Heather Forbes
Heather T. Forbes is a social worker from Orlando, Florida, who recently relocated to Boulder, Colorado. She describes herself as a psychotherapist specializing in Reactive Attachment Disorder and has trained “with nationally recognized, first-generation attachment therapists since 1999.” These therapists turn out to be Bryan Post and Martha Welch.
Together with Post, Forbes authored a book, Beyond Consequences, Logic, and Control. Earlier the two had created the Beyond Consequences Institute to offer treatment based on Post’s “Stress Model” found in that book. From the website (www.beyondconsequences.com), it appears that Forbes is the Institute’s principal.
Ronald Federici, a leading Attachment Therapist, says that Forbes is part of his staff as a “Professional Consultant for Intensive Parent Training.”
Forbes also co-authored, in 2002-2004, a book chapter and articles with Sophia Dziegielewski.
In Her Own Words
— Most Telling —
- [T]he chosen treatment for [this child] is holding therapy. — “Reactive Attachment Disorder” [with Sophia F. Dziegielewski], 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
— “Recapitulating Developmental Experiences” —
- Hoarding and Gorging … When discovering this behavior, recognize that your child needs you to … bottle-feed him to revisit an interrupted developmental process. — Beyond Consequences, Logic, and Control: A Love Based Approach to Helping Attachment-Challenged Children with Severe Behaviors, Volume I [with B. Bryan Post] (Orlando, FL: Beyond Consequences Institute, 2006), p. 63
- [P]arents are encouraged to … [b]egin bottle-feeding your child … yes, begin bottle-feeding your twelve or even fourteen-year-old. If a child needs it, regardless of his age, he will take the bottle. … Remember that if the child did not receive sufficient developmental nurturing, then he has a barrier in his development. Until the barrier is addressed, the other levels are going to continue to stagger. The bottle-feeding should only occur while the child is in the parent’s arms. — Beyond Consequences, Logic, and Control (2006), p. 59
— 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
- Parenting Example … The parents need to understand that [their adopted sixteen-year-old son] Tommy has been acting out aggressively from a primal state of fear, not anger. … The parent then closes the door of the room, creating physical containment for Tommy … [H]is parent needs to say to him, “Tommy, you must be really scared right now. By you telling me that you’re going to kill me, that only means that you’re really scared that someone might kill you.” The parent then closes the door of the room, creating physical containment for Tommy, and the parent sits on the floor, lessening the perceived threat of the parent. … [T]he parent sits on the floor … the parent then invites Tommy to express his emotions, “Tommy, tell me how scared you are right now. I’m not going anywhere…” Tommy will ultimately, even if it takes three or four hours, or even six hours, be able to safely discharge some of the bound-up fear-driven energy within his body. — Beyond Consequences, Logic, and Control (2006), pp. 70-71
- “…[Y]ou look really mad right now. I want you to tell me you’re mad. Really, tell me you’re angry you have to turn the TV off.” — Beyond Consequences, Logic, and Control (2006), p. 68
- When discovering your child has stolen, recognize that he needs you to … keep him close to you in that environment; limit his space and create containment for him… — Beyond Consequences, Logic, and Control (2006), p. 54
— “Neurology” —
- [W]here it was too late and Tina already became aggressive, her foster mother could help Tina understand that she was too stressed to play at that moment … Tina’s foster mother would then be addressing Tina at her state level of survival, calming her activated primal fear that is stored within the cells of Tina’s body. Tina’s foster mother would then have become Tina’s external hippocampus… — Beyond Consequences, Logic, and Control (2006), p. 67
— 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 Sophia Dziegielewski], Accredited Continuing Education Training, July 2004, p. 2.
— Repeat After Me… —
- [I]t is imperative that you read and reread this section as often as possible to fully comprehend the recommended new perspective. — Beyond Consequences, Logic, and Control (2006), p. 1
— Prior Endorsement —
- The Welch Center Intensive Family Treatment was the only viable and effective solution to the problems we were experiencing in our family. In fact, today, it is not only a solution, but also an integral part of our lives. — “The ONLY solution for us,” Treatment Success (Welch Center website, 24 Jan 2002, accessed 13 Jun 2007)
