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This is an archive of past discussions about Attachment therapy. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Comments on suggested changes

This is a really good start!. I'll be interested to see what other editors think and the read their suggested additions etc. I'll make mine above in the prev section. I encourage other editors to review the above material and make their suggested edits and changes to it so we can build consensus. DPeterson 00:28, 14 April 2007 (UTC)

Good. I will add my comments above to keep everything in one place.JonesRD_talk 17:00, 14 April 2007 (UTC)

Suggested Article by DPeterson

"Attachment Therapy", ”attachment therapy,” holding therapy, rebirthing therapy, or ‘’corrective attachment therapy’’ is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder, which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning, in the professional community, its actual definition is unclear. A number of advocacy groups, such as Advocates for Children in Therapy and Quackwatch have undertaken to label nearly all treatments for children with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies. The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing therapy. Care should be taken to distinguish between this subset of therapies and more mainstream therapies which may also be loosely described as attachment or attachment disorder therapy. For the purposes of this article, the term used to describe this subset is ‘Attachment Therapy.’

Definitions of Attachment Therapy

The term has little commonly agreed upon meaning in the professional literature. For example, it is not a term found in the American Medical Association's Physician's Current Procedural Manual. The American Professional Society on Abuse of children (APSAC) (Chaffin et al.,2006, PMID 16382093) does not use the term "Attachment Therapy," but has disapproved of coercive and intrusive methods of treatment as inappropriate for treatment while approving a broad range of effective treatments for children with disorders of attachment that do not use coercive methods. The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder and Attachment Problems (Chaffin et al 2006) describe it as follows; "The attachment therapy controversy has centred most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge. Variants of these treatments have carried various labels that appear to change frequently. They may be known as “rebirthing therapy,” “compression holding therapy,” “corrective attachment therapy,” “the Evergreen model,” “holding time,” or “rage-reduction therapy” (Cline, 1991; Lien, 2004; Levy & Orlans, 1998; Welch, 1988). Popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.”

Speltz (2002) in a paper for the APSAC describes ‘corrective attachment therapy’ as follows; ‘… the holding therapies included in “corrective” attachment therapy do not address safety needs. They differ in that a therapist or parent initiates the holding process for the purpose of provoking strong, negative emotions in the child (e.g., fear, anger), and the child’s release is typically contingent upon his or her compliance with the therapist’s clinical agenda.

Prior and Glaser (2006) describe ‘Attachment therapy’ as a combination of ‘loose’ diagnosis of attachment disorders and a variety of treatments offered to desperate carers of troubled, maltreated children which often include variants of holding, eg holding time (Welch 1998), therapeutic holding (Howe and Fearnley 2003), rage reduction therapy (Cline 1991) and rebirthing. They also cite age regression as ‘key to the holding therapy approach.’ p265.

The advocacy group, Advocates for Children in Therapy define, "Attachment Therapy (AT)..’ as ‘…a growing, underground movement for the treatment of children who pose disciplinary problems to their parents or caregivers. AT practitioners allege that the root cause of the children’s misbehavior is a failure to 'attach' to their caregivers. The purported correction by AT is — literally — 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."

There is no generally accepted definition of "Attachment Therapy," and it is not a term that is found in generally recognized texts on treatment modalities, such as Bergin & Garfield's Handbook of Psychotherapy and Behavior Change, nor is there any specific text that describes this "treatment" approach. However, the advocacy group, Advocates for Children in Therapy does offer guidance on this subject. While this group is not a professional mental health group in the same manner that the American Psychiatric Association or American Psychological Association or National Association of Social Workers are, and none of the leaders are licensed mental professionals or clinicians, they do offer some ideas for a description of what this term can mean.

ACT states, "Attachment Therapy is a growing, underground movement for the 'treatment' of children who pose disciplinary problems to their parents or caregivers." In discussing Attachment Therapy they state, "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."

ACT further defines "Attachment Therapy" as, "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 group also uses the terms "rebirthing" and "holding therapy" as terms for "Attachment Therapy."

history and underlying principles

In a paper for the APSAC by Speltz (2002) the roots of ‘Attachment Therapy’ are traced to Robert Zaslow in the 1970’s. Zaslow attempted to force attachment in those suffering from autism by creating pain and rage whilst enforcing eye contact. He believed that holding someone against their will would lead to a breakdown in their defence mechanism’s making them more receptive to others. Speltz point’s out that these ideas have been dispelled by research into autism and that, conversely, techniques based on behavioural principles have proved effective.

