Martha Welch

Martha Welch

Martha G. Welch, MD, is a major figure in Attachment Therapy, who for a time served on the board of ATTACh (Association for the Treatment and Training in the Attachment of Children), the trade organization for Attachment Therapists. She became widely noticed with her 1989 book, Holding Time (in English, Finnish, Italian, Japanese, and German). She has used various other terms for Holding Time, which include Welch Method Regulatory Bonding, Direct Synchronous Bonding, and Prolonged Parent Child Embrace (PPCE). These methods are more commonly known as both Holding Therapy and Compression Therapy.

A child psychiatrist and assistant clinical professor at Columbia University, Welch first gained notice by claiming Welch Method Regulatory Bonding was an effective treatment for autism, which she said she “pioneered” in the 1970s while at the Albert Einstein College of Medicine in New York City. Her ideas were initially supported by Nobel Laureate Nikolaas Tinbergen.

As the use of Holding Time (i.e., Holding Therapy) waned as an autism treatment, Welch continued to promote the practice for “attachment” between parent and child, and between other family members. The therapist’s role in her model is to supervise holding sessions. Welch also encouraged mothers to use these techniques frequently at home to prevent problems, as well as treat a host of conditions such ADHD and sundry learning disorders.

In 2003, the Acting Chairman of Columbia’s Psychiatry Department disclaimed any connection between Holding Time and his department: “…Dr. Welch does not utilize bonding therapy or related techniques in her work as part of the Department of Psychiatry. Her efforts here are devoted to non-clinical research. Her work on bonding therapy is conducted outside of her departmental activities.”

In 1997, with funds from a Federal Adoption Opportunities Grant (90-CO-0745), Welch produced the film “Introduction to Holding Time.” Two years later, Welch published a four-part video training tape entitled “Welch Method Attachment Therapy.” Here is a clip from that tape (note Welch sitting further back, giving direction):

The first (and to date) only published research on Holding Time (referred to as PPCE) appeared in 2006 as a pilot study (see mentions below). Among other questionable things in that research, Welch and her associates used Elizabeth Randolph’s unvalidated Attachment Disorder Questionnaire (RADQ) for outcome measures.

Meanwhile, Welch’s Holding Time approach has been embraced by the “gay-to-straight” movement. Richard Cohen, in his 2000 book, Coming Out Straight, suggested that therapists can cure homosexuality — or parents could avoid it in the first place — with Welch’s method: “I recommend the use of Attachment/Holding Therapy as taught by Dr. Martha Welch. My family and I did some healing work with Dr. Welch. If I had experienced holding time with my parents several decades ago, I would not have needed to process through my thoughts and feelings with so many therapists and groups.”

Two video clips from of Martha Welch’s Holding Therapy can be seen

In Her Own Words

— Most Telling —

  • [To a mother lying over her small son] Right! Say that again. “My way!” Yell, “My way!” Introduction to Holding Time (Cleveland, OH: Beech Brook Spaulding Adoption Program, videotape, 1997)

  • When we first used [Holding Time] with normal children, we were very puzzled by the extent of the fight they gave their mothers time after time. Holding Time: How to Eliminate Conflict, Temper Tantrums, and Sibling Rivalry and Raise Happy, Loving, Successful Children (New York: Simon & Schuster, 1988), p. 51

  • Even a young child will sometimes question the fairness of using this type of force. Holding Time (1988), p. 51

  • Rejection begins as the child tries to escape your embrace, your gaze, or your words. The child may spit, kick, writhe, butt, scream, turn purple with rage — or his sad crying may break your heart. Holding Time (1988), p. 51

  • It is a good idea to begin holding in the first years of life. But how do you hold a baby who can’t talk to you? Is it good to make the baby angry? … You will not be making your baby angry. You will be allowing your baby to express anger in order to become better attached. Holding Time (1988), p. 121

  • Holding … It is a period of intense physical and emotional contact. It is surprising that all children, even relatively well-adjusted, normal children, at first respond in the same way as autistic children, becoming angry and rejecting the mother. Holding Time (1988), p. 22

