Nursing Informatics and the Foundation of Knowledge.docx

Nursing Informatics and
the Foundation of
Knowledge

Contents
Introduction ............................................................................................................. 1
Chapter 1: The Complete Guide to Attachment ...................................................... 3
The Essence of Therapeutic Attachment ............................................................. 6
A Journey Through the Evolution of Attachment Therapy ................................ 14
Chapter 2: Grasping Autism and Its Treatment ..................................................... 25
Historical Foundations of Attachment Therapy ................................................. 28
Autism: A Look Back at Its History ..................................................................... 38

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Introduction

Welcome to "Consequences of Psychological Interventions," a
comprehensive exploration of the multifaceted impacts and outcomes of various
psychological interventions on individuals, relationships, and society as a whole.
In an era marked by increasing recognition of mental health concerns and the
growing demand for effective interventions, understanding the consequences of
psychological interventions has become paramount in promoting healing,
resilience, and personal growth.
"Consequences of Psychological Interventions" offers an in-depth
examination of the diverse consequences of psychological interventions across
different contexts and populations. From alleviating symptoms of psychological
distress to fostering self-awareness and promoting adaptive coping strategies,
psychological interventions play a crucial role in empowering individuals to
navigate life's challenges and cultivate a greater sense of well-being.
At its core, this book recognizes the transformative potential of
psychological interventions in facilitating positive change and improving quality of
life. It delves into the therapeutic process, exploring how skilled therapists
collaborate with clients to identify goals, explore underlying issues, and develop
strategies for overcoming obstacles and achieving personal growth. Through
evidence-based techniques, empathic listening, and compassionate support,
therapists create a safe and supportive environment where clients can explore
their concerns, gain insight, and work towards meaningful change.
Throughout the pages of this book, readers will encounter a wealth of
information on the various psychological interventions, including cognitive-
behavioral therapy, mindfulness-based interventions, interpersonal therapy, and
more. Each chapter provides insights into the theoretical foundations of these
interventions, as well as practical strategies for implementation and case
examples illustrating their effectiveness in real-world settings.

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Moreover, "Consequences of Psychological Interventions" explores the
broader societal implications of psychological interventions, highlighting their role
in reducing stigma, promoting mental health awareness, and fostering a culture
of empathy and understanding. From individual therapy sessions to community-
based programs and policy initiatives, psychological interventions contribute to
the creation of supportive environments where individuals can thrive and
flourish.
As we navigate the complexities of modern life, "Consequences of
Psychological Interventions" offers a comprehensive exploration of the outcomes
and impacts of psychological interventions on individuals and communities.
Whether you are a mental health professional, a student of psychology, or
someone interested in understanding the consequences of psychological
interventions, this book invites you to explore the transformative power of
psychological interventions and their role in promoting healing, growth, and
resilience in individuals and societies alike.

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Chapter 1: The Complete Guide to
Attachment

Within the scope of this chapter, a paramount inquiry revolves around
understanding how the body actively contributes to or partakes in shaping
psychological experiences. Descartes, in his philosophical delineation, sought to
address this by partitioning the responsibilities of the mind and body. He ascribed
to the body the management of physical needs that could be communicated to
the mind, while reserving for the mind not only the faculty of rational thought but
also the realm of the "passions of the soul" – encompassing emotions and
motivations disconnected from mere physical drives. This dualistic framework
acknowledges the influence of bodily sensations on emotions but does not
propose that memory or immediate conscious experience is situated within the
body itself.
During the early nineteenth century, a heightened recognition of the body's
role in shaping mental functions emerged, particularly evident in severe mental
illnesses where disease processes or exposure to toxic substances such as
mercury could precipitate alterations in mood or behavior. However, the
acknowledgment of the body's influence on more commonplace cognitive and
emotional processes evolved gradually, mirroring the sentiments of the Romantic
movement. Simultaneously, there was a burgeoning interest in Eastern spiritual
practices like yoga, particularly notable among groups such as the Theosophical
Society, which emphasized physical rituals as integral components of direct
spiritual experiences.
In parallel, William James, a seminal figure in psychology, contributed to the
understanding of the body's role in psychological phenomena through his
formulation of the James-Lange theory of emotion. This theory posited that the
experience of emotion stemmed from physiological changes elicited by external
stimuli, rather than the reverse. In essence, James argued that alterations in
mental states could be induced by interventions that targeted the body. This

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perspective marked a significant departure from traditional views and
underscored the interconnectedness of bodily processes with psychological
experiences.
Georg Groddeck, in his work "The Book of the It," articulated his belief that
both mental and physical events were influenced by the "It" – the universal life
force that Groddeck posited operated through human beings. While Groddeck
primarily focused on how physical disorders symbolically represented mental
conflict and were amenable to psychological treatment, his clinical approach
included modalities such as massage and hot baths, indicating a preliminary step
in the development of bodywork. Notably, in 1931, Groddeck delivered a paper
on "Massage and Psychotherapy" at a psychoanalytic conference in Dresden,
further highlighting the intersection of physical interventions with psychological
treatment approaches.
It's worth highlighting, as previously discussed in this text, that Georg
Groddeck's influence extended beyond his direct contributions to psychoanalysis,
as evidenced by his impact on notable figures like Ferenczi. Ferenczi's visit to
Groddeck's clinic, along with Frieda Fromm-Reichmann's, underscores the
interwoven nature of their professional exchanges and the cross-pollination of
ideas in the field. Fromm-Reichmann's early research interests, such as her
doctoral dissertation on pupillary changes in schizophrenics, foreshadowed her
later exploration of the intricate connections between bodily manifestations and
psychological states.
The lineage of influence stemming from Groddeck to Ferenczi extends
further to Wilhelm Reich, whose contributions were arguably pivotal in shaping
the trajectory of bodywork. Reich's theory, as elucidated in preceding chapters,
posited a direct link between traumatic memories and muscular tensions, with
specific muscles representing the locus of stored distress. According to Reich, the
body's developmental stages determined which area bore the brunt of traumatic
events, such as the head segment during early development. The concept of
"character armor," signified by stiffness in these areas, corresponded to
characteristic psychological issues like depression. Reich's therapeutic approach
centered on releasing this armor through physical interventions, ultimately

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aiming to restore the body's natural fluidity and flexibility, particularly focusing on
the spine.
Reich's profound insights into the body-mind connection were not solely
derived from within psychoanalysis; they were also informed by his exposure to
body awareness practices and dance movements in Germany. His partner, Elsa
Lindenberg, herself a dancer and student of Elsa Gindle, a pioneering gymnastics
instructor, provided Reich with firsthand exposure to techniques promoting
movement and breathing awareness. This amalgamation of influences led Reich
to emphasize the body as the primary locus of his "character analysis"
intervention, relegating verbal therapies to secondary roles in his therapeutic
approach.
Reich's exploration into the intricate connection between physical and
psychological processes unfortunately led him down a controversial path with his
advocacy of "orgone therapy," a concept rooted in the belief of a universal energy
that purportedly influenced both body and mind. Tragically, Reich's endeavors
culminated in his incarceration and untimely demise. However, prior to these
tumultuous events, devoted followers began to carry forth the torch of Reich's
teachings, establishing a legacy that endures through the publication of journals
dedicated to Reichian methods. Among these disciples was Alexander Lowen,
who embarked on a journey of learning under Reich's tutelage in 1940, eventually
commencing therapy sessions with his mentor in 1942.
Lowen's immersion in Reichian principles paved the way for the
development of his own innovative therapeutic approach, which he termed
bioenergetic analysis. This multifaceted intervention incorporated a spectrum of
Reichian techniques, ranging from specialized breathing exercises and cathartic
screaming sessions to manipulative procedures and tailored physical exercises.
Central to Lowen's methodology was the conviction that the expression of
negative emotions, whether through verbal articulation or physical outlets such
as hitting pillows, held the key to reclaiming one's capacity for joy and vitality.
Notably, Lowen himself adhered to a rigorous regimen of daily kicking and hitting
exercises as part of his personal therapeutic routine.
In his diagnostic endeavors, Lowen adopted a holistic approach,
meticulously observing various somatic indicators such as facial expressions,

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postural dynamics of the head and shoulders, patterns of respiration, pelvic
mobility, and limb movements. These assessments were often conducted in real-
time, with patients encouraged to engage in movement while sharing their
experiences verbally. The legacy of Lowen's pioneering work endures through the
Institute of Bioenergetic Analysis, which continues to certify practitioners and
perpetuate the tenets of body-centered therapy. Notably, Lowen's potential
connection with renowned hypnotherapist Milton Erickson warrants further
exploration, a topic that will be delved into in subsequent chapters.
As elucidated earlier in this chapter, the notion of bodily influences on
mental states has garnered support from figures such as Bessell van der Kolk, who
posits that certain memories are encoded within the body itself. Van der Kolk's
perspective, however, is nuanced by contemporary insights into the functioning
of specific brain regions implicated in emotion and memory processing, diverging
from the simplistic notion of traumatic memory representation solely through
muscular tension. Furthermore, acclaimed authors like Alice Miller have
underscored the role of the body as a repository for repressed and unconscious
memories, emphasizing the intricate interplay between somatic experiences and
psychological well-being. This holistic perspective on the self, integrating bodily
processes into the fabric of identity, echoes sentiments articulated by luminaries
in psychoanalytic theory such as Freud, Winnicott, and Mahler, whose seminal
contributions continue to inform contemporary perspectives on the complex
interrelationship between body and mind.
The Essence of Therapeutic Attachment
Central to the historical backdrop of bodywork lies the intricate interplay
between Dance and Movement Therapy (DMT) and the pioneering theories of C.
G. Jung. While Freud viewed the arts primarily as vehicles for sublimating libidinal
energies, Jung took a divergent perspective, regarding them as potent gateways
to the unconscious, offering glimpses into primal truths. This profound insight led
to the conceptualization of "active imagination," a transformative process
involving the expression of images sourced from the depths of the unconscious
mind.
Though all forms of artistic expression hold potential for facilitating
beneficial shifts in ego functioning and fostering creativity, Jung accorded

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particular significance to dance and movement as avenues for delving into the
depths of the unconscious. It is purported that Jung himself discovered the
profound communicative power of movement when he found resonance with a
schizophrenic woman through the emulation of her gestures. Moreover,
anecdotal evidence suggests that some of Jung's patients found solace and
expression through spontaneous dance, illustrating the profound impact of
movement on psychological well-being.
Jung's keen interest in dance and movement reverberated through the field
of psychotherapy, influencing the trajectories of prominent figures in DMT.
Notably, two stalwarts of DMT in the United States, Mary Whitehouse and Joan
Chodorow, were steeped in Jungian philosophy and methodologies. Drawing from
their Jungian training, Whitehouse and Chodorow pioneered the practice of
"authentic movement," a therapeutic modality that delves deep into the somatic
unconscious, exploring the realms of the unconscious as they manifest and
express themselves on a bodily level.
The profound influence of Jungian principles on the practice of DMT
underscores the rich tapestry of connections between psychological theory and
embodied experience. Through the lens of Jungian psychology, movement
transcends mere physical expression, becoming a vehicle for profound
introspection, self-discovery, and healing. As practitioners continue to explore the
synergies between movement and the unconscious, the legacy of Jung's visionary
insights continues to shape the landscape of body-centered psychotherapy,
offering profound avenues for exploration and transformation.
Whitehouse coined the term "movement-in-depth" to encapsulate her
deeply Jungian approach to Dance Movement Therapy (DMT). Within this
framework, the practitioner surrenders to an inner guidance, allowing
movements to organically emerge from within rather than being directed or
premeditated. Through this process, individuals give tangible form to the images
and emotions that arise from their somatic experiences, delving into the depths
of their psyche through embodied expression.
At the core of Whitehouse's practice is the concept of "authentic
movement," a transformative modality conducted in the presence of a witness.
The witness plays a crucial role, tasked with observing the dancer's movements