Speltz cites Martha Welch and ‘holding time’ (1984 and 1989) as the next significant development. 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 bonding process was believed to begin. Similar techniques were subsequently promoted by Foster Cline and associates at the Attachment Centre at Evergreen, Inc. (now renamed the Institute For Attachment and Child Development) and duplicated elsewhere in other clinics such as ‘The Center’ in the Pacific northwest.

According to Prior and Glaser (2006) ‘there is no empirical evidence to support Zaslows theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children’s behaviour (Cline 1991)’.

Chaffin et al describe the underlying principles as follows; “In contrast to traditional attachment theory, the theory of attachment described by controversial attachment therapies is that young children who experience adversity (including maltreatment, loss, separations, adoption, frequent changes in child care, colic or even frequent ear infections) become enraged at a very deep and primitive level. As a result, these children are conjectured to lack an ability to attach or to be genuinely affectionate to others. 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. The children are described as failing to develop a conscience and as not trusting others. They are said to seek control rather than closeness, resist the authority of caregivers, and engage in endless power struggles. From this perspective, children described as having attachment problems are seen as highly manipulative in their social relations and actively trying to avoid true attachments while simultaneously striving to control adults and others around them through manipulation and superficial sociability. Children described as having attachment problems are alleged by proponents of the controversial therapies to be at risk for becoming psychopaths who will go on to engage in very serious delinquent, criminal, and antisocial behaviors if left untreated’.

Prior and Glaser cite the one published study which ‘purports to be an evaluation of holding therapy’ by Myeroff et al (1999). This study covers the ‘across the lap’ type holding therapy, described as ‘not restraint’ by Howe and Fearnley (2003) but ‘being held whilst unable to gain release.’

Attachment Disorder

Prior and Glaser (2006) describe ‘two discourses’ on attachment disorder. One science based, found in academic journals and books with careful reference to theory, international classifications and evidence. They list Bowlby, Ainsworth, Tizard, Hodges, Chisholm, O’Connor and 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’.

Attachment disorders are classified in DSM-IV-TR and ICD-10. DSM describes Reactive Attachment Disorder of Infancy or Early Childhood, divided into two subtypes, Inhibited Type and Disinhibited Type. The ICD classification describes two types, Reactive Attachment Disorder of Childhood and Disinhibited Attachment Disorder of Childhood. Both classifications are under constant discussion and both 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.

DSM and ICD are limited and some researchers in the field of attachment such as Zeannah have proposed alternative diagnostic criteria to describe broader disorders of attachment but the exact parameters are not yet established.

Chaffin et al and Prior and Glaser describe the proliferation of alternative ‘lists’ and diagnoses, particularly on the Internet, by proponents of Attachment Therapies that do not accord with either DSM or ICD classifications and which are partly based on the unsubstantiated views of Zaslow and Menta (1975) and Cline (1991). Neither do these lists accord with alternative diagnostic criteria as proposed above. According to Chaffin et al 'These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain.' Prior and Glaser 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.

Treatment characteristics

Attachment theory holds that caregiver qualities such as environmental stability, parental sensitivity, and responsiveness to children’s physical and emotional needs, consistency, and a safe and predictable environment support the development of healthy attachment. From this perspective, improving these positive caretaker and environmental qualities is the key to improving attachment. From the traditional attachment theory viewpoint, therapy for children who are maltreated and described as having attachment problems emphasizes providing a stable environment and taking a calm, sensitive, nonintrusive, nonthreatening, patient, predictable, and nurturing approach toward children (Haugaard, 2004a; Nichols, Lacher,&May, 2004). (Chaffin et al). Treatment and prevention programs that use methods congruent with attachment theory and with well established principles of child development (American Academy of Child and Adolescent Psychiatry) include: Alicia Lieberman (Parent-child Psychotherapy) (Lieberman & Pawl in Infant Mental Health, 1993 )(Lieberman 2003), Stanley Greenspan (Floor Time), Daniel Hughes (Dyadic Developmental Psychotherapy) (Becker-Weidman & Shell, 2005) (Hughes, 2003), Mary Dozier (autonomous states of mind), Robert Marvin (Circle of Security) (Marvin & Whelan 2003), Phyllis Jernberg (Theraplay), Daniel Schechter (Clinician Assisted Videofeedback Exposure Sessions) (Schechter, 2003), and Joy Osofsky (Safe Start Initiative) (in Infant Mental Health, 1993.