  • Sometimes mothers are afraid to start holding time because the children might tell the fathers, who in turn might object to it. … After one [holding] session, which lasted about five hours, [the mother] felt a connection with [her son] that she hadn’t experience since his infancy. The father heard about this session and decided to go to court to prevent further therapy. Holding Time (1988), pp. 181-182

  • For older children — and certainly for adolescents and adult children — the mother and father have to use their whole body to contain the child. So they have to lie down. And it¹s more like a wrestling match. Introduction to Holding Time (1997)

  • Often a child will not give in [during Holding Time] until his mother has exposed the depths of her feelings of hurt, anger, rejection, and frustration. Holding Time (1988), p. 225

  • [T]he child was for the first time truly responsive to maternal cues. It was notable that both mother and child achieved an equal state of calm and bliss, in which they breathed in unison, melted into each others’ bodies, inhaled each others' smells, often kissing and licking each others’ faces and engaging in deep eye gaze.… — “Autism” Martha G. Welch Center for Family Treatment (website, 2000, accessed 19 April 2007) onlinetext

  • One of the most touching examples … Mike, age four, … ran to his mother after being hit on the head with a block by his two-year-old sister. Instead of blaming her or asking for attention for himself, he said, “Mommy, Christine hit me. She needs a holding.” Holding Time (1988), p. 212

  • Holders who live in apartments often explain to their neighbors, even before they are asked, that they are practicing holding time. Holding Time (1988), p. 49

  • It is very difficult at times to believe that your child really wants to be held, because of the intense resistance and rejection. Common complaints that really hurt a mother relate to the mother’s smell: “You stink.” “I can’t stand the way you smell.” “You have bad breath.” “You have B.O.” “I can’t breathe.” Holding Time (1988), p. 215

Compression Therapy —

  • In the case of a larger/older child, [mother] can lie down using her body weight to maintain physical connection. — “What is Holding Time?” (with Nancy D’Antonio) Attach-China/International (2001, accessed 19 April 2007) onlinetext

  • [During therapy session with Welch]

  • Mother [lying on young daughter]: You think I’m a big joke.

  • Daughter: I’m not thinking you’re a big joke.

  • Mother: Yes. Well, that’s how I feel. Because every time I ask you something, most of the time, when I ask you to do something, you blow me off. You do. You know you do. Now you’ve got a smirk on your face and you think it’s real funny. … Tell me how it makes you feel.

  • Daughter: Right now?

  • Mother: Right now

  • Daughter: [squirming] I can’t breathe!

  • Mother: I don’t care about that right now.

  • Daughter: Then, that’s how I feel.

  • Mother: No. That’s not a feeling … You’re not going to get up until we resolve it. … I want you to talk, because I know you’re mad.

  • Daughter: …I’m not mad…

  • Mother: You are mad.…

  • Daughter: I’m not mad. I want to get up.… Introduction to Welch Method Attachment Therapy (1999, videotape)

  • Mothers who are trying to restrain a very aggressive child find lying down to be the best position. They can use their bodies to keep the child from hurting them. Two hands are not always enough. Holding Time (1988), p. 218

  • [In Direct Synchronous Bonding,] “Direct” means eyeball to eyeball, chest to chest. Welch Method (1999)

“Holding Time” —

  • Confrontation is a brief phase during which you and your child come together to initiate holding. Holding Time (1988), p. 46

  • The child is held in a position that allows the parent to make direct eye contact while controlling the child’s attempts to protest, to struggle, and to escape. The technique anticipates and indeed facilitates confrontation … [The mother] uses her stength and tenacity to intensify the contact and prevent withdrawal. The struggle becomes desperate for both… Holding Time (1988), p. 25

  • I have found that the responses of parent and child in holding usually go through a specific sequence: Confrontation, Rejection, Resolution Holding Time (1988), p. 25

