Holding Therapy, Autism-Spectrum, and Child Behavior
- Cassandra Killpack (Autumn Blackwell)
- Adoption USA
- Reactive Attachment Disorder: A New Understanding
- How to care for the traumatized child
- Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems
- Do the terms RAD and Attachment Disorder mean anything to you?
- Withdrawal in a relationship
- Holding Therapy
In a previous post, Ignorance and Attachment/Adoption Issues, I listed many concerns I have related to Holding Therapy, and how it is being used to change or modify a child's behavior. Based on what I have read in cases where adoptees were abused by parents following the teachings and suggestions made by those associated with "attachment therapists", my concerns about the use of HT with a child include:
- What may work for an adult may not work well for a child, especially in terms of "bonding" and "behavior modification".
- People with money are not afraid to travel outside their town, state, or country, if it means they will get the promised reward they seek. [So the argument that questionable practices are "banned" in certain areas only means certain people are banned from using them.]
- Desperate people will see only what they want to see, and are likely to make their final decision based on sentiments, like fear and hope, not facts.
- Some PAPs can get mighty desperate, especially if they have spent years trying to get pregnant via fertility treatments. [This is a very special breed of PAP, one that should come with all sorts of flags and warnings....]
- Adoption agencies do NOT prepare, educate, or support as they should or need to
- There is NO transparency in adoption.
- In many cases, blame should NOT be placed on the parents; it ought to be placed on sketchy opportunists trying to save or make money, at the cost of others.
My concerns fall under the umbrella of one simple question: What are children with behavior problems being diagnosed with? [Can these diagnosticians be trusted?] For instance, if a person has autism, can the person also have PTSD? If a child is diagnosed with an attachment disorder, like RAD, can that child have autism, too? How would PTSD influence any other diagnosis given to a child or adult? And last but not least, if a child does not want to bond or attach to a particular person, does that mean the child is mentally ill?
For the sake of open discussion, I'd like to share what Jirina Prekop, a seemingly highly enlightened psychologist and Holding Therapist, has to say about Holding Therapy, a therapeutic approach made popular by America's own Martha Welch.
But first, who is Jirina Prekop, other than a Czech psychologist? According to a translated wiki-page,
Jirina Prekop left after studying psychology, philosophy and pedagogy in 1970 Czechoslovakia and settled in the Federal Republic of Germany down. She was a psychologist at the Olga Hospital in Stuttgart operates. In 1981 she took over from the American psychologist Martha Welch of the principles of holding therapy for the treatment of autism and developed it, including the "systemic approach" of equally controversial Bert Hellinger  to the "holding therapy after Prekop" continues. She also published several educational guides and supports the family policy, conservative Christian pressure group Family Network , which is committed against non-family child care primarily.  Today, Jirina Prekop lives in Lindau .
I myself had difficulty finding a quick easy-to-read summation on this particular psychologist. Nevertheless, according to Jirina Prekop's "Until Love Flows" page, I was able to learn a lot more about Holding Therapy, as it's being used outside the USA. (Keep in mind, even in states, like Utah, where amendments to the Mental Health Professional Practice Act and the Psychologist Licensing Act, now make it unlawful to use or recommend re birthing or similar therapies, it does not mean lay people, like Nancy Thomas or others in her circle are banned from writing books, distributing videos, or teaching instruction to desperate parents who want to know how to discipline and control the difficult to care-for fostered/adopted child.)
While I understand the panic that goes through the mind of a parent facing a new and scary situation no one in the family has ever seen before, I am in awe of those who think prolonged use of violence or punishment is "good" for child-conditioning. I myself read Dobson's "Dare to Discipline" book, and found it rather educational, because at no point did I read anything that told me the "dare to discipline" routine ought to include torture and forced confinement. ( Did I miss anything? Did I skip over the areas where natural consequences include going to court, because the parent needs to defend his/her method of teaching and discipline?). Readers need to understand, I went into parenting with the mind-set that I was not going to repeat the negative acts and actions all four of my parents did against me. I wanted to learn how to love and discipline, and do things using moderation, not extremes.
Below are some questions answered by Jirina Prekop, from her website. My comments following the Q&A boxes are not to mock or correct. Instead, I want to offer my own response, and whether I myself would have wanted my Aparents to consent to this type of therapy if I was 5 or 9 or 13. I think it's important to see how "informed consent" alters the dynamics of a relationship, between two or more people, especially when one person decides it's time to change or control a list of unwanted behaviors. My POV is from the victim's perspective -- the brainwashed person who has been controlled by those who held her against her will, told her to do things she did not want to do, and suffered tremendously, because of repeat like-traumas, which took place many many years ago (during childhood). And my POV reflects the survivor, who studied, learned and saw how trauma produces a verbal and non-verbal language few truly comprehend and understand.
