In
those days, we did not conceptualize the Nearly thirty years ago, in the early
'70s, The Attachment Center at Evergreen had it beginning in The Youth Behavior
Program. At that time, in a then fairly new concept, Tim Faust and other founding
therapists took kids with identified problems into the wilds of Colorado. Even
then wilderness experiences were being directed for youth all across the United
States, however at that time, few directly targeted moderately to severely disturbed
youth and identified the experience as therapeutic with the therapist accompanying
the youth on the trips. In those days there were no "challenge courses" and
no one outside of the Armed Services had heard of aerial obstacle courses. However,
we found that difficult teens and disturbed younger children somehow were quickly
able to relate in a healthy, new and tighter therapeutic alliance with their
therapists after they had dangled from a rope, feared being swept down a river,
or reached a mountain top that they had previously felt would be impossible
to climb.
Bonding Cycle with the precision that it is now taught and understood. We only
knew that "something special" happened after these problem city youth were encouraged
(euphemism) or pushed and cajoled (more accurate) into a situation where they
achieved after definitely feeling unsure of themselves. In the beginning of
these experiences, most were confounded, confused, and downright scared in an
unknown surroundings far away from peers, booze and bravado. When challenged
to excel in a far different environment than their urban underpinnings "something"
marvelous often happened.
Although
perhaps we were not theoretically clear in those days, we did know that somehow
the mix of downright fright, or at least solid concern followed by achievement,
pride, gratification and relief produced a therapeutic alliance that was far
tighter far more quickly than what we could generally obtain in the office using
good traditional techniques. At that time, we might have even characterized
it as a "bonding experience". We did recognize that, strangely, following the
experience, the youth identified with, emulated and wanted to be like the youth
leader.
Then,
at that same time, in the early to mid 70s, an old therapist, who was a walking
amalgam of wisdom, therapeutic genius, boisterous humor, and dogmatic positions
wrapped in a cantankerous personality came to Evergreen to teach and consult
on very difficult youth. This controversial figure, Bob Zaslow, and his "team"
of graduate students taught all across the nation, and although he sometimes
left both acrimony and adulation in his wake, and although he left few published
writings, his influence was vast.
Bob
taught about Bonding with a capital "B". He taught that it was necessary to
disturb the disturbed. He clarified that Bonding and Attachment were far different
that "the growth of love" or the "building of an alliance" in the more traditional
sense. He was an unabashedly directive therapist in a therapeutic universe that
mainly preached non-directiveness, reflective listening, and the slow process
and analysis of transference and countertransference. He took extremely disturbed
youth, forced eye contact in a holding position, and carried out family therapy
in a circle around the prone youth while the mother or father held the head.
He taught parents to be confrontive, and straight with themselves and the child
they held. He "coached" parents to bond with their child. And he achieved dramatic
results, with his controversial techniques.
That
was then. Now is now. America has become a much more protective, victim-oriented
and regulated environment. And the effective techniques that encourage rapid
attachment and bonding have, for a number of reasons, have fallen on difficult
times. Before exploring those reasons here, let us first look with some precision
at the Bonding Theory upon which all Attachment Therapy is based.
Bonding
Theory is on both observations and clinical assumptions that evolve from clinical
experience. The two basic empirical observations appear to be unarguable at
this point. They are observations that everyone can validate with their own
inspection and commitment. These observations were first remarked upon by Bowlby
and his followers nearly half a century ago. These observations have not been
seriously contested since Bowlby's time and are now incorporated officially
part of DSM IV Reactive Attachment Disorder:
1)
The normal bonding process between child and mother takes place in infancy,
mainly around feeding and physical contact in a flow that occurs as the mother
and child interact around the child's distress.
2)
Most severely disturbed individuals have had developmental problems occurring
during the time of the bonding cycle, problems occurring early in life, generally
around early parenting techniques or early life developmental disorders. Generally,
alone or in combination, such individuals:
a) Have had physical or mental developmental disorders such that the normal
cycle of pain followed by gratification and relief could not be achieved.
b) Have suffered early abuse and/or neglect
c) Have, before birth, been bathed in alcohol or drugs to the extent that the
normal early neurologic functioning is impaired.
d) Have been moved from care taker to care taker early in life
e) Have had the physical trauma of either surgery, pain or undiagnosed infantile
illnesses such that the normal bond cannot form - such infants generally have
problems recognizing or obtaining relief from their distress
Bonding
Theory is based upon the following four arguable clinical assumptions. These
assumptions, at the foundation of Attachment Therapy are open to disagreement,
but believed to be true by the vast majority of practicing therapists:
1)
All true bonding has elements of trauma, pain, difficulty or uncertainty followed
by gratification and/or relief.
All true bonding involves, in short, the successful completion of an "ordeal".