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and facilitating verbal processing to unpack the deeper meanings embedded
within the somatic expressions. Central to the witness's role is the cultivation of
kinaesthetic, intuitive, and empathic attunement, allowing them to tap into their
own subconscious responses to better understand the nonverbal communication
unfolding before them.
However, Chodorow has highlighted certain challenges inherent in this
practice, particularly regarding the potential influence of the witness's movement
preferences on observation. Despite the best intentions, empathic attunement
may sometimes be influenced by factors beyond the dancer's movements,
underscoring the nuanced dynamics at play within the therapeutic encounter.
Across various bodywork modalities, characterized by their diverse
practices, there exists a shared lack of plausibility and a tenuous evidentiary
foundation. Positioned within the "manipulative" category by NCCAM, these
practices often trace their roots back to the Romantic period, marked by a
heightened emphasis on emotion, non-verbal communication, and the enigmatic
workings of the unconscious mind.
Many bodywork approaches exhibit a vitalistic undertone, particularly
those with origins in chiropractic or osteopathic traditions, although vitalism is
not an inherent feature of all bodywork systems. When employed for
psychotherapeutic purposes, these practices are often deemed "alternative,"
reflecting their departure from conventional therapeutic modalities.
While adverse events associated with bodywork methods are rare, their
physical nature, coupled with the potential lack of medical training among
practitioners, poses a risk for both direct and indirect harm. Thus, careful
consideration and oversight are warranted to ensure the safety and efficacy of
these therapeutic interventions.
Attachment Therapy, characterized by its physically intrusive methods, has
gained notoriety due to documented cases of child deaths attributed to therapists
practicing this intervention. Additionally, parents employing techniques endorsed
by Attachment Therapists have been implicated in numerous child fatalities. Thus,
Attachment Therapy not only falls under the umbrella of alternative
psychotherapy but also warrants classification as a potentially harmful treatment.

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It's crucial to distinguish Attachment Therapy from the widely recognized
"attachment parenting," which, while lacking empirical support, is not associated
with the same level of risk.
Rooted in the theoretical framework of John Bowlby's attachment theory,
Attachment Therapy ostensibly draws upon insights into the emotional bonds
between young children and their primary caregivers. However, practitioners of
this intervention have predominantly focused on adopted children, operating
under the assumption that separation from birthparents inevitably results in
emotional disturbances, regardless of the child's age at the time of separation.
Central to Attachment Therapy is the purported treatment of Reactive
Attachment Disorder (RAD), a recognized diagnosis featured in several editions of
the Diagnostic and Statistical Manual of Mental Disorders. However, RAD is
relatively rare and challenging to diagnose beyond the preschool years. Some
proponents of Attachment Therapy extend their scope beyond RAD, diagnosing
children with what they term "Attachment Disorder," a speculative condition
characterized by symptoms such as an obsession with violent imagery, pervasive
lying even when detection is certain, and emotional detachment. Notably,
"Attachment Disorder" is a term exclusive to alternative therapists, diverging from
conventional discourse that may refer to attachment-related issues more
generally.
A comprehensive examination of Attachment Therapy is imperative not
only due to its potential adverse effects but also because of the extensive
literature detailing its methodologies and theoretical frameworks. While much of
this literature may be found in obscure publications or online sources, certain
works have been published by conventional publishing houses, lending credibility
to the discourse surrounding this alternative treatment. A recent ethnographic
study, conducted in the late 1990s, has provided valuable insights into
Attachment Therapy, corroborating existing knowledge while delving into the
motivations of adoptive parents seeking this form of intervention. Moreover, the
proliferation of information on the Internet, including papers authored by
practitioners and discussions among parents in online forums, has contributed to
our understanding of Attachment Therapy. Proponents of this therapy have

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drawn upon influential works from both mainstream and alternative fields,
facilitating deeper explorations into its foundations.
The academic landscape also reflects a growing interest in Attachment
Therapy, with numerous doctoral dissertations addressing attitudes towards the
treatment and attempts to evaluate its efficacy. Additionally, training materials in
the form of videotapes and news coverage have provided further insights,
enabling a relatively accurate tracing of the treatment's evolution over time.
Categorizing Attachment Therapy presents challenges, as it encompasses
elements from various categories suggested by NCCAM. These include biologically
based approaches such as dietary interventions, manipulative techniques like
physical restraint, and aspects of a vitalistic, transcendental approach.
At its core, Attachment Therapy operates under the premise that adopted
children, regardless of age at adoption, grapple with deep-seated rage and grief
stemming from separation from their birthmothers. This therapy predicts dire
outcomes, including antisocial behavior like serial killing, unless this inner turmoil
is addressed and the children are facilitated in forming emotional bonds with
their adoptive parents. Any perceived misbehavior or emotional detachment is
attributed to the failure of attachment, with even involuntary actions like
vomiting or bed-wetting interpreted as manifestations of resistance rooted in
unresolved anger and attachment issues.
Attachment Therapy, which is also referred to by alternative names like
Holding Therapy and Rage Reduction Therapy, encompasses a spectrum of
techniques that vary among therapists and have evolved over time, mirroring the
fluidity inherent in many mental health interventions, regardless of their
conventional or unorthodox nature. The depiction provided here draws primarily
from published materials elucidating the essence of the treatment. Initially,
practitioners of Attachment Therapy were keen on disseminating detailed
descriptions and insights, along with offering training resources such as
videotapes. However, following the tragic death of ten-year-old patient Candace
Newmaker in 2000, there has been a notable decline in descriptive publications
on the subject.

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In the iteration of Attachment Therapy witnessed in Candace Newmaker's
case, the treatment protocol involved a combination of physical contact,
movement, eye contact, and verbal communication. The therapist positioned
themselves with the child's head and upper body cradled in one arm, while the
torso rested in their lap, and the legs extended along a sofa or similar surface. To
restrict movement, one of the child's arms was often placed behind the
therapist's back, serving as a point of leverage or restraint. Meanwhile, the
therapist would typically hold the child's other hand or enlist the assistance of an
adult helper. This setup afforded the principal therapist the freedom to utilize
their spare hand to exert pressure on specific areas of the child's body, such as
the chin, ribs, or underarms, as deemed necessary for the therapeutic process.
The sessions commenced with a directive for the child to simulate
swimming by kicking her legs vigorously, with instructions to start and halt
promptly upon command. Proponents of Attachment Therapy claim that such
physical exercise enhances oxygen flow to the brain, purportedly facilitating
improved learning and clarity of thought in the child. Following this physical
warm-up, the therapist initiated a cathartic procedure aimed at the expression
and subsequent release of pent-up anger. The child was subjected to a narrative
wherein the therapist recounted the circumstances of her separation from her
birthmother, emphasizing notions of abandonment and betrayal. It's worth noting
that in Candace's case, her removal by child protective services stemmed from
what appears to have been a familial misunderstanding rather than a deliberate
act of abandonment. During these sessions, the child was repeatedly prompted to
vocalize sentiments of hatred towards her birthmother, often accompanied by
painful physical stimuli such as tickling and prodding to heighten emotional
intensity.
Furthermore, the therapist delved into discussions regarding the child's
perceived misbehavior, disobedience, and expressions of ingratitude towards her
adoptive mother. These interactions were characterized by the therapist's
insistence on maintaining full eye contact, often achieved by physically grasping
the child's chin. The child was warned that failure to comply with the therapy
regimen might result in her adoptive mother leaving her behind and returning
home without her, potentially leading to placement in residential care. These
sessions, spanning two to three hours each and occurring three to four times

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weekly over a duration of two weeks, maintained a consistent pattern of verbal
and physical interventions aimed at eliciting emotional responses and fostering
attachment.
In the tragic case of Candace Newmaker, her untimely death was not
directly caused by the interventions outlined in the preceding paragraph. Rather,
her demise, along with that of other children, stemmed from related practices
deeply rooted in misguided beliefs. Central to these beliefs was the notion that
children who displayed disobedience were doing so intentionally, indicating a lack
of attachment, which, in turn, was presumed to be predicated on the child's
recognition of adult authority. Candace's therapists augmented her treatment
regimen with a session known as "rebirthing," a distressing reenactment of the
birth experience conceived by adults.
During the "rebirthing" session, Candace was positioned on the floor and
enveloped in a flannel sheet, leaving one end partially open to simulate the birth
canal. Several adults encircled her, applying pressure akin to uterine contractions
by leaning or pressing against her. Candace was instructed to struggle her way out
of the wrap, symbolizing a metaphorical rebirth into her adoptive mother's care.
Tragically, she was unable to extricate herself, and her natural reactions of
weeping, pleading, and vomiting were misconstrued as acts of defiance and an
indication of the need for further imposition of adult authority.
Despite "rebirthing" sessions typically lasting mere minutes, Candace was
subjected to this ordeal for an excruciating seventy minutes, during the final
thirty of which she fell silent. Upon being unwrapped, it was discovered that she
had tragically succumbed to asphyxiation. Similarly, in another heart-wrenching
incident linked to Attachment Therapy, a preschooler named Krystal Tibbets met
her demise when her adoptive father suffocated her with his full weight, a
practice he had been instructed to perform by her therapists as a means of
addressing her problematic behavior.
Remarkably, the adoptive father had previously observed Krystal ceasing to
breathe during similar sessions, only to resume breathing afterward. However,
under the misguided guidance of the therapists, he continued with the
compression technique, believing it to be imperative. Regrettably, on the fateful
occasion, Krystal failed to regain her breath, resulting in her tragic passing.

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Subsequently, the adoptive father was sentenced to six years in prison for his
unwitting involvement in the misguided action, which had catastrophic
consequences.
Attachment Therapists extend their influence beyond therapy sessions,
providing parenting guidance and offering what they term "respite care," where
trained foster parents implement similar techniques. These methods include
imposing strict control over children's choices, even down to basic necessities like
food, drink, and bathroom use, which must be requested from adults. Dietary
options are often restricted to simplistic fare like peanut butter sandwiches and
milk for prolonged periods. Education takes a backseat, with children being
assigned menial tasks devoid of purpose, such as moving stones back and forth in
the yard. In an effort to foster attachment, children may be rocked, cuddled, and
offered caramels, a confection believed to hold special significance due to its
lactose content resembling that of human milk.
Initially, Attachment Therapy garnered attention for its application in cases
involving severe emotional disturbances like autism and schizophrenia. However,
like many alternative treatments, it soon acquired a reputation for purportedly
addressing a broad spectrum of issues. Nonetheless, the therapy's name itself
underscores its primary focus on matters of emotional attachment. This emphasis
stems from the speculations of John Bowlby, the progenitor of widely accepted
attachment theory, who suggested that early childhood experiences of
inadequate care could correlate with delinquent behavior later in life—a notion
embraced by proponents of Attachment Therapy.
In the 1980s, the Diagnostic and Statistical Manual of Mental Disorders
(DSM) published by the American Psychiatric Association introduced a diagnosis
known as Reactive Attachment Disorder of Infancy and Early Childhood. This
disorder, as outlined in the then-current edition of the DSM, manifested as an
eating disorder stemming from the quality of the bond between mother and
child. Subsequent revisions of the DSM expanded the scope of Reactive
Attachment Disorder to encompass atypical social behaviors observed in children
under five years old. These behaviors ranged from excessive friendliness towards
strangers to a lack of typical attachment to familiar individuals, or conversely,