Shall I tell my child why I hold him?
That depends an how mature your child is. If he hasn't got any insight, because he is too young or handicapped, you can't talk with him and appeal to his reason. But the more mature people are, the sooner I can and should do it thus respecting their dignity. Five or six year old children and older ones should be informed at any rate. They should be encouraged to express everything that makes them sad or furious; but violence is strictly forbidden on both sides. You can actually tell your child that he is physically stronger than his mother. But that's not the point; what matters is that both express everything that depresses them, and hold each other until both are all right again.
When I was little, I HATED when an adult would tell me to do something, and not explain why it was being done. I was told not to ask why, but to just follow directions because that's what was expected. In my profession (health-care) I can't think of any circumstance where I myself, "a care-giver", would NOT tell the person I'm caring for what it is I'm going to do, and why. Patients always have the right to refuse, even if refusal goes against medical advice. Those of us who have been touched or handled in ways that was unexpected, rough, and painful can understand just how critical 'fair warning' is to the mind that wants to fight for dear life. [Stress hormone response is real, and often forgotten, until it hits... like a ton of bricks.] Therefore, in some cases, if a patient decides, for whatever reason, he/she wants to refuse treatment, that patient has the right to do so. Forcing a child to go to a specific class, lesson, or treatment session may work for a while, but the child does not forget who said what, when and why. The consequence of being forced to do something you don't want to do manifests itself later in life.
What can you talk about while you are holding?
In no case you should discuss about anything. What matters most is the faculty of perception - of oneself and of others. And here sensual perception plays a leading role.
You should use only words that bring about crises and open wounds, by no means negative attributions like "you are a naughty child" or pedagogical demands like "I want you to do your homework properly". The purpose of Holding lies in the confrontation of emotions. That's why both have to utter their own feelings and reflect the feelings of the opposite person to give him the feeling of being accepted. This reflection can additionally be brought about verbally, e.g. "You are so furious with me!" "I have hurt so much!" "Let it out, give vent to your anger!"
If you watch the Martha Welch video, you will see how the mother yells at the child, but the child does not seem to be allowed to yell at the mother. I'm going to guess this is one of the Welch-methods that got re-worked and translated into a different form of HT. However, I don't see how having the parent hold and confess feelings, like, "You are furious with me!" or "I have hurt so much" or "Let it out, give vent to your anger!" would make matters much better. Knowing myself, as I was back then, and how I am now... I'd listen, I'd respond in the way that would get me out of that situation the fastest, and I would know, from that point on, "this person" only cares about his/her own feelings. There's not much a child can do about that type of person, other than adapt to the life-style that goes with the person who shows no real genuine concern about another person's needs or feelings.
Only after the storm has passed over, after the crisis is settled and both enjoy holding each other and caress each other, then talking can help to happiness as well.
The sexual connotation here is so strong, I don't know how else to respond other than this -- I know a lot of sex partners who could learn this "hold each other and caress each other" skill after 'the crisis' has settled. [Wham-bam, thank-you-ma'am is not the most loving way to share intimate moments with another]. In addition, I know plenty of sex-addicts who have trouble and struggle with the ability to turn to a loved-one during a crisis. [It's often much easier to turn to a stranger, than a partner who might be critical and judge.] And so a form of thrill-seeking (as a way to cope with stress) develops. This may explain why some "desperate mothers" are looking at this extreme form of therapy as effective and good. The rush it must give must be very similar to the rush a thrill chaser experiences when he gets involved in an extreme sport. Ahhh, the adrenaline, and the need to rest and relax, afterwards....
Newsflash -- a child who was raped, violently, does not know about "tender loving touches", after the crisis has settled. They know all about whispered warnings, and the shame and guilt that goes with the (not so sweet) whispered messages. The ability to shut-down (and become numb) becomes a survival skill, one young victims need to learn how to turn-off, so later in life, they can react to stress in a more healthy, more self-controlled way.
Is Holding easier when I am angry?
An acute occasion always makes Holding more dynamic. To the child it seems logical as well to practice Holding in an acute situation, but your anger must refer to the child. He shouldn't become a scapegoat if his mother is angry with a third person.
