Atlas›Domain XVI · Historical, discredited & harmful›Guide 087
Guide XVI-087

Coercive holding therapy and rebirthing-attachment therapy

Robert Zaslow, Foster Cline1970Evergreen, Colorado
A 29 · L 59 · M 1218 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the coercive "attachment therapy" lineage as US courts, licensing authorities, major news and professional bodies describe it (the APSAC Task Force report, 2006; the AACAP practice parameter, 2016; NICE NG26, 2015), centred on the 2000 Colorado rebirthing death and the conviction of the two therapists, Connell Watkins and Julie Ponder. This guide does not teach the practice; it equips the psychotherapist to recognise it, to work with people harmed by it or drawn to it, and to act on safeguarding and reporting duties.

Coercive holding therapy and rebirthing-attachment therapy are a family of practices, not a single therapy, promoted mainly for adopted and fostered children labelled as having "attachment disorder". Proponents held that a child who had been maltreated or moved between carers carried suppressed rage that blocked bonding, and that physically holding the child to provoke and then exhaust that rage, or re-enacting birth, would leave the child receptive and bonded to the adoptive carer [source: Deseret News 2004; Deseret News 2001]. Professional bodies now reject physically coercive, restraining and cathartic "attachment" methods as carrying a risk of harm with no proven benefit, and several have been linked to child deaths [source: APSAC Task Force 2006, abstract; CEBC topic page citing APSAC and AACAP]. Lilienfeld (2007) placed attachment therapies on his provisional list of potentially harmful therapies [source: The Psychologist 2008, reporting Lilienfeld 2007; Lilienfeld 2007 via APS page].

The breathwork practice also called "rebirthing", which its practitioners describe as non-physical, is a different practice covered in Domain X 160; news reporting records such practitioners distinguishing their methods from the Colorado session [source: WRAL]. The clinician should not conflate the two, and should not assume either is safe.

2. Framework

Historical phases of the practice (outline) [source: Deseret News 2004 unless stated]

  • 1970s: Robert Zaslow developed holding-based methods intended to provoke rage, originally for autistic children, on the belief that this broke down defences and made the person more cooperative. The names "Z-process" and "rage reduction" are commonly attached to his work [uncertain: not verified].
  • About a decade later: "holding time", in which mothers held defiant children tightly to provoke anger, was popularised [source: Deseret News 2004]; its originator is [uncertain].
  • From about 1991: Foster Cline and colleagues at the Attachment Center in Evergreen, Colorado, promoted similar holding methods for adopted and maltreated children described as having attachment disorder [source: Deseret News 2004]. Evergreen became a hub for practitioners, including Connell Watkins [uncertain: Watkins's institutional history not verified].
  • April 2000: a ten-year-old adopted girl from North Carolina died of asphyxiation after a videotaped "rebirthing" session in Colorado run by Watkins and Ponder [source: Deseret News 2001; ABC News 2001].
  • 2001: both therapists were convicted of reckless child abuse resulting in death and each sentenced to 16 years, the minimum term [source: ABC News 2001; Deseret News 2001]. Colorado passed a 2001 law "Concerning a Prohibition on the Therapeutic Technique Known as Rebirthing" (Session Laws 2001, ch. 129) [source: Colorado Law Scholarly Commons]; North Carolina later banned rebirthing therapy, a first offence being a misdemeanour and a second a felony [source: WRAL; date of enactment uncertain].
  • 2002 to 2008: in Utah, a four-year-old adopted girl died in 2002 after her adoptive parents forced water on her as a punishment; her adoptive mother was convicted of child abuse homicide in 2005 and the Utah Supreme Court upheld the conviction in 2008; her lawyer said she had followed professionals' advice [source: KSL 2008]. Utah licensing officials later ordered the state's last known holding-therapy practitioner to stop [source: Deseret News 2005].
  • 2006 onward: the APSAC Task Force (Chaffin et al. 2006) rejected coercive and restraining approaches and recommended interventions that increase caregiver sensitivity [source: OJP abstract]; AACAP (2016) revised its practice parameter for reactive attachment disorder (RAD) and disinhibited social engagement disorder [source: Oklahoma State University record]; NICE NG26 (2015) set out supported interventions for UK children in or on the edge of care [source: NICE NG26].

