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In His Own Words

— Most Telling —

• “Therapeutic holding” includes hugging, embracing, restraining and provocative physical containment. — Troubled Transplants: Unconventional Strategies for Helping Disturbed Foster and Adopted Children (Richard Delaney & Frank R. Kunstal; Oklahoma City, OK: Wood ‘N’ Barnes Publishing, 2nd ed., 1997), p. 139

• [T]he more intrusive, restraining and provocative holding strategies used, the more close monitoring by the treatment team is required. — Troubled Transplants (1997), p. 166

• When held in place, [the boy] became livid and struggled against the adults — to no avail. His rage escalated quickly as he screamed louder and louder at those holding him. He commanded them to let him go, he threatened to turn them into the police, and he claimed that they were breaking his arms. The adults kept [the boy] in a “therapeutic restraint,” nonetheless. — Troubled Transplants (1997), p. 141

• [I]t is essential for foster and adoptive parents (and caseworkers and therapists) to be ready for such interventions. Many parents and professionals may find this approach quite overwhelming and intense — even contrary to their beliefs about helping. However for some children in placement, therapeutic holding is imperative to stimulate them to cathart, vent and then sort out what it all means afterwards. Without such extreme intervention, some children may be returned to hospital or residential settings… — Troubled Transplants (1997), p. 142

• While [the boy] was in a rage [while being restrained], the therapist began to insert remarks about Jay’s feelings towards his birth parents. … Initially [the boy] refused to acknowledge the remarks…though he was helpless.… Ultimately, [the boy] exploded, “Okay, okay … I hate them! …” — Troubled Transplants (1997), p. 142

• As with many of the unconventional strategies, it is important that the child be placed “off balance”… — Troubled Transplants (1997), p. 83

• Many children initially react to infantalization with embarrassment, discomfort and resistance. — Troubled Transplants (1997), p. 81

— More on Holding Therapy —

• Restraining and provocative physical containment is used in severe cases where maltreated children — massively resistant and guarded — present on-going problems with passive-aggressive behavior, resistance to forming attachments to anyone. — Troubled Transplants (1997), p. 140

• [W]hat we attempting in the confrontive sessions with the child is to allow him to vocalize his feelings of grief, rage, depression and frustration which have been suppressed. — Troubled Transplants (1997), p. 95

• Whatever the cause, there are many children who need touch desperately but are too active, too withdrawn or too “unattached” to allow, let alone initiate, contact with parent figures. With these youngsters, interventions from parents can range from playful, loving hugs to more forceful, aggressive holding and restraint. — Troubled Transplants (1997), p. 140

• Two approaches may be appropriate…[One is] to confront his birth parents…The other approach involves therapeutic holding which might confront and address Jay’s angry feelings in the safety of the foster home setting or therapist’s office. — Troubled Transplants (1997), p. 141

• The “verbal eruptions” from non-verbalizing, acting-out children can provide most beneficial encounters with them. Often those encounters follow upon physical restraint. — Troubled Transplants (1997), pp. 142-143

• In the maddening, yet safe, embrace of his restraining foster parents, [the boy] was freer than he’d ever been to voice unspeakable rage without fear of obliterating others in the process. — Troubled Transplants (1997), p. 143

• [T]herapeutic holding helps us to get a grip on the child. — Troubled Transplants (1997), p. 142

• We advise professionals to consult their professional insurance carrier and perhaps their attorney about the potential liability issues before employing intrusive/invasive approaches in their practice. — Troubled Transplants (1997), p. 144

— Attachment Therapy —

• The therapist and caseworker should typically take on the role of confronters of reality as a way of sparing the foster parents…that is, the therapist and caseworker should play “bad cop,” allowing the foster parents the role of comforter of the child when his feelings of pain and anguish emerge. — Troubled Transplants (1997), p. 93

• Teasing can be an invaluable tool in reaching disturbed children. It can engage and enliven the flat, depressed and withdrawn child, or it can taunt and provoke the controlled and controlling hostile child to ventilate underlying grief and rage. — Troubled Transplants (1997), pp. 130-131

