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In Her Own Words

— Most Telling —

• [T]he chosen treatment for [this child] is holding therapy. — “Reactive Attachment Disorder” [with Heather T. Forbes], as Chapter 5 (pp. 143-168) of DSM-IV-TR in Action (ed. by Dziegielewski; Hoboken, NJ: Wiley, 2002 [ISBN 0471414417]), p. 163

• If one were to watch a therapeutic hold for the first time, without an understanding behind the technique, he or she might perceive it to be abusive or coercive. — DSM in Action (2002), p. 164

• With Welch Method DSB [Direct Synchronous Bonding], the mother-child hold begins with the mother taking the child into her arms and holding him closely. If the child is too large for this cradle hold, the child lies down on his or her back and the mother lies on top of him or her, with her face facing the child’s. This physical contact is imperative to the success of this intervention. — DSM in Action (2002), p. 164

• [F]ew longitudinal studies are available to legitimize current treatment modalities. One such treatment method, holding therapy, is an emotionally driven and intense therapeutic intervention. … With an increase in international adoptions, this therapy should be considered for treatment of the young client who is suffering from the residual effects of beginning life in an orphanage where bonding with the caretaker and physical touch have not been present. — DSM in Action (2002), p. 143

— Conflating “Attachment Disorder” with the DSM’s Reactive Attachment Disorder —

• [T]he term RAD [Reactive Attachment Disorder] used from this point includes both the criteria defined in the DSM-IV-TR combined with the clusters of behavioral symptoms accepted among professionals treating these children. — DSM in Action (2002), p. 149

• Many seasoned practitioners who work in the area of attachment suggest that the current definition is limited. … The result is that although the diagnosis of RAD is still taken from the DSM-IV-TR, it is being used in a freer and less stringent manner than most would expect, deviating from time to time from the specific criteria outlined in the DSM-IV-TR. — DSM in Action (2002), p. 147

• It is important to note that much of the literature written today does not make a distinction between RAD and attachment disorder. A great deal of the literature erroneously uses the two terms interchangeably. These two disorders are distinct from one another. — DSM in Action (2002), p. 147

• Overall, the behavior of children with severe attachment difficulties is characterized as being aggressive, controlling, and attention seeking. In their attempts to control the external environment, children with severe attachment difficulties demonstrate a blatant disregard for authority. — DSM in Action (2002), p. 147

• It appears that the ODD is simply a by-product of the RAD and that these behaviors will be resolved upon treatment for RAD. — DSM in Action (2002), p. 159

— Holding Therapy —

• There are several different types of holding therapy being practices in attachment therapy and all are limited in published and proven effectiveness. However, most practitioners in the attachment field would argue that it is the only therapy that offers hope for true change. — DSM in Action (2002), pp. 163-164

• In this case presentation, Welch Method DSB [Direct Synchronous Bonding] is the particular type of holding therapy being advanced… — DSM in Action (2002), p. 164

• …Welch Method DSB directly and intensely activates this behavioral system, creating an environment conducive to attachment — DSM in Action (2002), p. 165

• Critics believe it is a violation of the child’s rights to be held and that therapy should always follow the child’s lead. Many critics further believe that strong confrontation is bad for children. However, many proponents of holding therapy believe it to be exactly the opposite. Some attachment professionals believe that children with RAD need strong confrontation in order to break through the child’s overdeveloped defenses. Other attachment professionals believe that physical touch is necessary in their therapeutic experiences in order for deep interior changes to happen because children with RAD are so skillful at keeping people at a distance. — DSM in Action (2002), p. 164

• At the beginning, the child has a short period of feeling good in the mother’s arms. Then the child begins to want out of the hold and becomes angry and attempts to get free. The child then works through this conflictual stage with the mother, usually with a full range of emotions from yelling to crying to attempts at biting or hitting. It is at this stage that the anger and conflict is used in a positive way in order to reach resolution. Once the anger is expressed by both the mother and child, the deeper emotions beneath can then be explored. — DSM in Action (2002), p. 165

