Be Wary of Attachment Therapy

Shannon-Bridget Maloney

An epidemic of unfounded, untested, and unregulated therapies is being foisted on the youngest members of our society. Children, most of them adopted, are being subjected to a form of "therapy" that several state licensing boards have deemed grossly negligent. Some states have had cases in criminal and civil courts against the practitioners.

Therapists have been fined, sanctioned, and even sent to prison for their treatment of children. "Attachment therapy" (AT), as the practitioners call their trade, has a frightening history, a devastating present, and, if legislatures and mental health licensing boards don't get more involved, a deadly future.

Mainstream mental health sources state that children with Reactive Attachment Disorder (RAD) have difficulty or are unable to form attachments in early life. The disorder may manifest itself through indiscriminant attachments, overfriendliness, or withdrawal from others. (Diagnostic and Statistical Manual-IV, 1994.) However, self-proclaimed "attachment therapists" claim that the disorder has many characteristics that DSM-IV omits. The Institute for Attachment and Child Development (formerly the Attachment Center at Evergreen), for example, states:

Children who do not have healthy attachments with a loving caregiver . . .

• Do not trust caregivers or adults in authority.
• Have extreme control problems, manifested in covertly manipulative or overtly hostile ways.
• Do not develop a moral foundation: no empathy, no remorse, no conscience, no compassion for others.
• Lack the ability to give and receive genuine affection or love.
• Resist all efforts to nurture or guide them.
• Lack cause and effect thinking.
• Act out negatively, provoking anger in others.
• Lie, steal, cheat, manipulate.
• Are destructive, cruel, argumentative and hostile.
• Lack self-control -- are impulsive.
• Are superficially charming and engaging. (Institute for Attachment, 2003)

These "diagnostic criteria" set a child up for the roller coaster that is attachment therapy. Phrases such as, "superficially charming and engaging" are used to nullify any positive relations the child has with others as being unreal and manipulative. "Lack the ability to give and receive genuine affection or love" allows another (in most cases parent or therapist) to determine what genuine affection and love are, completely undermining the child's ability to recognize and/or exhibit such emotions. Notice, too, that the child's acting out is said to provoke "anger in others." The theory claims that on one hand the child is out-of-control and unable to be responsible for him or herself and on the other hand the child is responsible for the feelings and actions of the caretakers. Thus instead of investigating the caretakers' role in family discord, ATs blame the adults' feelings on the child placed in their care. The Institute for Attachment also lists parental characteristics that may be used to help diagnose the child:

• Feel isolated and depressed.
• Feel frustrated and stressed.
• Are hypervigilant, agitated, have difficulty concentrating.
• Are confused, puzzled, obsessed with finding answers.
• Feel blamed by family, friends, and professionals.
• Feel helpless, hopeless, and angry.
• Feel that problems are minimized by the helping profession." (Institute for Attachment, 2003)

Nancy Thomas, a "therapeutic parenting specialist" who is the leading proponent of attachment disorder parenting methods, states that a well-adjusted child should do things, "quick and snappy and right the first time." The child should also be "fun to be around." (Thomas, 2000) Thomas seems to feel that a healthy child is one who makes parents happy, not one who experiences life and grows through those experiences.

Attachment Therapy

Attachment therapy has four core characteristics that clash with generally accepted principles of psychological practice.

1. The belief that the child must express rage that is within himself in order to improve. AT holds that the negative emotions of a child must be "released" in order for a child to function "normally." Gail Trenberth, founder of a national support group says, "They [children with RAD] won't learn to love until they can release that anger and helplessness and hopelessness that came from their early experiences." (Crowder, 2000) Interestingly, these same practitioners do not caution their patients against excessive happiness in fear that they may "run out" of joy. (Mercer, 2003)
2. Informed consent, as used in AT, is a mockery of the term as used elsewhere. Ordinarily, when patients consent to treatment they can stop it if they change their minds. But in AT circles, if the patient asks for the treatment to stop, the therapists interpret this as resistance for which the level of intervention must be increased.
3. While one could argue very persuasively that touch (such a hand on a shoulder, a brief hug) may be therapeutic, AT practitioners take the use of touch to new levels. In one case outlined in his book, Ken Magid tells of a young child being forced to undergo a three-and-one-half-hour session which included six "experienced body holders." (Magid, 1987)
4. AT practitioners regularly tell children what they are feeling, based on the therapist's beliefs rather than those of the child. Indeed, a parent whose child was treated at the Evergreen clinic of Foster Cline reported: "What we saw with Tina is they went to the rage, telling her why she was feeling the rage." (Oprah Winfrey, 1988)