• We do foster obnoxious behavior and vocalizations in the horrendously repressed, intimidated and meek child… — Troubled Transplants (1997), p. 103

• If you stop the child from talking about all of the negative things that have happened to her, aren’t you just forcing her to keep it inside? You would if indeed the child was sharing her hurt and pain with you. There is a difference between merely talking about pain and actually feeling it. — Troubled Transplants (1997), p. 102

— Requiring Eye Contact —

• …other strategies for use with withdrawn, avoidant, inadequate children … In some instances merely insisting on proximity — physical closeness — may help … by simply insisting on eye contact. — Troubled Transplants (1997), p. 99

— Dismissing Conventional Therapy —

• Rarely do professionals recognize adequately the child’s pathology and its damaging effect on the foster/adoptive family. — Troubled Transplants (1997), p. 33

• Many disturbed foster and adoptive children often fail to respond to conventional interventions. In fact, some traditional approaches may interfere inadvertently with the stability of foster and adoptive placements. — Troubled Transplants (1997), p. 67

— Who Needs Research? —

• These strategies have not been researched by any statistical, controlled study. However, anecdotal reports by foster and adoptive parents and caseworkers working on treatment teams underscore the general impactfulness of inventive strategies with certain disturbed children. — Troubled Transplants (1997), p. 166

— Scare Tactics —

• Foster and adoptive family members can quickly fall prey to the child’s negative mental blueprint… — Troubled Transplants (1997), p. vi

• This history of maltreatment has almost inevitably damaged the child at a deep level psychologically. — Troubled Transplants (1997), p. 11

• The abused and maltreated child is often the master at finding and exploiting the foster or adoptive parents’ “Achilles heel.” — Troubled Transplants (1997), p. 155

• Central to our work with foster and adoptive families is the notion of “importing pathology.” … In effect, when a family takes on an adoptive or foster child, they often, as it were, “transplant” a diseased young shoot into their family garden. The planting…often bears bitter fruit. — Troubled Transplants (1997), pp. 30-31

— Parent as Co-Therapist —

• In our view, foster and adoptive parents are the key members of the treatment team. — Troubled Transplants (1997), p. 67

• It is essential that parents work collaboratively with the treatment team when employing the more controversial holding approaches: restraint or provocation of the child to rage. — Troubled Transplants (1997), p. 143

— Mother vs. Father —

• Typically the mother feels that she is the target of anger, passive-aggression and vengeance from the child, while the father enjoys a somewhat idealized relationship… — Troubled Transplants (1997), p. 32

• Professionals characteristically take sides with the father and child — with the father who appears more rational, available and stable… — Troubled Transplants (1997), p. 32

• The “Wait ’Til Your Dad Gets Home” Strategy … The purpose could be described as extracting the mother from the thankless job of punishing and correcting her adopted son…. Without a change she cannot take on a more relaxed role….In working to reverse roles, the mother needs to force herself to not enforce rules but to wait until her husband can take that on when he gets home. — Troubled Transplants (1997), pp. 119-122

— Food Issues —

• The “Unending Pizza” Strategy … Sally had her dream come true. She was given pizza for breakfast, lunch and dinner…Sally was, in effect, given exactly what she wanted — total control over her diet. — Troubled Transplants (1997), pp. 70-72

• [If a child refuse to eat much] … parents might try sitting the child on their lap and spoon or bottle feeding the child, as if he were an infant. … [W]herein the child steals food in order to eat wolfishly in private, again use of close parent contact is crucial. In this instance the parent might site the younger child on her lap and feed him with baby utensils, insisting on eye contact between each bite. — Troubled Transplants (1997), p. 74

• Take for example the child who refuses seconds at the dinner table but sneaks a “midnight snack.” The compulsion to steal is deeply entrenched… — Troubled Transplants (1997), p. 82

— Being Scary and Unpredictable —

• “Creating A Catastrophy” [sic] seems to work well … Mrs. T., having conferred with the psychologist, was prepared for the next explosive episode … Brandon made a big scene on his birthday … Mrs. T marched of to the kitchen. In a few minutes she started talking to herself in a louder and louder voice, “Nobody appreciates what I do around here…” Just for effect, she rattled pots and pans together and closed the cabinet doors with a force. … Mrs. T’s “outburst” had a way of upstaging her manipulative son. — Troubled Transplants (1997), pp. 75-76

