View source for Attachment therapy

{{pp-semi-sock|expiry=13 October 2010|small=yes}}
{{Dablink|This article is about a specific form of therapy commonly known as "'''attachment therapy'''". For therapies based on [[John Bowlby|Bowlby]]'s attachment theory, see [[Attachment-based therapy (children)]].}}

'''Attachment therapy''' is the most commonly used term for a controversial category of alternative child mental health interventions intended to treat [[attachment disorder]]s.<ref name=tfr83/> The term generally includes accompanying parenting techniques. Other names or particular techniques include "the Evergreen model", "holding time", "rage-reduction", "compression therapy", "rebirthing", "corrective attachment therapy" and Coercive Restraint Therapy.<ref name=tfr83/> It is found primarily but not exclusively in the United States and much of it is centered in about a dozen clinics in [[Evergreen, Colorado]] where Foster Cline, one of the founders, established his clinic in the 1970s. This article describes this particular set of interventions although in clinical literature the term "attachment therapy" is sometimes used loosely to mean any intervention based, or claiming to be based, on [[attachment theory]], particularly outside the USA.

Attachment therapy is a treatment used primarily with [[foster care|fostered]] or [[adopted]] children who have behavioral difficulties, sometimes severe, but including disobedience and perceived lack of gratitude or affection for their caregivers. The children's problems are ascribed to an inability to [[attachment theory|attach]] to their new parents because of suppressed rage due to past [[maltreatment]] and abandonment. The common form of attachment therapy is ''holding'' therapy, in which a child is firmly held (or lain upon) by therapists or parents. Through this process of restraint and confrontation, therapists seek to produce in the child a range of responses such as [[rage (emotion)|rage]] and despair with the goal of achieving [[catharsis#Therapeutic uses|catharsis]]. In theory, when the child's resistance is overcome and the rage is released, the child is reduced to an infantile state in which he or she can be "re-parented" by methods such as cradling, rocking, bottle feeding and enforced [[eye contact]]. The aim is to promote attachment with the new caregivers. Control over the children is usually considered essential and the therapy is often accompanied by parenting techniques which emphasize obedience. These accompanying parenting techniques are based on the belief that a properly attached child should comply with parental demands "fast, snappy and right the first time" and should be "fun to be around".<ref name=tfr79/> These techniques have been implicated in several child deaths and other harmful effects.<ref name=tfr77>Task Force Report, Chaffin et. al. p. 77</ref> 

This form of [[therapy]], including diagnosis and accompanying parenting techniques, is scientifically unvalidated and is not considered to be part of mainstream [[psychology]] or, despite its name, to be based on [[attachment theory]], with which it is considered incompatible.<ref name="O'Connor (2003)">{{citation |author=O'Connor TG, Zeanah CH |title= Attachment disorders: assessment strategies and treatment approaches |journal=Attach Hum Dev |volume=5 |issue=3 |pages=223–44 |year=2003 |pmid=12944216 |doi= 10.1080/14616730310001593974 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/14616730310001593974&magic=pubmed}}</ref><ref name="Ziv">{{citation |author=Ziv Y |year=2005 |contribution=Attachment-Based Intervention programs: Implications for Attachment Theory and Research |title=Enhancing Early Attachments. Theory, Research, Intervention and Policy |editor=Berlin LJ, Ziv Y, Amaya-Jackson L, Greenberg MT |series=Duke series in child development and public policy |publisher=Guilford Press |isbn=1-59385-470-6 |pages=63}}</ref> It is primarily based on Robert Zaslow's rage-reduction therapy from the 1960s and '70s and on [[psychoanalytic]] theories about suppressed rage, catharsis, regression, breaking down of resistance and [[defence mechanism]]s. Zaslow, [[Nikolaas Tinbergen|Tinbergen]], Martha Welch and other early proponents used it as a treatment for [[autism]], based on the now discredited belief that autism was the result of failures in the attachment relationship with the mother.

It has been described as a potentially abusive and [[pseudoscientific]] intervention that has resulted in tragic outcomes for children, including at least six documented child fatalities.<ref name="Berlin et al.">{{citation |author=Berlin LJ et. al. |year=2005 |contribution=Preface |title=Enhancing Early Attachments: Theory, Research, Intervention and Policy |editor=Berlin LJ, Ziv Y, Amaya-Jackson L, Greenberg MT |series=Duke series in child development and public policy |publisher=Guilford Press |isbn=1-59385-470-6 |pages=xvii}}</ref> Since the 1990s there have been a number of prosecutions for deaths or serious maltreatment of children at the hands of "attachment therapists" or parents following their instructions. Two of the most well-known cases are those of [[Candace Newmaker]] in 2000 and the [[Michael and Sharen Gravelle|Gravelles]] in 2003. Following the associated publicity, some advocates of attachment therapy began to alter views and practices to be less potentially dangerous to children. This change may have been hastened by the publication of a Task Force Report on the subject in January 2006, commissioned by the [[American Professional Society on the Abuse of Children]] (APSAC) which was largely critical of attachment therapy.<ref name="Task Force Report, Chaffin et al.">Task Force Report, Chaffin et. al.</ref> In April 2007, ATTACh, an organization originally set up by attachment therapists, formally adopted a White Paper stating its unequivocal opposition to the use of coercive practices in therapy and parenting, promoting instead newer techniques of attunement, sensitivity and [[emotional dysregulation|regulation]].<ref name="attach07"/> Some leading attachement therapists have also specifically moved away from coercive practices.

This form of treatment differs significantly from mainstream [[attachment-based therapy (children)|attachment-based therapies]], talking psychotherapies such as [[attachment-based psychotherapy]] and [[relational psychoanalysis]] or the form of [[attachment parenting]] advocated by the pediatrician [[William Sears (physician)|Sears]]. Further, the form of rebirthing sometimes used within attachment therapy differs from [[Rebirthing-Breathwork]].

==Treatment characteristics==
The controversy, as outlined in the 2006 [[American Professional Society on the Abuse of Children]] (APSAC) Task Force Report,<ref name="Task Force Report, Chaffin et al."/> has broadly centered around "holding therapy"<ref name="Welch">{{citation |author=Welch MG |others=foreword by Niko Tinbergen |title=Holding Time: How to Eliminate Conflict, Temper Tantrums, and Sibling Rivalry and Raise Happy, Loving, Successful Children |year=1989 |month=September |publisher=Simon & Schuster |location=New York |isbn=0671688782}}</ref> and [[coercion|coercive]], [[wikt:restrain|restraining]], or [[aversives|aversive]] procedures. These include [[deep tissue massage]], aversive tickling, punishments related to food and water intake, enforced eye contact, requiring children to submit totally to adult control over all their needs, barring normal social relationships outside the primary caretaker, encouraging children to [[age regression in therapy|regress]] to [[infant]] status, [[reparenting]], attachment parenting, or techniques designed to provoke [[Catharsis#Therapeutic uses|cathartic emotional discharge]]. Variants of these treatments have carried various labels that change frequently. They may be known as "rebirthing therapy", "compression therapy", "corrective attachment therapy", "the Evergreen model", "holding time", "rage-reduction therapy"<ref name=tfr83>Task Force Report, Chaffin et. al. p. 83</ref> or "prolonged parent-child embrace therapy".<ref name="Welsh et al.">{{citation |author=Welch MG, Northrup RS, Welch-Horan TB, Ludwig RJ, Austin CL, Jacobson JS |title=Outcomes of Prolonged Parent-Child Embrace Therapy among 102 children with behavioral disorders. |journal=Complement Ther Clin Pract |volume=12 |issue=1 |pages=3–12 |year=2006 |pmid=16401524 |doi= 10.1016/j.ctcp.2005.09.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S1744-3881(05)00097-6}}</ref> Some authors critical of this therapeutic approach have used the term Coercive Restraint Therapy.<ref name="Mercer2">{{citation |author=Mercer J |year=2005 |title=Coercive Restraint Therapies: A dangerous alternative mental health intervention |journal=Medscape General Medicine |volume=7 |issue=3}}</ref> It is this form of treatment for attachment difficulties or disorders which is popularly known as "attachment therapy".<ref name=tfr83/> [[Advocates for Children in Therapy]], a group that [[advocacy|campaigns against]] attachment therapy, give a list of therapies they state are attachment therapy by another name.<ref name="ACTwhatis">{{Citation |last=Advocates for Children in therapy |title=What is Attachment Therapy |url=http://www.childrenintherapy.org/essays/index.html |quote=''Z-therapy, rage-reduction therapy, Theraplay, holding therapy, attachment holding therapy, attachment disorder therapy, holding time, cuddle time, gentle containment, holding-nurturing process, emotional shuttling, direct synchronous bonding, breakthrough synchronous bonding, therapeutic parenting, dynamic attachment therapy, humanistic attachment therapy, corrective attachment therapy, developmental attachment therapy, dyadic attachment therapy, dyadic developmental psychotherapy, dyadic support environment, affective attunement'' |accessdate=2008-09-17}}</ref> They also provide a list of additional therapies used by attachment therapists which they consider to be unvalidated.<ref name="ACTwhatis2">{{Citation |last=Advocates for Children in therapy |title=What is Attachment Therapy |url=http://www.childrenintherapy.org/essays/index.html |accessdate=2008-09-17}}</ref>
 