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heightened clinginess and separation anxiety. To qualify for the diagnosis, such
behaviors needed to be linked to a history of abuse and neglect.
Attachment Therapists began to assert that their treatment was effective
for addressing Reactive Attachment Disorder, although they faced several
challenges in making this claim. One significant obstacle was the absence of clear
diagnostic criteria for identifying Reactive Attachment Disorder in children
beyond preschool age. Additionally, Attachment Therapy practitioners began
making alarming predictions about the future outcomes of untreated adopted
children, such as the possibility of them becoming serial killers. However, there
was no empirical evidence linking Reactive Attachment Disorder to such extreme
outcomes.
In response to these challenges, Attachment Therapists introduced the
concept of Attachment Disorder, which they argued was distinct from Reactive
Attachment Disorder and not yet formally described in diagnostic manuals like
the DSM. Attachment Disorder was characterized by behaviors such as "crazy
lying" (lying when the truth was evident), cruelty to animals and other children,
and a fixation on blood and gore. However, it was noted that Attachment Disorder
could also manifest alongside a lack of overtly problematic behavior, as some
children were adept at manipulating others' perceptions.
To diagnose Attachment Disorder, Attachment Therapists developed the
Randolph Attachment Disorder Questionnaire, which relied on reports from
parents or other individuals familiar with the child's behavior. This approach
allowed Attachment Therapists to create a diagnosis unique to their practice,
thereby directing their treatment towards a specialized disorder that they
claimed to be uniquely equipped to address. Additionally, the broad criteria of
Attachment Disorder encompassed a wide range of behaviors, facilitating the
popularization of Attachment Therapy by offering a diagnosis that could be
applied to many children exhibiting undesirable conduct.
A Journey Through the Evolution of Attachment Therapy
A comprehensive examination of the origins of Attachment Therapy reveals
a gradual evolution of its fundamental tenets, dispelling any notion that its
principles were haphazardly conceived. However, it is imperative to acknowledge
that Attachment Therapy diverges significantly from the attachment theory

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pioneered by British psychiatrist John Bowlby, despite attempts by proponents to
suggest otherwise. In fact, Attachment Therapy's deviations from Bowlby's theory
have been characterized as "Bowlby abuse," highlighting the stark contrast
between the two frameworks. Furthermore, attributing the use of restraint in
Attachment Therapy to Bowlby's colleague, D. W. Winnicott, is erroneous, as
Winnicott's concept of "holding" pertained to emotional support with minimal
physical intervention, bearing little resemblance to the physical coercion
employed in Attachment Therapy practices.
In essence, Bowlby's seminal theory posits that human beings possess an
innate inclination towards social relationships, forming special attachments with
familiar caregivers during infancy, which serve as models for subsequent
relationships. Separation from these caregivers during the first year of life can
elicit profound grief, impeding emotional recovery. Bowlby suggests that
sustained absence of attachment opportunities, such as through frequent
changes in caregivers, may impede the development of personality, social skills,
and morality.
In stark contrast, Attachment Therapists posit that emotional attachment
originates from a biological connection between a mother and her unborn child,
asserting that attachment is inherently present at birth. According to Attachment
Therapy, separation from the primary caregiver, such as through adoption,
engenders severe distress, manifesting as unexpressed rage and grief. Failure to
address these underlying emotions through Attachment Therapy is purported to
lead to psychopathic conditions later in life. Quoting Bowlby's observations
regarding the authoritative nature of adult attachment figures, Attachment
Therapists emphasize the importance of authority and obedience in fostering
attachment and promoting normative psychological development.
Treatments reminiscent of Attachment Therapy found precedent in the
pioneering work of Wilhelm Reich, an Austrian-born psychiatrist who traversed
the realms of psychoanalysis under the tutelage of Freud and the profound
influence of Sandor Ferenczi. Despite his eventual notoriety for propounding the
concept of "orgone," a purported life energy linked to maladies such as cancer,
Reich's earlier contributions to personality theory and therapeutic techniques

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earned him recognition within conventional psychology circles during the mid-
20th century.
Reich's seminal work, "Character Analysis," delineated how adverse
personality traits stemmed from the somatic manifestation of "armoring," a
process whereby bodily segments became stiffened and constricted following
traumatic or unfulfilling early-life experiences. This "character armor," manifested
not only in psychological dispositions but also in idiosyncrasies of movement and
posture, served as a physical embodiment of emotional repression. In his clinical
practice, Reich adopted an unconventional approach, often conducting sessions
with patients who were partially or fully unclothed to discern the bodily markers
indicative of their character armor.
Central to Reich's therapeutic methodology was the utilization of sustained
mutual gaze as a means to penetrate the armor of the highest body segment,
facilitating the release of pent-up emotional tension. Additionally, he employed
tactile interventions such as prodding and tickling of the ribs and underarms to
alleviate muscular constriction and promote somatic release. This holistic
approach, integrating psychological insight with somatic intervention, sought to
dismantle the barriers erected by unresolved emotional traumas, thereby
fostering greater emotional and physical well-being in his patients.
Renowned psychiatrist and hypnotherapist Milton Erickson was renowned
for his unconventional and authoritative therapeutic approaches. In a seminal
publication in 1962, Erickson recounted a case involving a divorced mother
grappling with her disobedient pre-teen son, particularly regarding the mother's
interactions with her boyfriend. Erickson's solution was unorthodox: he advised
the mother to physically subdue her son by pushing him to the ground and sitting
on him for extended periods, ensuring she had sustenance and reading material
for herself during these sessions. This procedure was repeated on multiple
occasions. Upon release, the mother provided herself and her daughter with a
delectable meal while serving the son cold oatmeal. Remarkably, Erickson
reported that after several weeks of this regimen, the boy not only complied with
his mother's wishes but exhibited signs of trembling in her presence.
Interestingly, a video presentation by bioenergetics advocate Alexander
Lowen, published by the Milton H. Erickson Foundation in 1990, hinted at

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Erickson's inclination towards physical interventions, suggesting a theoretical
underpinning for his pragmatic approach. Erickson's colleague Jay Haley further
expounded on these methods by proposing "paradoxical interventions," which
entail demanding that a patient repetitively engage in actions deemed
undesirable or compulsive.
While it is unlikely that Erickson or Haley were familiar with Attachment
Therapy or its practitioners, their work appears to have inadvertently influenced
certain aspects of the unconventional treatment. Foster Cline, an Attachment
Therapy proponent, extensively quoted Erickson's 1962 publication in one of his
books, albeit without acknowledgment beyond the initial citation. Moreover,
contemporary Attachment Therapists have embraced a form of "paradoxical
intervention," wherein they coerce children into actions such as drinking or eating
excessively spicy food as a means of correction. Tragically, one such incident
resulted in the death of Cassandra Killpack due to hyponatremia induced by
forced drinking.
Robert Zaslow, a clinical psychologist, passed away in 2001, leaving behind a
controversial legacy in the field. Prior to his death, Zaslow practiced in California
until his license was revoked in 1972 due to a disturbing incident involving a
patient under his care. This incident involved the restraint of a patient in a supine
position by ten to twelve assistants for an alarming duration of over twelve hours.
Additionally, the patient's jaw was manipulated by inserting fingers into her
mouth and pressing down her tongue, resulting in significant injury. Despite the
revocation of his license, Zaslow continued to be associated with San Jose State
University as a faculty member. During his tenure there, he authored several
publications detailing what he termed "Z-therapy."
According to Zaslow, Z-therapy was founded on a synthesis of the theories
of Wilhelm Reich and John Bowlby. Central to his beliefs was the notion that
personality development hinges largely on emotional attachment, which is
fostered through experiences with a dominant caregiver during early childhood.
Zaslow posited that the absence of proper attachment during the toddler years
could lead to various detrimental outcomes, including impaired vision, autism,
schizophrenia, attention deficits, hyperactivity, and more. He asserted that
intensive experiences with a skilled therapist could offer corrective experiences

18

and mitigate emotional and psychological issues. These experiences often
involved elements reminiscent of Reichian therapy, such as physical restraint and
forceful manipulation, including prodding to the point of bruising, as well as
enforced eye contact. Zaslow labeled this approach "rage reduction therapy,"
suggesting that the expression and subsequent neutralization of rage through
cathartic means could lead to therapeutic breakthroughs.
Notably, Zaslow placed a strong emphasis on the interconnectedness of
bodily and psychological functions in his approach. Even before formalizing his Z-
therapy, he remarked on observations such as the behavioral tendencies of left-
handed boys being characterized by resistance and non-compliance, indicating his
early recognition of the potential links between physical traits and psychological
dispositions.
Zaslow's fascination with the therapeutic potential of eye contact became
more apparent in a subsequent article published in a German journal. In this
piece, Zaslow introduced the concept of a "Medusa complex," positing its
significance as equal to Freud's Oedipus complex in shaping personality
development. According to Zaslow, the Medusa complex was rooted in the
experience of mutual gaze, which he deemed a crucial component of his
treatment methodology. He illustrated this with the case of a young girl he
treated at the Colorado School for the Blind, asserting that she experienced a
restoration of normal vision following his intervention, although the mechanics of
mutual gaze in a blind patient were left unexplained.
After parting ways with San Jose State University, Zaslow embarked on a
journey, conducting demonstrations of his techniques at various universities and
institutions. These demonstrations often required volunteer assistants to
facilitate the treatment process. An eyewitness, then a young college student,
recounted a grueling twelve-hour session involving the physical restraint of a
schizophrenic man, shedding light on the intensity and duration of Zaslow's
therapeutic sessions.
During his travels, Zaslow crossed paths with a Colorado-based physician
named Foster Cline, who adapted Z-therapy to create "holding therapy" or
"Attachment Therapy." Cline's modifications aimed to capitalize on Zaslow's
techniques, leading to the proliferation of Attachment Therapy as a burgeoning

19

industry in Evergreen, Colorado. In response to criticism, Cline defended his
approach by arguing that all forms of bonding, or what he termed "trauma
bonding," involve an element of frustration and anger over unmet needs.
Drawing parallels to the Stockholm syndrome, Cline contended that emotional
attachment, whether in infants or hostages, follows a similar cycle rooted in
unfulfilled desires.
Cline's justification for his therapeutic approach seemed to draw inspiration
from the work of Vera Fahlberg, who in turn referenced the research of infancy
expert René Spitz. This speculative concept of an "attachment cycle" proposed by
Cline formed the basis of his defense against detractors. Despite surrendering his
medical license in Colorado following an incident resulting in patient injury, Cline
relocated to Idaho, where he continued to advocate for and consult on
Attachment Therapy.
As Zaslow's theories gained traction in Evergreen, a parallel narrative
emerged in the practices of New York psychiatrist Martha Welch. Welch, who rose
to prominence in the late 1970s, asserted that physical contact held the key to
treating autistic children. Advocating for her methods outlined in the book
"Holding Time," Welch recommended that all parents embrace daily face-to-face
restraint sessions as part of their routine. These sessions, particularly designed
for older children, involved the mother assuming a prone position atop the supine
child. Within the confines of this intimate interaction, both mother and child were
encouraged to express a full spectrum of emotions, ranging from anger and
hostility to love and affection. Despite the anticipated resistance from the child,
the session was expected to culminate in a state of relaxation and emotional
bonding.
Welch's methodology and her proposals for autism treatment received
significant validation when she crossed paths with Elisabeth Tinbergen, a
distinguished special education teacher married to Nobel Laureate Nikolaas
Tinbergen. Renowned for his contributions to ethological studies and theory,
Nikolaas Tinbergen took a keen interest in behavior patterns shaped by
experiences during critical developmental periods. Intrigued by the notion
posited by Welch and others that autism could stem from disrupted attachment
processes during infancy, the Tinbergens delved into the subject in their 1983