• Creating A Catastrophy [sic] … the objective of this strategy is to disrupt the child’s outburst by our outlandish, ludicrous, up-staging behavior. — Troubled Transplants (1997), pp. 75-77

• In one adoptive home the father would lie down on the floor next to the child and yell and scream along with him. — Troubled Transplants (1997), p. 77

• The “Inspector Clousseau” Strategy … Children who are inert, withdrawn, depressed and/or “wooden” emotionally…require the therapeutic equivalent of “shock therapy,” not unlike the invigorating “surprise attacks” from Kato. — Troubled Transplants (1997), pp. 116-117

• As [the girl] shuffled into the therapist’s room, she wore her trademark wooden expression. As usual there was no luster in her eye, no spring in her step. By previous agreement, the therapist and the adoptive mother started in on the “kinetic” exercise. First, the adoptive mother asked [the girl] to stand next to her, as she explained the fun new game. [The child] compliantly stood and listened without apparent curiosity. Then, the adoptive mother bent over and grabbed hold of [the child’s] ankles as the therapist reached for [the child’s] wrists. The two of them lifted the child off the ground… [The child’s] face remained impassive — a blank screen. The therapist suggested that they begin the swinging … higher and higher … she and the therapist released their grip, sending [the child] flying up, across and down onto the couch. [The child] bounced safely, but showed no expression, no reaction. … Without kinetic strategies inert children … often fail to develop reciprocal relationships with caregivers … This leaves the placement in ultimate jeopardy. — Troubled Transplants (1997), pp. 128-129

— Parental Coercion —

• [The parents] agreed to rock her daily in their arms — despite her fairly large size for a ten-year-old. They also bottle-fed her … we might help her with the clothes selection, help her button her shirt, zip her zippers and tie her shoes. These all are infantilizing strategies … We may need to actually “overdo it"… — Troubled Transplants (1997), pp. 128-129

— The Trap of Reasoning —

• [The boy] was an accomplished debater by the age of eleven. A bright, verbally precocious boy, he took delight in arguing any point with anyone. And, he almost always won. His greatest and most enduring debates occurred … with the adoptive mother. This woman … had fallen into the trap of reasoning with him. … Ultimately she found herself outwitted … [the boy] sadly was … arguing himself right out of his adoptive placement. … Referred to as the “Not Now I Have a Headache” strategy, the approach relies on a “convenient” excuse to avoid an argument. … [D]on’t let him “hook” you back into explaining yourself, your points, your motives. … [With this strategy] the adoptive mother continued to grow stronger by growing weaker. — Troubled Transplants (1997), pp. 85-87

— “Dose of Reality” Strategum —

• A Dose of Reality” Strategy … Joint conferences between the therapist, caseworker and foster parents came to the conclusion that [the boy] should see more of his [birth] mother rather than less … to provide [the boy] with a “dose of reality” — increased contact with the true source of his anguish and bitter frustration. — Troubled Transplants (1997), pp. 90-93

• In some instances, increased face-to-face contacts and visitation between the [birth] parents and child provides “fodder” for the therapist and caseworker in treatment. Provided with more frequent (and lengthier) visits with his birth parent, the child receives a “dose of reality” which can be useful therapeutically whether the child can be expected ever to return home or not. — Troubled Transplants (1997), p. 94

— Alarms —

• Sometimes [sleep problems] presents a danger to the family … [F]amilies can deploy motion detectors or other alarms to alert them to the child’s roaming. — Troubled Transplants (1997), p. 107

— Threatening Abandonment —

• The “Line in the Sand” Approach. The unconditional acceptance may in reality frighten this child. … Sometimes it comes to this: the child must know that the placement will be in jeopardy and he may be moved — unless things change for the better … and soon. — Troubled Transplants (1997), pp. 107-109

• Can’t this approach throw children into a state of panic over abandonment…? Yes….The “Line in the Sand” approach should not be used as an idle threat….this approach should be used only with the sanction of the treatment team and only if it complies with relevant child statutes and regulations. — Troubled Transplants (1997), p. 110

