Holding Therapies – Are They Effective?

cranial_sacral_1Following up on last week’s blog post on the different schools of thought about attachment therapy, I’ve done more research into holding therapies. Much of what I’ve read and heard about them is negative, but I’ve also had some positive feedback. In this post I wanted to set predispositions aside for a balanced view of the subject with my usual disclaimer that I come at this as a curious layperson, not a mental health professional.

Like most people, I began my research by Googling “holding therapy.” The results were not positive. In fact, it was hard to find an article supportive of the practice. Here is a sampling of what I found in my search results. Again, I haven’t vetted any of these sites or authors, but the consistently negative tone of each result is telling.

On the site, naturalchild.org, Ms. Jan Hunt wrote an article called The Dangers of Holding Therapy. She notes that holding therapy is recommended in the book Holding Time, by Dr. Martha Welch (I’ll get to her later.) It consists of forced holding by a therapist or parent until the child stops resisting or until a fixed time period has elapsed; sometimes the child is not released until there is eye contact.

She considers this practice to be completely at odds with attachment parenting, which is above all a relationship based on mutual trust. It can be immensely difficult for a child to regain full, genuine trust after being forcibly held – regardless of the parent’s “good intentions” or the resulting surface behavior.

Even if there were an emotional “breakthrough”, it would be at a great hidden cost, as there is no way to avoid the child’s feelings of anger, frustration, resentment, and betrayal. Like spanking and all other forms of punishment, the child may appear to comply, while his deeper feelings become submerged until they can be more freely expressed. Further, where force is used, the authenticity of any “success” is forever in doubt.

As an alternative, Ms. Hunt suggests meeting the child’s legitimate needs (undivided attention, food, sleep, attention to hidden allergies, relief of family stress factors, etc.) Where force is simply unavoidable (the proverbial child running into a street), it should be kept to the barest minimum possible, and followed by gentle explanations and apologies.

On the site, bigthink.com, there was an article titled, Holding Therapy: Blowing The Whistle on Institutionalized Child Abuse in the UK. The article begins by stating that a “bizarre and potentially inhumane treatment which originated in the US” was being used on children in the UK using techniques including scheduled holding, binding, rib cage stimulation and/or licking. Similar but less physically coercive approaches may involve holding the child and psychologically encouraging the child to vent anger toward the parent with the intended purpose of making the child “regress” and attach. The induction of anger is done out of the belief that existing anger blocks attachment and must be “drained” before attachment can occur.

The therapy goes under the names of holding therapy, rage reduction therapy, re-birthing and attachment therapy. It actively induces rage and has only the vaguest background in John Bowlby’s renowned theory of attachment.

According to Professor of Psychology, Jean Mercer, in her piece, Adoption and Fostering, “holding therapy has never been shown to be safe and effective by independently-conducted systematic research designed to show results objectively. Rather than an evidence-based treatment, it is one supported primarily by anecdotes and testimonials that come from parents and therapists rather than the children who experienced the treatment.”

That’s what I heard from Dr. Marvin.

In the blog, charlydmiller.com, I read her piece titled, A Near Death Holding Therapy Survivor’s Story, about an email she received from someone who had had a traumatic experience in holding therapy. In short, the patient spoke of the same kind physical restrictions in the sessions and a lasting effect it had on her ability to trust, among other things. But these were from the 1970’s. Still, I got the picture.

Trying to play devil’s advocate, I thought about therapies that I’d experimented with that were perceived by outsiders as “bizarre and inhumane.” In 1979, I did the est training in a hotel room in Boston. Indeed I wasn’t allowed to go to the bathroom and, at one point, I had such a ferocious headache I thought I’d throw up. I raised my hand and was given an airsickness bag. It was uncomfortable but not traumatic. In fact, it was an eye-opening experience. Similarly, in the 1980’s I tried rebirthing. It sounded interesting but was kind of a let down. There was no holding other than comforting by a “facilitator” but I had trouble imagining myself in my mom’s womb, at birth or in infancy. I did my best while other people in the room were clearly having very strong reactions. I must have been doing something wrong.

Which brings me back to Dr. Martha Welch and her 1989 book, Holding Time. Surely this would shed a positive light to balance my report. According to childrenintherapy.org, she was a clinical professor at Columbia with all sorts of impressive credentials and associations. Unfortunately, in 2003, the Acting Chairman of Columbia’s Psychiatry Department distanced himself from her work. “…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.”

