COMMENTARY

Reader's Response to "Coercive Restraint Therapies: A Dangerous Alternative Mental Health Intervention"

Letters

Arthur Becker-Weidman, PhD

Disclosures

December 01, 2005

To the Editor,

My work with, and research on, children with disorders of attachment was mischaracterized in the article, "Coercive Restraint Therapies," by Jean Mercer,[1] which was also previously published on the Web.[2] The techniques that Mercer describes as CRT [coercive restraint therapy] are never appropriate, and I do not use such methods in my work. I practice Dyadic Developmental Psychotherapy,[3] which is a relationship-focused approach based on attachment and developmental theories, for treating children with disorders of attachment. Dyadic Developmental Psychotherapy's central therapeutic mechanism is the development and maintenance of a contingent collaborative and affectively attuned relationship between therapist and child, between caregiver and child, and between therapist and caregiver. These principles, and the therapeutic approach that is Dyadic Developmental Psychotherapy, are generally understood to be within the mainstream of current thinking in the field of attachment research and practice.[4]

I would like to draw your attention to several inaccuracies and misrepresentations about my work in the Mercer article. Although Mercer is entitled to her opinions and positions, her misrepresentation of my work as CRT indicates is a substantial lapse in the monitoring of accuracy and truth. I am surprised at this oversight.

Specifically, Mercer states, "Two simple before-and-after studies claiming to support CRT have been posed on the Internet . . . The first, by Becker-Weidman, administered the RADQ and a behavior checklist to parents of 34 children before and after CRT. Becker-Weidman concluded that CRT had caused changes in the children.[1]" Mercer goes on to state (paraphrasing) that the significant differences between the test scores were confounded by simultaneous maturational change and natural variations in behavior because parents are most likely to bring children for treatment when their behavior is at its worst, so that spontaneous improvement occurs during the time of treatment but not because of treatment.

The Mercer article has several inaccuracies and misrepresentations regarding my study.

First, my study does not claim to support CRT. It does claim to support Dyadic Developmental Psychotherapy. "The study examined the effects of Dyadic Developmental Psychotherapy on children with trauma-attachment disorders who meet the DSM IV criteria for Reactive Attachment Disorder.[5]" This study is briefly excerpted with a few tables on my Web site https://www.center4familydevelop.com/prelimanaryresults.htm and https://www.center4familydevelop.com/outcomecontrol.htm. It is further elaborated in print.[5] In December of this year, the complete study will be published in a professional peer-reviewed journal, Child and Adolescent Social Work Journal. (Until then, the manuscript is available from the author).

Second, my study did not use a "behavior checklist," but used the Achenbach,[6] which is a well-researched instrument with excellent reliability and validity.

Third, Mercer states that I "administered the RADQ and a behavior checklist to parents of 34 children before and after CRT.[1]" As stated above, the treatment was not CRT but Dyadic Developmental Psychotherapy. More disturbing is the omission by Mercer of the fact that there was a control group of 30 children in the study. The inclusion of the control group was specifically to address issues of maturation and the possibility of spontaneous improvement. The study found that "Significant reductions were achieved in all measures studied . . . There were not changes in the usual-care group subjects (who received play therapy, individual therapy, family therapy, and other treatment from other providers not at the Center For Family Development).[5]" Both groups showed no differences on a variety of demographic variables measured, and they showed no differences on their pretest scores on the Achenbach. The 2 groups' post-test scores were based on instruments completed over 1 year after treatment ended, about 2 years after the initial test scores. The use of the control group, which was matched with the treatment group, makes Mercer's statement regarding maturational change and change caused "during the time of treatment but not because of treatment,[1]" wrong.

Mercer's characterization of Dyadic Developmental Psychotherapy as CRT is untrue, inaccurate, and misleading. Mercer[1] defines CRT as:

. . . alternate mental health interventions that are generally directed at adopted or foster children, that are claimed to cause alterations in emotional attachment, and that employ physically intrusive methods . . . CRT practices involve the use of restraint as a tool of treatment rather than simply as a safety device . . . and the withholding of food (italics added).

Dyadic Developmental Psychotherapy has nothing in common with CRT, as I demonstrate below.