Matthew Speltz of the [[University of Washington School of Medicine]] describes a typical treatment taken from The Center's material (apparently a replication of the program at the Attachment Center, Evergreen) as follows:
<blockquote>"Like Welsh (''sic'')(1984, 1989), The Center induces rage by physically restraining the child and forcing eye contact with the therapist (the child must lie across the laps of two therapists, looking up at one of them). In a workshop handout prepared by two therapists at The Center, the following sequence of events is described: (1) therapist 'forces control' by holding (which produces child 'rage'); (2) rage leads to child 'capitulation' to the therapist, as indicated by the child breaking down emotionally ('sobbing'); (3) the therapist takes advantage of the child's capitulation by showing nurturance and warmth; (4) this new trust allows the child to accept 'control' by the therapist and eventually the parent. According to The Center's treatment protocol, if the child 'shuts down' (''i.e.'', refuses to comply), he or she may be threatened with detainment for the day at the clinic or forced placement in a temporary [[foster home]]; this is explained to the child as a consequence of not choosing to be a '[[family]] boy or girl.' If the child is actually placed in foster care, the child is then required to 'earn the way back to therapy' and a chance to resume living with the adoptive family."<ref name="Speltz">{{citation |author=Speltz ML |year=2002 |title=Description, History and Critique of Corrective Attachment Therapy |journal=The APSAC Advisor |volume=14 |issue=3 |pages=4–8 |url= http://www.kidscomefirst.info/Speltz.pdf|format=PDF|accessdate=2008-03-16}}</ref></blockquote>

According to the APSAC Task Force,
<blockquote>"A central feature of many of these therapies is the use of psychological, physical, or aggressive means to provoke the child to catharsis, ventilation of rage, or other sorts of acute emotional discharge. To do this, a variety of coercive techniques are used, including scheduled holding, binding, rib cage stimulation (e.g., tickling, pinching, knuckling), and/or licking. Children may be held down, may have several adults lie on top of them, or their faces may be held so they can be forced to engage in prolonged eye contact. Sessions may last from 3 to 5 hours, with some sessions reportedly lasting longer... Similar but less physically coercive approaches may involve holding the child and psychologically encouraging the child to vent anger toward her or his biological parent."<ref name=tfr79/></blockquote>

The APSAC Task Force describes how the conceptual focus of these treatments is the child's individual internal [[pathology]] and past caregivers rather than current parent-child relationships or current [[social environment|environment]]. If the child is well-behaved outside the home this is seen as successful manipulation of outsiders, rather than as evidence of a problem in the current home or current parent-child relationship. The APSAC Task Force noted that this perspective has its attractions because it relieves the caregivers of responsibility to change aspects of their own behavior and aspirations. Proponents believe that traditional therapies fail to help children with attachment problems because it is impossible to establish a trusting relationship with them. They believe this is because children with attachment problems actively avoid forming genuine relationships. Proponents emphasize the child's [[psychological resistance|resistance]] to attachment and the need to break it down. In rebirthing and similar approaches, protests of distress from the child are considered to be resistance that must be overcome by more coercion.<ref name=tfr78/>

Coercive techniques, such as scheduled or enforced holding, may also serve the intended purpose of demonstrating dominance over the child. Establishing total adult control, demonstrating to the child that he or she has no control, and demonstrating that all of the child's needs are met through the adult, is a central tenet of many controversial attachment therapies. Similarly, many controversial treatments hold that children described as attachment–disordered must be pushed to revisit and relive early [[psychological trauma|trauma]]. Children may be encouraged to regress to an earlier age where trauma was experienced or be reparented through holding sessions.<ref name=tfr78/> Other features of attachment therapy are the "two week intensive" course of therapy, and the use of "therapeutic foster parents" with whom the child stays whilst undergoing therapy. According to O'Connor and Zeanah, the "holding" approach would be viewed as intrusive and therefore non-sensitive and [[therapeutic|countertherapeutic]], in contrast with accepted theories of attachment.<ref name="O'Connor (2003)"/>

According to Advocates for Children in Therapy,
<blockquote>"Attachment Therapy almost always involves extremely confrontational, often hostile confrontation of a child by a therapist or parent (sometimes both). Restraint of the child by more powerful adult(s) is considered an essential part of the confrontation." The purported correction is described as "...&nbsp;to force the children into loving (attaching to) their parents; ... there is a hands-on treatment involving physical restraint and discomfort. Attachment Therapy is the imposition of boundary violations – most often coercive restraint – and verbal abuse on a child, usually for hours at a time; ... Typically, the child is put in a lap hold with the arms pinned down, or alternatively an adult lies on top of a child lying prone on the floor."<ref>{{Citation |last=Advocates for Children in therapy |title=Abusive Techniques |url=http://www.childrenintherapy.org/essays/abuses.html |accessdate=2008-09-17}}</ref></blockquote>

Psychiatrist [[Bruce D. Perry|Bruce Perry]] cites the the use of holding therapy techniques by caseworkers and foster parents investigating a [[Satanic Ritual Abuse]] case in the late 1980s, early 1990s, as instrumental in obtaining lengthy and detailed alleged "disclosures" from children. In his opinion, using force or coercion on traumatised children simply re-traumatizes them and far from producing love and affection, produces obedience based on fear, as in the trauma bond known as [[Stockholm syndrome]].<ref name=perry>{{citation|author=Perry B, Szalavitz M|title=The Boy Who Was Raised as a Dog|publisher=Basic Books|location=Philadelphia|year=2006|isbn=9780465056538|pages=160–169}}</ref>

===Parenting techniques===
Therapists often instruct parents to follow programs of treatment at home, for example obedience-training techniques such as "strong sitting" (frequent periods of required silence and immobility) and withholding or limiting food.<ref name=tfr79>Task Force Report, Chaffin et al. p. 79</ref><ref name="Thomas">{{citation |author=Thomas N |year=2000 |contribution= Parenting children with attachment disorders |editor=Levy TM |title=Handbook of attachment interventions |location=San Diego, CA |publisher=Academic}}</ref> Earlier authors sometimes referred to this as "[[German Shepherd]] training".<ref name="Cline">{{citation |author=Cline FW |title=Hope for High Risk and Rage Filled Children: Reactive Attachment Disorder: Theory and Intrusive Therapy |year=1992 |publisher=EC Publications |location=Golden, CO |isbn=0963172808}}</ref> In some programmes children undergoing the two-week intensive stay with "therapeutic foster parents" for the duration or beyond and the adoptive parents are trained in their techniques.<ref name=stryker/>

According to the APSAC Task Force, because it is believed children with attachment problems resist attachment, fight against it and seek to control others to avoid attaching, the child's character flaws must be broken before attachment can occur. Attachment parenting may include keeping the child at home with no social contacts, home schooling, hard labor or meaningless repetitive chores throughout the day, motionless sitting for prolonged periods of time, and control of all food and water intake and bathroom needs. Children described as attachment-disordered are expected by attachment therapists<ref name="hage">{{citation |author=Hage D |title=Holding therapy: Harmful? Or rather beneficial! |accessdate=2005-08-22 |journal=Roots and Wings Adoption Magazine |year=1997}}</ref> to comply with parental commands "fast and snappy and right the first time", and to always be "fun to be around" for their parents.<ref name=tfr79/> Deviation from this standard, such as not finishing chores or arguing, is interpreted as a sign of attachment disorder that must be forcibly eradicated. From this perspective, parenting a child with an attachment disorder is a battle, and winning the battle by defeating the child is paramount.<ref name=tfr79/>

Proper appreciation of total adult control is also considered vital, and information, such as how long a child will be with therapeutic foster parents or what will happen to him or her next, is deliberately withheld.<ref name="Mercer et al.98105">Mercer et. al. pps. 98–105</ref> Attachment parenting expert Nancy Thomas states that attachment-disordered children act worse when given information about what is going to occur because they will use the information to manipulate their environment and everyone in it.<ref name="Thomas"/>

In addition to restrictive behavior, parents are advised to provide daily sessions in which older children are treated as if they were babies to create attachment.<ref name= "Thomas"/> The child is held in the caregiver's lap, rocked, hugged and kissed, and fed with a bottle and given sweets. These sessions are carried out at the caregiver's wish and not upon the child's request. Attachment therapists believe that reenactments of aspects of infant care have the power to rebuild damaged aspects of early development such as emotional attachment.<ref name="Mercer et al. 7579">Mercer et. al. pps. 75–79, 195</ref>

===Contrasting attachment theory based methods===
{{See also|Attachment-based therapy (children)}}
In contrast, traditional attachment theory holds that the provision of a safe and predictable environment and caregiver qualities such as sensitivity, responsiveness to children's physical and emotional needs and consistency, support the development of healthy attachment. Therapy based on this viewpoint emphasizes providing a stable environment and taking a calm, sensitive, non-intrusive, non-threatening, patient, predictable, and nurturing approach toward children. Further, as attachment patterns develop within relationships, methods to correct problems with attachment focus on improving the stability and positive qualities of the caregiver-child interactions and relationship.<ref name="Haugaard">{{citation |author=Haugaard JJ |title=Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: introduction |journal= Child Maltreat |volume=9 |issue=2 |pages=123–30 |year=2004 |pmid=15104880 |doi=10.1177/1077559504264304}}</ref><ref name="Nichols">{{citation |author=Nichols M, Lacher D, May J |year=2002 |title=Parenting with stories: creating a foundation of attachment for parenting your child |location= Deephaven, MN |publisher=Family Attachment Counseling Center |isbn=0974602906}}</ref><ref>Task Force Report, Chaffin et. al. p. 76</ref> All mainstream interventions with an existing or developing evidential foundation focus on enhancing caregiver sensitivity, creating positive interactions with caregivers, or change of caregiver if that is not possible with existing caregivers.<ref name="Prior and Glaser p. 231–32">Prior and Glaser p. 231–32</ref><ref name="AACAP 05"/> Some interventions focus specifically on increasing caregiver sensitivity in foster parents.<ref name="Prior and Glaser p. 231–32"/><ref name= "AACAP 05">{{citation |journal= J Am Acad Child Adolesc Psychiatry |year=2005 |volume=44 |issue=11 |pages=1206–19 |title=Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood |author=Boris NW, Zeanah CH, Work Group on Quality Issues |pmid=16239871 |url= http://www.aacap.org/galleries/PracticeParameters/rad.pdf |format=PDF |accessdate=2008-01-25 |doi=10.1097/01.chi.0000177056.41655.ce}}</ref>