Phases of the psychotherapist's own work [synthesis, informed by NICE NG26 1.3 and APSAC 2006]

  1. Recognition and assessment. Goal: identify whether a client (child, carer, or adult survivor) has been exposed to coercive "attachment" methods, and whether any child is at current risk. Move on once immediate safety is established and the history is understood well enough to plan.
  2. Safety and safeguarding. Goal: stop current exposure, make any required child-protection report, and route medical concerns to medical services. Move on when the child or client is no longer exposed and statutory duties are discharged.
  3. Processing and repair. Goal: trauma-informed work with survivors; psychoeducation and support for carers moving to supported approaches; family repair. Move on when symptoms, relationships and functioning are improving and the client chooses to address wider meaning (justice, identity, adoption history).
  4. Advocacy and follow-up. Goal: reporting colleagues or programmes to regulators, support with legal routes, and connecting with supported services. Session number and length follow the client's needs and the setting [synthesis]; NICE NG26 gives session formats only for its own recommended interventions.

3. Guiding principles

  • No coercion, restraint or provoked catharsis. Never use, recommend, supervise or refer to physical coercion, enforced holding, restraint, provoked rage, humiliation, or withholding or forcing food or water [source: APSAC 2006 abstract; CEBC citing APSAC]. In practice: if any part of a plan depends on overpowering a child, it is not therapy.
  • Diagnose carefully. "Attachment disorder" is not in any accepted classification system; NICE says diagnose an attachment disorder only when DSM-5 or ICD criteria are met [source: APSAC 2006 abstract; NICE NG26 1.3.6]. In practice: challenge broad "attachment disorder" labels and checklists, and assess properly.
  • Assess before intervening. A comprehensive assessment covers attachment patterns, placement history, maltreatment, parental sensitivity, physical health and coexisting conditions [source: NICE NG26 1.3.2]. In practice: treat what is actually present (for example PTSD, anxiety, neurodevelopmental conditions) with the relevant guidance.
  • Work through the caregiving relationship. Supported approaches build carer sensitivity rather than forcing the child to submit [source: APSAC 2006 abstract; NICE NG26 1.4-1.5]. In practice: the carer is a partner in change, not an enforcer.
  • Child safety outranks family loyalty and confidentiality. In practice: know local mandatory-reporting and child-protection routes before you need them [synthesis].
  • Touch: consent before and during, a right to stop, never sexual. In practice: in this field a clinician should not use holding or restraint at all; any ordinary touch (for example a carer's comforting hug the child welcomes) is the child's choice [synthesis].
  • Consent and assent. In practice: children are told in age-appropriate terms what will happen and can say no; carers' consent never overrides a child's distress [synthesis].
  • Non-blaming, non-moralising stance. Many carers chose these methods in desperation and were misled. In practice: hold them accountable for safety without shaming, so they stay engaged [synthesis].
  • No medication advice. NICE advises against medicines for attachment difficulties themselves; prescribing questions for coexisting conditions belong to the prescriber [source: NICE NG26 1.1.20]. In practice: never advise starting, stopping or changing a medicine.
  • Duty when colleagues use harmful methods. In practice: resolve informally only where appropriate and safe; otherwise report to the licensing board or regulator; the APA Ethics Code (https://www.apa.org/ethics/code) Standard 3.05 on multiple relationships is relevant where a clinician holds overlapping roles with a family [synthesis, except the Standard reference].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Historical literacy and term recognition

  • Purpose / when: before working with adoptive, foster or kinship families, or adult adoptees, so you recognise the language of coercive attachment methods when a client uses it [synthesis; history per Deseret News 2004].
  • Steps: (1) Learn the labels clients may use: holding therapy, holding time, rage reduction, rebirthing, "attachment therapy", "therapeutic parenting" packages that stress control and compliance [uncertain: last label not verified as a named programme]. (2) Know the 2000 Colorado death, the 2001 convictions and the state bans in outline [source: ABC News 2001; Colorado session law page; WRAL]. (3) Know the professional positions (APSAC 2006; AACAP 2016; NICE NG26) [source: OJP abstract; CEBC]. (4) Distinguish breathwork "rebirthing" (Domain X 160) from coercive attachment rebirthing.
  • Example language (illustrative): "When you say the last therapist did 'holding', can you tell me what that looked like for your son?"
  • Watch for: your own assumptions; some carers use benign words for coercive acts, and some use the same words for ordinary comfort. Ask, do not assume [synthesis].