20

publication, "Autistic Children—New Hope for a Cure." Within the pages of this
book, Welch's methods were extensively detailed and commended, albeit
acknowledging the absence of empirical evidence supporting their efficacy. Welch
herself contributed a substantial appendix to the book, offering insights into her
therapeutic approach accompanied by a photographic record.
According to Welch's curriculum vitae, she later ventured to Evergreen,
Colorado, the epicenter of Foster Cline's endeavors, where she delivered a
presentation on her groundbreaking work. Additionally, she shared her insights at
various conventional professional gatherings, further disseminating her
revolutionary approach to autism treatment.
The emergence and advocacy of Attachment Therapy were significantly
bolstered by the establishment of a companion entity, the Association for
Treatment and Training in the Attachment of Children (ATTACh), during the early
1990s. Functioning as a hybrid organization comprising both parents and
therapists, ATTACh boasted a considerable number of ardent supporters who
endorsed physically intrusive treatment methodologies akin to those championed
by Zaslow.
In response to public outcry following several tragic incidents involving child
fatalities linked to Attachment Therapy, notably the tragic demise of Candace
Newmaker at the hands of her therapists in 2000, ATTACh took decisive action.
This included enlisting the services of public relations experts and undergoing
internal restructuring. The organization issued position statements denouncing
the use of restraint and advocating for a shift towards less intrusive therapeutic
approaches. Consequently, physical contact within Attachment Therapy was to be
restricted to nurturing gestures such as cuddling or a gentle "nurturing hold,"
with sustained eye contact remaining a central component of the treatment
regimen.
Simultaneously, ATTACh commenced a gradual distancing from Nancy
Thomas, a prominent "foster parent educator" closely associated with Foster
Cline and instrumental in propagating parenting practices endorsed by
Attachment Therapists. Despite being a sought-after speaker at ATTACh events
previously, Thomas found her ties to the organization diminishing over time.
Nonetheless, she retained her own following outside the confines of ATTACh.

21

Candace Newmaker's tragic demise prompted ATTACh to swiftly disassociate itself
from these contentious areas, recognizing their potential for harm.
During its period of reorganization, ATTACh, an entity not directly affiliated
with any professional clinical or child welfare body, initiated a certification
process allowing therapists to identify themselves as Registered Attachment
Therapists subsequent to attending ATTACh-sponsored training sessions. While
certain training programs are accredited for professional continuing education
credits by national organizations, it's important to note that registration as an
attachment therapist does not equate to professional licensure. As per
information available on the ATTACh website, the organization currently boasts
approximately 600 active members.
"Holding therapies," also known as "Attachment Therapies," akin to the
methodologies pioneered by Welch and Zaslow, have predominantly targeted
adopted children, particularly those in the pre-teen age group. Conversely,
treatments employing less coercion have found more traction with teenagers.
This practical distinction stems from logistical and financial considerations, as
exemplified by Zaslow's reliance on ten to twelve assistants for restraining
teenagers and adults. Attempting such restraint with fewer individuals not only
presents logistical challenges but also carries the risk of inefficacy and potential
harm.
Martha Welch, a proponent of "holding" techniques, has advocated for
their use in marriage therapy, employing face-to-face positioning and mutual
physical restraint. In instructional videos, one spouse is depicted atop the other,
engaged in a struggle while both exert significant effort, accompanied by grunting
and swearing, over extended periods. Welch has also applied similar methods in
resolving conflicts between family members, such as mothers-in-law and
daughters-in-law.
Richard Cohen has drawn inspiration from Welch's techniques in his
endeavors to "convert" adults from a homosexual to a heterosexual orientation.
Cohen's approach hinges on the premise that homosexuals have failed to grasp
that physical or emotional intimacy need not be inherently sexual. His
interventions involve clients sitting in the lap of a parent or therapist, who then

22

holds and cuddles them while maintaining eye contact and offering affirmations
of the client's positive qualities.
Meanwhile, Czech therapist Jirina Prekopova has proposed the
incorporation of holding practices into routine family dynamics as a means to
foster familial affection and address conditions like autism and oppositional
behavior. Prekopova's advocacy has led to the establishment of clinics in several
countries, with her efforts extending to lecturing engagements in Russia as recent
as 2013.
As mainstream psychology and mental health practitioners increasingly
embraced evidence-based practices, Attachment Therapists found themselves
recognizing the importance of substantiating their treatment methods with
empirical support. Consequently, they began to undertake research endeavors to
bolster their claims, seeking to move beyond mere anecdotal evidence. One such
attempt involved a "before-and-after" study, which reported observed
improvements in children's behavior post-treatment. However, like similar
studies, it faced criticism for its methodological limitations, particularly the
absence of a comparison group. Without a control group, it remained uncertain
whether the observed improvements were solely attributable to the treatment or
could have occurred spontaneously or through other factors.
Furthermore, the reliance solely on parental assessments for evaluating the
children's progress introduced another layer of subjectivity and potential bias into
the study's findings. Attachment Therapists tended to prioritize parental
perspectives, often overlooking the possibility of parental error or intentional
misrepresentation of outcomes.
A more comprehensive investigation of Attachment Therapy was
undertaken as a doctoral dissertation, subsequently published in a peer-reviewed
journal by Myeroff, Mertlich, and Gross (1999). This study sought to compare the
outcomes of children who underwent Attachment Therapy in Evergreen with a
control group of children whose parents had sought treatment but did not follow
through with therapy. While the study reported greater improvements in the
treated group based on parental checklists, the statistical analysis employed
raised concerns about its appropriateness and the robustness of the findings.

23

Moreover, the study's reliance on subjective parental reports and the lack
of objective measures for evaluating changes posed significant methodological
challenges. Additionally, issues regarding the comparability of the two groups
prior to treatment complicated the interpretation of the results. Despite attempts
to match key demographic factors, inherent differences between the groups
could have influenced the observed outcomes, undermining the study's ability to
conclusively support the efficacy of Attachment Therapy.
The decision-making process leading to the enrollment or non-enrollment
of children in Attachment Therapy likely involved a myriad of complex factors that
could have influenced both parental attitudes and subsequent reporting of
children's behavior. While all parents initially expressed interest in the program by
applying for it, disparities between those who ultimately pursued treatment and
those who did not warrant careful consideration.
Several plausible scenarios could have contributed to this discrepancy.
Disagreements between parents regarding the suitability or efficacy of
Attachment Therapy might have deterred some from proceeding with treatment.
Additionally, practical obstacles such as logistical challenges related to
employment, familial illness or disabilities, or other familial obligations could have
impeded the ability of some parents to commit to the two-week therapy program
in Colorado. Moreover, the study conducted by Myeroff and her colleagues failed
to delve into these potential influencing factors, overlooking their potential
impact on treatment outcomes and parental perceptions.
Furthermore, the experience of participating in a two-week therapy
program away from home could have exerted varying effects on parental
attitudes and subsequent reporting of children's behavior. Parents relieved of
their daily responsibilities during the therapy period may have perceived their
children's behavior differently compared to those managing the challenges of
everyday life at home. However, these nuanced dynamics were not explored in
the study's analysis.
In another study, Welch and colleagues purportedly supported the efficacy
of her holding technique, now termed Prolonged Parent-Child Embrace (PPCE).
However, this investigation, characterized as a simple before-and-after study
devoid of comparison groups, failed to provide robust evidence for the

24

effectiveness of PPCE. Similarly, another researcher reported limited efficacy of a
holding technique employed with children and adolescents in residential
treatment settings, casting doubt on the widespread adoption of such
approaches without robust empirical support.

25

Chapter 2: Grasping Autism and Its
Treatment

Attachment Therapy lacks a robust foundation in empirical evidence,
particularly in terms of replicated randomized controlled trials, as discussed in the
preceding chapter. The existing research supporting Attachment Therapy is
predominantly at low levels of evidence, irrespective of the method used for
ranking. While the Myeroff study is commendable for incorporating a comparison
group, its limitations, including small sample sizes and the uncertain factors
influencing participant allocation to each group, impede definitive conclusions
regarding the efficacy of the treatment.
Moreover, the theoretical underpinnings of Attachment Therapy raise
doubts about its plausibility when evaluated against established psychological
principles and empirical evidence. Zaslow's reliance on Reichian concepts lacks
empirical substantiation, as there is scant evidence supporting notions such as
"character armor" or the therapeutic efficacy of painful prodding. Similarly, the
emphasis placed on eye contact as a pivotal aspect of therapy lacks empirical
validation.
Although Bowlby's attachment theory enjoys greater empirical support, the
interpretations of Zaslow, Cline, and others diverge significantly from established
tenets. Notably, the notion propagated by Attachment Therapists that attachment
processes begin prenatally and exert a dominant influence on personality
development is not congruent with conventional psychological understanding.
Moreover, Cline's assertion that failure to attach results in violent behavior,
including serial killings, is unsubstantiated and runs counter to Bowlby's original
research, which primarily focused on correlations between adverse early
childhood experiences and later antisocial behavior.
It is essential to recognize the potential ramifications of overemphasizing
attachment in psychological development, as highlighted by Woolgar and Scott
(2013). Cline's sensational claims linking attachment deficits to extreme antisocial

26

behaviors, such as those exhibited by notorious criminals like Ted Bundy, lack
empirical grounding and extrapolate far beyond the scope of Bowlby's research,
which primarily examined less severe manifestations of antisocial behavior.
A crucial aspect highlighting the implausibility of the assumptions
underpinning Attachment Therapy is its reliance on the concepts of regression
and recapitulation to elicit therapeutic effects. As elucidated in chapter 2, both
regression and recapitulation are conceptual or metaphorical constructs rather
than empirically validated mechanisms for producing desirable outcomes in
therapy. Consequently, the treatment's dependence on these notions significantly
undermines its plausibility and efficacy.
Attachment Therapy proponents frequently reference the concept of the
"attachment cycle" to justify their approach. Diagrams depicting the attachment
cycle typically illustrate a series of interactions wherein a baby expresses a need,
the caregiver responds appropriately, and the baby experiences gratification.
Through repeated iterations of this cycle, the baby purportedly develops
attachment to the caregiver. Conversely, a disrupted attachment cycle occurs
when the caregiver fails to meet the baby's needs, leading to a lack of trust and
the emergence of persistent rage in the child.
Some proponents, such as Cline and others, extend the concept of the
attachment cycle beyond infancy, delineating a "second-year attachment cycle."
According to this framework, attachment is not considered complete until the
child learns to accept and embrace the limitations and boundaries imposed by a
powerful caregiver during the second year of life. While the first-year cycle
focuses on establishing trust through meeting the baby's needs, the hypothetical
second-year cycle emphasizes the child's adaptation to authority and boundaries.
This nuanced understanding of the attachment cycle underscores the
multifaceted nature of attachment development and the interplay between trust-
building and boundary-setting in caregiver-child relationships. However, it is
essential to critically evaluate the empirical basis and theoretical coherence of
these constructs to ascertain their validity and applicability in therapeutic
contexts.