==Theoretical principles==
Like a number of other alternative mental health treatments for children, attachment therapy is based on some assumptions that differ strongly from the theoretical foundations of other attachment based therapies.<ref name=tfr78>Task Force Report, Chaffin et. al. p. 78</ref> In contrast to traditional attachment theory, the theory of attachment described by attachment therapy proponents is that young children who experience adversity (including [[maltreatment]], loss, separations, [[adoption]], frequent changes in child care, [[colic]] or even frequent [[ear infection]]s) become enraged at a very deep and [[primitive (biology)|primitive]] level.<ref name=tfr78/> This results in a lack of ability to attach or to be genuinely affectionate to others. [[Psychological repression|Suppressed]] or unconscious rage is theorized to prevent the child from forming bonds with caregivers and leads to behavior problems when the rage erupts into unchecked aggression. Such children are said to fail to develop a conscience, to not trust others, to seek control rather than closeness, to resist the authority of caregivers, and to engage in endless power struggles. They are seen as highly manipulative and as trying to avoid true attachments while simultaneously striving to control those around them through manipulation and superficial sociability. Such children are said to be at risk of becoming [[psychopath]]s who will go on to engage in very serious delinquent, criminal, and antisocial behaviors if left untreated.<ref name=tfr78/> The tone in which the attributes of these children are described has been characterized as "demonizing".<ref name=pg186>Prior and Glaser p. 186</ref>

Advocates of this treatment also believe that emotional attachment of a child to a caregiver begins during the [[prenatal]] period, during which the unborn child is aware of the mother's thoughts and emotions. If the mother is distressed by the pregnancy, especially if she considers abortion, the child responds with distress and anger that continue through postnatal life. If the child is separated from the mother after birth, no matter how early this occurs, the child again feels distress and rage that will block attachment to a foster or adoptive caregiver.<ref name="Mercer et al.92">Mercer et. al. p. 92</ref>

If the child has had a peaceful [[gestation]], but after birth suffers pain or ungratified needs during the first year, attachment will again be blocked. If the child reaches the toddler period safely, but is not treated with strict authority during the second year, according to the so-called "attachment cycle", attachment problems will result. Failure of attachment results in a lengthy list of mood and behavior problems, but these may not be revealed until the child is much older. According to attachment therapist Elizabeth Randolph, attachment problems can be diagnosed even in an asymptomatic child through observation of the child's inability to crawl backward on command.<ref name="Mercer et al. 180">Mercer et. al. p. 180</ref><ref name="Randolph">{{citation |author=Randolph E |year=2001 |title=Broken hearts, wounded minds |location=Evergreen, CO |publisher=RFR Publications}}</ref>

Critics say holding therapies have been promoted as "attachment" therapies, even though they are more antithetical to than consistent with attachment theory,<ref name="O'Connor and Nilsen p. 316">O'Connor and Nilsen p. 316</ref> and not based on attachment theory or research.<ref name="Berlin et al."/> Indeed they are considered incompatible.<ref name= "O'Connor (2003)"/> There are many ways in which holding therapy/attachment therapy contradicts [[John Bowlby|Bowlby's]] attachment theory, e.g. attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity.<ref name=pg265/> According to Mary Dozier "holding therapy does not emanate in any logical way from attachment theory or from attachment research".<ref name="dozier 03">{{citation |author=Dozier M |title=Attachment-based treatment for vulnerable children |journal=Attach Hum Dev |volume=5 |issue=3 |pages=253–7 |year=2003 |month=September |pmid=12944219 |doi=10.1080/14616730310001596151 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/14616730310001596151&magic=pubmed}}</ref>

==Diagnosis and attachment disorder==
Attachment therapists claim to diagnose [[attachment disorder]],<ref name="tfr81">Task Force Report, Chaffin et. al. p. 81</ref> and [[reactive attachment disorder]].<ref name= "tfr8282">Task Force Report, Chaffin et. al. pp. 79, 82–83</ref> However, within attachment therapy, the diagnoses of attachment disorder and reactive attachment disorder are used in a manner not recognised in mainstream practice. Prior and Glaser describe two discourses on attachment disorder.<ref name="Prior and Glaser p. 183">Prior and Glaser p. 183</ref> One is science-based, found in academic journals and books with careful reference to theory, international classifications and evidence. They list [[John Bowlby|Bowlby]], [[Mary Ainsworth|Ainsworth]], Tizard, Hodges, Chisholm, O'Connor and [[Charles H. Zeanah|Zeanah]] and colleagues as respected attachment theorists and researchers in the field. The other discourse is found in clinical practice, non-academic literature and on the [[Internet]] where claims are made which have no basis in attachment theory and for which there is no empirical evidence. In particular unfounded claims are made as to efficacy of treatments.<ref name="Prior and Glaser p. 183"/> The Internet is considered essential to the popularization of holding therapy as an "attachment" therapy.<ref>O'Connor and Nilsen p. 318</ref>

The APSAC Task Force describes the relationship between the proponents of attachment therapy and mainstream therapies as polarized. "This polarization is compounded by the fact that attachment therapy has largely developed outside the mainstream scientific and professional community and flourishes within its own networks of attachment therapists, treatment centers, caseworkers, and parent support groups. Indeed, proponents and critics of the controversial attachment therapies appear to move in different worlds."<ref name=tfr78/>

===Diagnosis lists and questionnaires===
Both the APSAC Task Force and Prior and Glaser describe the proliferation of alternative "lists" and diagnoses, particularly on the Internet, by proponents of attachment therapy, that are not in accord with either DSM or ICD classifications and which are partly based on the unsubstantiated views of Zaslow and Menta<ref name="Zaslow"/> and Cline.<ref name= "Task Force Report, Chaffin et al."/><ref name="Cline"/><ref name=pg186/> According to the Task Force, "These types of lists are so nonspecific that high rates of [[false-positive]] diagnoses are virtually certain. Posting these types of lists on internet sites that also serve as marketing tools may lead many parents or others to conclude inaccurately that their children have attachment disorders."<ref name=tfr83list>{{citation |author=Task Force Report, Chaffin et. al. |pages=83–84 |quote=Many of the controversial attachment therapies have promulgated quite broad and nonspecific lists of symptoms purported to indicate when a child has an attachment disorder. For example, Reber (1996) provided a table that lists "common symptoms of RAD." The list includes problems or symptoms across multiple domains (social, emotional, behavioral and developmental) and ranges from DSM-IV criteria for RAD (e.g., superficial interactions with others, indiscriminate affection toward strangers, and lack of affection toward parents), to nonspecific behavior problems including destructive behaviors; developmental lags; refusal to make eye contact; cruelty to animals and siblings; lack of cause and effect thinking; preoccupation with fire, blood, and gore; poor peer relationships; stealing; lying; lack of a conscience; persistent nonsense questions or incessant chatter; poor impulse control; abnormal speech patterns; fighting for control over everything; and hoarding or gorging on food. Others have promulgated checklists that suggest that among infants, "prefers dad to mom" or "wants to hold the bottle as soon as possible" are indicative of attachment problems (Buenning, 1999). Clearly, these lists of nonspecific problems extend far beyond the diagnostic criteria for RAD and beyond attachment relationship problems in general. These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain. Posting these types of lists on internet sites that also serve as marketing tools may lead many parents or others to conclude inaccurately that their children have attachment disorders}}</ref>

Prior and Glaser describe the lists as "wildly inclusive" and state that many of the behaviors in the lists are likely to be the consequences of neglect and abuse rather than located within the attachment [[paradigm]]. Descriptions of children are frequently highly pejorative and "demonizing". Examples given from lists of attachment disorder symptoms found on the internet include lying, avoiding eye contact except when lying, persistent nonsense questions or incessant chatter, fascination with fire, blood, gore and evil, food related issues (such as gorging or hoarding), cruelty to animals and lack of conscience. They also give an example from the Evergreen Consultants in Human Behavior which offers a 45-symptom checklist including bossiness, stealing, [[enuresis]] and language disorders.<ref name=pg186/>

A commonly used diagnostic checklist in attachment therapy is the ''Randolph Attachment Disorder Questionnaire'' or "RADQ", which originated at the Institute for Attachment in Evergreen.<ref name="RADQ">{{citation |author=Randolph EM |year=1996 |title=Randolph Attachment Disorder Questionnaire |publisher=Institute for Attachment, Evergreen CO}}</ref> It is presented not as an assessment of reactive attachment disorder but rather attachment disorder. The checklist includes 93 discrete behaviors, many of which either overlap with other disorders, like [[Conduct Disorder]] and [[Oppositional Defiant Disorder]] or are not related to attachment difficulties.<ref name="Cappelletty et al.">{{citation |quote=The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care |author=Cappelletty G, Brown M, Shumate S |title=Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement |journal=Child and Adolescent Social Work Journal |volume=22 |issue=1 |month=February |year=2005 |pages= 71–84 |doi=10.1007/s10560-005-2556-2}}</ref> It is largely based on the earlier Attachment Disorder Symptom Checklist which itself shows considerable overlap with even earlier checklists for indicators of [[sexual abuse]]. The Attachment Disorder Symptom Checklist includes statements about the parent's feelings toward the child as well as statements about the child's behavior. For example, parental feelings are evaluated through responses to such statements as "Parent feels used" and "is wary of the child's motives if affection is expressed", and "Parents feel more angry and frustrated with this child than with other children". The child's behavior is referred to in such statements as "Child has a grandiose sense of self-importance" and "Child 'forgets' parental instructions or directives". The compiler of the RADQ claims validity by reference to the Attachment Disorder Symptom Checklist. It also purports to diagnose attachment disorder for which there is no classification.<ref name="Mercer">{{citation |author= Mercer J |title=Attachment Therapy: A Treatment without Empirical Support |journal=The Scientific Review of Mental Health Practice SRMHP Home|year=Fall ~ Winter 2002 |volume=1 |issue=2}}</ref> A critic has stated that a major problem of the RADQ is that it has not been validated against any established objective measure of emotional disturbance.<ref name="Mercer J">{{citation |author=Mercer J |title=Coercive restraint therapies: a dangerous alternative mental health intervention |journal=MedGenMed |volume=7 |issue=3 |pages=6 |year=2005 |pmid=16369232 |url= http://www.medscape.com/viewarticle/508956 |pmc=1681667}}</ref>