4.2 Screening intake for past and current therapies

  • Purpose / when: at intake with any child in or adopted from care, and their carers [synthesis; comprehensive assessment per NICE NG26 1.3.2].
  • Steps: (1) Ask which therapies, camps, intensives, books or online programmes the family has used. (2) For each, ask what the child experienced, whether the child was held against their will, whether food, water, sleep or toilet access was controlled as a consequence, and whether the child was isolated. (3) Ask how the child responded and whether anything is still in use at home. (4) Record answers verbatim where possible.
  • Example language (illustrative): "Some programmes ask parents to use strict consequences around food, holding or time alone. Has anyone ever suggested anything like that to you?"
  • Watch for: carers' defensiveness or rehearsed justifications ("he needs to learn who is in charge"); a child who looks to the carer before answering. A disclosure of current coercion moves you straight to 4.4 and 4.5 [synthesis].

4.3 Careful diagnostic assessment and challenging the label

  • Purpose / when: when a child arrives already labelled with "attachment disorder" or RAD, often from a checklist or a programme's own assessment [source: APSAC 2006 abstract; NICE NG26 1.3.6].
  • Steps: (1) Note that "attachment disorder" is not an accepted diagnosis; RAD is narrow and rare, with onset of severely inappropriate social relating in early childhood [source: APSAC 2006 abstract]. (2) Assess using direct observation of the child with primary caregivers, as AACAP describes [source: AACAP 2016 abstract]. (3) Consider the age-appropriate tools NICE lists, used only by staff trained in them [source: NICE NG26 1.3.4-1.3.5]. (4) Assess trauma, PTSD, neurodevelopmental and other coexisting conditions and treat those under their own guidance [source: NICE NG26 1.3.3; CEBC]. (5) Write a formulation that names the child's strengths and needs, not a deficit label.
  • Example language (illustrative): "The term 'attachment disorder' gets used for a lot of different behaviour. I'd like to understand what your daughter is actually struggling with, so we can match help to that."
  • Watch for: relief in carers when the label is softened, or anger if the label justified a programme they invested in. Working when the plan addresses observed difficulties and carers can describe them in specific terms [synthesis].

4.4 Assessing a child's current safety

  • Purpose / when: whenever coercive methods are disclosed, suspected, or recently stopped [synthesis].
  • Steps: (1) See the child alone where age and setting permit, with assent. (2) Ask open questions about home routines, punishments, being held down, food and drink, and being kept alone. (3) Look for observable signs: unexplained bruising, fear of being touched or held, hoarding food, extreme compliance or freezing. (4) Ask the carers directly what they do when the child refuses or rages. (5) Decide whether a report is required (4.5) and whether medical review is needed (4.6).
  • Example language (illustrative): "When you get in trouble at home, what happens next? Is there anything that happens that scares you?"
  • Watch for: do not lead or suggest; record the child's words. A child who has been told that resistance is "the disorder" may minimise. Never test the child's response to holding [synthesis].

4.5 Safeguarding and mandatory reporting

  • Purpose / when: whenever there is reasonable suspicion that a child is being physically coerced, restrained, deprived or forced to take food or water [synthesis; the conduct described is what APSAC rejects, OJP abstract].
  • Steps: (1) Know your jurisdiction's reporting duty and route (in the US, child protective services under state mandatory-reporting law; in the UK, local authority children's social care, following local safeguarding procedures) [synthesis]. (2) Report promptly with facts and the child's words; do not investigate yourself. (3) Tell carers you are making a report unless doing so would increase risk to the child. (4) Consult your supervisor or safeguarding lead, and record decisions. (5) Continue to offer therapy where safe.
  • Example language (illustrative): "What you've described puts Sam at risk of being hurt, and I'm required to share it with children's services. I'd like to keep working with you through this."
  • Watch for: pressure from carers or a programme not to report; your own wish to protect the therapeutic alliance. Child safety comes first [synthesis].