• [E]nuresis may be a direct result of the RAD [Reactive Attachment Disorder] and may be resolved through successful treatment of RAD. — DSM in Action (2002), p. 161

— Holding Therapy for the Whole Family —

• Treatment would include holding sessions with these grandparents with the mother in order to resolve the issues of the past. These intergenerational holds will allow the mother to be liberated from her past pains to be emotionally available to [her child], even during times of his complete rejection. — DSM in Action (2002), p. 166

• Holding therapy is also used as an intervention to resolve conflicts between the child’s parents and the child’s extended family members. — DSM in Action (2002), p. 143

— Compression Therapy for Spouses —

• The Welch Method DSB [Direct Synchronous Bonding] will also be used to help the mother and father improve on their marital relationship. … [W]ith the husband physically on top of the mother … Again, the confrontation and anger are used as a tool in order to reach deep emotions that have been buried and it will help the couple to find some of their "honeymoon" connections that have been lost. — DSM in Action (2002), pp. 151-152

— Resurrecting the Notion of Catharsis —

• [A child in Holding Therapy] does not want to feel these emotions. He then fights for his life in order to keep from being hurt and from feeling these emotions. Welch Method DSB will allow [the child] to work through his past emotions and push him to express his buried feelings while being loved during the cathartic experience of the hold. — DSM in Action (2002), p. 165

• Since so many of these children live in an inner world of anger and fear, attachment therapy is needed to release the internalized rage in order for the child to be able to accept love. — DSM in Action (2002), p. 163

— The “Attachment Cycle” —

• A child who is scared or has needs such as hunger, instinctively searches to satisfy that need from his mother; the mother acts as the regulator and satisfies this need. Thus the child is gratified, is receptive to his mother’s gratifying efforts, and returns to a state of homeostasis. [figure 5.1: "attachment cycle"] — DSM in Action (2002), p. 151

• When this attachment cycle is not repeated, literally thousands of times (Hughes, 1997) in the mother-child relationship in the first two years, attachment problems are likely to occur. — DSM in Action (2002), p. 152

— Isolation —

• It is important to note at this point that the goals, objectives, and interventions are not community-based. … [A] community-based approach would be detrimental to Joseph’s treatment. Outside interactions with Joseph would only serve to distract him from his mother. … Instead, the focus needs to be contained within the home itself — DSM in Action (2002), p. 163

• The mother is to stay with the client 24 hours a day, 7 days a week, with the child having no direct interactions with friends, teachers, or baby-sitters. — DSM in Action (2002), p. 163

• Additional support is also needed for the mother as the treatment involves isolation in the home with the child. Although the isolation is imperative for the child, it will be extremely difficult for the mother. — DSM in Action (2002), p. 166

• Children with RAD typically project their anger, resentment, and sadness onto the mother; the mother becomes the main target. — DSM in Action (2002), p. 148

— School —

• Mother is to remove her child from school and register her child for home school status with the local school system. — DSM in Action (2002), p. 161

— Parental Coercion —

• Mother will continue to physically contain the client when he becomes anxious, angry, or aggressive. … To accomplish this she will watch a video tape and role-play the demonstrations of more passive restraint.…
• Mother is to join adoptive support group through the Internet.…
• Mother is to allow the client to verbally and physically release his anxieties, frustrations, fears, and sadness with her.…
• Mother will verbally and physically release her anxieties, frustrations, fears, and sadness with her husband.…
• Mother and father are to read from a recommended reading list of attachment books and articles.…
• Mother and father are to watch a recommended series of videos with parenting strategies for how to best handle children with RAD. — DSM in Action (2002), p. 161

— Affect Regulation by Parent —

• The therapeutic alliance between the therapist and child developed in traditional play therapy can be used to facilitate and build the relationship between the child and the parent, but it is the parent who is biologically designed and equipped to be the regulator of the child, not the therapist. — “Re-Examining Play Therapy — with the Parents” [with Heather T. Forbes], Accredited Continuing Education Training, July 2004, p. 2.