AT practices have not varied much during the past 25 years. Its practitioners routinely use restraint and physical and psychological abuse to seek their desired results. Sessions of Z-process, holding therapy, and rage reduction have been noted to last as long as 12 hours per session. (Magid, 1987, State of California, 1973) In its most basic form, the child is placed lying across a couch on the therapist's lap with his right arm pinned behind the therapist and left arm held by a "holder." Additional holders restrict the child's legs. The child is then asked, "Who is the boss?" This is supposed to encourage the child to understand that he or she is not in control. The therapist then goes on to provoke the child to rage by using "rib cage stimulation" (e.g. tickling, pinching, knuckling). (Magid, 1987 and Cline, 1992) The child invariably demands and/or pleads for the treatment to end, which is interpreted as resistance. In one case, the therapist began by telling the client to resist and then harassed the client until the resistance stops. (Magid, 1987) The child is in a "catch 22," facing physical and/or mental pain no matter what he does.

The therapist continues the session by bringing up behavioral issues of the child. The therapist may refer to behavior the child denies, such as fire-setting. However, the child in these settings is always considered to be deceptive and manipulative. If the child denies the behavior, the therapist applies more physical and emotional stimuli, such as such as swearing, screaming in child's face, and grabbing child's jaw. (State of Colorado, 1995, State of California 1973, Lowe, 2001 a) If the child agrees to the behavior, he or she must do so in a way that "convinces" the therapist that the responses are honest. If the therapist is not convinced, the "stimulation" continues.

Ironically, the session ends with the therapist hugging the client and congratulating him or her on their "good work." (Magid, 1987, Cline, 1992) It is easy to see how such treatment could lead a child to develop not a healthy bond built on love and respect, but rather a fearful one built on pain and a desire to survive.

In addition to these practices, AT has rarely, if ever, been subjected to pure scientific evaluation and peer review. What little "research" is available on the subject is usually done "in house" and is scientifically questionable. (Mercer, 2003)

The "Attachment Community"

Psychologist Ken Magid states, "For some it is not difficult to see how holding therapy could be controversial. Some uninitiated observers viewing this therapy for the first time might think holding a screaming child against his will is barbaric." (Magid, 1987) Magid's use of the term "uninitiated" speaks volumes.

It has been estimated that 500 ATs practice in in the United States.(Graham, 2001) Gaining "membership" in the "attachment community" is a cult-like brainwashing process. Parents come to the practitioners frustrated and exhausted. In addition to not being the instant happy family they expected, adoption is proving to be hard work. The child they adopted is acting out and, at times, hurting themselves and others. Some parents have gone from therapist to therapist in hope of finding a quick fix. Some parents are frustrated with therapists who want to explore problems in the home because they insist that there were no problems before the child. arrived. (Institute for Attachment, 2003)

In the attachment community, parents are told (a) that things are not their fault, (b) the only effective treatment for RAD is AT, and (c) that their child is terribly sick and, if untreated could go on to be the next Ted Bundy. (Magid, 1987 and ADSG 2003) One parent, in quoting a therapist at the Youth Behavior Program, stated, "One of the greatest things that happened recently, was the time when we were sitting with the therapist that now has our daughter and he was in a session with other therapists working with us, and he says, 'What we have here basically is a healthy family and a sick child.'" (Oprah Winfrey, 1988) While no mainstream, modern psychological model holds that humans can live completely unaffected by environment, it did make that particular parent feel better. The parent went on to say, "It was like the load of the world had been taken off our backs because all this time thinking it was us." (Oprah Winfrey,1988)

ATs prey on adopted and foster children. Some claim that up to 90% of adopted children have RAD. (Reed, 2001) Some therapists go so far as to advertise a 75-80% "effectiveness" rate, a claim unheard of in mainstream psychological circles. (Institute for Attachment, 2003) Some ATs offer workshops and claim to be specialists in "adoption issues," which places them in contact with their target audience. Unsuspecting families seeking professional assistance in "doing" adoption "right" can easily fall into their trap. Many children who have already suffered a terrible loss in their lifetime become the target of a lucrative scheme that is polluting the mental help marketplace.

Mainstream therapists who criticize AT may illicit from parents a belief that the therapist is not well-trained in AT and a fear that the therapist is the enemy and will report that parent to Child Protective Services.

The attachment community has several people they generally regard as "experts." Parents are told they should be certain their child's therapist is aware of, ideally trained by and, if very fortunate, perhaps they can even get their child a coveted appointment with one of them personally.