Bonding, then, is a process that is different than the growth of love, esteem,
respect and sense that it is usually visualized. Bonding experiences take place
in normal infancy; in the armed services; in the use of challenge courses; to
survivors following a catastrophe, to cult members; in interrogation and indoctrination
routines; in brainwashing situations and in reparenting and certain "attachment
therapy" routines. Bonding routines can be seen throughout the bible; in Mien
Kamph; and in many other situations. In fact, bonding routines are everywhere,
from the shores of Normandy, to college campuses where Greeks involve plebes
in "hell week".
Thus, it may be seen that bonding routines can be used for good or for evil
purposes. It depends on who is in control, the motives and the outcome.
2)
The lack of completion of the normal bonding cycle results in predictable symptoms:
They include but are not limited to:
a) The inability to show gratification, Basic Trust, Love, Attachment and normal
affection to parental figures.
b) The internalization of rage and anger that leads to childhood cruelty to
animals and other children, lack of self respect and severe control problems.
c) Other first year of life developmental problems such as hoarding and gorging
on food, an inability to show remorse, and a general lack of conscience.
3)
That if the normal bonding cycle has not been completed at a developmentally
appropriate time, during infancy, then it must be repaired in an "corrective
emotional experience".
4)
That this corrective emotional experience, when used in therapy, is the purposeful
use of a bonding cycle with the therapist, parents or other significant others
and that the bonding routines will generally involve, in one way or another,
an ordeal followed by feelings of relief, achievement or gratification.
But
there are problems in the therapeutic use of purposeful use of therapeutic bonding
routines. Therapists have always been best at rescuing people, and providing
nurturing, sometimes insight, and even, infrequently, confrontation when individuals
are upset. However, the helping community looks with some suspicion on the encouragement
of upset, or the purposeful provocation of painful emotions in order to provide
the client with opportunity to work through those emotions in a "corrective
emotional experience". Freud taught that the negative transference and neurotic
feelings would, in and of themselves, eventually appear if the therapist took
a non- directive course and eventually the client would work through these feelings.
Of course, psychoanalysis took a long time! And it was based on the assumption
that the individual wanted to change.
Nevertheless,
even decades ago, a few therapists often braving the doubt, if not outright
scorn of the professional majority encouraged pushing patients into primary
angry, anguished, and painful feelings in order to facilitate their working
through these emotions. Such were the early writings of Jacqui Schiff in All
my Children; Janov in The Primal Scream; Helen Waite in Valiant Companions;
Daniel Casriel in A Scream Away from Happiness and Milton Erickson in Jay Haley's
Uncommon Therapy.
In
the 70s, outside the therapeutic mainstream, Reality Attack Groups and other
high intensity groups used "in your face confrontation" to bond patients into
a "family" of ex-drug abusers at Synacore, Sydrinar and on Delancy Street. More
modern versions of high confrontation have been attempted in the "boot camps
for youth" and other programs attempted to bond youth into a more healthy group
identification and a healthier way of life.
Regardless
of the effectiveness of such groups, they all tended to remain, as may Attachment
Therapy itself, outside the mainstream of therapeutic methods. There are a number
of reasons, for this, but perhaps the most lethal reason for mainstream suspiciousness
and rejection is the fact that these methods do carry inherent risks. These
risks can always be minimized but they can never be completely vanquished. And
over the last thirty years, I have seen many outstanding treatment centers closed
or hassled by well-meaning outsiders because their techniques were perceived
as "dangerous", "too harsh" or robbed individuals of their individual rights.
There are six reasons why any bonding technique, regardless of its safeguards
and appropriateness is open to such charges.
The individuals who need the therapy often have been victimized previously in
their lives.
Character disturbed individuals may not see themselves as having problems. They
are filled with denial, and are unlikely to establish the necessary therapeutic
contract in a traditional manner. At any age, they must be cajoled, or strongly
encouraged to engage in therapy by an outside force - either parents in the
case of children, or by "court motivation" in the case of adults - or by the
requirements of the organization in the case of the armed services.
Many traditional therapists believe that the symptoms engendered by abuse or
dysfunctional childhoods should be respected. That is, if a woman has trouble
with men, she should see a female therapist to work through her problem; if
an abused child has trouble with touch, then touch should take place cautiously
if at all; if a child has been sexually abused, then he or she should not be
held by an adult of the same sex as the abuser; etc.
Such individuals easily feel victimized and claim victimization in situations
where others would not feel victimized.
The therapy needed to establish the bond does always involve an ordeal in one
form or another. The therapy, in cross section, without taking reasons and usual
outcome into account could be seen as abusive.
This is a litigious society where people are quick to sue over perceive abuse.
Much of the legal system's remuneration is based on finding pain and suffering.
If the job of therapy is truly to disturb the disturbed, and if bonding therapy
is more disturbing than the usual therapy, then litigation is always possible
if not likely.
Aside
from the inherent problems that bonding and attachment therapy face, there are,
in addition, five commonly expressed concerns about aspects of the various bonding
therapies as they are used in Attachment work. These include:
1)
It is built upon the belief that the end justifies the means 2) It is dangerous
work 3) It doesn't always work 4) There is no proof positive it works at all
5) The therapy merely recreates the traumatic abuse cycle that caused the problems
in the first place. It creates a "trauma bond".
