pseudoscience the fact that AD is not even a well-defined disorder as a differentiable diagnosis, the clinical practice of AT/P qualifies for the label of quackery.

In mental-health practice, as in medicine, there are therapies whose safety and efficacy have been scientifically established — and then there is everything else. Practicing something that falls into the “everything else” category is either
fraudulent (like quackery) or experimental.

The post-war trials of Nazi doctors established an internationally recognized code of conduct, known as the
Nuremberg Code on Permissible Medical Experiments. It has been accepted in the US that this Code applies to mental-health practices as well as medical. Moreover, it was established in 2001 with a Colorado jury in the criminal trial of Connell Watkins, an AT pioneer and practitioner, that Attachment Therapy violates at least eight of the ten principles laid down in the Nuremberg Code. It is therefore not unfair to say that AT/P is either fraudulent or a crime against humanity.

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The success of advocates in getting state and federal governments to pay for AT/P, directly or indirectly, raises another wrinkle. The practices of AT/P in general are mentally and physically torturous. Indeed, those techniques resembling brainwashing and using coercive restraint are internationally recognized as torture. Along with having state workers (including judges) refer children for AT/P, government payments mean that Attachment Therapy is, literally, state-sponsored torture. This means that the US is in violation of the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.

AT/P arguably violates the rights of children in other international instruments as well. There is, of course, the non-binding Universal Declaration of Human Rights passed by the United Nations’ General Assembly in 1948. There is also the Convention on the Rights of the Child (though, unlike the Convention Against Torture, it has not been ratified by the US).

Whether as pseudoscientific fraud, quackery, a crime against humanity, state-sponsored torture, or contrary to human rights and dignity, AT/P is a heinous violation of children. It is no excuse that it may be done with loving intentions and in an environment of caring. Some of the best love and care we can give children is protection from deliberate abuse.

No child is ever deserving of harsh, irrational, undignified, painful treatment, especially by, or at the direction of, a therapist. AT/P is merely another name for child abuse. It rob children and parents alike of the pursuit of happiness that is their birthright.