— Unreliable Notions from Questionable Sources —

• [P]ublished journal articles on attachment research and books authored by attachment specialists go beyond those outlines in the DSM-IV-TR for RAD [Reactive Attachment Disorder] and indicate a wider range of behavioral symptoms for a child with attachment difficulties. The boxed chart gives examples of such behavioral lists from experts such as Daniel Hughes, Gregory Keck and Regina Kupecky, and Foster Cline and C. Helding. — DSM in Action (2002), p. 147

• Welch Method DSB allows both the mother and the child to release their anger. … Welch Method DSB addresses both the needs of the child and the mother. — DSM in Action (2002), p. 164

• REACTIVE ATTACHMENT DISORDER (RAD)[:] Jeffrey Dahmer, Edgar Allen Poe, Hitler, Ted Bundy, Saddam Hussein, and Ted Kaczynski, the Unabomber — what do all of these infamous individuals have in common? All had attachment breaks in their childhood and did not receive therapeutic help (L. Thomas [sic], 2000, p. 67). — DSM in Action (2002), p. 143

• Many children with RAD are typically misdiagnosed with. … conduct disorder, oppositional defiant disorder, disruptive behavior disorder, posttraumatic stress disorder, and separation anxiety disorder (Reber, 1996). — DSM in Action (2002), p. 150

• Allowing a child to play out stress within a controlled therapeutic play environment with the help of a therapist has been an accepted model of treatment. — “Re-Examining Play Therapy” (2004), p. 3.

• …Bed-wetting often ceases after four to six weeks of attachment therapy (Welch, 1988, p. 228). — DSM in Action (2002), p. 159

• [Traditional] types of therapy work on the premise that the individual can trust authority, has sufficient concern for others, and feels enough anxiety or guilt to want to change. These therapies are typically based on cognitive theory and will not reach and change a child at the depth of an emotional disorder such as RAD (Pickle, 2000) — DSM in Action (2002), p. 163

• Adopted children can be powerful forces in upsetting even the most stable of marital relationships. Many special needs children successfully disrupt the relationship between the triad of the mother, the father, and the child; they can “manipulate and triangulate, divide and conquer” (Foster Cline and Helding, 1999:71). — “Issues Facing Adoptive Mothers of Children with Special Need,” (with Sophia F. Dziegielewski), Journal of Social Work, 3(3):301-320 (2003), p. 306

• Adopted children work at creating conflict between their parents in order to improve their odds in the ongoing battle (Keck and Kupecky, 1995). — “Issues Facing Adoptive Mothers” (2002), p. 306

• Children who have not had their needs met, develop more aggressive strategies in satisfying their needs, such as screaming, charming, or manipulating, all in an effort to gain control over others (Hughes, 1999). — DSM in Action (2002), p. 147

• Many of the behaviors of children with attachment problems also include cruelty to others and animals; persistent lying, stealing, and self-destructive behaviors; thoughts about fire, blood, or gore; and a refusal to accept responsibility for consequences or actions (Cline and Helding, 1999). — DSM in Action (2002), p. 147

• Bryan Post, PhD, an internationally recognized family therapist writes, ”The child is only as healthy as the parent.“ — “Re-Examining Play Therapy” (2004), p. 3.

— The Unvalidated RADQ —

• Research indicates “there is no standardized or even widely accepted assessment protocol used to validate this diagnosis” (Hanson & Spratt, 2000, p. 140). However, one standardized tool that can assist in the diagnostic assessment is the measure adopted by attachment specialists known as the Randolph Attachment Disorder Questionnaire (RADQ). — DSM in Action (2002), p. 164

• It is important to make the distinction that the RADQ was developed to measure attachment disorder, not RAD (M. Randolph [sic], personal communication, August 2001). — DSM in Action (2002), p. 164

• In comparison to the behaviors listed on the RADQ, these behaviors [of antisocial personality disorder] have a chilling similarity. — DSM in Action (2002), p. 164