Attachment therapy also sometimes called "holding therapy" is an ambiguous term which is sometimes used to describe a form of treatment for behavioral difficulties in children suffering from attachment disorder. However, because the term has no common meaning, its actual definition is unclear. As such, it has little commonly agreed upong meaning in the professional literature. For example, it is not a term found in the Amereican Medial Association's Physician's Current Procedural Manual. A number of advocacy groups, such as Advocates For Children in Therapy have undertaken to label nearly all treatments for children with disorders of attachment as "attachment therapy" and attempt to discredit those therapies. Some components of "attachment therapy" have been disapproved by a task force of the American Professional Society on Abuse of children (APSAC). (Chaffin et al.,2006, PMID 16382093). Specifically, the task force addressed coercive methods and practices as inappropriate for treatment.

Treatment characteristics

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The "attachment therapy" or "holding therapy" group of treatments vary in their specifics, but share certain characteristics. However, these common traits are subject to much debate and are ill-defined since there is no common definition for this term. For example, it is not a term found in the American Psychiatric Associations's DSM IV-R or in the American Medical Association's book of CPT codes for treatment methods.

"Attachment therapy" is not a mainstream approach to treating children experiencing attachment disoder. The term is not applicable to generally accepted approaches to the treatment of children and adolescents with disorders of attachment (see APSAC report). Treatment and prevention programs that use methods congruent with attachment theory and with well established principles of child development (American Academy of Child and Adolescent Psychiatry) include: Alicia Lieberman (Parent-child Psychotherapy) (Lieberman & Pawl in Infant Mental Health, 1993)(Liberman 2003), Stanley Greenspan (Floor Time), Daniel Hughes (Dyadic Developmental Psychotherapy) (Becker-Weidman & Shell, 2005) (Hughes, 2003), Mary Dozier (autonomous states of mind), Robert Marvin (Circle of Security) (Marvin & Whelan 2003), Phyllis Jernberg (Theraplay), Daniel Schechter (intergenerational communication of trauma), and Joy Osofsky (Safe Start Initiative) (in Infant Mental Health, 1993).

Parenting methods association with attachment therapy

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"Attachment therapy" treatments may be accompanied by parenting interventions that are coercive, painful or shaming (APSAC report). For that reason, they have been criticized as inappropriate in accordance with some professional association standards, such as the American Academy of Child and Adolescent Psychiatry and APSAC. For example, obedience-training techniques such as "strong sitting" (frequent periods of required silence and immobility) and withholding or limiting food (Thomas, 2001). However, since this is not a clearly defined treatment, it is generally unclear what methods fall under this approach.

Theoretical background

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Advocates of attachment therapy in its various forms claim that the treatment derives from John Bowlby's theory of the development of emotional attachment (Bowlby, 1982). Bowlby's work stresses the infant's experiences of social interactions in the second half of the first year as the foundation of attachment; his theory considers attachment to be shown by a toddler's ability to use an adult as a secure base for exploration and learning, as well as by concerns about separation. The theory also considers disobedience and bargaining to be normal parts of attachment relationships in the preschool years and later. Bowlby would not expect any emotional problems to result from adoption during the first 6 months of life.

"Attachmant therapy" is also connected to belief systems such as those of Verny (Verny & Kelly, 1981) and Emerson (1996), who claimed that memories dating from the time of conception (or earlier) shape personality and that these memories are contained in all cells. The ideas that attachment resulted from stimulation of cathartic expression of rage and on the experience of the complete authority of the adult were codified by Cline (1994), Levy (2001), and Zaslow (Zaslow & Menta,1975), whose practices involved physically-intrusive actions intended to bring about those events.

Criticisms

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Some components of attachment therapy have been disapproved by a task force of the American Professional Society on Abuse of children. (Chaffin et al.,2006, PMID 16382093) Specifically, the task force addressed coercive methods and practices as inappropriate for treatment. In this regard the task force's recommendations mirror that of generally accepted practices for treatment generally, and specifically for children. Some have criticized the treatment as using coercion and physically painful methods to achieve the desired results.

The APSAC report does not describe "Attachment Therapy", it uses the term "attachment therapy" (no caps). They state, “The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions. Pg 77 Furthermore, what seems to be focus of this proposed page only addresses a very narrow area, “Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists.” Pg 76 Attachment therapy is better discussed in context, especially if the focus is on “a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners” pg 77. The controversy is a narrow one and should be placed in context so that readers understand the full range of issues. “ The attachment therapy controversy has centered most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as deep tissue massage, aversive tickling, punishments related to food and water intake, enforced eye contact, requiring children to submit totally to adult control over all their needs, barring children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge” pg 83.

See also

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• Attachment disorder
• Attachment theory
• Bowlby
• Child Development
• Dyadic Developmental Psychotherapy
• reactive attachment disorder
• Stanley Greenspan
• Theraplay

References

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Becker-Weidman, A., & Shell, D., (2005) Creating Capacity for Attachment. Oklahoma City, OK: Wood 'N' Barnes.

Bowlby, J. (1982). Attachment. New York: Basic.

Chaffin M, Hanson R, Saunders BE, Nichols T, Barnett D, Zeanah C, Berliner L, Egeland B, Newman E, Lyon T, LeTourneau E, Miller-Perrin C. "Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems." Child Maltreat. 2006 Feb;11(1):76-89. PMID 16382093

Cline, F. (1994). Hope for high risk and rage-filled children. Evergreen, CO: EC Publications.

Hughes, D., (2003). Psychotherapeutic interventions for the spectrum of attachment disorders and intrafamilial trauma. Attachment and Human Development 5-3, 271-279.

Liberman, A., (2003). The treatment of attachment disorder in infancy and early childhood. Attachment and Human Development 5-3, 279-283.

Marvin, R., & Whelan, W., (2003) Disordered attachment: toward evidence-based clinical practice. Attachment and Human Development 5-3, 284-299.

Thomas, N. (2001). Parenting children with attachment disorders. In T.M. Levy (Ed.), Handbook of attachment interventions. San Diego, CA: Academic.

Verny, T., & Kelly, J. (1981). The secret life of the unborn child. New York: Dell.

Welch, M.G. (1989) Holding time. New York:Fireside.

Welch, M.G., Northrup, R.S., Welch-Horan, T.B., Ludwig, R.J., Austin, C.L., & Jacobson, J.S.(2006). Outcomes of prolonged parent-child embrace therapy among 102 children with behavioral disorders. Complementary Therapies in Clinical Practice, 12, 3-12.

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

Zeanah, C., (1993) Infant Mental Health. NY: Guilford.