4.6 Routing medical concerns

  • Purpose / when: when a child shows breathing difficulty, injury, confusion or collapse after holding or restraint, or has been forced to eat or drink or deprived of food or water [synthesis; deaths by asphyxiation and after forced water per Deseret News 2001 and KSL 2008].
  • Steps: (1) If a child is unresponsive, struggling to breathe, confused or collapsed, call emergency services at once. (2) For non-urgent concerns, refer to the child's physician or paediatric service. (3) Do not give medical or medication advice yourself. (4) Document and report as in 4.5.
  • Example language (illustrative): "I'm worried about her physical health after what's happened. I'd like her to be seen by a doctor today."
  • Watch for: carers' reassurance that distress is "just the rage coming out". In the Colorado session the child's statements that she was dying were not acted on [source: ABC News 2001].

4.7 Psychoeducation for carers drawn to coercive methods

  • Purpose / when: with exhausted or desperate carers who are considering a holding, rebirthing or intensive "attachment" programme [synthesis].
  • Steps: (1) Validate the strain of caring for a traumatised child. (2) Explain in plain terms the professional consensus: physical coercion, enforced holding, restraint and provoked catharsis are contraindicated because of risk of harm and no proven benefit, and have been associated with deaths [source: CEBC citing APSAC and AACAP]. (3) Explain what supported approaches do differently: they build carer sensitivity and predictable care [source: APSAC 2006 abstract; NICE NG26]. (4) Offer a concrete alternative plan and respite or support options. (5) Agree what the carer will do instead in the next crisis.
  • Example language (illustrative): "I can hear how worn down you are. The methods you've read about have hurt children, and the bodies that review child treatments advise against them. Let's look at approaches that have been tested."
  • Watch for: the programme's own claims that critics "don't understand attachment"; avoid argument and return to the child's safety and to what the carer wants for the relationship [synthesis].

4.8 Working with carers currently using a coercive programme

  • Purpose / when: when a family is enrolled in or following such a programme at home [synthesis].
  • Steps: (1) Clarify exactly what is being done; any restraint, deprivation or forced feeding means a safeguarding report (4.5). (2) Ask the carers to stop coercive elements immediately and agree a safety plan. (3) Explore what they hoped the programme would achieve and link those hopes to supported care. (4) Agree contact with the programme ends or is paused. (5) Review at each session.
  • Example language (illustrative): "I can't support any part of the plan that involves holding him down or controlling food. What else were you hoping that programme would give you?"
  • Watch for: concealment, and a split where carers attend you while continuing the programme. Working when carers can describe a new crisis plan in their own words [synthesis].

4.9 Referral to supported interventions

  • Purpose / when: once assessment is complete, to connect the family with interventions guideline bodies recommend [source: NICE NG26 1.4-1.5].
  • Steps: (1) For pre-school children, NICE recommends video feedback programmes first, or parental sensitivity and behaviour training if declined [source: NICE NG26 1.4.1-1.4.5; 1.5.1-1.5.3]. (2) For school-age children in care or adopted, NICE suggests intensive carer training and support with group therapeutic play, or carer group training with mentoring for older children [source: NICE NG26 1.5.4-1.5.10]. (3) For maltreated children with PTSD, offer trauma-focused CBT and other NICE PTSD interventions [source: NICE NG26 1.4.12]. (4) In the US, check the CEBC ratings for attachment interventions and be aware of its "Concerning Practice" category [source: CEBC]. (5) Refer to services with specialist attachment expertise linked to mental health, education and social care [source: NICE NG26 1.3.8].
  • Example language (illustrative): "There's a programme where we film short bits of you playing together and look at them with you. It's been tested with children like Ellie."
  • Watch for: a referral service using holding, restraint or regression under another name; ask what sessions involve before referring [synthesis].

4.10 Trauma-informed work with a child survivor

  • Purpose / when: with a child who was subjected to holding, rebirthing or related coercion and shows trauma symptoms [source: NICE NG26 1.4.12 for PTSD interventions; remaining steps synthesis].
  • Steps: (1) Establish safety and predictability first: the child knows they will not be held, restrained or punished in sessions. (2) Use a recognised trauma-focused approach where PTSD is present (for example trauma-focused CBT, per NICE). (3) Include the current carer as an ally where safe. (4) Pace any discussion of the coercive experiences to the child's tolerance, with the right to stop. (5) Monitor symptoms and functioning.
  • Example language (illustrative): "In here nobody will hold you down or make you do anything with your body. If you want to stop talking about something, you can say 'stop' and we will."
  • Watch for: freezing, compliance that looks like progress, or distress at physical closeness. Working when the child can say no and be heard, and symptoms reduce [synthesis].