Robert Zaslow, who died in 2001, is the often forgotten Father of American Attachment Therapy. It was his creation, the "Z-Process" that gave roots to rage reduction therapy, holding therapy and the like. The attachment community makes light of findings against Zaslow, who was successfully sued in 1972 by one of his adult clients for a rage reduction session that didn't work. As a result, he lost his license to practice psychology in California, but he continued to teach the therapy he developed. Zaslow will probably be seen someday as a great pioneer who pushed back the frontiers for treating severely disturbed children." (Magid, 1987) Documents from the California State Board of Medical Examiners make no reference to a lawsuit over "a session" that "didn't work." They do, however, describe a patient restrained on her back for 10-12 consecutive hours by Zaslow and many (10-12) unlicensed, unregistered "assistants." The patient was not only physically injured by the treatment but was also choked when Zaslow instructed his assistants to put their fingers in her mouth and press down on her tongue and again when he instructed them to pour water into her mouth as she was screaming. Zaslow also refused to stop treatment when asked by the patient to do so. (Before the State Board of Medical Examiners, State of California, 1973)

Foster Cline has been dubbed the founder and pioneer in Attachment Therapy by many. When Zaslow lost his license in California, he fled to Colorado and Cline met him there. Cline founded the Youth Behavior Program in Evergreen, Colorado, which later changed its name to The Attachment Center at Evergreen and is in the process of changing its name again to "Institute for Attachment and Child Development." He also was a founding member of ATTACh, the grassroots professional organization of choice for Attachment Therapists. Foster Cline has lined his pockets with money from parents, insurance agencies and school districts who use his Love and Logic discipline methods. Not surprisingly however, there is a dark side. In 1995 Cline was charged with various breaches of professional conduct by the Colorado State Board of Medical Examiners. The charges were related to Cline's supervision of Connell Watkins and Michael Orlans in their treatment of a minor child, "T.B." Cline claims that the child recanted his complaint soon after making it, (Cline, personal communication, 2001) Despite this claim, the case history of the complaint states:

Respondent admits and agrees that in 1988, patient T.B. and other patients diagnosed with severe attachment disorders received Rage Reduction Therapy at Evergreen Consultants in Human Behavior in Evergreen, Colorado. This therapy was provided in part by one or more mental health professionals working under the supervision of Respondent, and it included averse physical and/or verbal stimulation for the purpose of releasing rage in the patient that aroused from early childhood abandonment, sexual abuse, and the failure to bond in early childhood development." (Before the State of Colorado, 1995)

The decision of the board to pursue sanctions against Cline were made based upon issues of his own admission and upon the Board's examination of a video tape of the treatment of minor child, T.B., not upon the recanted story of a child. The matter was settled with Cline accepting a compromise and settlement which included a letter of admonition and his agreement that he would no longer treat anyone or supervise the treatment of anyone with therapies that involve, "averse physical stimulation or verbal abuse as depicted in the video tape relating to the treatment of T.B." (Before the State of Colorado, 1995)

Michael Orlans has practiced in Evergreen, Colorado for decades. At times he has been licensed, at times not. He was the second therapist under supervision of Cline in the T.B. case. Apparently in reference to the case he claims that he was charged with child abuse by a boy who "beat himself" with rocks and that the charges were later dropped. (Crowder, 2000) He currently is practicing in Evergreen Colorado and writing articles and books on attachment issues.

Neil Feinberg is a licensed Social Worker in the State of Colorado whose name is mentioned in the informal "Who's Who" of AT. Feinberg was found, (2000) to have failed to report child abuse within generally accepted standards of practice and has a stipulation against his license for restricted practice. Feinberg also has a previous disciplinary record. (Before the State Board of Social Work Examiners, State of Colorado, 2000)

Larry VanBloem practices outside of Salt Lake City at the Cascade Center. He and his associate Jeannie Murdock Gwilliam are facing charges of gross incompetence and gross negligence before Utah's State Department of Professional Licensing. The petition to the board states that VanBloem uses "compression holding therapy" in which he lies on top of the child and "uses his body weight to compress the child client's chest and, thereby, to restrict the child's breathing, promote fear and induce "belly breathing" and that "children attempt to resist these procedures by kicking, sobbing,, screaming and biting." (Petition, 2002)

ATs also mobilize guilt and fear to make it difficult for parents to remove their children from therapy. A California adoption advocate tells of a time in the mid 1990s when she sought help from Connell Watkins for the child of a friend: "Watkins called the boy 'stupid,' wrapped him in blankets 'like a burrito,' and told his mother to yell at him. He wet his pants, but Watkins wouldn't stop, even when the mother begged to end the session. Watkins lashed out saying, 'Do you want to bond with him or not?'" (Crowder, 2001)