"An acute occasion", like an acute crisis? First thing that comes to my mind is, "acute adrenal crisis", which is perhaps the WORST time a parent can try to do "Holding Time" with an acting-out child. But let's assume this 'acute occasion' means a triggered event has sent emotions and behaviors in a bad direction. I cannot begin to express how bad and dangerous it would be if an adult tried to make Holding the child more "dynamic". One of two things would happen, depending on my state of mind at the time of contact/intervention. I would either go along, and play the game (but I'd remember who did what, and when, because those memories add-up, over-time.) OR I'd fight like hell. If someone got hurt, so be it. If I died, as a result, all the better. That would teach those people a little lesson about "natural consequence".
How long does one Holding Session last?
That depends on the temperament of the persons concerned and on the kind of conflict as well as on the depth of the grief and how long it has bottled up. I witnessed sessions of about a quarter of an hour and other ones lasting 3-4 hours.
Oh... WOOOOOOW. Imagine a person with PTSD subjected to this type of "control producing" therapy. The victim has no control over the situation, re-victimizing the victim over and over until the message becomes clear: the victim is allowed no control, ever. The victim learns subservience to power is required to survive. Fast forward to a marriage, where the controlling (more powerful) spouse does not let the victim ("I am weak") do or have anything he/she wants. How healthy is that bond?
The common denominator of these very long sessions is that emotions are kept back and can therefore be not worked on. The process doesn't actually get started. That is a definite indicator that therapeutical help is absolutely necessary. The reasons for keeping back emotions can be very different.
Surely a trained health professional understands the dangers of prolonged stress on a patient receiving treatment. Making the traumatized victim weak in this context is not that ideal, as the case of Candace Newmaker (Candace Tiara Elmore) exhibits.
Jeane and Candace made national news in April after Candace was smothered during an unconventional "rebirthing" exercise conducted by unlicensed Colorado therapist Connell Watkins and three of Watkins' aides. The April 18 exercise involved wrapping Candace tightly inside a blanket in a simulation of a baby curled inside a birth canal.
While Watkins and her aides surrounded and pushed on Candace with pillows to mimic labor contractions, the adopted girl was supposed to struggle free from her blue-flannel bonds and be "reborn," free of traumas that had marred her troubled childhood.
Instead she died, sweaty and streaked with her own vomit and begging for her life. A videotape of that session, which is now under court-ordered seal in Colorado, captured her repeated, insistent pleas to be freed because she could not breathe.
[From: The death of a new beginning]
The race for a "major breakthrough", is astoundingly self-centered on the therapist's and parent's part, and reflects nothing more than the parent's desire to be done with the bad stuff (quickly), so a normal life can be resumed.
What are PAPs being taught to expect when they agree to an adoption plan? What are the adoption agencies NOT telling these parents? And why are therapists trying to rush results?
This is where I have to insert the angry child, displaced and harmed by strangers is not the same as an autistic child, or the child with physiological deficits, found in the brain. And if the child is autistic, parents need to be taught the signs of conditions that pose a life-threatening event, like hypoglycemia or adrenal crisis.
So, I have to confess, it makes brilliant business-sense (to someone like me) to see someone like Prekop team-up with someone like Bert Hellinger - who has therapists in America, and the UK, - all over - following the traditions of his teachings learned through his own life experience. As one website explains:
Hellinger acknowledges several important influences on his life and work: his parents, whose faith immunized him against accepting Hitler's National Socialism; his 20 years spent as a priest and missionary with the South African Zulus; and his participation in interracial, ecumenical training in group dynamics led by Anglican clergy. After leaving the priesthood, he immersed himself in the study of the major forms of psychotherapy, including Psychoanalysis, Gestalt Therapy, Primal Therapy, Transactional Analysis and Family Systems Therapy, out of which, Family Constellation Work evolved.
[From: Hellinger Family Constellation Work ]
One could be perfectly formed, have 100% mental capacity and function, and have great parents (never abused or did anything harmful to the child before) but witness and experience such depraved events, like seen in war, or an orphanage, and have so much rage inside it alters the child's ability to communicate calmly and effectively. This is where PTSD comes in, and it's the part of the story that makes the fictional character Hannibal Lecter seem like the ultimate (diabolic) vigilante, and someone like Bert Hellinger a questionable saint.
One man's quest for knowledge can be another man's need for revenge (and "pay-back")... it all depends of the state of mind of the person seeking relief.
What's hidden behind these kept back emotions, by which the process of Holding is obstructed? We know that particularly mothers don't feel well in that case.