4.11 Restoring bodily autonomy and consent around touch

  • Purpose / when: children and adults whose bodies were overpowered in the name of therapy [synthesis].
  • Steps: (1) Make the right to refuse touch explicit. (2) Coach carers to offer, not impose, comfort, and to accept a no. (3) Practise asking and answering in ordinary daily moments. (4) Never use holding, restraint or any physical technique yourself.
  • Example language (illustrative, to a carer): "Try asking 'Would you like a hug?' and letting her answer. If she says no, that's her telling you she trusts you to listen."
  • Watch for: carers who read refusal as rejection; touch is always consensual, the right to stop is continuous, and touch is never sexual [synthesis].

4.12 Work with an adult survivor of coercive attachment therapy

  • Purpose / when: adults (often adoptees) who were treated as children [synthesis].
  • Steps: (1) Take a full history, including the therapy, the adoption and placement history, and current symptoms. (2) Assess for PTSD, depression, shame and relationship difficulties and treat with evidence-based approaches. (3) Validate that what was done was rejected by professional bodies and in some cases prosecuted [source: APSAC 2006 abstract; ABC News 2001]. (4) Explore the meaning for their relationship with adoptive carers. (5) Offer help with records or complaints if wanted (4.17).
  • Example language (illustrative): "What happened to you was called therapy, but professional bodies now say methods like it are harmful. It makes sense that it still affects you."
  • Watch for: self-blame ("I was a bad kid"); mistrust of therapists, so be transparent about every method you propose [synthesis].

4.13 Suicide-risk assessment

  • Purpose / when: with adolescent and adult survivors, and with carers in crisis or bereaved [synthesis].
  • Steps: (1) Ask directly about suicidal thoughts, intent and plans using standard risk-assessment practice. (2) Build a safety plan, including lethal-means safety (storage and removal). (3) Give crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). (4) Follow safe-messaging principles: no method details, no glamorising of deaths.
  • Example language (illustrative): "Sometimes when people have been through something like this, they think about ending their life. Has that been on your mind?"
  • Watch for: escalation around anniversaries, court cases or media coverage [synthesis].

4.14 Working with carers' guilt, grief and accountability

  • Purpose / when: carers who used or paid for coercive methods and now recognise the harm, including bereaved families [synthesis].
  • Steps: (1) Separate responsibility from shame. (2) Explore how they came to the programme. (3) Support repair with the child (4.15). (4) Where a criminal or regulatory process is under way, stay within your role and do not discuss the case beyond what is clinically needed; seek legal and supervisory advice.
  • Example language (illustrative): "You were told this would help. You can take responsibility for what happened and still deserve help yourself."
  • Watch for: guilt that becomes withdrawal from the child, or denial that leads back to coercive practice [synthesis].

4.15 Family repair work

  • Purpose / when: after coercion has stopped and the child is safe [synthesis].
  • Steps: (1) Agree with the child (with assent) whether and how carers will acknowledge what happened. (2) Help carers give a clear, age-appropriate acknowledgement and apology without demanding forgiveness. (3) Rebuild predictable routines and warm, child-led time. (4) Connect with a supported caregiver-sensitivity intervention (4.9).
  • Example language (illustrative, carer to child, rehearsed in session): "We did things that frightened you. That was wrong, and we will never do them again."
  • Watch for: pressure on the child to say it is "fine"; repair is shown over time, not in one conversation [synthesis].

4.16 Adolescence, adoption identity and birth family

  • Purpose / when: young people for whom coercive therapy was tied to their adoption story [source: NICE NG26 1.5.11 for adapting to adolescence and birth-family feelings; steps synthesis].
  • Steps: (1) Explore what they were told about why they "needed" the therapy. (2) Address feelings about birth family and contact sensitively, as NICE advises. (3) Support a self-narrative free of the "disordered child" label.
  • Example language (illustrative): "You were told something was wrong with how you love people. What do you think now?"
  • Watch for: identity confusion and anger at adoptive carers; hold both loyalty and anger [synthesis].