The site notes that the first (and to date) only published research on Holding Time appeared in 2006 as a pilot study. Among other questionable things in that research, Welch and her associates used Elizabeth Randolph’s un-validated Attachment Disorder Questionnaire (RADQ) for outcome measures. Meanwhile, Holding Time has been embraced by the “gay-to-straight” movement, probably not the best of endorsements, particularly in light of the controversy surrounding Rep. Michelle Bachman’s husband, Marcus, and their “war” on homosexuality.

So much for me trying to be “Fair and Balanced.” I’m still puzzled by those who claim positive results from this controversial practice and invite any of my readers to point me toward something that supports their viewpoint.

My Enlightening Interview With An Attachment Expert

Apologies go out to my readers for my lack of postings these last couple of weeks.

IMG_0481My wife and I have been swamped moving back into our home – a 1917 cottage on a hillside above Fairfax, California – that has been under renovation for the past six months. On top of that, I just got a new job after being out of the market since Casey’s suicide. Yes they still hire geezers like me out there, amazing as that seems. So the last few weeks have been like fighting off a water cannon.



dr_marvinThis week I want to share more of my research into different schools of thought over attachment theories and therapies that I learned in an interview with Dr. Robert Marvin. Dr. Marvin is the Director of the Mary D. Ainsworth Child-Parent Attachment Clinic at the University of Virginia Medical Center. He began his career as a research associate with Mary Ainsworth – an early founder with John Bowlby of attachment theory – at Johns Hopkins. For the next four decades, his work focused on attachment research, developing assessment tools for families of foster and adopted children, and intervention with families experiencing varying forms of disrupted relationships and separation.

He talked at length about two groups of professionals who’d worked with children suffering attachment-related difficulties. One group emerged in the 1980’s, comprised primarily of clinicians, who took a behavioral approach to the mysterious disorders observed in children from foster care and orphanages. They developed a group of therapies, most commonly called holding therapies (where the therapist and/or parents literally hold the child in an embrace), but also known as rage reduction, rebirthing and attachment-parenting therapies. Their goal was to regress the child to an earlier age and then bring her back a whole person. Marvin believed that the mistake the clinicians made was to focus on the child’s undesirable behavior as something she did deliberately. Consequently, it had to be to controlled. But their work turned out to be coercive and controversial. These physical forms of therapy sometimes resulted in serious damage to children, including eight deaths, and landed some practitioners in prison.

The second group was comprised of researchers, academics, medical school clinicians and adoption agency staffers whose work was grounded in the Bowlby-Ainsworth theory of attachment. Since the 1950’s, they’ve compiled a huge body of peer-reviewed research, which has been used in the assessment and treatment of children and families with a variety of challenges from disrupted homes.

Marvin’s work rejects the notion that the child’s undesirable behavior (such as rages and tantrums) is deliberately aimed at tormenting those around her. Rather, it’s based on the premise that the child lacked an early parenting partner who could’ve helped her co-regulate her distress. Left without any soothing skills, she’d blow up when upset.

He observed over the years that children neglected in Eastern European orphanages hadn’t had the thousands of interactions that parents and babies have every day, so their brains didn’t develop in the same way as “normal” babies’ brains. He believes that orphanage practices that discourage attachment with caregivers – for fear that the child will suffer when faced with letting go – are more harmful than not allowing the child to attach at all.

“We now know that if the child is adopted within the first year, the adverse effects of institutionalization are not too difficult to treat.” He explained. “But for a child like Casey, adopted at fourteen months, there’s already been a fair amount of psychological and brain development damage that leads to very unusual behavior.”

“This information still hasn’t fully made its way into the mainstream.” He said. “Only in the last few years have we come to realize what’s happened to these kids and how to intervene.”

He went onto tell me that some adoptive parents seemed to know intuitively or trip over the right way to parent these children. Many didn’t, but it wasn’t their fault. He heard from many parents, feeling unloved and exhausted from their efforts to “fix” their child, who felt they had no choice but to hand the child over to a professional. But Marvin claimed that it’s the parents whom the child loves, even though she may not act like it, and it’s the parents who need to lead the child back to a normal developmental pathway.

I came away from this interview with a pretty negative impression of holding therapies, but I talked to other professionals who were not so dismissive of the practice. I’ll look at this further in an upcoming post.