  • …[Holding] may progress quickly, even instantaneously, to the rejection phase. … Your child will begin to resist you. He may fight you physically, verbally, or both. As you hold on despite the child’s entreaties to let him go, his full range of feelings will begin to emerge, usually starting with anger but sometimes with fear or sadness. Holding Time (1988), pp. 46-47

  • Usually a child begins to fight to escape from holding to avoid the distress. Holding Time (1988), p. 226

  • [Three-year-old] Emily doesn’t want to hold.
    She cries.
    She pulls her mother’s hair.
    She refuses contact by shutting her eyes.
    After a protracted struggle, Emily allows eye contact. Holding Time (1988), pp. 36-38 [photo captions]

  • As long as you allow your child to battle through the rejection phase and join together with you in the resolution, you will be doing holding time correctly. Holding Time (1988), p. 218

  • But don’t let go! As you hold on, the child will begin to squirm and fuss or argue about getting down. Holding Time (1988), p. 49

  • It is not enough to give. What you give has to be received by your child. Holding time ensures that what you can give is utilized. Holding Time (1988), p. 144

  • Holding time … Do not wait for your child’s approval. Just do it. Holding Time (1988), p. 219

  • In some ways it is easier to do [holding time] when you are provoked. Holding Time (1988), p. 220

  • Holding is a good way to reassure the child that he is still loved, still your baby… Holding Time (1988), p. 207

  • When a child is ill, simple cuddling as opposed to holding is often the best option. Holding Time (1988), p. 227

The Promise of “Biological Synchrony” —

  • The resolution is a very nice time when [mother and child] get into biological synchrony. They melt into each other’s bodies. They gaze into each other’s eyes. They breathe in unison. Introduction to Holding Time (1997)

  • Resolution is marked by a sweet molding together of the mother and child, physically and emotionally. The pair relax in each other’s arms, gaze into each other’s eyes, and offer tender physical caresses. They feel a closeness that goes beyond mere cuddling or hugging. However long this stage may last, mother and child both seem to wish it would go on indefinitely. Holding Time (1988), p. 47

“New Idea of Child Development” —

  • …I began to use the technique with normal children with the same happy results. … I had assumed that the various “norms,” such as the “terrible twos,” sibling rivalry, or teen rebellion, were routine and unavoidable. When they began to disappear from children who were being exposed to my technique regularly, I began to formulate a new idea of child development. Holding Time (1988), p. 20

  • I theorized that developmental problems of children might well be caused by a break or disturbance in the mother-child attachment or bonding process … I went on to treat other disturbed children with mother-child holding as an adjunct to therapy. Holding Time (1988), p. 19

Holding Time as a Panacea —

  • Pretty soon word got around that [Holdings] had miraculous changes … in the development of the children. Welch Method (1999)

  • When this Welch Method Regulatory Bonding was used on a wide variety of disorders of regulation, such as Pervasive Developmental Disorder, Oppositional Defiant Disorder, Conduct Disorder, ADHD, Learning Disorders and disorders of attention and motivation, PTSD, Adjustment Disorders, and affective disorders, the outcomes were strikingly similar. — “Autism” (2000)

  • One mother … said, “Holding has established a bond in our family that has transcended every problem.” Holding Time (1988), p. 45

  • I have many examples of normal families who profited from holding time, families who successfully solved a wide variety of problems from temper tantrums to whining, from drug and alcohol abuse to accident-prone behavior. Holding Time (1988), p. 21

  • The list of distress signals that holding time mitigates is a long one: sibling rivalry, clinging, shyness, sleep disturbances, bed-wetting, stealing and other antisocial behavior, stuttering and speech delays, whining, destructive or dangerous acts, and tantrums. Holding Time (1988), p. 35

  • Holding time is protection against the devastating effects of divorce. Holding Time (1988), p. 188

  • [A holding] releases children’s energy for learning, for concentrating, for cooperating, and for getting along with other children. Holding Time (1988), p. 145