Death and Denial

ATs have been implicated in the deaths of at least four children. The most publicized case is that 10-year-old Candace Newmaker, who died in the care of Watkins, Julie Ponder, Brita St. Clair, and Jack McDaniel. The coroner listed the cause of death as asphyxiation brought about by a bizarre plan to re-enact the birth process so that Candace could be "reborn" to her adoptive mother, Jean Newmaker. (Mercer, 2003) Candace was wrapped tightly in a flannel sheet and sofa cushions were placed around her. Over a 70-minute period, five adults pushed on her, encouraged her to be "reborn," and told her to "go ahead and die." For the last 45 minutes, the only sounds coming from the child were whimpering and panting. During the final 20 minutes, she made no sound. (Siegel, 2001) During the trial, many hours of videotaped therapy sessions where shown. In addition to the "standard" holding or rage reduction therapy, Candace received "compression therapy" in which her 195-pound mother laid on top of her in a face-to-face position telling Candace that she would be going home without her daughter if Candace did not change, licking her daughter in the face and otherwise demeaning and frightening her. (Lowe, 2001a) In one session, Watkins brought in a local woman to cut off Candace's long hair. Candace had not been told that this would be happening, and when she asked about it was told that it was to make it easier for her mother to take care of her. The woman cutting her hair also announced that, perhaps she would come back and cut off all of her hair and tattoo her head, again, if the girl did not comply with Watkins. (Lowe, 2001b) Convicted of "reckless child abuse" and three other charges, Watkins is currently serving a 16-year prison sentence. Watkins is referred to by her maiden name (Cooil) in an autobiography written by Nancy Thomas, whom she mentored. (Mercer, personal communication, 2003)

Referring to Candace, another "expert," Dr. John Dicke, clinical director of the Child and Adolescent Psychotherapy Institute in Colorado stated:

In many ways [Candace] was 'the devil' that we are afraid of in all of us. She was destined for a life of misery and perhaps drug abuse, living on the streets or in prison. In five to six years, she might have been prosecuted by the same district attorney who convicted Watkins and Ponder. Instead of homicide, perhaps they should have been charged with defiling a corpse, for, tragically, Candace Newmaker's soul died the day her unable mother cast her aside." (Reed, 2001)

In addition to the troubling statements Dicke made about Candace Newmaker's torture and death, he seems to venture into another area of expertise he may or may not be trained in. The concept of a human soul is a theological, not a scientific one. It is impossible, in a strictly Christian frame of reference, to claim that a child's soul has died. (Maloney, 2001) In December 2001, the Colorado State Board of Psychologist Examiners issued a stipulation and order temporarily barring Dicke from using several disputed practices in treating children.

Krystal Tibbets was 3 years old when she died in 1995 when adoptive father followed the advice of the family's AT. "This is a violent therapy. It is abuse," said Donald Tibbets of Midvale, who spent time in prison for killing the child. "We laid on top of Krystal from head to toe," Tibbets said. "By the time I discovered she had quit breathing, it was too late." Tibbets was accused of pressing his fist into his daughter's abdomen and putting his weight against her chest. Tibbets said he was instructed by therapist Larry Van Bloem of the Cascade Center, Orem. Van Bloem, a social worker accused by state licensing officials of practicing an extreme form of holding therapy, insisted his methods were gentle." (Foy, 2003)

David Polreis Jr. was 2 years old when he died. David's Mother was charged in his death and the defense argued that,

David spent his infancy severely neglected in a Russian orphanage, he suffered from a psychological syndrome called "attachment disorder" and inflicted upon himself the terrible bruising found on his buttocks, genitals, belly, and thighs." He died, the defense will contend, of natural causes. (Horn, 2001)

David was being seen by attachment therapists at the time of his death. Mourners at his funeral were asked to contribute to the attachment center at Evergreen. The attachment community watched the case with baited breath and rallied to support the parents in what "could have happened to any of us." (Horn, 2001)

Cassandra Killpack died at age 4 when her adoptive parents forced her to drink large amounts of water as punishment for drinking juice meant for her sister. The Killpack's claim that they were practicing "hydro-therapy" allegedly taught to them by VanBloem. Cassandra's parents are charged with child abuse homicide and child abuse in the death of their daughter. Interestingly, in his call to 911, when asked "What's going on?" Cassandra's father immediately described that his daughter "has a lot of emotional problems, but to make a long story short, she had one of her temper tantrums today." (Karlinsky, 2002) Killpack seems to spend a great deal of time with the police department dispatcher explaining not why he was calling for help, but what his daughter had done wrong.