27

The recurrent sequences described by Cline and Fahlberg, purportedly
forming part of a first-year attachment cycle, undoubtedly occur in early
childhood. Infants cry to signal their needs, and their caregivers may respond
appropriately or not. Similarly, toddlers often engage in boundary-testing
behaviors, receiving either correction or leniency from their caregivers. Given the
vulnerability of infants and toddlers, it is evident that repeated instances of
neglect or inappropriate treatment could have dire consequences, including
physical harm or even fatality.
However, the direct correlation between these observed sequences and the
formation of attachment is less clear. Despite assertions by Cline, Fahlberg, and
their adherents, empirical evidence linking these behavioral patterns to
attachment remains elusive. The depiction of these sequences as constituting an
attachment cycle seems designed to serve as self-justification rather than
grounded in empirical research. Cline and his associates made no effort to
provide empirical data supporting their claims, instead attributing certain
elements of the cycle to other authors.
For instance, Fahlberg referenced René Spitz's work, particularly his
exploration of the long-term impact of early caregiving experiences. Spitz
highlighted the interplay between hunger, crying, and gratification, emphasizing
how these experiences contribute to the infant's developing perception and
understanding of causality. However, the term "attachment" was notably absent
from Spitz's discussions, indicating that his work does not serve as the origin of
the "attachment cycle" concept.
While Spitz's insights offer valuable perspectives on early childhood
development, particularly in understanding the formation of cognitive processes,
they do not directly address the concept of attachment as proposed by Cline and
Fahlberg. Thus, the true origins of the "attachment cycle" remain uncertain,
underscoring the need for further examination and empirical investigation into
the mechanisms underlying attachment formation during infancy and early
childhood.
Neither Cline nor Fahlberg explicitly address the potential role of operant
conditioning in the formation of attachment. However, exploring this perspective
leads to an examination of the reinforcement process for both the caregiver's

28

attentiveness to the baby and the baby's attentiveness to the caregiver. J. L.
Gewirtz proposed a theory suggesting mutual effects between parent and child,
positing social reinforcement for both parties derived from the exchange of care
and affectionate attention. Through systematic observations of mothers and
babies, Gewirtz demonstrated how their behaviors mutually reinforced each
other, leading to gradual changes in their interactions.
Gewirtz's theory aligns closely with the concept of the "first-year
attachment cycle," as both involve spontaneous behaviors related to infant needs,
adult responses, and subsequent learning. However, Gewirtz's operant
conditioning approach suggests that attachment behavior could persist even as
adult responses become less frequent over time. In contrast, the "attachment
cycle" theory posits that failure to respond adequately produces rage and
impedes the development of emotional attachment.
Furthermore, Fahlberg's inclusion of the "arousal-relaxation cycle" diagram
offers insight into the potential origins of the "attachment cycle" concept. This
cycle, involving arousal of energy and attention in response to a physical need,
closely resembles Wilhelm Reich's "four-beat" motivational cycle. Reich proposed
that all motivation involves mechanical tension, increased electrical charge,
electrical discharge, and subsequent relaxation, attributing these phenomena to
the transfer of an energy called "orgone."
Reich's motivational cycle, which he believed had a biological basis and
manifested in various events from orgasm to mitosis, likely influenced the
development of the "first-year attachment cycle" concept presented by Fahlberg,
Cline, and others. Thus, it appears that elements of Reich's theoretical framework
contributed to the formulation of the "attachment cycle" theory and its
subsequent adoption by practitioners in the field of Attachment Therapy.
Historical Foundations of Attachment Therapy
The concept of the "second-year attachment cycle," as proposed by Cline
and other Attachment Therapy proponents, centers on the influence of parental
limit setting during the toddler stage on the formation of attachment. This notion
stems from Bowlby's assertion that attachment figures typically possess greater
strength and wisdom than young children, a characteristic shared by most adults
with whom a child does not form an attachment. However, proponents of

29

Attachment Therapy have selectively emphasized the power differential between
toddlers and adults, overlooking other critical attributes of attachment figures
such as social responsiveness. Additionally, they have disregarded Bowlby's
insights into the evolving nature of attachment and the importance of
compromise and negotiation in nurturing it, opting instead to equate attachment
solely with obedience to parental authority.
Exploring the historical roots of Attachment Therapy reveals connections to
older sources, although these connections may not necessarily imply a direct
causal relationship. Rather, these sources may have familiarized certain beliefs
through past exposure, thereby facilitating parents' evaluation of Attachment
Therapy as a reasonable treatment option.
A distinctive aspect of Attachment Therapy involves the use of purification
measures aimed at achieving catharsis through the repetition of angry and
insulting remarks about the birthmother. It is believed that the rage stemming
from separation from the biological mother impedes the development of a
healthy attachment to adoptive parents. Without such attachment, proponents
argue, a child's development may veer toward violent aggression and criminal
behavior. To foster emotional attachment and mitigate the risk of aggression,
especially toward the adoptive family, it is deemed crucial to address and
alleviate the blocking rage. Thus, therapists often require children to vocalize
their rejection of the birthmother during holding sessions as a means of
confronting and releasing pent-up emotions.
In the realm of Attachment Therapy, purification extends beyond the
cathartic release of negative emotions to include the neutralization of any
positive thoughts or sentiments regarding the birth family. Children undergoing
this therapy are reminded of their abandonment and are encouraged not to allow
memories or thoughts of their birthmothers to emotionally control them. The
expression often employed in this context is "be the boss of you," emphasizing
the need for emotional autonomy and detachment from past attachments.
Embedded within Attachment Therapy are discernible traces of Romantic
influences, manifesting in the emphasis placed on intense emotions and the
perceived power of Nature. The profound emotional upheaval triggered by
separation from attachment figures, particularly in older infants and toddlers,

30

serves as a central model for all experiences of separation within this therapeutic
approach. Rather than delving into the cognitive aspects of attachment as
delineated in Bowlby's theory, Attachment Therapy places primary emphasis on
the emotional dimensions associated with attachment and separation. This
emotional-centric focus may lead Attachment Therapists to assume a uniformity
of emotional response across all ages, attributing similar feelings to children
regardless of the timing or circumstances of their early life separations.
Moreover, the emphasis on emotion as the crux of attachment
relationships extends to a preoccupation with the emotional experiences of
adoptive parents. Within the framework of Attachment Therapy, adoptive parents
are consistently portrayed as "loving" figures providing a "loving" home
environment. Even in cases where adoptions have been disrupted and children
are placed in residential care, parents are described as "loving at a distance,"
underscoring the enduring significance attributed to parental affection and
emotional connection. Thus, the emotional rapport between parent and child
emerges as the fundamental cornerstone of family dynamics within Attachment
Therapy circles. Strikingly, Attachment Therapists often employ contemporary
slang, such as the term "awesome," to describe adoptive parents, evoking a sense
of admiration akin to Romantic descriptions of natural phenomena.
Rooted in the Romantic tradition, Attachment Therapy espouses a fervent
belief in the supremacy of "Nature" as the primary force shaping and guiding
human behavior. Central to this philosophy is the notion that attachment
between a child and their birthmother is inherently "natural," "biological," or
"instinctive," thereby laying the groundwork for problems within adoptive
relationships. Adoption and fostering are viewed as noble endeavors aimed at
serving humanity, yet they are also perceived as perilous interventions disrupting
a supposedly natural order, potentially leading to violent outcomes. A subset of
Attachment Therapists, along with other unconventional thinkers, subscribe to
the notion of a "Primal Wound," positing that the separation of a child from their
birthmother results in deep emotional scars, even if the child is raised by
adoptive parents from infancy.
Reflecting the nineteenth-century Transcendentalists' preoccupation with
diet's influence on human development, Attachment Therapy proponents

31

advocate for a regimen akin to what the Victorians may have termed "low
feeding." While not explicitly endorsing vegan or vegetarian diets, Attachment
Therapists endorse a diet characterized by plain, simple foods, limited in variety
and quantity. Some proponents even advocate for hand-feeding milky sweets
during prolonged eye contact as a means to foster emotional attachment,
although the broader emphasis on dietary restrictions likely stems from a desire
for child obedience and adult control over nourishment.
The narrative of Attachment Therapy revolves around the assumption that
treatment is necessary to cultivate attachment due to the child's alleged trauma
from early separation, encapsulated in the concept of the "Primal Wound."
However, alternative perspectives on the role of trauma have emerged within this
framework. One perspective posits that emotional attachment is rooted in the
experience of trauma itself—that attachment forms when a child experiences
distressing needs like hunger or pain, which are then alleviated by a caregiver,
thus forging the attachment bond. Conversely, if the caregiver fails to assuage the
child's distress, attachment fails to materialize. This perspective extends
Attachment Therapy's purview to non-adopted children who faced early medical
challenges, such as those who spent time in neonatal intensive care or
experienced severe colic. According to this viewpoint, these children may
encounter attachment difficulties, with any behavioral issues attributed to
attachment failure.
In addition to drawing from various intellectual wellsprings, Attachment
Therapy finds its roots intertwined with psychoanalytic tenets, each contributing
to its theoretical framework. Among these, the concept of the unconscious mind
and repression stands prominently, offering a lens through which early infantile
experiences, unrecalled by memory, purportedly shape later behavior. However,
Attachment Therapy diverges from traditional psychoanalytic interpretation by
attributing children's actions primarily to conscious, deliberate intentions
stemming from a perceived lack of attachment. According to this perspective,
behaviors deemed disruptive or harmful to adults are viewed not as
manifestations of unconscious conflict but rather as deliberate acts of resistance
to treatment, echoing Zaslow's earlier interpretation of left-handedness as
defiant behavior.

32

Similarly, while the notion of repression is employed within Attachment
Therapy, it is wielded in a somewhat mixed manner. Here, wishes and thoughts
are considered consciously accessible to individuals, straying from Freudian
orthodoxy where certain thoughts and desires are believed to be buried in the
unconscious realm.
Furthermore, the concept of regression, a cornerstone of psychoanalytic
theory, assumes significance within Attachment Therapy. Therapists view
regression as a necessary precursor for the reenactment of early experiences,
pivotal in fostering attachment during the therapeutic process. These experiences
include being cradled in the caregiver's arms, relying on them for sustenance, and
partaking in sweet food offerings while maintaining prolonged eye contact – all
mirroring ordinary aspects of infantile existence. Additionally, Attachment
Therapists advocate for the emulation of caregivers' interactions with infants as a
means to induce "age regression" in older children, ostensibly facilitating a return
to the developmental trajectory of early attachment formation.
Moreover, the prevalent attribution of childhood mental health issues to
formative early experiences aligns with the concept of infant determinism, a
prevailing theme in psychoanalytic discourse. This deterministic perspective
underscores the belief that events in infancy wield profound and enduring
influences on mental health and personality development, a notion echoed in
popular conceptions of psychological well-being and illness.
The parallels between Attachment Therapy and what can be described as
"wild psychoanalysis" are striking, suggesting a departure from the conventional
Freudian approach towards a more radical and unconventional method of
treatment. This divergence is not unexpected, considering the influence of figures
like Reich, who himself drew inspiration from Groddeck and Ferenczi. In the realm
of "wild" practice, reenactments of hypothesized interactions between infants
and parents were commonplace, reflecting an emphasis on the intricate interplay
between mind and body. Much like their "wild" psychoanalytic counterparts,
Attachment Therapists have exhibited what Freud termed the furor sanandi, or
the fervent zeal for healing. This fervor has sometimes led to extreme measures,
as evidenced by the tragic case of Candace Newmaker, whose death by
asphyxiation during a prolonged restraint session underscores the risks associated