These
thoughtful concerns must be briefly addressed.
It
is built upon the belief that the end justifies the means
Although
the world of psychology and mainstream psychology has trouble with the end justifying
the means, most of medicine and all of surgery expresses this axiom. Attachment
therapists do not equivocate here. As many if not most of the individuals treated
with the therapy will most likely lead non-productive lives, and will continue
to be a danger to themselves and others, the therapists feel the probable good
outcome necessitates the method.
It
is dangerous work
True.
However, in general, the more effective any technology, the more dangerous it
is. This is true of airplanes, digitalis, and bonding techniques. Nevertheless,
the "negative results" that may be used to illustrate the dangers of using bonding
techniques often does not hold up under close scrutiny. Whenever a therapy is
"unorthodox" the therapy may be blamed for producing results that were there
in the first place and that it was attempting to remedy. I am reminded of a
Texas case where a social worker claimed that a young man was morose, angry
and resentful following his confrontive therapy. She blamed the therapy. However,
when the issue was closely examined by a board of psychologists, it was determined
that the young man had always had those problems, and that perhaps he had them
less following the therapy.
It
doesn't always work
True.
And this is true of all the psychological therapies. There is a problem however,
that those treated with bonding techniques have often been refractory to the
more traditional techniques. Usually the bonding techniques are not attempted
as a first approach. In dealing with a particularly difficult population, some
failure must be accepted.
There
is no proof it works
Unfortunately
much of the dynamic therapies suffer from this criticism. There is no proof
positive that gestalt therapy, family therapy or play therapy are effective.
This is because the establishment of control groups is difficult and global
results are sometimes hard to quantify. However, all therapists using bonding
techniques were schooled and trained in good traditional techniques. No therapist
I have encountered uses the bonding techniques exclusively. Most wish they were
not needed at all! Other techniques are neither as demanding nor as controversial.
If the techniques were not overwhelmingly successful, no therapist would have
motivation for using them. They provide no more remuneration, and are much more
likely, within the therapeutic community, to cause problems for the therapist.
Studies
are now underway to quantify improvement. The remarkably positive results on
long term follow-up of 47 children treated in Evergreen are given in my book
Hope for High Risk and Rage Filled Children.
There
are an increasing number of therapists who have written of their first hand
experiences with the bonding techniques used for attachment therapy, and they
give strong testimony to its effectiveness.
The
therapy merely recreates the traumatic abuse cycle that caused the problems
in the first place. It creates a "trauma bond".
Abuse
takes place when a child:
Is
put through an ordeal to gratify the needs of an adult With painful outcome
Leaving residual problems to work through
Therapeutic
bonding situations:
Put
one through an ordeal to help the person face their own impediments to growth
With a positive outcome Alleviating the residual problems previously present
There
is no doubt that in cross section, not taking the motivation or outcome into
account, that the method could appear abusive, for it generally does provide
and ordeal of one type or another.
If
an ordeal is considered "trauma" then it is present in almost all bonding situations."
All bonding could then be considered a "trauma bonding" whether the bonding
be in infancy, in the service, in a "boot camp" or in reparenting and attachment
techniques. Perhaps it is better to clarify that trauma bonding per se occurs
when one is unable to work through the negative outcome of a cycle designed
to meet the "perpetrator's" needs, in a situation in which the victim was unable
to cope. Bonding on the other hand encourages the development of coping skills
in a safe environment that revisits the negative or traumatized feelings and
confronts the individual's inability to express loving emotions.
Many
traditional therapists believe strongly in respecting a person's neurosis. That
is, an abused child should not be held if the child has problems with being
held - particularly by a person of the same sex as the perpetrator. If a woman
has trouble with men, then that should be respected and she should work through
her feelings with a female therapist. A child who has been emotionally bruised
should never be treated with a loud voice, etc. Attachment therapists feel that
such therapists have confused respecting the person with respecting their neurosis.
Attachment therapists believe that the corrective emotional experience involves
the re-experience of the traumatic situation with a different and loving outcome.
In fact, attachment oriented therapists feel that by not confronting the problem
and holding the abused child, the abuse is validated and locked in. For instance,
when a person who has been sexually abused is never hugged because of the sexual
overtones it may raise, then that person is doomed to forever feel that physical
contact means sex.
This
book could perhaps be characterized, depending upon the reader's belief system,
as being filled with writings that are either the cutting edge of therapeutic
technique or an example of, as one traditionalist put it, of the "lunatic fringe".
It may be of some comfort to realize that the cutting edge of any field, prior
to it's eventual acceptance has always been characterized as the lunatic fringe.
But
the hundreds of children and adults who have been helped by the therapy appreciate
these authors straightforward candor and explicit sharing of their techniques
so that everyone can better understand this controversial work.
Foster
W. Cline, M.D. 4/27/94