ATs typically claim that it was not their methods that killed the children. Claims range from unsubstantiated allegations of hidden medical conditions (Cline, personal communication, 2001), to parents practicing a technique inappropriately, to the "crazy child just up and died" (Horn, 2001) Ironically, for these same practitioners, an inability to accept responsibility for one's actions and irrational lying are deemed as symptoms of the very disorder they claim their child patients suffer from. In each of these cases, various neighbors, friends, and school officials reported that the children were loveable and kind. But AT defenders say that children with RAD are "superficially charming" towards others and even list as a symptom of the child's disorder, parents who seem unusually angry. It would appear that in the practice of attachment therapy, the children are the only ones expected to take responsibility for their own actions.

In Fort Worth, Texas, Jeannie Warren successfully presented a case against her former psychiatrist Dr. Robert Gross of the Psychiatric Institute. Jeanne was 15 years old when she underwent 25 "rage reduction" session in 14 months of therapy. "District Judge Ken Curry of Tarrant County ruled that her psychiatrist had committed assault, battery, and intentional infliction of emotional distress." (Cohen, 1996) As part of his trial, Dr. Gross argued that, "the object of the session was to stimulate the rage, not inflict any physical pain. Sometimes the only way a person can get there, unfortunately, is through pain." (Cohen, 1996) Cline came to Gross' defense, stating in the article, "It always hurts me, but I do understand it, when I see negative things about some therapy this or that taken out of context," (Cohen, 1996) Cline claimed that the treatment was misunderstood.

The State of Colorado has enacted a bill dubbed, "Candace's Law" which attempts to regulate the use of physical restraint in "rebirthing" sessions but has many loopholes. Colorado still allows unlicensed psychotherapists to practice legally in the state.

Recently, a Utah group lead by Larry Van Bloem, sought to achieve a separate licensure status in the state of Utah for ATs. On hand to speak against the proposal were, the Utah Medical Association, Utah Association of Marriage and Family Therapists, Utah Chapter of the National Association of Social Workers, Utah Psychology Association, National Association for Consumer Protection in Mental Health Practices, American Association for the Humane Treatment of Children in Therapy (now called Advocates for Children in Therapy), and a psychiatrist who read the APA policy against holding therapy. The proponents withdrew their request after seeing the array of organizations there to oppose them. (Rosa, 2003) Utah has also considered legislation to ban the use of restraint practices as psychotherapy. Mainstream mental health organizations have criticized AT, but have expressed concern about states attempting to legislate something that only trained professionals can speak to. And so, the horror continues.

The Bottom Line

Dr. David Waller of the University of Texas Southwestern Medical School says of restraint model therapies, "My personal opinion of these so-called therapies is that they are very controlling, manipulative, aggressive, abusive ways of adults behaving toward children, in the guise of treatment." (Waller, 2001) There are many effective treatments for Reactive Attachment Disorder. (James, 1989) Claims of quick cures and anyone promising a "different" child in two weeks are preposterous. Parents and professionals who to claim that traditional therapies do not work on Reactive Attachment Disorder must be reminded that their statement is not supported by scientific evidence and that there is no excuse for torturing a child in the name of therapy.

Preceding her 2001 trial for the suffocation death of Candace Newmaker, Connell Watkins was asked by the Assistant District Attorney whether she had ever experienced this "therapy" herself. She replied, "No, I thought it would be too traumatic."

For Additional Information

• Advocates for Children in Therapy (ACT)
• American Psychiatric Association Position Statement on Reactive Attachment Disorder

References

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Colorado, State of. Before the state board of examiners of social workers; in the matter of disciplinary proceeding against the license to practice social work of Neil Feinberg.

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Mercer, J. (June 30, 2003) Personal communication.

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Reed, Christopher. (2001, June 21). The cuddles that kill. The Herald, (Glascow, Scotland).

Rosa, L. (2003) Holders fold. AT News Commentary.
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Thomas, N. (2000). Parenting children with attachment disorders. In T.M. Levy (Ed.), Handbook of attachment interventions. San Diego, CA: Academic Press.

Waller, D. (April 19, 2001) Personal communication.

Winfrey, Oprah. Televised February 29, 1988.

Zaslow, R., & Menta, M. (1975). The psychology of the Z-process: Attachment and activity. San Jose, CA: San Jose State University Press.

__________________

Ms. Maloney is a Ph.D. student from Texas who earned a Master of Arts in Counselor Education from Sam Houston State University in 1995. She also holds a Master of Divinity from Brite Divinity School at Texas Christian University. She can be reached at SBMaloney@aol.com