33

with the fervent pursuit of therapeutic goals. This has led some commentators to
characterize such incidents as "death by theory," highlighting the perilous
consequences of unchecked therapeutic enthusiasm.
The connections between Attachment Therapy and "mind-cure"
movements such as Christian Science may appear enigmatic at first glance.
However, upon closer examination, it becomes apparent that these movements
share commonalities with Attachment Therapy, particularly in their emphasis on
the mind-body connection and the power of physical interventions in healing. The
influence of "mind-cure" approaches, chiropractic treatment, and the legacy of
"wild psychoanalysis" and Reichian principles may help explain the prominent
role of physical contact and manipulation in Attachment Therapy. Indeed, both
Zaslow and Cline advocated for physical restraint as an integral component of
therapy, arguing that it was necessary to prevent patients from escaping the
discomfort and intensity of the therapeutic process. While claims have been
made that physical restraint has been replaced with gentler techniques like
"cuddling" or a "nurturing hold" following Candace Newmaker's tragic death, the
underlying belief in the transformative power of physical experiences remains
steadfast. This belief is further reflected in recommended parenting practices
such as "strong sitting" or "power sitting," which seek to instill obedience and
compliance through physical exertion and restriction.
In essence, Attachment Therapy's departure from traditional psychoanalytic
methods towards a more radical and physically-oriented approach aligns with the
ethos of "wild psychoanalysis" and other alternative healing modalities,
emphasizing the pivotal role of physical contact and intervention in fostering
psychological well-being and personal growth.
Despite the extensive physical control integral to Attachment Therapy, it
diverges from the principles of “mind-cure” approaches, particularly regarding
the belief in the healing force of nature. While “mind-cures” advocate for
allowing the body's innate healing mechanisms to operate unhindered through
rest, faith, and minimal intervention, Attachment Therapists view healing as
requiring intensive efforts from therapists, children, and families alike. This
perspective implies a lack of faith in the natural healing process, instead

34

emphasizing the need for proactive intervention to address behavioral and
emotional issues, even in cases where symptoms are not overtly present.
Moreover, Attachment Therapists often reject conventional
psychotherapies, alleging that such treatments exacerbate the child's condition
by allowing them to manipulate the therapist. This stance echoes the rejection of
medication by “mind-cure” advocates, albeit with the recommendation of a
different form of intervention. The rejection of conventional therapies
underscores Attachment Therapy's reliance on alternative methods and its
skepticism towards mainstream psychological practices.
Furthermore, proponents of Attachment Therapy frequently invoke the
Jacksonian theme of the wisdom of the common man, positioning themselves in
opposition to conventional therapies. They assert that conventional treatments
not only fail to address the underlying issues but also worsen the child's
condition. Moreover, there is a strong reluctance to attribute child problems to
parental factors, with any reference to family dynamics perceived as unwarranted
blame. Unlike conventional psychotherapists who involve parents in the
therapeutic process, Attachment Therapists limit their engagement with parents
to educational endeavors, assuming that adoptive parents possess emotional
correctness and only require guidance to fulfill their roles effectively.
Consequently, issues such as post-adoption depression or the motives behind
adopting multiple children remain unexplored within the framework of
Attachment Therapy.
In alignment with the Jacksonian ethos, Attachment Therapy places
particular emphasis on individuals with direct experience in adoption, whether as
adoptive parents or as adoptees themselves. This preference extends to
therapists, where personal adoption experiences are deemed more valuable than
academic or professional qualifications. While some early practitioners held
advanced degrees, many contemporary Attachment Therapists hold licenses
requiring minimal academic study, such as Licensed Professional Counselor or
Licensed Marriage and Family Therapist credentials. This shift underscores a
departure from the traditional elite medical and psychological circles, positioning
Attachment Therapy practitioners as representatives of the Jacksonian "common

35

man." Consequently, highly educated professionals are often viewed as ill-
equipped to understand and support adoptive families.
Furthermore, the role of foster parents, who provide essential respite care
for children undergoing Attachment Therapy, is noteworthy. Unlike licensed
professionals, foster parents are not required to possess relevant professional
training. Nancy Thomas, a prominent figure in Attachment Therapy with a
background in dog training, exemplifies this unconventional approach. The
emphasis on personal experience over formal qualifications highlights the
Jacksonian theme of valuing practical knowledge and common sense over
academic expertise.
Additionally, Attachment Therapy fosters a strong sense of community
through chat and support groups, facilitated in part by online platforms. These
groups, reminiscent of historical self-help organizations like the Emmanuel
Movement, serve as vital forums for reinforcing Attachment Therapy principles
and deflecting criticism. By echoing group maxims and affirming core beliefs,
participants bolster adherence to the therapy's principles and practices. The
hybrid nature of organizations like ATTACH, which bring together both parents
and professionals, further underscores the self-help ethos by bridging the
perceived gap between these two groups with ostensibly distinct needs and
interests.
Following the tragic death of Candace Newmaker and several other highly
publicized incidents of adverse effects associated with Attachment Therapy, there
was a brief period during which professional objections to this unconventional
treatment gained traction. Notable organizations such as the American Psychiatric
Association, American Psychological Association, and National Association of
Social Workers took firm stances against Attachment Therapy, as did a
congressional resolution. In response, Colorado enacted legislation aimed at
regulating such therapies, although similar efforts in Utah over several years did
not yield the same success. However, amidst the flurry of concern, there was
some confusion regarding the distinction between Attachment Therapy and the
controversial "rebirthing" procedure that resulted in Candace Newmaker's tragic
death.

36

It's important to note that "rebirthing" is actually a rare component of
Attachment Therapy, and the rejection of this procedure by professional
organizations has limited impact on the more common treatment methods
associated with Attachment Therapy. In fact, some speculate that Attachment
Therapists may join in the condemnation of "rebirthing" as a means to deflect
attention from other aspects of their treatment practices.
In response to mounting concerns about Attachment Therapy's potential
role in child fatalities, the organization ATTACH released its own position paper
disavowing coercive methods and advocating for a gentler approach to physical
holding, contingent upon the child's consent. Notably, a member of ATTACH also
served on a task force convened by the American Professional Society on the
Abuse of Children (APSAC), which issued a report expressing apprehension about
the use of physical restraint and techniques involving age regression. However, it
remains unclear to what extent members of ATTACH align with these positions, as
evidenced by a subsequent letter to the editor affirming continued support for
age regression methods.
Despite the controversy, a chapter in a social work textbook published in
2002 strongly advocated for the use of holding therapies, particularly those
associated with Martha Welch. Similarly, Marilyn Menta, the co-author of
Zaslow's book, reportedly continues to endorse the use of Zaslow's methods and
maintains an online platform related to these practices.
Advocates of Attachment Therapy have adeptly utilized online platforms
such as blogs and websites to propagate their views, resulting in widespread
dissemination of terms like Reactive Attachment Disorder, often conflated with
symptoms attributed to a theoretical Attachment Disorder. This terminology has
permeated mainstream media portrayals of childhood mental illness,
perpetuating the misconception that adopted children are uniquely predisposed
to severe emotional disturbances and behavioral issues. Despite evidence to the
contrary, these misconceptions have become ingrained in public consciousness,
posing challenges to efforts aimed at dispelling them. Notably, the Wikipedia
article on Attachment Therapy has faced prolonged attacks from proponents of
the therapy, requiring considerable effort to maintain its accuracy.

37

Meanwhile, adoption advocacy groups, blogs, and websites continue to
perpetuate the notion of a "Primal Wound," positing that adopted children suffer
from enduring emotional scars stemming from separation from familiar
caregivers. While there is scant evidence supporting this notion, it persists in
influencing attitudes towards adoption and shaping adoption-related policies and
reforms. Although these groups may not explicitly endorse Attachment Therapy,
their belief systems align closely with the principles underlying alternative
therapies.
Determining the appropriate classification for Attachment Therapy within
the framework of NCCAM categories presents challenges due to the diverse
elements comprising the treatment and its adjunctive methods. Elements of
biologically based therapy are evident in the strict dietary restrictions imposed on
children, with particular emphasis on manipulating food items to induce
emotional attachment. The manipulative aspect of the therapy is manifested
through physical interventions such as restraint, tickling, and positioning, aimed
at inducing psychological change. Furthermore, the emphasis on eye contact
underscores a mind-body component, suggesting that prolonged mutual gaze can
influence the child's mental state. Finally, Attachment Therapy exhibits strong
vitalistic or transcendental tendencies, positing that children can regress to earlier
stages of development and recapitulate growth without adherence to
conventional temporal constraints.
Over the past several decades, the treatment landscape for autism has
been inundated with alternative psychotherapies. This complex developmental
disorder, which profoundly impacts cognitive and emotional functioning from
early childhood or even before, has become a significant source of concern for
parents, often beginning from the child's infancy. Driven by the belief that early
diagnosis and intervention could potentially alter the course of this challenging
condition, both parents and practitioners are hopeful for the emergence of a
treatment modality capable of redirecting atypical developmental trajectories
towards more typical ones. This hope, fueled in part by sensationalized media
coverage, creates a fertile environment for the proliferation of treatments lacking
in both plausibility and empirical support.

38

The allure of alternative therapies is further heightened by the demanding
nature and high costs associated with conventional treatments. Furthermore, as
will be explored later, conventional interventions for autism may lack robust
research backing. Alarmingly, it has been observed that parents with higher levels
of education are more inclined to explore alternative methods for managing
autism spectrum disorders. In some cases, these parents may even opt to
discontinue established treatments in favor of unconventional approaches. This
trend could be attributed to the dearth of reliable information available from
commercially-driven autism websites, which may inadvertently steer parents
towards unproven or dubious treatments.
In the realm of physical and pharmaceutical interventions for autism, a
variety of approaches have been explored, including the administration of mega-
vitamins, chelation therapy aimed at eliminating purported toxic metals from the
body, and gastrointestinal treatments. These modalities often stem from the
belief that autism can be triggered or exacerbated by vaccination. Initially, this
theory centered around the presence of mercury-containing preservatives in
vaccines, but even after their removal from most vaccines, the focus shifted to
implicating the vaccines themselves or the vaccination schedule as the causative
factors.
The dissemination of the British physician Andrew Wakefield's research
findings served as a cornerstone for the burgeoning "anti-vax" movement.
Despite subsequent discrediting of Wakefield's work, the movement has
persisted, illustrating the phenomenon whereby the repudiation of a strong claim
or prediction can paradoxically reinforce its adherents' beliefs. While alternative
medical treatments for autism have garnered significant interest and discussion in
their own right, they will not be the primary focus of this book, which centers on
alternative psychotherapies. Nonetheless, it is important to acknowledge their
existence, as they represent yet another manifestation of the eagerness with
which parents seek unconventional interventions for their children with autism.
Autism: A Look Back at Its History
In delving into the complexities of autism, this book adopts a distinctive
approach, recognizing the evolving landscape of definitions and assumptions
surrounding this condition over the span of several decades. Rather than