Prior and Glaser (2006) describe evidence based treatments, all of which revolve around enhancing caregiver sensitivity, or change of caregiver if that is not possible. Based on meta-analyses by Bakermans-Krananburg et al (2003) covering 70 published studies for assessing sensitivity, 81 studies on sensitivity and 29 on attachment security and many further randomised intervention studies involving over 7,000 families, the methods singled out to have shown good results were 'Watch, wait and wonder' (Cohen et al 1999), manipulation of sensitive responsiveness, (van den Boom 1994 and 1995), modified 'Interaction Guidance' (Benoit et al 2001), 'Preschool Parent Psychotherapy', (Toth et al (2002) and 'Circle of Security' (Marvin et al 2002).

According to O’Connor and Zeanah (2003 p235) "The holding approach would be viewed as intrusive and therefore non-sensitive and counter therapeutic".

Chaffin et al (2006) describe how the conceptual focus of these treatments is the childs individual internal pathology and past caregivers rather than current parent-child relationships or current environment, to the extent that if the child is well behaved outside the home this is seen as manipulative. It was noted that this perspective has its attractions because it relieves the caregivers of responsibility to change aspects of their own behavior and aspirations. Proponents of the controversial therapies emphasize the child’s resistance to attachment and the need to break down the child’s resistance.'

Often parents are required to follow programmes 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 (Thomas, 2001). Also requiring children to submit totally to adult control over all their needs and barring children’s access to normal social relationships outside the primary parent or caretaker.

The APSAC report does not describe "Attachment Therapy", it uses the term "attachment therapy" (no caps or quotation marks). They state, “The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions. Pg 77 Furthermore, what seems to be focus of this proposed page only addresses a very narrow area, “Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists.” Pg 76 Attachment therapy is better discussed in context, especially if the focus is on “a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners” pg 77. The controversy is a narrow one and should be placed in context so that readers understand the full range of issues. “ The attachment therapy controversy has centered most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge” pg 83.

ACT’s site contains descriptions of the more extreme versions of these attachment therapies, including a link to the transcript of the ‘rebirthing’ process that lead to the death by suffocation of Candace Newmaker at the hands of her ‘therapists’. According to ACT "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."

Prevalence

There are no reliable statistics on how many professionals actually practice "Attachment Therapy" or "rebirthing as it is also known. However, as defined in this article, "Attachment Therapy" involves the use of practices prohibited by a large number of professional organizations such as the following: American Psychological Association], National Association of Social Workers], American Professional society on the Abuse of Children (APSAC) ], Association for the Treatment and Training in the Attachment of Children, American Academy of Child and Adolescent Psychiatrry ("Practice Parameter for the Assessment of Children and Adolescent with Reactive Attachment Disorder of Infancy and Early Childhood" in the Journal of the American Academy of Child and Adolescent Psychiatry, vol 44, Nov 2005 and at ]) , and the American Psychiatric Association. ]. Members of those organizations are prohibited from using methods and techniques proscribed by those organizations codes of ethics and practice parameters. Violations of those standards would result in expulsion of the organization. Therefore there are very few practitioners of "AT" as defined in this article. Furthermore, several states have outlawed "rebirthing," and anyone using such methods would be guilty of malpractice, which is a small problem in all professions.

by Chaffin et al state, ‘The practice of some forms of these treatments has resulted in professional licensure sanctions against some leading proponents of the controversial attachment therapies. There have been cases of successful criminal prosecution and incarceration of therapists or parents using controversial attachment therapy techniques and state legislation to ban particular therapies. Position statements against using coercion or restraint as a treatment were issued by mainstream professional societies (American Psychiatric Association, 2002) and by a professional organization focusing on attachment and attachment therapy (Association for Treatment and Training in the Attachment of Children , 2001). Despite these and other strong cautions from professional organizations, the controversial treatments and their associated concepts and foundational principles appear to be continuing among networks of attachment therapists, attachment therapy centers, caseworkers, and adoptive or foster parents (Hage, n.d.-a; Keck, n.d.)’.

Suggestion for another approach

I'd like to hear what other editors think of the following proposal. Instead of trying to cover the waterfront and all aspects here. Why not just have an article that defines attachment therapy using available mateirals? JonesRD_talk 17:13, 14 April 2007 (UTC)

SUGGESTION FOR ARTICLE

Definitions of Attachment Therapy

"Attachment Therapy", ”attachment therapy,” holding therapy, rebirthing therapy, or ‘’corrective attachment therapy’’ is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder, which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning in the professional community, its actual definition is unclear. A number of advocacy groups, such as Advocates for Children in Therapy and Quackwatch have undertaken to label nearly all treatments for children with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies. The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing therapy. Care should be taken to distinguish between this subset of therapies and more mainstream therapies which may also be loosely described as attachment or attachment disorder therapy. For the purposes of this article, the term used to describe this subset is ‘Attachment Therapy.’

