Coercive Restraint Therapies: A Dangerous Alternative Mental Health Intervention

Jean Mercer, PhD

Disclosures
In This Article

Discussion

CRT lacks an evidentiary basis, is derived from an unconventional theoretic background, and is at odds with practices accepted by the helping professions. There is clear evidence of serious harm done to children by adults influenced by the CRT view. Professional organizations and academic publications have rejected CRT practices and beliefs. Nonetheless, Internet sites offering CRT flourish, and state agencies promulgate the CRT philosophy. Why is this happening, and what can be done?

The apparent public regard for CRT may be related to advertisement and advocacy that are protected as free speech under the First Amendment.[21] Advocacy of CRT cannot be prevented even when CRT practices cause injury. The media, the Internet, and practitioners themselves are all free to claim safety and efficacy for CRT.

The mass media have made a practice of presenting CRT as exciting and acceptable. From the depiction of CRT years ago in the Elvis Presley movie Change of Habit to a Dateline program in 2004,[22] CRT has been shown as strange and frightening but effective. The media have never presented clear arguments against the use of CRT.

The rise of the Internet was a gift to CRT advertisers, who can now contact and be contacted by families in every part of the country. Internet parent support groups have allowed families involved with CRT to develop cultlike support systems that counter criticisms of CRT practices. A recent survey reported in The Wall Street Journal showed that in 2004, 23% of Internet users searched for experimental treatments,[23] providing a large audience for CRT-related material.

Although practitioners who cause harm directly are legally liable, it would appear that many CRT practitioners are moving from practices of which they themselves restrain children to an approach of which they teach parents to do this. Any injury to the child is then caused by the parent. The practitioner's speech to the parent is protected, as are workshops and courses that claim efficacy for CRT.

As was noted earlier, some professional organizations have adopted resolutions rejecting CRT. However, other organizations have acted in ways that support CRT practices. These actions include publication of a book by the Child Welfare League of America[24] and approval of continuing education credit for CRT workshops by the American Psychological Association and the National Association of Social Workers.

One accredited educational institution, Texas Christian University, Fort Worth, Texas, now offers credit-bearing courses involving the CRT belief system. A number of unaccredited institutions, such as the Santa Barbara Graduate Institute, Santa Barbara, California, also do so.

Given that curtailment of freedom of speech is neither possible nor generally desirable, it cannot be expected that advertisement of CRT will stop. Professionals who are concerned about CRT have the responsibility of employing their own freedom of speech to present the facts to other professionals and to parents who consult them, bearing in mind that the concepts and empirical evidence are not easy to summarize. An important start would be for all relevant professional organizations to adopt resolutions rejecting CRT and to communicate those resolutions to the media. In the meantime, physicians should be prepared to respond to parents' references to CRT and should realize that poor growth in adopted and foster children may result from CRTP practices.

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