They suffer under their inability to oppose the problem and they experience a deep anxiety. In nearly every case the reason for that lies in their own socialization. A spontaneous expression of conflict-orientated feelings has been punished severely under an authoritarian pressure. Thus an open confrontation has been put under a strict taboo. It also happens again and again that in case of a woman holding or being held tightly other taboos are touched, e.g. the strictly hidden secret of an abuse. She remains silent in Holding as she had been silent then. Sometimes women even get into a panic which suffocates every word or feeling.
Am I the only one who sees the problem with a child having to endure Holding Therapy with the disturbed adult? Honestly, if HT works for adults, FINE, but is it really wise to use a child with rage issues and association problems in this type of situation?
If Holding is a matter of breaking taboos, then one has to wonder what taboo needs to be broken (and wrestled with) in order for a mother-figure to receive love and acceptance from a child.
As far as I can see, all these issues in 'holding therapy' have to do with the battle for control. I see the battle of good v. bad, the battle of strong v. weak. The battle of acceptance v. rejection. The question is, who is allowed to be the victor in this scenario, and who is allowed to be the victim? If a parent is trying to re-condition a child who has been brutalized in a previous home, the parent needs to have the good common sense to know the victim (the child) ought to be allowed to have small victories, where he/she is free to have the power to say, "I can't do anymore, let's stop for now. [we can try again, another time, but right now, I'm not ready to expose my thoughts... its too scary and confusing to me right now]". The good, compassionate, understanding person knows, that is not giving-up...that is allowing another chance, a new beginning, once the terror subsides.
And if a child is not quite at ease after Holding - what can be the reason for that?
This is always a sign that the Person holding has missed the crucial point, the central problem of the child. E.g. she expressed her anger about the child's retreatment, but didn't mention that she did him harm by prefering his little brother or sister. Even such few sensitive words like "I did you harm" would have broken the child's resistance. A satisfactory management of the crisis can also be prevented by a shift of positions in the family system. E.g. if a father is not yet grown up, but behaves like a child, helpless and full of self-pity, then the child would have to be strong instead of him. But such a sort of compensation is not at all satisfactory for both sides and quite unbearable for the child. In the process of Holding he tests his father if he actually is so weak, and is therefore disappointed if this test is 'successful'. But there are other offences against systemic patterns as well. E.g. a child fights against his mother because he stands in for somebody his mother has banished out of her mind. He stays loyal to his father after a divorce and ignores his mother to the same degree as she ignores his father. We can also make this observation with regard to adopted children who - deep in their hearts - stay loyal to their mother-german. Guided by his innate sense of balance many a child forms a coalition with the black sheep of the family. - In all these cases help from a Holding therapist is urgently necessary.
After I read "missed the crucial point", I lost interest in the rest. This is why my mind wandered: If HT is being used on an adopted child, and that child was the victim of neglect and abuse, one should not always assume the stubborn child is being loyal to a first-mother. Mythical mother issues... a huge favorite within the adoption community. I know in my own case, yes, I longed for my mom. More correctly, I longed for a warm loving mommy-figure in my life. It was assumed my Amother WAS that warm loving mommy-figure. She was not. She was moody, inconsistent and emotionally draining and needy. I was more a mom to her than she was a mommy to me.
THIS is where hurt, angry adoptees are failed, in therapy.
And what can break such a resistance?
You can only help if you are ready to love, to love the black sheep of the family dearly. In a holding embrace the child shall get the allowance to love his father, his mother-german or who-so-ever. As long as we separate from people belonging to us and repress our feelings towards them, we are ill. Only love, which allows every kind of emotion and has a heart for all people, reaches an integration into a consistent whole and heals.
Patient kindness and a lot of positive re-enforcement are the slow steps that breed trustworthy attachment between any two partners, including mother and child. There is no "instant" version to this recipe. For those looking for a quick-fix, they will have to understand anything worth having takes time to develop. Rushing will not make the end-result better... it will only create problems that will have to be addressed later, at a time where it not exactly easy or convenient. [Natural consequence.]
As far as I'm concerned, so much of future human behavior has to do with biology and the way in which the person is treated, especially after severely traumatic events. Some psychologists, like Penelope Leach (my personal favorite mom-instructor, and author of Your Baby and Child) believe, birth itself is a traumatic event, one parents need to appreciate a little more before they begin to parent the next generation.
Leach, whose baby-first philosophy is legendary for making parents feel guilty, has always been against leaving babies to cry.
But this time around, she has science on her side to back up her attack on today’s mothers, many of whom wait until they are well into their thirties to procreate, but who then can’t bear their lives being out of control so resort to the strict routines advocated by the likes of Ford, which hinge on controlled crying. Or “deliberately not responding to your baby”, as Leach puts it.