Attachment Therapy is a term with little commonly agreed upon meaning in the professional literature. For example, it is not a term found in the American Medical Association's Physician's Current Procedural Manual. It is not a term that is found in generally recognized texts on treatment modalities, such as Bergin & Garfield's Handbook of Psychotherapy and Behavior Change (2006), nor is there any specific text that describes this "treatment" approach. However, the advocacy group, Advocates for Children in Therapy does offer guidance on this subject. While this group is not a professional mental health group in the same manner that the American Psychiatric Association or American Psychological Association or National Association of Social Workers are, and none of the leaders are licensed mental professionals or clinicians, they do offer some ideas for a description of what this term can mean.

The advocacy group, Advocates for Children in Therapy define, "Attachment Therapy (AT)..’ as ‘…a growing, underground movement for the treatment of children who pose disciplinary problems to their parents or caregivers. AT practitioners allege that the root cause of the children’s misbehavior is a failure to 'attach' to their caregivers. The purported correction by AT is — literally — 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."

The American Professional Society on Abuse of children (APSAC) (Chaffin et al.,2006, PMID 16382093) does not use the term "Attachment Therapy," but has disapproved of coercive and intrusive methods of treatment as inappropriate for treatment while approving a broad range of effective treatments for children with disorders of attachment that do not use coercive methods. The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder and Attachment Problems (Chaffin et al 2006) describe it as follows: "The attachment therapy controversy has centred most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge. Variants of these treatments have carried various labels that appear to change frequently. They may be known as “rebirthing therapy,” “compression holding therapy,” “corrective attachment therapy,” “the Evergreen model,” “holding time,” or “rage-reduction therapy” (Cline, 1991; Lien, 2004; Levy & Orlans, 1998; Welch, 1988). Popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.”

Prior and Glaser (2006) describe ‘Attachment therapy’ as a combination of ‘loose’ diagnosis of attachment disorders and a variety of treatments offered to desperate carers of troubled, maltreated children which often include variants of holding, eg holding time (Welch 1998), therapeutic holding (Howe and Fearnley 2003), rage reduction therapy (Cline 1991) and rebirthing. They also cite age regression as ‘key to the holding therapy approach.’ p265.

ACT states, "Attachment Therapy is a growing, underground movement for the 'treatment' of children who pose disciplinary problems to their parents or caregivers." In discussing Attachment Therapy they state, "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."

ACT further defines "Attachment Therapy" as, "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." ACT’s site contains descriptions of the more extreme versions of these attachment therapies, including a link to the transcript of the ‘rebirthing’ process that lead to the death by suffocation of Candace Newmaker at the hands of her ‘therapists’. According to ACT "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."

JonesRD_talk 17:26, 14 April 2007 (UTC)

Comments

I think that the above defines the term reasonably well and could be the entire article. What do other contributors think?JonesRD_talk 17:26, 14 April 2007 (UTC)

With all due respect Mr Jones, I don't think your proposal addresses what is wrong with the existing article. It prioritises ACT over and above valid credible verified and relevant sources like Chaffin et al, Speltz, Prior and Glaser. Why give ACT the lead in definitions and descriptions? The entire Chaffin report is about the subject matter of this article. It was compiled by all the big names in this field. Lets use that guys! Lets quote their definition, not ACT's. Better still, lets write the whole article without even mentioning ACT! ACT didn't invent this controversy about Attachment Therapy, attachment therapy or coercive attachment therapy. Chaffins definition is as good as it's going to get. Also, The article ought to include the theoretical base of these 'therapies' and point out the history and differences. I thought you liked those bits!Fainites 18:15, 14 April 2007 (UTC)

By the way, the italics thing was fun but it got a little messy. We all need to read all the versions and comments though to avoid repeating ourselves.Fainites 18:15, 14 April 2007 (UTC)

evidence based treatments

Actually this might be a great consensus builder. If the material were reordered to put Chafin first as Fainities wants, then it would be a nice tightly focused article that defines, or attempts to define, this vague term. The entirel Chafin report is really about a broader set of issues. Put their relevant quotes first, and then the others. This way all the material about "other treatments" can be avoided, and a lot of other material can be left out. DPeterson 18:53, 14 April 2007 (UTC)