===Patient recruitment===
In addition to concerns about the use of non-specific diagnostic checklists on the Internet being used as a marketing tool, the Task Force also noted the extreme claims made by proponents as to both the prevalence and effect of attachment disorders. Some proponents suggest most or a high proportion of adopted children are likely to suffer attachment disorder. Statistics on the prevalence of maltreatment are wrongly used to estimate the prevalence of RAD.<ref name=tfr79/> Problematical or less desirable styles such as insecure or disorganized attachment are conflated with attachment disorder. Children are labeled as "RADs", "RAD-kids" or "RADishes".<ref name=tfr79/> They are seen as manipulative, dishonest, without conscience and dangerous.<ref name=tfr79/> Some attachment therapy sites predict that attachment-disordered children will grow up to become violent predators or psychopaths unless they receive the treatment proposed.<ref name=tfr79/> A sense of urgency is created which serves to justify the application of aggressive and unconventional techniques.<ref name=tfr79/> One site was noted to contain the argument that [[Saddam Hussein]], [[Adolf Hitler]], and [[Jeffrey Dahmer]], were examples of children who were attachment-disordered who "did not get help in time".<ref name=tfr79/> Foster Cline in his seminal work on attachment therapy ''Hope for high risk and rage filled children'' uses the example of [[Ted Bundy]].<ref name="Cline"/>

In answering the question posed as to how a treatment widely regarded by attachment clinicians and researchers as destructive and unethical came to be linked with attachment theory and to be seen as a viable and useful treatment, O'Connor and Nilson cite the use of the Internet to publicize attachment therapy and the lack of knowledgeable mainstream professionals or appropriate mainstream treatments or interventions. They set out recommendations for the better dissemination of both understanding of attachment theory and knowledge of the more recent evidence-based treatment options available.<ref>O'Connor and Nilsen pp. 316–19</ref>

Rachel Stryker in her anthropological study "The Road to Evergreen" argues that adoptive families of institutionalized children who have difficulties transitioning to a nuclear family are attracted to the Evergreen model despite the controversy, because it legitimises and reanimates the same ideas about family and domesticity as does the adoption process itself, offering renewed hope of "normal" family life. Institutionalized or abused children often do not conform to adopters conceptualizations of family behaviours and roles. The Evergreen model pathologizes the childs behaviour by a medical diagnosis, thus legitimising the family. As well as the promise of working where traditional therapies fail, attachment therapy also offers the idea of attachment as a negotiable [[Social contract|social contract]] that can be enforced in order to convert the unsatisfactory adoptee into the "emotional asset" the family requires. By the use of confrontation the model offers the means to [[Operant conditioning|condition]] children to comply with parental expectations. Where the therapy fails to achieve this the fault is attributed to the child's conscious choice to not be a family member, or the child's inability to perform as family material.<ref name=stryker>{{citation|author=Stryker R|title=The Road to Evergreen: Adoption, Attachment Therapy, and the Promise of Family|year=2010|publisher=Cornell University press|location=Ithaca, London|isbn=9780801446870}}</ref>

===Contrasting mainstream position===
{{See also|Attachment disorder|Reactive attachment disorder}}
Within mainstream practice, disorders of attachment are classified in [[DSM-IV-TR]] and [[ICD-10]] as reactive attachment disorder (generally known as RAD), and [[Disinhibited attachment disorder]]. Both classification systems warn against automatic diagnosis based on abuse or neglect. Many symptoms are present in a variety of other more common and more easily treatable disorders. There is as yet no other accepted definition of attachment disorders.<ref name="Boris & Zeanah">{{citation |author=Boris NW, Zeanah CH |year=1999 |title= Disturbance and disorders of attachment in infancy: An overview |journal=Infant Mental Health Journal |volume=20 |pages=1–9 |doi=10.1002/(SICI)1097-0355(199921)20:1<1::AID-IMHJ1>3.0.CO;2-V}}</ref>

According to the [[American Academy of Child and Adolescent Psychiatry]] (AACAP) practice parameter published in 2005, the question of whether attachment disorders can be reliably diagnosed in older children and adults has not been resolved. Attachment behaviors used for the diagnosis of RAD change markedly with development and defining analogous behaviors in older children is difficult. There are no substantially validated measures of attachment in middle childhood or early adolescence.<ref name="AACAP 05"/>

==Prevalence==
Attachment therapy prospered during the 1980s and '90s as a consequence of both the influx of older adopted orphans from Eastern European and [[third world]] countries and the inclusion of [[reactive attachment disorder]] in the 1980 [[Diagnostic and Statistical Manual of Mental Disorders]] which attachment therapists adopted as an alternative name for their existing unvalidated diagnosis of attachment disorder.<ref name="crossman"/>

According to the APSAC Task Force, these therapies are sufficiently prevalent to have prompted position statements or specific prohibitions against using coercion or restraint as a treatment by mainstream professional societies such as: [[American Psychological Association]] (Division on Child Maltreatment), [[National Association of Social Workers]] [http://www.childrenintherapy.org/resolutions/index.html#nasw] (and its Utah Chapter), [[American Professional Society on the Abuse of Children]],<ref name="Task Force Report, Chaffin et al."/> American Academy of Child and Adolescent Psychiatry,<ref name="AACAP 05"/> and [[American Psychiatric Association]]. The Association for the Treatment and Training in the Attachment of Children, (ATTACh), an organization for professionals and families associated with attachment therapy, has also issued statements against coercive practices.<ref name=attach06>{{citation |title=ATTACh White paper on coercion |year=2006 |url=http://www.attach.org/WhitePaper.pdf |format=PDF |publisher=ATTACh |accessdate=2008-03-16}}</ref><ref name=attach03/> Two American states, Colorado and North Carolina, have outlawed rebirthing.<ref name="act2">{{citation |title=North Carolina Bans "Rebirthing" |url= http://www.childrenintherapy.org/newsroom/atnews/20030802.html#NC |author=Advocates for Children in Therapy |accessdate=2008-09-17}}</ref> There have been professional licensure sanctions against some leading proponents and successful criminal prosecutions and imprisonment of therapists and parents using attachment therapy techniques. Despite this, the treatments appear to be continuing among networks of attachment therapists, attachment therapy centers, caseworkers, and adoptive or foster parents.<ref name=tfr78/> The advocacy group [[Advocates for Children in Therapy|ACT]] states, "Attachment Therapy is a growing, underground movement for the 'treatment' of children who pose disciplinary problems to their parents or caregivers."<ref name="ACTwhatis2"/>

Rachel Stryker in her anthropological study "The Road to Evergreen" states that attachment therapies "of all stripes" are increasingly popular in the USA and that the number of therapists associated with the Evergreen model registering with ATTACh grows each year. She cites the large number of formerly institutionalized domestic and foreign adoptees in the USA and the apparently higher risk of disruption of foreign adoptions, of which there were 216,000 between 1998 and 2008.<ref name=stryker/>

The practice of holding therapy is not confined to the US. Prior and Glaser cite at least one clinic in the UK.<ref name=pg263/> Attachment therapists from the USA have conducted conferences in the UK.<ref name=stryker/> The British Association for Adoption and Fostering, (BAAF), has issued an extensive position statement on the subject which covers not only physical coercion but also the underlying theoretical principles.<ref name="baaf">{{citation |title=Attachment Disorders, their Assessment and Intervention/Treatment |author=BAAF Position Statement 4 |accessdate=2008-10-19 |url=http://www.baaf.org.uk/about/believes/ps4.pdf |format=PDF}}</ref> However, therapists calling themselves "attachment therapists" practicing in the UK tend to be practicing convential forms of psychotherapy based on attachment theory.<ref name=keys/>

==Developments==
The APSAC Task Force stated that proponents of attachment therapy correctly point out that most critics have never actually observed any of the treatments they criticize or visited any of the centers where the controversial therapies are practiced. Proponents argue that their therapies present no physical risk if undertaken properly and that critics' concerns are based on unrepresentative occurrences and misapplications of techniques, or misunderstanding by parents. Holding is described as gentle or nurturing and it is maintained that intense, cathartic approaches are necessary to help children with attachment disorders. Their evidence for this is primarily clinical experience and testimonials.<ref name=tfr78/>

According to the APSAC Task Force, there are controversies within the attachment therapy community about coercive practices. There has been a move away from coercive and confrontational models towards attunement and emotional regulation amongst some leaders in the field, notably Hughes, Kelly and Popper. A number of therapies are quite different from those that have led to the abuse and deaths of children in much publicized court cases. The Task Force, however, points out that all the therapies, including those using frankly coercive practices, present themselves as humane, respectful and nurturing, therefore caution is advised.<ref name="Reply">{{citation |author=Chaffin M, Hanson R, Saunders BE |title= Reply to Letters |journal=Child Maltreat |year=2006 |volume=11|page=381 |doi=10.1177/1077559506292636 |accessdate=2008-10-19|url=http://cmx.sagepub.com/cgi/reprint/11/4/381}}</ref> Some practitioners condemn the most dangerous techniques but continue to practice other coercive techniques.<ref name=tfr78/> Others have taken a public stand against coercion. The Task Force was of the view that all could benefit from more transparency and specificity as to how the therapy is behaviorally delivered.<ref name="Reply"/>