4.17 When a colleague or institution uses coercive methods

  • Purpose / when: you learn that a clinician, programme, camp or agency uses holding, restraint, rebirthing or deprivation as "therapy" [synthesis].
  • Steps: (1) If a child is at current risk, report to child-protection services first (4.5). (2) Report the practitioner to their licensing board or regulator; licensing authorities have acted against such practitioners [source: Deseret News 2005]. (3) Note that some states ban rebirthing outright [source: Colorado session law page; WRAL]. (4) Document what you know and how. (5) Never co-work, supervise or refer to such a service. (6) Where you hold overlapping roles with the family or service, consider APA Ethics Code Standard 3.05 [source: APA Ethics Code].
  • Example language (illustrative, to a colleague): "I'm concerned that holding children down is being used here. Professional bodies say it's contraindicated, and I'm obliged to raise it."
  • Watch for: retaliation, or pressure to keep it informal. Seek advice from your professional body and supervisor [synthesis].

4.18 Advocacy with schools and child welfare

  • Purpose / when: a child's school or social worker is following a programme's coercive advice or a broad "attachment disorder" label [synthesis; NICE NG26 1.2 on schools].
  • Steps: (1) With consent, share a formulation based on assessed needs. (2) Point to NICE's school recommendations: trained staff, a key person, a safe space, avoiding exclusions where possible [source: NICE NG26 1.2.1-1.2.7]. (3) Ask that no restraint or deprivation-based behaviour plans are used as "attachment" measures. (4) Join multi-agency reviews.
  • Example language (illustrative): "Rather than consequences based on control, Jordan responds best to a named adult and a predictable place to calm."
  • Watch for: plans that quietly reintroduce isolation or withholding [synthesis].

5. Handling problems

All guidance in this section is [synthesis] unless a source is given.

  • Carers insist the coercive method "worked". Do not debate anecdotes. Ask what changed and what the child now does when frightened; compliance and fear can look like bonding. Restate the professional position (contraindicated, no proven benefit, associated with deaths) [source: CEBC citing APSAC and AACAP] and offer a tested alternative (4.9).
  • Carers refuse to stop. Where restraint, deprivation or forced food or water continues, report (4.5); you cannot hold this risk in confidence. Keep offering engagement after the report.
  • Carers are exhausted or in crisis. Treat carer burnout as a risk factor: arrange respite, peer support and crisis contacts; NICE includes daily telephone supervision, support groups and a 24-hour crisis line in its intensive carer support model for school-age children in care [source: NICE NG26 1.5.4-1.5.7].
  • Non-adherence to the supported plan. Simplify; agree one change at a time; review whether the plan fits the assessed needs, and arrange a multi-agency review where progress stalls [source: NICE NG26 1.4.3, 1.4.6 on multi-agency review].
  • The child is stuck in compliance or freezing. Slow down; reduce demands; emphasise choice. Progress is the child saying no safely, not doing what is asked.
  • The child becomes overwhelmed in session. Stop, ground, and return to safety; never hold or restrain to contain distress. If there is risk of serious harm, follow your setting's emergency procedures and call emergency services as needed.
  • Rupture: the client fears you will repeat what was done. Name it; describe each method before using it; invite the client to stop anything; repair openly when you misjudge.
  • Adult survivors' anger at the profession. Accept it as legitimate; do not defend the field; point to professional bodies' rejection of these methods [source: APSAC 2006 abstract].
  • A referral service markets itself as "attachment-focused" but uses coercion. Ask what a session looks like; check the CEBC listing in the US [source: CEBC]; do not refer if holding, restraint, regression or deprivation is involved.
  • Media coverage or court cases revive distress. Plan ahead with the client; use safe-messaging principles; give crisis resources (988 US; Samaritans 116 123 UK and Ireland).
  • Confusion with breathwork "rebirthing". Clarify which practice the client means; the Colorado death and convictions concern a coercive physical session, and North Carolina's lawmakers concluded that rebirthing's benefits did not outweigh its risks [source: WRAL].
  • Religious or spiritual framing. Where a family's choice of method rests on religious teaching about obedience or discipline, explore meaning respectfully; the DSM-5-TR "Religious or Spiritual Problem" may apply, coded Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)], while safety rules still apply. DSM-5-TR wording [uncertain: not verified].