  • Holding time helps a preschooler to increase his verbal facility. Holding Time (1988), p. 136

  • If you use holding time regularly, chances are you won’t have much need for punishment. Holding Time (1988), p. 218

  • Holding helps a mother to have high expectations because she becomes better attuned to her child, which means she knows more precisely what he is capable of. Holding Time (1988), p. 138

  • If you are an overprotective mother, you need holding time even more. Holding Time (1988), p. 142

  • [W]ithout holding time your attachment with your child is constantly threatened by the complexities of daily life. Holding Time (1988), p. 211

  • In fact, holding time will become indispensable to any mother who wishes to raise healthy, happy, successful children who are capable of loving others. Holding Time (1988), p. 26

  • Nothing works the way Direct Synchronous Bonding does to achieve the optimal state in the family. Welch Method (1999)

Starting with Infants —

  • At what age do I start holding time? The ideal time to start holding is, of course, at birth. Holding Time (1988), p. 219

  • It is a good idea to begin holding in the first years of life. But how do you hold a baby who can’t talk to you? Is it good to make the baby angry? … You will not be making your baby angry. You will be allowing your baby to express anger in order to become better attached. Holding Time (1988), p. 121

  • You might wonder how to hold a baby who can’t talk. … If he arches his back, averts his gaze, or squirms to be put down, tighten your grasp. He will fight you. You must resolve not to let go until he relaxes happily in your arms. He will most likely become very frustrated. He may cry and scream. Most babies turn pink or purple from intense crying. … Some babies fall asleep … If he awakens still fighting, then you must hold on until he feels better. Holding Time (1988), p. 121-122

  • I will never forget the first resolution I saw with one eight-month-old. His holding was filmed on videotape by a colleague. The baby struggled fiercely … about forty minutes … It is truly shocking to see how much resistance your baby has. You must persevere. Holding Time (1988), p. 122-123

Holding Time for Benefit of Mothers —

  • Often mothers say, “Well, I can’t do a holding just because I’m upset.” And I say absolutely you can. If you’re upset for whatever reason — even having nothing to do with the child… Welch Method (1999)

  • Adoptive mothers often say after the first holding “I feel as though I just gave birth”, or “I feel the way I felt when I first nursed my biological child.” — “Reactive Attachment Disorder” Martha G. Welch Center for Family Treatment (website, 2000, accessed 19 April 2007) onlinetext

  • Divorce is a situation in which it is crucial to the mother’s well-being. You need love, affection, and mutual closeness. Without a spouse, you will be operaing at a deficit. Holding a child can help to compensate. Holding Time (1988), p. 184

  • [B]oth mother and child achieved an equal state of calm and bliss, in which they breathed in unison, melted into each others’ bodies, inhaled each others’ smells, often kissing and licking each others’ faces and engaging in deep eye gaze. — “Autism” (2000)

  • You have to express feelings every single day in this Direct Synchronous Bonding if you want to get your needs met. Welch Method (1999)

  • The mother can express her anger and sadness during holding with her child. At first this may sound unfair to the child, but in fact he will be greatly relieved to discover that he is not the cause of her depression. Holding Time (1988), p. 191

  • In fact, an excellent occasion for holding time is when you are feeling impatient. Holding Time (1988), p. 187

  • Holding Time … should happen when a mother needs it. Introduction to Holding Time (1997)

  • So if you aren’t feeling that your relationship with your child is feeding you and buoying you up, holding time can help. Holding Time (1988), p. 184

  • Some mothers worry that they are using their children. Holding Time (1988), p. 184

  • So many mothers report feeling that all they ever did was give, give, give. … If you feel this way, you need to start holding immediately and do it until you feel that your relationship is mutual. Holding Time (1988), p. 186

Holding Time for the Working Mother —

  • So you are wondering how you can raise a child yourself if you work. … Within the security of a relationship fostered by holding time, we all can do it. Holding Time (1988), p. 159