No responsible provider of therapy could sanction the use of physically intrusive actions, intentionally causing pain, affective dysregulation, or the withholding of food as therapeutic. "The use of physical restraint and other coercive practices by CRT advocates stands in the sharpest possible contrast to conventional mental health practices.[1]"

Mercer's misrepresentations and inaccuracies regarding my work and Dyadic Developmental Psychotherapy are the following.

I do not practice CRT. My work is Dyadic Developmental Psychotherapy[3] and not CRT. Dyadic Developmental Psychotherapy does not meet Mercer's defining characteristics of CRT for the following reasons.

Alternate mental health practice: Dyadic Developmental Psychotherapy is based on generally accepted theory and practices. Hughes,[7] the developer of Dyadic Developmental Psychotherapy, states, "In looking for treatment strategies that are congruent with how secure attachments are facilitated, it is immediately obvious that the 'holding and coercive therapies' described by O'Connor and Zeanah have no place." Dr. Hughes goes on to list 7 principles of treatment for children with attachment disorders, none of which include the use of intrusive, coercive, violent, or restraining techniques or methods. O'Connor and Zeanah,[4] in describing treatment for children with attachment disorders, and referencing the work of Dr. Hughes, seem to support Dr. Hughes' approach. Daniel Siegel, MD, Associate Professor, UCLA School of Medicine [Los Angeles, California], and author of The Developing Mind,[8] described the book that I co-edited about Dyadic Developmental Psychotherapy as:

An informative assembly of chapters by people working on the frontlines to help children create the attachments that will help them thrive. Written from the point of view of what is practical and informed by new findings in science, the book will be of use to a wide array of caregivers and professionals. Here is a wealth of hard-won wisdom that will enrich the lives of many. [9]

Physically intrusive methods; CRT use of restraint as a tool of treatment rather than as a safety device: Dyadic Developmental Psychotherapy does not use physically intrusive or coercive methods. Nor is Dyadic Developmental Psychotherapy a "holding therapy," as defined by O'Connor and Zeanah.[10] My informed consent document[5] specifically identifies all intrusive and coercive behaviors as not therapeutic or part of treatment:

At The Center For Family Development we do not use wraps, compression hold, or holds that utilize provocative stimulation. The following are interventions that we DO NOT USE . . . . shaming a child or eliciting fear to get compliance. Coercing a child to engage in long or painful physical activities in order to get compliance or a response. Wrapping a child, lying on top of a child, "rebirthing," or similar techniques. Interventions based on power/control and submission. Interventions that are based solely on compliance.

In addition, this informed consent document has been on my Web site https://www.center4familydevelop.com/informedconsent.htm for several years. Sir Richard Bowlby[11] described dyadic developmental psychotherapy and the book that I coedited on this subject as:

A new paradigm for treating some of the most deeply troubled children in our society. One of the very few therapies that offers practical help to the most difficult to reach children and their families. The authors' passion for this groundbreaking therapy, and their deep understanding of attachment theory and how to apply it, shines through. This book offers both hope and new therapeutic insights; it is inspirational and daunting, scientifically logical and deeply moving.

Having met Sir Richard Bowlby and having had the opportunity to discuss Dyadic Developmental Psychotherapy in depth with him, his observations are well grounded in the facts.

Mercer's article is a polemic, rather than a scientific, approach to the issues that are involved in the diagnosis and treatment of children with disorders of attachment. An example of such a scientific approach can be found in the special issue of Attachment and Human Development.[12] Mercer is Chairwoman of Advocates for Children in Therapy's (ACT) Professional Board of Advisors.[13] ACT is an activist group with a limited focus on eliminating any treatment for children that uses attachment-based interventions.

I appreciate your giving me the opportunity to respond to the inaccuracies and misrepresentations in the Mercer article. I would also welcome the opportunity to respond to any questions that readers may have about Dyadic Developmental Psychotherapy or the evaluation and treatment of children with disorders of attachment.

Sincerely,

Arthur Becker-Weidman, PhD
Director, Center For Family Development, Williamsville, New York
Diplomate, American College of Forensic Examiners
Diplomate, American Board of Psychological Specialties in Forensic Psychology
Diplomate, American Board of Psychological Examiners in Child Psychology
Registered Clinician, Association for the Treatment and Training in the Attachment of Children
Aweidman@Concentric.net

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