DHS curbs use of holding therapies

loading...

AUGUSTA – Concerns about a controversial restraint therapy has prompted the Department of Human Services to form a committee to review the treatment of abused and neglected children.

Created last fall, the group is charged with developing guidelines to help children who have attachment disorder, a condition in which they are unable to form relationships.

DHS has instituted an interim policy that bars therapists from using holding therapies and “other intrusive, nontraditional interventions for children” without written permission from the district administrator, according to Karen Westburg, director of the Bureau of Child and Family Services. Westburg unveiled the policy in her letter last fall to the 14 DHS officials, mental health professionals and representatives from private agencies she asked to be on the committee.

Some forms of holding therapy call for the child to be held immobile by a therapist who purposely provokes anger by poking him in the ribs or screaming at him.

The theory is that repressed rage is keeping the child from attaching and that once he surrenders he’ll be able to bond with the foster or adoptive parent.

Therapists in Maine typically use a milder version of holding therapy in which the child isn’t held against his will or subjected to physical and verbal onslaughts, mental health experts said Wednesday. The treatment is not uncommon in Maine, according to Jim Welsh, assistant director for children’s services at Community Health and Counseling Services of Bangor.

Holding therapy is not a quick fix and it’s not for every kid, according to DHS Adoption Program Manager John Levesque, who said the procedure has always been controversial.

Holding therapy is similar to another procedure called “rebirthing,” which was responsible for the death last year of a 10-year-old Colorado girl. The rebirthing technique isn’t used in Maine, according to adoption and mental health experts.

Although the Colorado tragedy was partly responsible for the creation of the DHS committee, it wasn’t the entire reason. “We’re always looking for opportunities for improvement,” said DHS spokesman David Winslow. “It’s the way we manage our system. It’s sort of a continuous quality improvement as opposed to a reaction to one particular thing.”

DHS Commissioner Kevin Concannon could not be reached for comment Wednesday.

So far only rumor and innuendo have connected the asphyxiation death of 5-year-old Logan Marr of Chelsea to her foster mother’s use of holding therapy or rebirthing technique. “I don’t see a link; it was a crime, nothing more than that,” Winslow said.

Attorney Jed Davis of Winthrop, who represents foster mother Sally Schofield, couldn’t be reached for comment Wednesday. A former DHS worker, Schofield has been charged with manslaughter after she allegedly put duct tape over Marr’s mouth during a temper tantrum. Marr had been taped to her high chair, according to police.

Dr. Dan Hughes of Waterville, an expert on attachment therapy who does training for DHS, said to his knowledge, Schofield was never part of his classes, nor did he ever give her any parenting suggestions.

He said he has no idea whether Schofield was using some type of attachment therapy when she put duct tape over the Chelsea girl’s mouth and left her alone.

“It was nothing I ever saw or heard recommended,” said Hughes, who 15 years ago spent two weeks at the Evergreen Institute in Colorado, commonly associated with both holding therapy and the rebirthing technique. He liked about 50 percent of what he saw there and incorporated it into his practice, he said.

“I did see screaming [during holding therapy] and I immediately said to myself, ‘This isn’t something I believe in, I don’t see this in any way as therapeutic,'” Hughes said. By that time, the process no longer incorporated poking or jabbing the child, he said.

Hughes said he uses a type of therapy that some would label holding, but that he calls attachment therapy or trauma therapy.

The goal is to get the child to talk about his trauma and to hold him so he feels “safe and relaxed, comforted and supported while he’s doing this tough work,” Hughes said.

Setting the child free even when he asks may not always be in his best interests, according to Hughes.

“This is much less intrusive or difficult than being put in a psychiatric hospital or having to move [from the foster parent] again,” he said. “Although having a child confront issues is stressful, it’s one-tenth as stressful as having a disruption in his life.”

In cases where a child is resistant to being held, Hughes’ technique is to tell him, ‘I’m sorry it’s so hard, but we have to do this in order to help you.’

“But I’d never do it in anger or to terrify the child – I’d do it with a lot of empathy,” he said.

Community Health and Counseling Services began pulling away from holding therapy last year even before the tragedy out West and now bans it completely, according to Welsh, a former therapist himself.

Any type of intrusive intervention requires a tremendous amount of oversight and checks and balances because of the possibility for abuse, he said.

“There’s the potential to get into a control issue in the sense that [the adult] believes he or she has to come out on top and the situation tends to escalate. And we didn’t feel comfortable that we could do it in any safe way or in the best interests of the child,” he said.

That’s why last month CHCS ended its contract with Hughes. “This is not a reflection on Dan, but we don’t want to send mixed messages as to our approach on attachment work,” Welsh said.

The agency is judging him unfairly, according to Hughes. “Intrusive [therapies] have nothing to do with my practice. I won’t accept guilt by association because I went to [Evergreen] for a couple of weeks 10 years ago,” he said.

“I probably have contracts in consulting arrangements with 10 other well-known and well-respected agencies around the country who would never dream about terminating my contract.”

CHCS has been ambivalent about its relationship with him, according to Hughes, who said the agency terminated its contract with him once before and then re-established ties.

“There’s been a lot of dissension there as to whether I have something to offer the program. Many at CHCS have never seen my work; they say they don’t want me working for them … because they heard rumors and gossip about [my use of] holding therapy. But other people at CHCS have liked my work and wanted to keep working with me.”

Less than 10 percent of children who have been abused and neglected or abandoned have attachment disorder, according to Stockton Springs psychologist Tom Gaffney.

But far more – 50 percent to 60 percent – have attachment issues in which they may act out aggressively or turn inward and feel anxious, frightened or depressed.

Both holding therapy and rebirthing technique operate under the philosophy that a child with attachment disorder lacks free will and is manipulative and unable to make a decision for himself and that it’s up to adults to impose their will, according to Welsh.

The similarities don’t end there. Both procedures involve taking a child back in time.

With holding therapy, the assumption is that a child has missed the closeness and nurturing that infants are supposed to have.

By taking the child emotionally through the attachment process and having him go through some discomfort, he finally ends up with a feeling of well-being and is able to bond with the parent, according to Gaffney, who has found the therapy effective.

A variation of holding therapy, the rebirthing technique attempts to re-create the birth experience. The child is enclosed in a blanket and encouraged to fight for his life and struggle to emerge from the womb.

“It’s an experience drawing on imagery,” Gaffney said. “By encouraging the child to get a fresh start, the bonding experience can take place.”

No one will ever know if 10-year-old Candace Newmaker of Colorado could have bonded with her adoptive mother, because the girl smothered while undergoing rebirthing therapy last year.

Wrapped in a flannel sheet while four adults held her down, Newmaker pleaded for help and said she couldn’t breathe and was going to die. The therapist has been charged with reckless child abuse and is awaiting trial.

Maine’s new committee could make a big difference, according to Welsh. “The treatment in the state has been a patchwork, with no consistency or agreed-upon approach,” he said.

Calling the review process “a progressive, bold action,” he praised Maine. “How many states say, ‘We may have a problem, let’s take a look by putting together a group of providers and talking about the best way to look at kids’?”

Working with kids who have attachment disorder is incredibly challenging. They have tantrums, they break things, they hurt people, he said.

“It’s easy to develop a feeling of, ‘What are you doing to me, you’re making my life a living hell.’ That’s the type of child who is extra vulnerable because it’s easy to violate their rights.”

Good-faith interventions are crucial to make sure a child’s basic rights and dignity and free will are intact, he said.

The committee has met three times and another meeting is expected to be scheduled.