  • In holding time … your biggest task is to accept your child’s anger. If you accept his anger, he can live with your absence. Holding Time (1988), p. 167-168

  • If you sometimes feel trapped by your responsibility, remember that holding time is your safety net. This approach will allow you to deviate a great deal from the traditional pattern of child rearing (mother at home full-time) with fewer deleterious effects. Holding Time (1988), p. 71

  • It gives parents a way to compensate for mistakes they make, as everyone does. It gives parents a way to make up for absences and even for accidents of life that divert attention. … It makes parents feel more confident in their parenting, knowing they are doing everything they can for their children. Holding Time (1988), p. 35

  • However, if time does not permit both holding time and play, then make sure to do holding. Holding Time (1988), p. 168

  • If the mother is working, [holding time] helps give her a good enough connection with her child to feel less divided when she is involved in work or career pursuits. Holding Time (1988), p. 43

  • [H]olding time will go very far toward compensating for even the most difficult circumstances. No matter how much you cede your child’s care to someone else, your child will prefer you. Holding Time (1988), p. 170

Using the Notion of Catharsis —

  • When both mother and child have reached to the depths of their feelings, a catharsis occurs and the resolution begins. Holding Time (1988), p. 54

  • Three-year-old Emily … answered, “Mom and I hold and get our angries out.” Holding Time (1988), p. 43

  • Holding time allows both of you to discharge your pent-up agression [sic] in a safe way. Holding Time (1988), p. 47

  • Children really want to be held, as you will discover. They fight you because it helps them deal with their feelings. … It does not break a child’s spirit; rather it frees his spirit from the burden of anger and other negative feelings… Holding Time (1988), p. 214-215

  • [C]hildren as young as toddlers learn to save their anger. Holding Time (1988), p. 223

  • We make [children] all bottled up … we don’t want their anger, their meanest, their grief … The only way you can ever share the joy and love and happiness and tenderness of that child is to pop the cork. Welch Method (1999)

Requiring Eye Contact —

  • Your insistence that he look at you, even by physically forcing him to look at you, will bring on the resistance that will lead to rejection. Holding Time (1988), p. 50

  • Insist on eye contact. If you don’t get it, you are still in a partial or full rejection. Holding Time (1988), p. 225

  • As a result of the eye contact that Susan and her baby shared, there was no problem in attachment. Holding Time (1988), p. 73

  • Fight for complete eye contact. … Insist on being hugged and cuddled. It is not enough for your child just to allow himself to be held by you. If he doesn’t snuggle into you, you are still in the rejection phase. Don’t give up until you feel better. Holding Time (1988), p. 225-226

  • [In Direct Synchronous Bonding] “Direct” means eyeball to eyeball, chest to chest. Welch Method (1999)

Holding Time as Diagnostic —

  • If you use Direct Synchronous Bonding as a therapy, you’ll find out it’s a diagnostic tool… Welch Method (1999)

  • Holding time makes you aware of existing problems. Fortunately, it solves the problems as it uncovers them. Holding Time (1988), p. 214

Holding Time for Autism —

  • The chances of evoking a direct emotional and meaningrul response from autistic children traditionally have been almost nil, nowithstanding the extraordinarily rare exceptions. But the breakthroughs that I was able to achieve and replicate were surprisingly consistent and significantly frequent. Holding Time (1988), p. 18

  • We had our first mothering therapy center at Albert Einstein College of Medicine. … Teenage unwed mothers of autistic children … We would have to run around and catch the mothers, capture them, thrown them on the couch, plaster their kids onto them and then the Direct Synchronous Bonding could take place. They just loved being chased and caught. Welch Method (1999)

  • …I decided to experiment and ask the clinic mothers in my care to hold their autistic children, forcibly if necessary. The children did not want to be held. They fought and kicked, spat and bit, screamed and cried. Holding Time (1988), p. 19

  • And this is what convinced Nobel Laureate Tinbergen to back my work. When he saw that state of calm arousal in autistic children after holding, he said, “This is right.” Welch Method (1999)