Harm account

What was actually done

  • Holding approaches. From the 1970s, Robert Zaslow held patients to provoke rage; a later "holding time" approach had mothers hold defiant children tightly to provoke anger; from about 1991 Foster Cline and colleagues at the Attachment Center in Evergreen, Colorado, promoted similar methods for adopted and maltreated children labelled as having attachment disorder. Children were restrained against their will to provoke anger and typically responded by screaming, swearing, spitting or biting before eventually crying; proponents said that if carers stayed calm and withheld sympathy the child would tire, relax and bond [source: Deseret News 2004]. A Utah licensing petition described children physically held down by adults or wrapped in blankets, and alleged painful pressure to their bodies; the practitioners denied hurting children [source: Deseret News 2005].
  • Rebirthing-attachment session, Colorado, April 2000. A ten-year-old adopted girl from North Carolina, brought to Colorado by her adoptive mother for treatment of attachment disorder, was wrapped in a blanket with pillows pressed around her by several adults to simulate birth and was urged to push her way out, so that she would be "reborn" and bond with her adoptive mother. The session went on for a long time and was videotaped; on the tape she cries that she is dying. She was not breathing when it ended and died in hospital the next day of asphyxiation [source: ABC News 2001; Deseret News 2001].
  • Punitive "attachment" parenting, Utah, 2002. A four-year-old adopted girl died after being forced to drink water, with her hands tied, as a punishment; her adoptive mother's lawyer said she had followed professionals' advice to correct behaviour [source: KSL 2008]. Her parents said they had learned the technique at a Utah holding-therapy centre; a county attorney's investigation did not implicate the centre [source: Deseret News 2005].

How it caused harm

  • Deaths: asphyxiation in the Colorado session [source: ABC News 2001]; the Utah death after forced water [source: KSL 2008]. APSAC records that controversial attachment therapies have been linked to children's deaths [source: OJP abstract].
  • Physical injury and pain alleged by former clients and in licensing proceedings [source: Deseret News 2005].
  • The underlying model reframed a frightened child's protest as "rage" to be broken, so signs of danger, including a child saying she was dying, were treated as part of the process [source: ABC News 2001; Deseret News 2004].
  • Mislabelling: "attachment disorder" is not an accepted diagnosis, and broad labels steered families away from assessment and supported care [source: APSAC 2006 abstract; NICE NG26 1.3.6].
  • Likely psychological harms (fear of touch, shame, mistrust of carers and therapists) are [synthesis] and have not been quantified [uncertain].

Recognising it today

  • Accountability: Watkins and Ponder were convicted of reckless child abuse resulting in death and sentenced in 2001 to 16 years each; the judge found no intent to harm [source: ABC News 2001; Deseret News 2001]. Colorado (2001) and North Carolina banned rebirthing [source: Colorado session law page; WRAL]. Utah regulators ordered a holding-therapy practitioner to stop [source: Deseret News 2005]. Current legal status in each state may have changed [uncertain].
  • Warning signs: a broad "attachment disorder" label from a checklist; any plan to hold, restrain, wrap or lie on a child; provoking rage or "catharsis"; regression or re-enacted birth; controlling food, water, sleep or toilet access; isolation; demands for total obedience; telling carers to ignore the child's distress or protests; programmes or camps that promise rapid bonding through confrontation [source: APSAC 2006 abstract; CEBC citing APSAC and AACAP; remaining signs synthesis].
  • How it reaches clients now: online parenting programmes, adoption support networks, books and intensives that use attachment language; the CEBC rates some attachment interventions and flags "Concerning Practice" [source: CEBC; channels synthesis].

What to do instead and how to help those harmed

  • Supported care: thorough assessment; diagnose attachment disorders only on DSM-5 or ICD criteria; video feedback programmes and parental sensitivity and behaviour training; intensive carer support for school-age children in care; trauma-focused CBT for PTSD; no medication for attachment difficulties themselves [source: NICE NG26]. APSAC recommends behavioural interventions that increase parental sensitivity [source: OJP abstract]. AACAP's goal of treatment is to establish an attachment relationship where none exists [source: AACAP 2016 abstract].
  • Survivors: trauma-informed therapy (4.10-4.12), suicide-risk assessment and crisis resources (988 US; Samaritans 116 123 UK and Ireland) (4.13).
  • Families: psychoeducation, carer support and repair (4.7, 4.14, 4.15).
  • Reporting and legal routes: child-protection reports; complaints to licensing boards; criminal prosecution where a child is harmed, as in Colorado and Utah (4.5, 4.17). No survivor organisation specific to this practice is known [uncertain].

Sources

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