This matters, because neuroscientists’ studies show that babies who have unresponsive carers have sky-high levels of cortisol, otherwise known as the stress hormone.
Now, for an adult, cortisol is no bad thing because, like adrenaline, it fires you up and gets you going. But for a baby, who is born with an unformed brain that still needs “hard-wiring”, too much cortisol can be “toxic”, Leach says, hence those claims of brain damage.
She goes on: “What you’re doing at this stage is sculpting the connections in the brain. When someone comes and comforts the baby, the cortisol [which is produced when the baby cries] gives place to the happy hormones, endorphins, which flood in instead. So over time, if the baby is almost always picked up and comforted, then the connections in the brain will teach it that when stress hormones flood the brain, endorphins kick in.”
And this is important because, as she adds: “Eventually you reach a point when stress corrects itself, and that’s what we talk about self-soothing. If this goes on then with any luck, early in its second year, when a baby wakes up and screams endorphins kick in on their own and baby won’t actually need a ‘someone’ because that’s the connection that’s been made.”
[From: Penelope Leach: ‘Face it: babies change your life’, May 6, 2010 ]
Cortisol is an interesting stress hormone, as noted in other articles featured on PPL. What needs to be remembered is this -- if the child is cared-for by a depressed or abusive mother, a negative shift will takes place in the brain of the developing child, as noted by several scientists, including Dario Maestripeiri, (through his monkey studies), and others:
Egeland and Susman-Stillman (1996) have found some significant differences between mothers who had been abused and went on to abuse their own children, and those who did not. High scores on the Dissociative Experience Scale (Bernstein & Putnam, 1986), idealised and inconsistent accounts of their childhoods, as well as attempts at psychological "escape" including early abuse of drugs and alcohol and attempts at self-harm, distinguished the 14 mothers who went on to abuse their own children from the 10 mothers who had been able to break the cycle of abuse. These latter mothers were able to talk about their past abuse in a coherent and integrated fashion, which enabled then to reflect on their style of parenting their own children. There are clear similarities here with findings from adults' attachment status on the Adult Attachment Interview (George, Kaplan, & Main, 1985), in which security of attachment is positively related to the coherence of the adult's account of their own childhood, rather than to the absence of maltreatment during childhood (Main, 1990). Further work on the relationship between childhood abuse and later sensitivity to a child's emotions shows that, in contrast to mothers who had an uneventful childhood, mothers with a self-reported history of physical abuse responded to a video of a smiling, but not a crying, infant with physiological arousal, as measured by increased skin conductance (Casanova, Domanic, McCanne, & Milner, 1994). This is a paradoxical finding that requires further exploration but which indicates an insensitivity and lack of attunement to infants' emotional cues in mothers who had a history of childhood physical abuse.
[From: Child Abuse and Neglect and the Brain: A Review (2000) ]
In other (more simple scientific) words, the more negative the feed-back, the more cortisol will be produced, creating a new set of negative variables, which include, a high risk of depression and increased risk of death (suicide), later in life. [The ultimate natural consequence, in trinity formation - paid in full.]
McGowan's results paint a very suggestive picture that links child abuse to later illness and death. Abuse leads to epigenetic changes that modify genes including NR3C1. These changes, especially those involving methyl groups, are very stable and they could slash the gene's activity for a very long time, potentially even for life. With the gene not working properly in many cells, the body can't produce enough glucocorticoid receptor.
As a result, the HPA trinity can't turn itself down properly and is constantly on high-alert. The body behaves as if it were stressed, even when nothing stressful is happening. The result is a higher risk of anxiety, depression and suicide. McGowan admits that this the whole picture is still speculative, but the individual steps make sense in the light of his results.
Other groups have found incredibly similar results in the brains of rats. The quality of care that a baby rat receives from its mother is reflected in the degree of methylation in the promoter region of its NR3C1 gene. If the bond between a mother rat and her baby is disrupted at an early age, the number of methyl groups in this critical area goes up, and the baby's HPA system becomes hyper-responsive to stress. And mice that lack the glucocorticoid receptor altogether behave in ways that are similar to depressed humans.
Mothers could affect the fates of their children through this chain of events, even before they are born. One fascinating study found that a newborn baby's NR3C1 gene is more heavily methylated if its mother was depressed or anxious during her third trimester. The epigenetic changes to this gene could allow children to inherit a vulnerability for depression from their mothers.
Puts a whole new twist to the adoption industry's Nature v. Nurture debate, and the merits of (stress-inducing) Holding Therapy doesn't it?