In 2001, 2003 and 2006, ATTACh, an organization set up by Foster Cline and associates, issued a series of statements in which they progressively changed their stance on coercive practices. In 2001, after the death of Candace Newmaker they stated "The child will never be restrained or have pressure put on them in such a manner that would interfere with their basic life functions such as breathing, circulation, temperature, etc."<ref name="Fowler">{{citation |author=Fowler KA |title=Book Review |journal=The Scientific Review of Mental Health Practice |volume=3 |issue=1 |year=2004 |month=Spring/Summer}}</ref> A White Paper, formally accepted in April 2007, "unequivocally state(s) our opposition to the use of coercive practices in therapy and parenting." They acknowledge ATTACh's historical links with catharsis, provocation of rage, and intense confrontation, among other overtly coercive techniques (and indeed continue to offer for sale books by controversial proponents) but state that the organization has evolved significantly away from earlier positions. They state that their recent evolution is due to a number of factors including tragic events resulting from such techniques, an influx of members practicing other techniques such as attunement and a "fundamental shift ... away from viewing these children as driven by a conscious need for control toward an understanding that their often controlling and aggressive behaviors are automatic, learned [[defence mechanism|defensive]] responses to profoundly overwhelming experiences of fear and terror."<ref name=attach07>{{citation |title=ATTACh White paper on coercion |year=2007 |url=http://www.attach.org/WhitePaper.pdf |format=PDF |publisher=ATTACh |accessdate=2008-03-16}}</ref><ref name=attach03>{{citation |title=ATTACh Position Statement Regarding Coercive Treatment |year=2003 |url=http://www.attach.org/position.htm |accessdate=2008-03-16 |publisher=ATTACh}}</ref> While being of the view that authoritative practices are necessary, and that nurturing touch and treatment aimed at the perceived developmental rather than chronological age are an integral part of the therapy, the White Paper promotes the techniques of attunement, sensitivity and [[emotional dysregulation|regulation]] and deprecates coercive practices such as enforced holding or enforced eye contact.<ref name="attach07"/>

A modest social work study and "invitation to a debate", based on interviews with the deliverers and recipients of a therapeutic intervention incorporating non-coercive holding at one centre in the UK, reports generally positive effects of the overall therapeutic process and calls for further consideration of the use of this type of intervention. The intervention was not described as "holding therapy" but as using a degree of holding in the course of therapy. The intervention also used a degree of intrusiveness, based on the idea that the recipients need this as they have no basis on which to build a reciprocal relationship. Although recipients were generally positive about the therapy received, the holding aspect was the least liked. The authors call for research and a debate on issues of what constitutes "coercion" and the distinctions between the different variants of "holding" in therapy.<ref name=keys>{{citation|doi= 10.1093/bjsw/bcp078|journal= British Journal of Social Work|year=2010|volume= 40|pages= 1534–1552|title=To Have and to Hold: Questions about a Therapeutic Service for Children|author= Sudbery J, Shardlow SM, Huntington AE}}</ref>

==History==
Matthew Speltz of the [[University of Washington School of Medicine]] states that the roots of attachment therapy are traceable to psychologist Robert Zaslow and his "Z-process" in the 1970s.<ref name="Speltz"/><ref name="Zaslow">{{citation |author=Zaslow R, Menta M |year=1975 |title=The psychology of the Z-process: Attachment and activity |location=San Jose, CA |publisher=San Jose University Press}}</ref> Zaslow attempted to force attachment in those suffering from [[autism]] by creating rage while holding them against their will. He believed this would lead to a breakdown in their [[defense mechanisms]], making them more receptive to others.<ref name="Speltz"/> Zaslow thought attachment arose when an infant experienced feelings of pain, fear and rage, and then made eye contact with the carer who relieved those feelings. If an infant did not experience this cycle of events by having his fear and rage relieved, the infant would not form an attachment and would not make eye contact with other people.<ref name="Mercer75">Mercer et. al. p. 75</ref> Zaslow believed that creating pain and rage and combining them with eye contact would cause attachment to occur, long after the normal age for such developments.<ref name="Mercer75"/> Holding therapies derive from these "rage-reduction" techniques applied by Zaslow.<ref name=o317>O'Connor and Nilsen p. 317</ref> The holding is not used for safety purposes but is initiated for the purpose of provoking strong negative emotions such as fear and anger. The child's release typically depends upon his or her compliance with the therapist's [[wikt:clinical|clinical]] agenda or goals.<ref name="Speltz"/> In 1971, Zaslow surrendered his California psychology license following an injury to a patient during rage-reduction therapy.<ref name="Zaslow 1970">{{citation |title=Accusation against Zaslow |author=The Executive Secretary of the Board of Medical Examiners of the State of California |url=http://www.kidscomefirst.info/zaslow.pdf |format=PDF |year=1971 |accessdate=2008-10-19}}</ref> Zaslow's ideas on the use of the Z-process and holding for autism have been dispelled by research on the
genetic/biologic causes of autism.<ref name="Speltz"/>

Zaslow and his "Z-process", a physically rough version of holding therapy, influenced Foster Cline (known as the "father of attachment therapy") and associates at his clinic in Evergreen<ref name="Mercer43">Mercer et. al. p. 43</ref> A key tenet of Zaslow's approach was the notion of "breaking through" a child's defenses—based on the model of [[defense mechanism|ego defenses]] borrowed from [[psychoanalytic]] theory, which critics state has been misapplied. The "breaking through" [[metaphor]] was then applied to children whose attachments were thought to be impaired.<ref name=o317/> The clinic, originally called the Youth Behavior Program, was subsequently renamed the Attachment Center at Evergreen.<ref name=act/>

In 1983, [[ethologist]] Nikolas [[Tinbergen]] published a book recommending the use of holding therapy by parents as a treatment or "cure" for autistic children. Tinbergen based his ideas on his methods of observational study of birds. Parents were advised to hold their autistic children despite resistance and to endeavor to maintain eye contact and share emotions.<ref name=tin>{{citation |author=Tinbergen N, Tinbergen EA |title=Autistic children: New hope for a cure |year=1983 |publisher=Allen & Unwin |location=London}}</ref> Tinbergen believed that autism related to a failure in the bond between mother and child caused by "traumatic influences" and that enforced holding and eye contact could establish such a relationship and rescue the child from autism.<ref name=tin/> Tinbergen's interpretations of autism were without scientific rigor and were contrary to the then growing acceptance that autism had a genetic cause. Despite the lack of a sound theoretical or scientific base, holding therapy as a treatment for autism is still practiced in some parts of the world, notably Europe.<ref name=bish>{{citation |title=Forty years on: Uta Frith's contribution to research on autism and dyslexia, 1966-2006 |author=Bishop DVM |journal=The Quarterly Journal of Experimental Psychology |volume=61 |issue=1 |month=January |year=2008 |pages=16–26 |doi=10.1080/17470210701508665 |pmid=18038335 |pmc=2409181}}</ref>

Speltz cites child psychiatrist Martha Welch and her 1988 book, ''Holding Time'',<ref name="Welch"/> as the next significant development. Like Zaslow and Tinbergen, Welch recommended holding therapy as a treatment for autism.<ref name="Welch"/> Like Tinbergen, Welch believed autism was caused by the failure of the attachment relationship between mother and child.<ref name="tinW">{{citation |author=Welch M |editor=Tinbergen N, Tinbergen EA |year=1983 |title=Appendix |encyclopedia=Autistic children: New hope for a cure |publisher=Allen & Unwin |location=London}}</ref> Mothers were instructed to hold their defiant child, provoking anger and rage, until such time as the child ceased to resist, at which point a [[affectional bond|bonding]] process was believed to begin.<ref name="Welch"/>

Foster Cline and associates at the Attachment Center at Evergreen, Colorado began to promote the use of the same or similar holding techniques with adopted, maltreated children who were said to have an "attachment disorder". This was replicated elsewhere such as at "The Center" in the Pacific Northwest.<ref name="Speltz"/> A number of other clinics arose in Evergreen, [[Colorado]], set up by those involved in or trained at the Attachment Center at Evergreen (renamed the Institute for Attachment and Development in about 2002).<ref name= act>{{citation |last=Advocates for children in Therapy |title=Foster W. Cline |url=http://www.advocatesforchildrenintherapy.org/proponents/cline.html |accessdate=2008–09–17}}</ref> These included one set up by Connell Watkins, formerly an associate of Foster Cline at the Attachment Center and its clinical director. Watkins was one of the therapists convicted in the [[Candace Newmaker]] case in 2001 in which a child was asphyxiated during a rebirthing process in the course of a two-week attachment therapy "intensive".<ref name="AOJ">{{Citation |title=Affirmation of judgement and sentence on appeal by Watkins |url=http://www.kidscomefirst.info/msoAB8FC.pdf |format=PDF |accessdate=2008-04-18}}</ref> Foster Cline gave up his license and moved to another state following an investigation of a separate attachment therapy related incident.<ref name=act/>

In addition to the notion of "breaking through" defence mechanisms, other metaphors were adopted by practitioners relating to the supposed effects of early deprivation, abuse or neglect on the child's ability to form relationships. These included the idea of the child's development being "frozen" and treatment being required to "unfreeze" development.<ref name=o317/> Practitioners of holding therapy also added some components of Bowlby's attachment theory and the therapy came to be known as attachment therapy. Language from attachment theory is used but descriptions of the practices contain ideas and techniques based on misapplied metaphors deriving from Zaslow and psychoanalysis, not attachment theory.<ref>O'Connor and Nilsen p. 317–18</ref> According to Prior and Glaser "there is no empirical evidence to support Zaslow's theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children's behavior."<ref name=pg263>Prior and Glaser p. 263</ref>