39

immediately delving into an examination of alternative treatments, it is prudent
to first navigate through the historical underpinnings that have shaped our
understanding of autism.
The historical trajectory of autism is marked by a series of challenges in
comprehending and defining the disorder. Autism manifests with a spectrum of
individual differences, ranging from severe incapacities in adulthood to the
remarkable achievements of high-functioning individuals like the renowned
animal husbandry professor Temple Grandin. Early manifestations of autism often
intertwine with symptoms associated with other conditions such as hearing
impairment and intellectual disability. Prior to Leo Kanner's seminal description of
autism in 1943, individuals exhibiting autistic traits were often lumped together
with those experiencing different challenges, including deafness, mutism, or even
victims of infectious diseases like measles or congenital syphilis. In societies
where formal education and equal rights were not emphasized, these individuals
found themselves relegated to roles as manual laborers, beggars, or confined
within workhouses and asylums.
The enactment of legislative measures like the Individuals with Disabilities
Education Act of 2004 signified a pivotal moment in modern society's approach
towards addressing the needs of individuals with autism. This legislation
underscored a growing recognition of the importance of providing education and
training opportunities for all individuals, thus sparking a heightened interest in
understanding the unique needs and capabilities of those diagnosed with autism,
distinct from individuals with superficially similar challenges.
Yudell's scholarship sheds light on the pre-Kanner era, where autism was
often mischaracterized as childhood schizophrenia or grouped within the broader
spectrum of neuropsychological disorders. Kanner's groundbreaking work
delineated autism as a distinct disorder characterized by disruptions in affective
contact with others, setting it apart from other diagnostic categories.
Anthropologist Roy Grinker, who happens to be the grandson of the
psychiatrist of the same name, undertook a retrospective examination of the
criteria and terminology for autistic disorders across different editions of the
Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative
publication by the American Psychiatric Association. Understanding the evolution

40

of DSM materials requires a recognition of the original contexts in which terms
like "autism" and "autistic" were employed. Initially, these terms were utilized to
delineate states of unresponsiveness to the environment, particularly during the
early stages of infancy when infants typically exhibit limited interest in
interpersonal interactions.
Despite Leo Kanner's early suggestion to differentiate autism from
schizophrenia, the inaugural edition of DSM in 1952 did not establish autism as a
distinct diagnostic category. Instead, it referred to the condition as "schizophrenic
reaction, childhood type." This presentation depicted the disorder as separate
from adult-onset schizophrenia and characterized it by primarily autistic
features—manifesting as a profound unresponsiveness to others. Similarly, in the
subsequent DSM-II edition of 1968, the term "schizophrenia, childhood type" was
used, denoting an onset before puberty. The disorder was characterized by a
constellation of behaviors including autism, atypical and withdrawn behavior,
failure to develop a distinct identity apart from the mother's, and general
unevenness, gross immaturity, and developmental inadequacy, which could
potentially lead to mental retardation. Importantly, these editions lacked any
reference to the onset of symptoms in early childhood, a cornerstone of
contemporary understanding of autism.
However, significant changes were introduced in the 1980 edition, DSM-III,
which marked a pivotal shift in conceptualizing autism. Here, the term "infantile
autism" was introduced, and the syndrome was described in more familiar terms.
The onset was specified to occur before thirty months of age, emphasizing a
pervasive lack of responsiveness to interpersonal cues. Language difficulties
became a central focus, with DSM-III highlighting not only gross deficits in
language development but also specific linguistic anomalies such as immediate
and delayed echolalia, and the reversal of pronouns. Additionally, autistic children
were noted for their resistance to change and unusual attachment to inanimate
objects. Crucially, DSM-III emphasized the distinction between autism and
schizophrenia, underscoring that the former lacked symptoms like delusions or
hallucinations typically associated with the latter.
In the evolution of the Diagnostic and Statistical Manual of Mental
Disorders (DSM), subsequent editions have endeavored to refine the diagnostic

41

criteria for autism spectrum disorders (ASD) in response to evolving
understanding and clinical observations. DSM-III-R, published in 1987, marked a
significant step forward by offering a more comprehensive approach to diagnosis,
acknowledging the variability inherent in autism spectrum presentations. This
edition introduced the diagnostic category of "autistic disorder," characterized by
symptoms manifesting before thirty-six months of age. Notably, DSM-III-R
recognized that autistic children continued to develop albeit atypically, thus
incorporating criteria tailored to the developmental stage of the individual. Key
features indicative of autistic disorder included qualitative impairments in
reciprocal social interactions, communication deficits, and restricted patterns of
interests and behaviors.
Building upon the framework established by DSM-III-R, subsequent
editions, namely DSM-IV (1994) and its 2000 revision, further refined the
diagnostic criteria for autistic disorder. These editions emphasized the importance
of distinguishing autistic disorder from other developmental disorders such as
Rett's disorder and childhood disintegrative disorder. Additionally, they
introduced the broader diagnostic category of Pervasive Developmental Disorders
(PDD), encompassing a spectrum of developmental challenges collectively known
as ASD. This spectrum included autistic disorder, Rett's disorder, childhood
disintegrative disorder, Asperger's disorder, and Pervasive Developmental
Disorder Not Otherwise Specified (PDD-NOS), reflecting the diverse
manifestations of ASD observed clinically.
However, the introduction of DSM-5 brought about significant changes in
the classification and terminology of ASD. Notably, Rett's disorder was excluded
from the ASD category due to its distinct genetic etiology, while the term "PDD"
was replaced with "Autistic Spectrum Disorders." Moreover, DSM-5 introduced
the diagnostic category of social (pragmatic) communication disorder, which is
closely associated with ASD. Concurrently, Asperger's disorder and childhood
disintegrative disorder were omitted from DSM-5, reflecting a shift in diagnostic
conceptualization.
These successive revisions in diagnostic criteria and terminology, while
aimed at enhancing clinical precision, have engendered confusion among parents
and practitioners alike. The complexity of navigating the evolving diagnostic

42

landscape has created fertile ground for the emergence of unconventional terms
and alternative approaches to diagnosing and treating autistic disorders.
The evolution of diagnostic categories and criteria for autism was
accompanied by shifts in beliefs regarding its underlying causes. In Kanner's
seminal paper from 1943, he posited that autistic children were born with an
innate inability to form typical affective connections with others, likening it to
physical or intellectual handicaps present at birth. However, this perspective
emerged before the elucidation of genetic mechanisms and the understanding of
chromosomal anomalies like those found in Down syndrome. Consequently, the
precise mechanisms underlying these innate inabilities remained unclear.
Moreover, as World War II progressed and societal attitudes shifted, nativist
viewpoints like Kanner's became less popular. The war's end brought about a
questioning of ethnic prejudices, while environmentalist perspectives on mental
illness gained traction, fueled in part by conferences sponsored by the Josiah
Macy Jr. Foundation. Notably, Gregory Bateson proposed that schizophrenia
stemmed from social "double bind" experiences, further challenging innate
explanations.
Nevertheless, Kanner's explanation of autism underwent a notable
transformation within a few years, shifting from innate causes to psychogenic
ones. By 1949, he attributed autism to emotionally distant and unresponsive
parenting, particularly that of "refrigerator mothers," whose cold demeanor
allegedly left their children feeling rejected and seeking solace in solitude. This
shift in perspective aligned with the growing emphasis on environmental factors
in psychology and psychotherapy, coinciding with societal concerns about the
changing roles and influence of women during and after World War II. Some
cultural artifacts from this period, such as Philip Wylie's provocative book
"Generation of Vipers" published in 1942 and reissued in 1954, even placed
blame on mothers for the perceived shortcomings of their adult sons, reflecting
broader anxieties and biases of the time.
As advancements in genetic understanding unfolded, Kanner revisited,
albeit partially, his initial stance on the constitutional factors contributing to
autism. However, the emphasis on parental influences persisted in the public
consciousness, largely due to the influential writings of Bruno Bettelheim in his

43

1967 book, "The Empty Fortress." Despite his background in art history,
Bettelheim assumed the role of an authority on childhood mental illness,
establishing himself as the founder and director of the Sonia Shankman
Orthogenic School in Chicago. Central to Bettelheim's perspective was the notion
that autism arose when a child felt rejected due to their mother's own
psychological issues, leading the child to withdraw from a disappointing and
hurtful social environment. According to Bettelheim, the treatment for autism
should involve indulging the child's desires for food and love, essentially
recreating the nurturing environment that the mother failed to provide—an
approach that resonated with various alternative psychotherapeutic theories.
While the prevailing view during the 1960s, 1970s, and 1980s continued to
attribute autism to environmental factors, Kanner's original biological explanation
resurfaced in 1964 through the work of Bernard Rimland. Rimland remained
steadfast in advocating for this biological perspective until his passing in 2006, all
while maintaining an interest in alternative treatments like holding therapy, which
he believed could offer beneficial neural stimulation. This prolonged adherence to
a biological explanation amidst the prevailing environmentalist paradigm
underscores the complexity and ongoing debate surrounding the etiology and
treatment of autism spectrum disorders.
Bettelheim’s earlier environmentalist perspective found resonance in the
work of Nikolaas Tinbergen, a renowned ethologist and co-recipient of the Nobel
Prize in Physiology or Medicine for his foundational contributions to the study of
animal behavior. Tinbergen, a pioneer in the field of ethology, drew insights from
his observations of various animal species, including fish, ducks, geese, and gulls,
to formulate his approach to understanding autism. Through numerous
publications, Tinbergen elucidated how these creatures exhibited socially
stereotyped responses to specific stimulus cues, known as "releasers," and
demonstrated heightened reactions to unusually intense stimuli compared to
routine events. For instance, Tinbergen documented instances where a gull,
typically devoted to incubating its own egg, would forsake its egg in favor of
attempting to brood a much larger artificial egg bearing similar markings.
Ethologists like Tinbergen also delved into the phenomenon of imprinting
observed in young waterfowl, whereby they become strongly attached to and

44

emulate adult figures or other moving objects. These imprinted behaviors often
persisted into adulthood, influencing their mating and social interactions with
conspecifics. Tinbergen extrapolated these findings to propose that, for humans,
visual and tactile stimuli, particularly eye contact and physical touch, served as
potent releasers triggering innate social approach behaviors. Accordingly,
Tinbergen theorized that a lack of exposure to such stimuli during infancy could
diminish the inclination for social interaction, potentially leading to autistic
behaviors.
Tinbergen’s ethological framework posited that certain behaviors were
biologically predetermined and species-specific, yet simultaneously underscored
the significance of early life experiences in shaping normal behavioral
development. He advocated for interventions aimed at coaxing or compelling
autistic children to engage in eye contact and close physical proximity with adults,
positing that such interventions could prompt a departure from autistic behaviors
and facilitate a return to a typical developmental trajectory. In essence,
Tinbergen’s synthesis of biological and environmental perspectives emphasized
the intricate interplay between innate predispositions and early environmental
influences in shaping human behavior, particularly in the context of autism
spectrum disorders.
In the 1980s, John Bowlby introduced the final iteration of his attachment
theory, which rapidly gained prominence as the leading framework for
understanding early emotional development. Over the subsequent two decades,
Bowlby's theory sparked a proliferation of research and theoretical publications,
solidifying its position as a cornerstone in developmental psychology.
Understandably, scholars began to explore whether autism spectrum disorders
(ASD) could be attributed to deficiencies or aberrations in attachment processes.
The DSM-III initially characterized autism as a condition marked by a failure
to cultivate typical attachment behaviors. Subsequent revisions, including the
1987 update, underscored the absence or distortion of seeking comfort during
times of distress—a behavior closely associated with attachment theory.
However, empirical investigations revealed that individuals with autism could
indeed form secure attachments, challenging the notion that poor attachment
experiences were causative factors in the development of autism. Consequently,

45

efforts to enhance attachment security were deemed unlikely to yield efficacious
treatments for ASD.
As genetic research surged forward in the 1990s, the focus of autism inquiry
shifted towards elucidating its biological underpinnings. While breakthroughs in
understanding genetic contributions to certain autism-related conditions, such as
Rett syndrome, offered clarity, similar revelations about all forms of ASD
remained elusive. Instead, genetic investigations unveiled a complex landscape
characterized by hundreds of gene mutations implicated in autism spectrum
disorders. Moreover, each mutation appeared capable of precipitating a diverse
array of outcomes, encompassing autism, intellectual disability, bipolar disorder,
epilepsy, and beyond. This genetic evidence suggests the existence of at least two
distinct forms of autism, underscoring the multifaceted nature of this
neurodevelopmental condition.
The discredited endeavors of British physician Andrew Wakefield in the
1990s instilled a widespread belief among the public that childhood vaccinations
were responsible for the onset of autistic disorders, often diagnosed around the
time when children typically receive multiple vaccinations. Unfortunately, this
misconception gained traction, fueled by the endorsement of Bernard Rimland, a
prominent advocate for individuals with autism, perpetuating as a dogma within
anti-vaccination groups.
Although Wakefield's assertions regarding the biological origins of autism
were ultimately debunked, they coincided with a growing apprehension
surrounding biological determinants of autistic conditions. In addition to genetic
inquiries, investigations delved into factors such as paternal age and early
nutritional influences. Observable phenomena like atypical patterns of head and
body growth in autistic children prompted scrutiny of prenatal and perinatal
variables, encompassing prenatal medication usage, occurrences of bleeding
during pregnancy, and gestational diabetes—all of which exhibited associations
with the prevalence of autistic disorders. While genetic predispositions are
acknowledged to influence susceptibility to environmental triggers potentially
linked to autism, contemporary theories no longer emphasize specific
environmental events as direct precursors to autistic behavior, diverging from
earlier environmentalist perspectives.