— Making “Ordeals” for Children —

• On the second night [the adoptive daughter] again had her fears, and was allowed into her mother’s bedroom. Immediately the “prayer vigil” began and stretched on for a full hour, with [the child] complaining about the reading and miserable about the memorization work….Not surprisingly, on the third and following nights, [the child] remained in her bedroom all night. … [I]t was necessary to find a way to turn [the child’s] “ideal” (getting into bed with her mother) into an “ordeal” and to allow Liz to have what she wanted, but to provide it on other, unbearable terms. …. Although successful treatment of [the child’s] broad psychological problems was not accomplished by means of this “prayerful” strategy, it provided the adoptive mother a sense of competence and some nights of uninterrupted sleep. — Troubled Transplants (1997), pp. 105-106

— Other Parenting Methods —

• The “Steal Thyself Blind” Strategy … [The boy] was challenged to find the hidden items without being caught in the act of “stealing.” According to the rules, if he were caught, the items were returned to the parents. — Troubled Transplants (1997), p. 82

• The “Sargeant [sic] Carter Approach”. … Sargeant [sic] Carter exhorted his troops … "I can’t hear you!" … With the passive/withdrawn or unresponsive child there is a need to help him to “come alive” … [T]he parents were directed … to play verbal “hard-ball”. — Troubled Transplants (1997), pp. 95-97

• Assuming the role of loving “therapeutic parent” may reduce the tendency for parents to both pressure themselves to “feel loving” towards the child and to expect reciprocal warmth and acceptance from the child. — Troubled Transplants (1997), p. 150

• Protecting the Nuclear Family … Careful, strategic, periodic use of respite care may provide the family with a well-deserved “holiday” from the disturbed foster or adoptive child. — Troubled Transplants (1997), pp. 150-151

— Belittling Children —

• [The boy], a dangerous, lurking character, looked like a ten-year-old “Quasimodo.” — Troubled Transplants (1997), p. 140

• [The boy] was a mixed type adopted child whose mealy-mouthed mumblings interfered with incorporation into the family. — Troubled Transplants (1997), p. 98

• One noteworthy symptom of the seriously troubled child is a cockeyed, stunted understanding of feelings. — Troubled Transplants (1997), p. 112

— Demonizing Birth Parents —

• Some children placed with foster or adoptive families have been so injured and damaged by their abusive pasts that they are simply “Family phobic.” These unfortunate victims are too traumatized, their selfhood annihilated by parents who committed “soul murder” on them…. While some of these “injured” children may eventually be ready for placement in a family, they need more intensive care first. — Troubled Transplants (1997), p. 157

• Neglectful [vs. abusive and sexually exploitive] families — possibly the most dysfunctional of all families and those who may leave the deepest “invisible scars” on the child… — Troubled Transplants (1997), p. 46

— References and Related Publications —

• Works by: Foster Cline, Vera Fahlberg, Ken Magid, Carole McKelvey, Martha Welch, Jay Haley. — Troubled Transplants (1997)

— Denouncing Coercion in Attachment Therapy —

[Ed. note: For contextual information about these statements, refer to the introduction at the top of this page.]

• Statements that coercive attachment therapy is not only effective, but should be considered “best practice” for RAD are wild, unsupported claims. — Fostering Changes: Myth, Meaning and Magic Bullets in Attachment Theory (Oklahoma City, OK: Wood ‘N’ Barnes Publishing, 3rd ed., 2006), p. 109

• Controversial attachment therapies include any approaches which involve coercive tactics, such as physical and emotional provocation of a child, aversive tickling, extreme isolation of the child, total control the child’s needs by the parent(s), emphasis on the child’s complete submission and surrender, holding therapy, and/or rebirthing approaches. These controversial attachment therapies often base their approach upon rage theory, an unsupported theory decidedly unrelated to mainstream attachment theory and research. … I refer to these alarming unrecommended therapies as a “subset” of controversial, maverick, radical, non-scientific, or coercive attachment therapists. — Fostering Changes (2006), p. 104