Cline's privately-published work ''Hope for high risk and rage filled children'' also cites family therapist and hypnotherapist [[Milton Erickson]] as a source, and reprints parts of a case of Erickson's published in 1961.<ref name="Cline"/><ref name="Erickson">{{citation |author=Erickson MH |year=1961 |title=The identification of a secure reality |journal=Family Process |volume=1 |issue=2 |pages=294–303 |doi=10.1111/j.1545-5300.1962.00294.x}}</ref> The report describes the case of a divorced mother with a non-compliant son. Erickson advised the mother to sit on the child for hours at a time and to feed him only on cold oatmeal while she and a daughter ate appetizing food. The child did increase in compliance, and Erickson noted, with apparent approval, that he trembled when his mother looked at him. Cline commented, with respect to this and other cases, that in his opinion all bonds were [[psychological trauma|trauma]] bonds. According to Cline, it illustrates the three essential components of 1) taking control, 2) the child's expression of rage; and, 3) relaxation and the development of bonding.<ref name="Cline"/>

In addition, proponents believed that holding induced age regression, enabling a child to make up for physical affection missed earlier in life.<ref name=o317/> Regression is key to the holding therapy approach.<ref name=pg265>Prior and Glaser p. 265</ref> In attachment therapy, breaking down the child's resistance by confrontational techniques is thought to reduce the child to an infantile state, thus making the child receptive to forming attachment by the application of early parenting behaviors such as bottle feeding, cradling, rocking and eye contact.<ref name="Shermer">{{citation |title=Death by theory |journal=Scientific American |url=http://atheism.about.com/gi/dynamic/offsite.htm?site=http://www.sciam.com/print_version.cfm?articleID=000490DD-702D-10A9-A47783414B7F0000 |accessdate=2008-02-12 |author=Shermer M |year=2004 |month=June}}</ref> Some, but by no means all, attachment therapists have used rebirthing techniques to aid regression. The roots of the form of rebirthing used within attachment therapy lie in [[primal therapy]] (sometimes known as primal scream therapy), another therapy based on beliefs in very early trauma and the transformational nature of age regression.<ref name="crossman">{{citation |author=Crossman P |title=The Etiology of a Social Epidemic |publisher=Skeptic Report |accessdate=2008-10-19 |url=http://www.skepticreport.com/pseudoscience/attachmenttherapy.htm}}</ref> Bowlby explicitly rejected the notion of regression stating "present knowledge of infant and child development requires that a theory of developmental pathways should replace theories that invoke specific phases of development in which it is held a person may become fixated and/or to which he may regress."<ref name=pg263/><ref name="Bowlby">{{citation |author=Bowlby J |year=1998 |title=A Secure Base: Clinical Application of Attachment Theory (A Tavistock professional book) |location=London |publisher=Routledge |pages=269 |isbn=0422622303}}</ref>

According to O'Connor and Nilsen, although other aspects of treatment are applied, the holding component has attracted most attention because proponents believe it is an essential ingredient. They also considered the lack of available and suitable interventions from mainstream professionals as essential to the popularization of holding therapy as an attachment therapy.<ref name="O'Connor and Nilsen p. 316"/>

In 2003, an issue of ''Attachment & Human Development'' was devoted to the subject of attachment therapy with articles by well-known experts in the field of attachment.<ref>{{citation |title=Special Issue: Current perspectives on assessment and treatment of attachment disorders |author=O'Connor TG |coauthors=Zeanah CH (eds) |year=2003 |month= September |journal=Attachment & Human Development |volume=5 |issue=3 |pages=219–326 |url=http://www.informaworld.com/smpp/title~db=all~content=g714022753 |doi= 10.1080/14616730310001594009 |pmid=12944214}}</ref> Attachment researchers and authors condemned it as empirically unfounded, theoretically flawed and clinically unethical.<ref name="O'Connor (2003)"/> It has also been described as potentially abusive and a [[pseudoscientific]] intervention, not based on attachment theory or research, that has resulted in tragic outcomes for children including at least six documented child fatalities.<ref name="Berlin et al."/> In 2006, the [[American Professional Society on the Abuse of Children]] (APSAC) Task Force reported on the subjects of attachment therapy, reactive attachment disorder, and attachment problems and laid down guidelines for the future diagnosis and treatment of attachment disorders.<ref name=tfr83/> The APSAC Task Force was largely critical of Attachment Therapy's theoretical base, practices, claims to an evidence base, non-specific symptoms lists published on the internet, claims that traditional treatments do not work and dire predictions for the future of children who do not receive attachment therapy. "Although focused primarily on specific attachment therapy techniques, the controversy also extends to the theories, [[diagnoses]], diagnostic practices, beliefs, and [[social group]] [[norm (sociology)|norms]] supporting these techniques, and to the patient recruitment and advertising practices used by their proponents."<ref name=tfr77/> In 2007, Scott Lilienfeld included holding therapy as one of the potentially harmful therapies (PHT's) at level 1 in his ''Psychological Science'' review.<ref name="lilien">{{citation |author=Lilienfeld SO |year=2007 |title=Psychological treatments that cause harm |journal=Perspectives on Psychological Science |volume=2 |pages=53–70|doi=10.1111/j.1745-6916.2007.00029.x}}</ref> Describing it as "unfortunately" referred to as "attachment therapy", Mary Dozier and [[Michael Rutter]] consider it critical to differentiate it from treatments derived from attachment theory.<ref name="DozRut">{{citation |author=Dozier M and Rutter M |contribution=Challenges to the Development of Attachment Relationships Faced by Young Children in Foster and Adoptive Care |editor=Cassidy J and Shaver PR |title=Handbook of Attachment: Theory, Research and Clinical Applications |year=2008|edition=2nd |publisher=Guilford Press |location=New York: London |isbn=978-1-60623-028-2}}</ref> A mistaken association between attachment therapy and attachment theory may have resulted in a relatively unenthusiastic view towards the latter among some practitioners despite its relatively profound lines of research in the field of socioemotional development.<ref name="Ziv"/>

==Claims==
According to the APSAC Task Force, proponents of attachment therapy commonly assert that their therapies alone are effective for attachment-disordered children and that traditional treatments are ineffective or harmful.<ref name=tfr78/> The APSAC Task Force expressed concern over claims by therapies to be "[[evidence-based medicine|evidence-based]]", or the ''only'' evidence-based therapy, when the Task Force found no credible evidence base for any such therapy so advertised.<ref name="apsac quote">"Some proponents have claimed that research exists that supports their methods, or that their methods are evidence based, or are even the sole evidence-based approach in existence, yet these proponents provide no citations to credible scientific research sufficient to support these claims (Becker-Weidman, n.d.-b). This Task Force was unable to locate any methodologically adequate [[clinical trials]] in the published peer-reviewed scientific literature to support any of these claims for effectiveness, let alone claims that these treatments are the only effective available approaches." Task Force Report, Chaffin et. al. op. cit p. 78</ref> Nor did it accept more recent claims to evidence base in its November 2006 Reply.<ref name="Reply"/>

Two approaches on which published studies have been undertaken are holding therapy<ref name="Myeroff">{{citation |author=Myeroff R, Mertlich G, Gross J |title=Comparative effectiveness of holding therapy with aggressive children |journal=Child Psychiatry Hum Dev |volume=29 |issue=4 |pages=303–13 |year=1999 |pmid=10422354 |doi=10.1023/A:1021349116429}}</ref> and [[dyadic developmental psychotherapy]].<ref name="Becker-Weidman 2006">{{citation |author=Becker-Weidman A |year=2006 |title=Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy |journal=Child and Adolescent Social Work Journal |volume=23 |issue=2 |pages=147–171 |month=April |doi=10.1007/s10560-005-0039-0}}</ref> Each of these non-randomized studies concluded that the treatment method studied was effective. Both the APSAC Task Force and Prior and Glaser cite and criticize the one published study on holding therapy undertaken by Myeroff et al., which "purports to be an evaluation of holding therapy".<ref name="Myeroff"/><ref>Task Force Report, Chaffin et. al. p.85</ref><ref>Prior and Glaser p. 264</ref> This study covers the "across the lap" approach, described as "not restraint" by Howe and Fearnley but "being held whilst unable to gain release."<ref name="Howe">{{citation |author=Howe D, Fearnley S |year=2003 |title=Disorders of attachment in adopted and fostered children: Recognition and treatment |journal= Clinical Child Psychology and Psychiatry |volume=8 |pages=369–387 |doi=10.1177/1359104503008003007}}</ref> Prior and Glaser state that although the Myeroff study claims it is based on attachment theory, the theoretical basis for the treatment is in fact Zaslow.<ref name=pg265/>