46

Why is it pertinent to delineate historical shifts in theories regarding the
etiology of autism? Firstly, it is common for parents and practitioners alike to
adhere to a "pathophysiologic rationale" or "mechanistic reasoning," presuming
that identifying a causal pathway enables therapy to effectively reverse or
redirect it. Consequently, theories positing simplistic causes for autism hold
allure, irrespective of their empirical substantiation. Secondly, while older, more
straightforward theories may be dismissed by researchers at the forefront of
autism studies, they retain appeal for parents and many practitioners.
Understanding the conceptual frameworks surrounding the causation of autism is
essential for comprehending alternative therapies, as they may be perceived by
users as strategies to counteract or reconfigure developmental pathways believed
to underpin the manifestation of undesirable outcomes.
In the realm of disorders and their respective treatments, this book
generally finds solace in the presence of established therapies supported by
sound research evidence. These therapies, while sometimes met with rejection
by certain clients due to reasons ranging from religious incongruence to financial
constraints, are undeniably existent and serve as essential benchmarks for
evaluating the efficacy of alternative treatments. However, the landscape shifts
when it comes to autism. Despite the existence of conventional treatments
endorsed by mainstream acceptance and covered by insurance plans, the
evidence supporting these treatments is not as robust as commonly presumed.
Consequently, this chapter endeavors to scrutinize both the plausibility and the
evidentiary foundation of both conventional and alternative treatments for
autism. The objective here is not to dismiss established treatments outright, nor
to adopt a stance akin to the dodo bird's proclamation in discussions of
psychotherapies that "all have won, and all shall have prizes." Rather, the aim is to
provide a comprehensive overview of the contextual framework within which
some therapies for autism are categorized as alternative.
Originating in the 1950s through the pioneering work of Ivar Lovaas at
UCLA, Applied Behavior Analysis (ABA) finds its philosophical roots in
behavioristic learning principles akin to those espoused by B. F. Skinner. Lovaas's
conceptualization revolves around the notion that behavior, in most instances, is
governed by experiences of reinforcement subsequent to its occurrence. Such
reinforcement can take the form of either positive outcomes, where the

47

individual gains access to desirable circumstances as a result of the behavior, or
negative outcomes, where the individual manages to escape from undesirable
situations. Lovaas postulated that autistic children may encounter a significant
hurdle in the form of their frequent engagement in self-stimulating behaviors and
tantrums, which could potentially impede their engagement in normative
behaviors and subsequent reinforcement. Consequently, he hypothesized that
leveraging reinforcement mechanisms could serve as a means to diminish the
frequency of autistic behaviors while bolstering engagement in desirable activities
like social interactions and speech. Drawing from Skinnerian theory as a
theoretical scaffold, Lovaas embarked on devising methodologies tailored to
individual children. Initially, Lovaas and his collaborators experimented with
aversive stimuli, such as electric shocks, in attempts to curb behaviors like
maintaining constant proximity to a wall. However, it became evident over time
that such methods were both ineffective and ethically objectionable. Present-day
ABA typically eschews the use of aversive stimuli, although certain situations may
warrant their application.
ABA stands as a prominent and well-established conventional treatment for
autism, with its principles and practices permeating various educational and
professional domains. It is a subject of discussion in undergraduate courses
spanning introductory, developmental, and clinical psychology, among others. The
foundational behavioristic learning theory upon which ABA is based finds its place
in numerous undergraduate and graduate psychology courses, reflecting its
significance in the field. Many college and university psychology departments
collaborate with families seeking undergraduate students to undergo ABA training
and engage with autistic children, demonstrating the widespread recognition of
ABA's effectiveness.
Moreover, public school child study teams acknowledge ABA as a suitable
albeit costly intervention for autistic children, while both public and private
health insurance providers reluctantly cover its expenses, albeit with reservations
due to the extensive time commitment required—typically involving thirty-five to
forty hours per week of individual treatment.
As a behavioristic approach, ABA boasts inherent plausibility, aligning
seamlessly with established knowledge about learning processes and the pivotal

48

role of reinforcement in shaping behavior. Goals of ABA treatment for autistic
children, such as tempering tantrums and fostering social interaction, are logically
framed within the framework of behavior therapy. While the direct influence of
behavior management on internal processes like Theory of Mind or Executive
Function may seem less straightforward, ABA's applicability to such cognitive
domains is not necessarily precluded.
Despite its widespread acceptance and intuitive appeal, the extent to which
ABA is supported by systematic evidence warrants examination. While internet
resources promoting ABA often tout it as "scientifically proven," the precise
nature of this purported proof remains ambiguous and undefined, raising
questions about the empirical foundation underpinning ABA's efficacy.
Since the inception of ABA, Lovaas diligently compiled systematic data on
the outcomes of autistic children undergoing ABA therapy. In 1987, he published
a report heralding a remarkable success rate: 47 percent of the children subjected
to ABA exhibited such significant improvement that they seamlessly integrated
into school settings, becoming virtually indistinguishable from their neurotypical
peers. However, a critical flaw marred the study's credibility: rather than
employing random assignment, children were grouped based on therapist
availability or parental preferences. While the influence of therapist availability on
the study's outcomes remains unclear, parental preference introduces a
confounding variable that undermines the study's robustness.
Moreover, the report failed to adequately address the children's baseline
characteristics prior to treatment initiation, complicating the attribution of
observed differences between treatment and control groups to the effects of ABA
therapy. Parents of children in the study were also requested to take a year off
from work to assist their children, further complicating the interpretation of
outcomes. Notably, children in the treatment group received intensive forty-hour-
per-week one-on-one sessions, while those in the comparison group received
only a fraction of that time—ten hours per week.
More recent research endeavors sought to rectify these methodological
shortcomings through genuinely randomized trials. In one such study, autistic
children were randomly assigned to either an ABA treatment group or a group
where parents received training to work with their children. Surprisingly, only 13

49

percent of children in the ABA-treated group achieved the level of success
reported by Lovaas—integration into regular classes without the need for special
services. Furthermore, little disparity was observed between the ABA and parent-
treatment groups across various outcome measures. Notably, this study abstained
from employing aversives.
Despite these challenges, ABA occupies a prominent position in the
therapeutic landscape, enjoying widespread acceptance and adoption. However,
its ascent to conventional therapy status has outpaced the accumulation of
robust empirical evidence supporting its efficacy. Additionally, while adverse
events have been associated with aversive treatments in the past, investigations
into the potential adverse effects of ABA therapy have been scant, mirroring a
broader trend across psychotherapeutic interventions until recent times.
The Developmental, Individual-differences, Relationship-based
(DIR)/Floortime approach, pioneered by Stanley Greenspan along with his
collaborators Serena Wieder and Nancy Thorndike Greenspan, has evolved
through years of dedicated research and clinical practice. In selecting DIR for
discussion within this chapter, it's important to note its classification as an
"alternative" or "controversial" treatment by certain authors exploring
unconventional therapies for children.
Differentiating itself from Applied Behavior Analysis (ABA), DIR emphasizes
distinct therapeutic goals. While ABA primarily targets the reduction of autistic
behaviors such as self-stimulation and the promotion of compliance with verbal
commands and external cues, DIR strives for the cultivation of spontaneous
communication, empathy, and reflective capacities in individuals.
The foundation of DIR lies in Stanley Greenspan's theoretical framework of
emotional development, which draws upon the seminal works of Jean Piaget
regarding intellectual maturation and Sigmund Freud's insights into emotional
growth. Both Piaget and Freud's theories propose a stage-like progression of
development, wherein behaviors and cognitive abilities manifest distinct
characteristics across various developmental phases.
Central to this perspective is the notion that each stage of development
builds upon the accomplishments of earlier stages. Thus, for a child to progress to

50

higher levels of development, it becomes imperative to address and master any
missed or incomplete developmental milestones from preceding stages. This
holistic understanding underscores the importance of tailoring interventions to
individual developmental needs and fostering a supportive relational context
conducive to emotional and cognitive growth.
According to Greenspan's developmental framework, successful navigation
through a series of key stages is essential for an individual to emerge as a
competent adolescent, poised to transition into a healthy adulthood. These
stages are pivotal in shaping the individual's ability to engage with the world and
form meaningful relationships.
The initial stage involves the development of shared attention and
regulation during infancy. This entails the infant's positive responsiveness to the
stimuli provided by caregivers, including pleasant sights, sounds, and movements,
which serve to regulate and soothe the infant. Typically occurring within the first
weeks of life, this stage lays the foundation for the infant's capacity to attune to
and derive pleasure from interpersonal interactions.
Building upon this foundation, the next stage unfolds over the subsequent
months, as the infant begins to derive pleasure from engaging and relating with
others, particularly primary caregivers. This phase marks the emergence of early
social bonds and the infant's increasing awareness of the significance of
interpersonal connections.
As the infant progresses, Greenspan identifies the development of two-way
intentional affective signaling and communication as a crucial milestone. This
entails the infant's ability to not only attend to caregivers' cues but also to
effectively communicate their own needs and desires through gestures and
vocalizations. Central to this stage is the reciprocal exchange of emotional signals
between the infant and caregiver, facilitating mutual understanding and
responsiveness.
Further advancing in social-emotional development, Greenspan outlines
the fourth stage characterized by the ability to engage in long chains of co-
regulated emotional signaling and social problem-solving. This involves complex

51

interactions wherein the child navigates social situations, seeks assistance when
needed, and experiences the joy of collaborative problem-solving with caregivers.
The progression continues with the fifth stage, wherein the child transitions
from relying solely on actions to express emotions to utilizing words and symbols
for communication. This represents a significant cognitive leap, enabling the child
to articulate their feelings and needs verbally, thereby enhancing their capacity
for interpersonal expression and negotiation.
In Greenspan's sixth stage, known as the "building bridges" period, the child
begins to develop a more nuanced understanding of emotions and their
variability. This includes recognizing gradations of emotions and understanding
the interconnectedness of different emotional experiences. Through this stage,
the child learns to navigate emotional nuances and communicate their emotional
states more effectively within social contexts.
Overall, Greenspan's developmental model underscores the intricate
interplay between emotional and cognitive development, highlighting the
significance of early experiences and interpersonal relationships in shaping a
child's trajectory towards healthy adulthood.

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