On Autism —

  • [T]he mother mentioned that she had never been held as a child and that, in fact, she had not be able to bring herself to hold or cuddle her son when he was a baby. The result was that he screamed and cried endlessly for most of the first eight months, then suddenly sent into autistic withdrawal. Holding Time (1988), p. 18

Group Holds —

  • They started a mothers’ group, which met weekly. One hour was devoted to mother-child holding. The second hour was for socializing and discussing issues … The group met in a local church… Holding Time (1988), p. 224

“Needs Cycle”? —

  • If a child’s needs are not met in a timely manner, they feel hurt, sad, angry and helpless. They feel bad about themselves and lose their sense of security and trust. In extreme cases, this will lead to mean, aggressive or even sadistic behavior. What is Holding Time? (2001)

For Mothers Only —

  • [A] father’s holding is not a substitute for a mother’s. Holding Time (1988), p. 220-221

  • …[T]he primary attachment is to the mother, and that is whether it’s a biological mother or adoptive mother and no one else can do it. It has to be a mother. Welch Method (1999)

Other Beliefs —

  • The infant arrives in the world already preferring his mother to all others. Holding Time (1988), p. 72

  • The moment of childbirth is extremely important to the formation of a strong attachment between you and your baby. Holding Time (1988), p. 96

  • Breast feeding is thought to provide the … closest bond between mother and child. Holding Time (1988), p. 93

  • It is very important to allow yourself and your baby [during breastfeeding] to … gaze into each other’s eyes during this time of gratifying his hunger. Holding Time (1988), p. 94

What Results? —

  • [M]y main efforts of the past several years have been aimed at spreading the Welch method of holding therapy as an effective treatment. … My results have been replicated by other professionals in the United States and in Europe. Holding Time (1988), p. 23

“Research” —

  • A typical PPCE [Prolonged Parent-Child Embrace] interaction between mother and child consisted of the mother embracing the child face to face for 20-90 min. Such an interaction progressed through a sequence of four stages (with associated emotional states):
  • Confrontation (discomfort, irritability);

  • Conflict (expressing fears, anger, or hurt);

  • Resolution of conflict (reciprocal embrace, caressing, kissing, conversation);

  • Synchrony (attunement, reciprocity, state of calm arousal).

…A successful PPCE cycle ended in stages 3 and 4… — (with Robert S. Northrup, Thomas B. Welch-Horan, Robert J. Ludwig, Christine L. Austin, and Judith S. Jacobson) “Outcomes of Prolonged Parent-Child Embrace therapy among 102 children with behavioral disorder,” Complementary Therapies in Clinical Practice, Feb 2006, 12(1):3-12 onlinetext

  • PPCE Therapy [for this study] was funded through state aid, private insurance, subsidies, and self-payment. — “Outcomes…” (2006)

  • The intensive component of the intervention consisted of two consecutive days of PPCE Therapy in a single large room. Four to seven families were treated simultaneously but independently in each session on separate cushioned mats with coaching from the therapist teams and mentor families. Up to 60 people attended each session, including therapists, mentor families, identified patients, parents, siblings, grandparents, and others close to the child. — “Outcomes…” (2006)

  • Parents in each family completed one or two baseline written measures. … These measures included the Achenbach CBCL and Randolph Attachment Disorder Questionnaire (RADQ). — “Outcomes…” (2006)

  • The RADQ is a 30-item instrument encompassing the most common adverse symptoms of the CBCL associated with this study’s population. It is widely used by therapists treating families with adopted children diagnosed with RAD. — “Outcomes…” (2006)

  • Parents tended to fill out the shorter RADQ measure (30 questions) as opposed to the lengthier CBCL measure (120 questions). — “Outcomes…” (2006)

  • …[T]he intervention proved to be effective from the parents’ perspective. — “Outcomes…” (2006)

  • PPCE Therapy appears to replicate or reinstate the effects of normal early nurturing on the infant… — “Outcomes…” (2006)