Dyadic developmental psychotherapy was developed by psychologist Daniel Hughes, described by the Task Force as a "leading attachment therapist". Hughes' website gave a list of attachment therapy techniques, repeated by the APSAC Task Force from an earlier website, which he stated do not or should not form part of dyadic developmental psychotherapy, which the Task Force took as a description of attachment therapy techniques.<ref name="Replyquote">{{citation |author=Chaffin M, Hanson R, Saunders BE |title=Reply to Letters |journal =Child Maltreat |year=2006 |volume=11 |page=381 |doi=10.1177/1077559506292636 |accessdate=2008-10-19 |url=http://cmx.sagepub.com/cgi/reprint/11/4/381 |quote=1. Holding a child and confronting him/her with anger. 2. Holding a child to provoke a negative emotional response. 3. Holding a child until s/he complies with a demand. 4. Hitting a child. 5. Poking a child on any part of his/her body to get a response. 6. Pressing against "pressure points" to get a response. 7. Covering a child's mouth/nose with one's hand to get a response. 8. Making a child repeatedly kick with his/her legs until s/he responds. 9. Wrapping a child in a blanket and lying on top of him/her. 10. Any actions based on power/submission, done repeatedly, until the child complies. 11. Any actions that utilize shame and fear to elicit compliance. 12. "Firing" a child from treatment because s/he is not compliant. 13. Punishing a child at home for being "fired" from treatment. 14. Sarcasm, such as saying “sad for you”, when the adult actually feels no empathy. 15. Laughing at a child over the consequences which are being given for his behavior. 16. Labeling the child as a "boarder" rather than as one's child. 17. "German shepherd training," which bases the relationship
on total obedience. 18. Depriving a child of any of the basic necessities, for example, food or sleep. 19. Blaming the child for one's own rage at the child. 20. Interpreting the child's behaviors as meaning that "s/he does not want to be part of the family", which then elicits consequences such as: A. Being sent away to live until s/he complies. B. Being put in a tent in the yard until s/he complies. C. Having to live in his/her bedroom until s/he complies. D. Having to eat in the basement/on the floor until s/he complies. E. Having "peanut butter" meals until s/he complies. F. Having to sit motionless until s/he complies. (Hughes, 2002, n.p.)}}</ref><ref name="Hughes">{{citation |author=Hughes D |title=An attachment-based treatment of maltreated children and young people. |journal=Attach Hum Dev |volume=6 |issue=3 |pages=263–78 |year=2004 |pmid=15513268 |doi= 10.1080/14616730412331281539 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/14616730412331281539&magic=pubmed}}</ref> Two studies on dyadic developmental psychotherapy have been published by Dr. Becker-Weidman, the second being a four-year follow up of the first.<ref name="Becker-Weidman 2006"/> Prior and Glaser state Hughes' therapy reads as good therapy for abused and neglected children, though with "little application of attachment theory", but the advocacy group [[Advocates for Children in Therapy|ACT]] and the Task Force place Hughes within the attachment therapy paradigm.<ref name="Reply"/><ref>Prior and Glaser p. 261</ref><ref name="act3">{{citation |author=Advocates for Children in Therapy |url=http://www.childrenintherapy.org/proponents/hughes.html |title=Daniel A. Hughes |accessdate=2008-09-17}}</ref>

In 2004, Saunders, Berliner and Hanson developed a system of categories for [[social work]] interventions which has proved somewhat controversial.<ref name="Saunders 2004">{{citation |author=Saunders BE, Berliner L, Hanson RF |title=Child Physical and Sexual Abuse: Guidelines for Treatment, Revised Report |date=April 26, 2004 |location=Charleston, SC |publisher= National Crime Victims Research and Treatment Center |url=http://academicdepartments.musc.edu/ncvc/resources_prof/ovc_guidelines04-26-04.pdf |format=PDF |quote=''Category 1'': Well-supported, efficacious treatment; ''Category 2'': Supported and probably efficacious; ''Category 3'': Supported and acceptable; ''Category 4'': Promising and acceptable; ''Category 5'': Novel and experimental; and ''Category 6'': Concerning treatment}}</ref><ref name="Gambrill">{{citation |author=Gambrill E |year=2006 |title=Evidence-based practice and policy: Choices ahead |journal=Research on Social Work Practice |volume=16 |pages=338–357 |doi=10.1177/1049731505284205}}</ref> In their first analysis, holding therapy was placed in Category 6 as a "Concerning treatment". In 2006 Craven and Lee classified 18 studies in a literature review under the Saunders, Berliner & Hanson system.<ref name="Craven & Lee 2006">{{citation |author=Craven P, Lee R |year=2006 |title=Therapeutic Interventions for Foster Children: A Systematic Research Synthesis |journal=Research on Social Work Practice |volume=16 |issue=3 |pages=287–304 |doi=10.1177/1049731505284863}}</ref> They considered both dyadic developmental psychotherapy and holding therapy.<ref name=Myeroff/><ref name="Becker-Weidman 2004">{{citation |author=Becker-Weidman A |year=2004 |title=Dyadic developmental psychotherapy: An effective treatment for children with trauma-attachment disorders |accessdate=2005–05–10 |url=http://www.Center4familyDevelop.com |publisher=Center for Family Development}}</ref> They placed both in Category 3 as "Supported and acceptable". This categorization by Craven and Lee has been criticized as unduly favorable,<ref name="Pignotti & Mercer">{{citation |author=Pignotti M, Mercer J |year=2007 |title= Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions: A systematic research synthesis revisited |journal=Research on Social Work Practice |volume=17 |issue=4 |pages=513–519}}</ref> a point to which Craven and Lee responded by arguments in support of holding therapy.<ref name="Craven & Lee 2007">{{citation |author=Lee RE, Craven P |year=2007 |title=Reply to Pignotti and Mercer: Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions |journal=Research on Social Work Practice |volume=17 |issue=4 |pages=520–521 |doi=10.1177/1049731506297043}}</ref> Both Myeroff et al.'s study and Becker-Weidman's first study (published after the main Report) were examined in the Task Force's November 2006 Reply to Letters and were criticized as to their methodology. Becker-Weidman's study was described by the Task Force as "an important first step toward learning the facts about DDP outcomes" but falling far short of the criteria necessary to constitute an evidence base.<ref name="Reply"/>

Some studies are still being undertaken on coercive therapies. A nonrandomized, before-and-after 2006 pilot study by Welch (the progenitor of "holding time") et al. on Welch's "prolonged parent-child embrace therapy" was conducted on children with a range of diagnoses for [[behavior|behavioral disorder]]s and claimed to show significant improvement.<ref name="Welsh et al."/>

In March 2007, attachment therapy was placed on a list of treatments that have the potential to cause harm to clients in the [[Association for Psychological Science|APS]] journal, ''Perspectives on Psychological Science''. Concern was expressed about methods that involve holding and restraint, and the lack of randomized, controlled experiments showing the effectiveness of the treatment.<ref name="lilien"/>

==Cases==
There have been a number of cases of serious harm to children in which controversial attachment therapy techniques, theories or belief systems have been implicated. An estimated six children have died as a consequence of the more coercive forms of such treatments or the application of the accompanying parenting techniques.<ref name="O'Connor (2003)"/><ref name= "Boris (2003)">{{citation |author=Boris NW |title=Attachment, aggression and holding: a cautionary tale |journal=Attach Hum Dev |volume=5 |issue=3 |pages=245–7 |year=2003 |pmid= 12944217 |doi=10.1080/14616730310001593947}}</ref>

*Andrea Swenson, 1990; a 13-year-old adopted girl undergoing attachment therapy at The Attachment Center, Evergreen. She was placed with "therapeutic foster parents". When the insurance company refused to continue to pay for her treatment, the adoptive parents were asked to allow the foster parents to adopt Andrea so that a fresh claim could be made. Andrea, having asked her foster parents what would happen if she took an overdose of drugs or slit her wrist, and been told she would die, took an overdose of aspirin. She was violently ill during the night and was incoherent, breathing heavily and still vomiting in the morning. Nevertheless the foster parents went bowling, leaving her alone. A visitor found her dead in the hallway. The suit was settled out of court.<ref>{{citation |first=Karen |last=Auge |newspaper=DenverPost.com |year=2000 |accessdate=2008-06-25 |title= Alternative therapies not new in Evergreen |url=http://web.archive.org/web/20010309205804/http://www.denverpost.com/news/news0617d.htm}}</ref><ref>{{citation |last=Advocates for Children in Therapy |title=Victim of Attachment Therapy |url=http://www.childrenintherapy.org/victims/swenson.html|accessdate=2008-09-17}}</ref>

*Lucas Ciambrone, 1995; a seven-year-old adopted boy who was starved, beaten, bitten and forced to sleep in a stripped bathroom. At the post-mortem he was found to have 200 bruises and five old broken ribs. The adoptive mother was convicted as the abuser and the adoptive father of being aware but doing nothing to prevent it or seek help. Foster Cline gave evidence for both parents claiming Lucas suffered from reactive attachment disorder and that living with such a child was like living "in a situation with the same psychic pressures as those experienced in a concentration camp or cult" and that the parents were in no way responsible for the genesis of Lucas' alleged difficult behaviors. No violent or angry behaviors were reported at school.<ref>{{Citation |last=Scarcella |first=Michael A |title=Ciambrone convicted of murder, gets life |newspaper=Herald Tribune |date=17 May 2007 |url= http://www.heraldtribune.com/apps/pbcs.dll/article?AID=/20070517/NEWS/705170460 |accessdate=2008-06-18}}</ref><ref>{{Citation |last=Advocates for Children in therapy |title=Parental Murder Victim |url=http://www.childrenintherapy.org/victims/ciambrone.html |accessdate=2008-09-17}}</ref>

*David Polreis, 1996; a two-year-old adopted boy who was beaten to death by his adoptive mother. Foster Cline gave evidence for the mother claiming David suffered from reactive attachment disorder. The adoptive mother, supported by attachment therapists practising the Evergreen model, claimed he had beaten himself to death as a consequence of his attachment disorder.<ref name=stryker/> (She subsequently claimed he had attacked her and she had acted in self defense).  David had been diagnosed with attachment disorder by an attachment therapist and was undergoing treatment and accompanying attachment parenting techniques. Mourners at the funeral were asked to contribute to The Attachment Center.<ref>{{Citation |last=Horn |first=Miriam |title=A dead child, a troubling defense |newspaper=U.S. News online |date=14 July 1997 |url=http://web.archive.org/web/19970731005244/http://www.usnews.com/usnews/issue/970714/14atta.htm |accessdate=2008-04-18}}</ref><ref>{{Citation |last=Bowers |first=Karen |title=Suffer-the-children |newspaper=Denver Westword News |date=27 July 2000 |url=http://www.westword.com/2000-07-27/news/suffer-the-children/ |accessdate=2008-04-18}}</ref><ref>{{Citation |last=Canellos |first=Peter S |title=Adoption ends in death, uproar Mother's murder defense: Son, 2, harmed himself; |newspaper=Boston Globe |location=Boston, Mass. |date=17 April 1997 |page=A.1}}</ref>

*Krystal Tibbets, 1997; a three-year-old adopted child who was killed by her adoptive father using holding therapy techniques he claimed had been taught to him by an attachment therapy center. This was denied by the therapist and the adoptive mother. He lay on top of Krystal, a technique known as "compression therapy", and pushed his fist into her abdomen to release "visceral rage" and to enforce bonding. When she stopped screaming and struggling he believed she had "shut down" as a form of "resistance". After his release from a five-year prison sentence the adoptive father campaigned to have attachment therapy banned.<ref>{{Citation |title=Timeline: Techniques blamed for several deaths |newspaper=Deseret Morning News |date=27 November 2004 |url=http://deseretnews.com/dn/view/0,1249,595108152,00.html |accessdate=2008-04-18}}</ref><ref>{{citation |first=Wendy |last=Grossman |title= Holding On |newspaper=Houston Press |url=http://www.houstonpress.com/2002-09-19/news/holding-on/ |pages=3–4 |date=19 September 2003 |accessdate=2008-10-25 |isbn=0670491926}}</ref>

*[[Candace Newmaker]], 2000; a ten-year-old adopted girl who was killed by [[asphyxiation]] during a rebirthing session used as part of a two week attachment therapy "intensive". The two attachment therapists, Connell Watkins (formerly of The Attachment Center, Evergreen) and Julie Ponder were each sentenced to 16&nbsp;years imprisonment for their part in the therapy during which Candace was wrapped in blankets and required to struggle to be reborn, against the weight of several adults. Her inability to struggle out was interpreted as "resistance". Her adoptive mother and the "therapeutic foster parents" with whom she had been placed received lesser penalties.<ref name="AOJ"/><ref>{{Citation |first=Audrey |last= Gillan |title=The Therapy That Killed |newspaper=Guardian |date=20 June 2001 |url=http://www.guardian.co.uk/g2/story/0,,509588,00.html |accessdate=2008-04-18}}</ref> Watkins was released on parole in August 2008 after serving approximately 7 years of her sentence.<ref>{{citation |last=The Associated Press |newspaper=cbs4denver.com |date=3 August 2008 |accessdate=2008-08-08 |title=Therapist In 'Rebirthing' Death In Halfway House |url=http://cbs4denver.com/local/denver.rebirthing.watkins.2.786701.html}}</ref>

*Logan Marr, 2001; a five-year-old child who had been fostered by a caseworker. While having a tantrum, the screaming girl was buckled into a highchair, wrapped with duct tape, including over her mouth, and left in a basement where she suffocated. The foster mother claimed to have used some attachment therapy ideas and techniques she had picked up when working as a caseworker.<ref>{{Citation |title=The Taking of Logan Marr |newspaper=FRONTLINE report |url=http://www.pbs.org/wgbh/pages/frontline/shows/fostercare/marr/ |accessdate= 2008-04-18}}</ref><ref>{{Citation |title=Logan Lyn Marr |last=Advocates for Children in Therapy |url=http://www.childrenintherapy.org/victims/marr.html |accessdate=2008-09-17}}</ref>

*Cassandra Killpack, 2002; a four-year-old adopted child who died from complications of [[hyponatremia]] secondary to [[water intoxication]]. This apparently occurred when she was restrained in a chair and forced to drink excessive amounts of water by her adoptive parents as part of an "attachment-based" treatment using techniques they claimed had been taught to them at the attachment therapy center where Cassandra was undergoing treatment. It appears this was a punishment for having drunk some of her sister's drink.<ref>{{Citation |author=Adams B |title=Families struggle to bond with kids |newspaper=The Salt Lake Tribune |date=29 September 2002 |accessdate=2008-04-18}}</ref><ref>{{Citation |first=Jesse |last= Hyde |title=Therapy or abuse? Controversial treatments may sink Cascade |newspaper=Deseret Morning News |date=14 June 2005 |url=http://deseretnews.com/article/1,5143,595108087,00.html |accessdate=2008-04-18}}</ref><ref>{{Citation |first=Jesse |last=Hyde |title=Court Hears Taped Killpack Interview |newspaper=Deseret Morning news |date=26 September 2005 |url=http://deseretnews.com/dn/view/0,1249,615153274,00.html |accessdate=2008-04-18}}</ref><ref>{{citation |url=http://www.utcourts.gov/opinions/supopin/Killpack071608.pdf |format=PDF |title=State of Utah .v. Jennete Killpack |author=Supreme Court of the State of Utah |year=2008 |accessdate=2008-07-24}}</ref>

*[[Gravelle]]s, 2003; 11 special needs children adopted by Michael and Sharon Gravelle. Many of the 11 children slept in cages. The case also involved allegations of extreme control over food and toileting and severe punishments for disobedience. The children were home-schooled. Some of the children underwent holding therapy from their attachment therapist and the adoptive parents used accompanying attachment therapy parenting techniques at home. The adoptive parents and therapist were prosecuted and convicted in 2003.<ref>{{Citation |author=Associated Press |title=Special Report: Gravelle trial |newspaper=[[The Plain Dealer (newspaper)|Cleveland Plain Dealer]] |url=http://www.cleveland.com/gravelle/ Gravelle Trial |accessdate=2008-04-18}}</ref><ref>{{Citation |title=Gravelle Siblings |newspaper=Advocates for Children in Therapy |url=http://www.childrenintherapy.org/victims/gravelle.html |accessdate=2008-04-17}}</ref><ref>{{Citation |author=Associated Press |title=Gravelle Daughter's Letter |newspaper=[[The Plain Dealer (newspaper)|Cleveland Plain Dealer]] |url= http://www.cleveland.com/news/pdf/gravelleletter.pdf |format=PDF |accessdate=2008-06-20}}</ref><ref>{{citation |title=Plea deal for Gravelle kids' therapist |newspaper=Sandusky Register online |first=Carol |last=Harper |date=21 February 2007 |accessdate=2008-06-24 |url=http://www.sanduskyregister.com/articles/2007/02/21/front/181339.txt}}</ref>

*Vasquez, 2007: four adopted children, three of whom were kept in cages, fed limited diets, and permitted only primitive sanitary facilities. The fourth child, the favorite, was given medication to delay puberty. The adoptive mother received a prison sentence of less than a year and her parental rights were terminated in 2007. There was no therapist in this case but the adoptive mother claimed that three of her four adopted children had reactive attachment disorder.<ref>{{Citation |first=Nick |last=Welsh |title='Caged Kids' Case Nears End, Vasquez's Fate in Judge's Hands |newspaper=The Santa Barbara Independent |date=3 May 2007 |url=http://www.independent.com/news/2007/may/03/caged-kids-case-nears-end-vasquezs-fate-judges-han/ |accessdate=2008-04-18}}</ref><ref>{{citation |newspaper=The Santa Barbara Independent |url=http://www.independent.com/news/2007/may/11/judge-brings-hammer-down-caged-kids-case/ |title=Judge Brings Hammer Down in 'Caged Kids' Case |date=11 May 2007 |first=Nick |last=Welsh |accessdate=2008-06-18}}</ref>

==See also==
* [[Child development]]
* [[Rebirthing-breathwork]]
* [[Theraplay]]
* [[Advocates for Children in Therapy]]

==Notes==
{{Reflist|2}}

==References==
* (APSAC Task Force report), {{citation |author=Chaffin M, Hanson R, Saunders BE, et. al. |title=Report of the APSAC Task Force on attachment therapy, reactive attachment disorder, and attachment problems. |journal=Child Maltreat |volume=11 |issue=1 |pages=76–89 |year=2006 |pmid=16382093 |doi=10.1177/1077559505283699}}
* {{citation |author=Mercer J, Sarner L, Rosa L |year=2003 |title=Attachment Therapy on Trial: The Torture and Death of Candace Newmaker |publisher=Praeger| isbn=0275976750}}
* {{citation |author=O'Connor TG, Nilsen WJ |year=2005 |contribution=Models versus Metaphors in Translating Attachment Theory to the Clinic and Community |title=Enhancing Early Attachments: Theory, Research, Intervention and Policy |editor=Berlin LJ, Ziv Y, Amaya-Jackson L, Greenberg MT |series=Duke series in child development and public policy |publisher= Guilford Press |isbn=1-59385-470-6}}
* {{citation |author=Prior V and Glaser D |title=Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice |year=2006 |series=Child and Adolescent Mental Health Series |publisher=Jessica Kingsley |location=London |isbn=1-84310-245-5 |oclc=70663735}}

==External links==
* [http://www.attach.org Association for Treatment and Training in the Attachment of Children (ATTACh)] – Self-described as "an international coalition of professionals and families dedicated to helping those with attachment difficulties by sharing our knowledge, talents and resources"
* [http://www.advocatesforchildrenintherapy.org Advocates for Children in Therapy] – Child advocacy group opposing attachment therapy
* [http://www.quackwatch.org/01QuackeryRelatedTopics/at.html "Be Wary of Attachment Therapy"] from [[Quackwatch]] – medical watchdog website
* [http://www.usatoday.com/news/nation/2006-01-18-swapping-children_x.htm "Underground network moves children from home to home"] Koch W. USAtoday article.
* [http://www.ebm-first.com/?cat=67 ebm-first.com] - evidence-based medicine campaign group.
* [http://www.kidscomefirst.info/ kidscomefirst] anti-attachment therapy source site
* [http://www.caica.org/Attachment%20Disorder%20Main.htm Attachment therapy page from Coalition Against Institutionalized Child Abuse (CAICA)]
* [http://www.dleg.state.mi.us/fhs/brs/reports/CP140201012_SIR_2008C0105024.pdf 2008 investigation into death of a foster child]

{{Attachment theory}}

{{DEFAULTSORT:Attachment Therapy}}
[[Category:Popular psychology]]
[[Category:Pseudoscience]]
[[Category:Attachment theory]]
[[Category:Alternative therapies for developmental and learning disabilities]]
[[Category:Adoption, fostering, orphan care and displacement]]
[[Category:Childhood psychiatric disorders]]
[[Category:Psychotherapy]]

[[de:Festhaltetherapie]]
[[nl:Holdingtherapie]]
[[Category:2Fix]]