As I reread it, I think it flows well. The Chafin material is up there and so are other sources. ACT is quoted, as it should be along with the other sources so we get several descriptions. DPeterson 18:55, 14 April 2007 (UTC)

I don't agree that Chaffin is about a 'broader set of issues'. If that's going to be the basis of editing of this article, then the only solution is to have two articles. One which is called Attachment Therapy with capitals and deals with the ACT side of things only and another which tackles the whole issue of the 'attachment therapy' controversy as per Speltz/Chaffin/Glaser etc. You guys presumably wouldn't be interested in editing that article so you could concentrate on the ACT one here. Then we can disambiguate 'Attachment Therapy' and 'attachment therapy'.Fainites 09:26, 15 April 2007 (UTC)

On the issue of ACT's 'list', that's actually quite a big topic in itself. This is the list; 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-some of these are just so vague they're not individual therapies at all. Most of them however (I have actually looked them up!) look like a true bill. The two most controversial inclusions here are Theraplay and Dyadic Developmental Psychotherapy. I don't really want to get involved in DDP's ongoing feud with ACT, but the point is, none of the other therapies in Glasers list or the current articles list apart from these two are in this ACT list. I don't therefore see how we can say (in the introduction no less) that ACT have labelled nearly all treatment's as attachment therapy. I've tried to think of a way of wording it in a more encyclopaedic way but it's a bit tricky.Fainites 12:51, 15 April 2007 (UTC)

ACT and Quackwatch also take aim at EMDR and some other therapies. Dyadic Developmental Psychotherpay has professional peer reviewed research (meets the wikipedia standard of being verifiable) to support it as being effective and the descriptions of it in the various articles and books are clearly consistent with the other treatments. It looks like they just took a bunch of words and there them together...what is the basis for their labeling these as intrusive and problematic? What methods does ACT label as acceptable? I don't see any listed on their site. So, it probably is accurate to say they label nearly all...DPeterson 15:29, 15 April 2007 (UTC)

As you know I also take issue with their 'list of shame' of other therapies offhandedly condemned as quackery. I'm also no fan of Quackwatch. However, there is no reason why they should list acceptable therapies. That's not their thing! But none of the therapies named by Glaser are in their list. I managed to find examples of most of whats on ACT's list. Also their beef with Dyadic developmental Psychotherapy is set out pretty plainly on their page on Hughes. Basically they say a leopard doesn't change it's spots, whereas Hughes himself in various places makes it clear that he has discarded 'attachment therapy' type methods and developed a new therapy that he clearly means to be congruent with attachment theory. Whether he has suceeded or not is not for us to say unless we can find verified or credible sources to speak authoritatively on this point. Also I have seen a study on theraplay which makes it plain that it is in some respects 'intrusive' but this was not being said in a perjorative sense. Maybe ACT have other sources, or maybe they just picked up on this. The point I'm making is that it is a big piece of work to decide whether various therapies are 'evidence based' or congruent with attachment theory or all the professional codes and something that really needs to be dealt with individually for each therapy. Chaffin avoided specifically naming therapies. I think we should too, or we get into difficulties about what is and what isn't evidence based. Wiki can't accept self-report for evidence base or compliance with codes of professional conduct.Fainites 20:24, 15 April 2007 (UTC)

We don't have to decide whether anything is evidence based. We only need to list sources that meet the Misplaced Pages standard for being WP:verifiable. If the source makes a statement and it is verifiable, then we can use that statement. The list of therapies and citations is consistent with Misplaced Pages standards for being verifiable. But, anyway, lets stick with getting the article written and focus on the intro paragraph and move along. OK?DPeterson 12:49, 17 April 2007 (UTC)

We do have to ascertain if they're evidence based if we are going to say they are evidence based. eg on 'Circle' we can say Prior and Glaser say it's evidence based. On Dyadic Developmental Psychotherapy we can't say it's evidence based just because it's proponents say it is. We could only say it claims to be evidence based unless we can find a verified and credible source that says its evidence based. As you know, 'evidence based' has a fairly specific meaning in science and doesn't just mean it's published a peer-reviewed study. This is why I think it's fairer and wiser to do what Chaffin et al did and not start listing therapies as evidence based. It's all too complicated and it's not necessary for the scope of this article. Fainites 20:53, 19 April 2007 (UTC)

The fact that the material is published in professional peer-reviewed journals (and that these are all empirical studies) means they are evidence based. Therefore, the material should be included. My reading of the comments above, is that most editors, so far, agree with this view and so the mateiral should be included. JohnsonRon 21:02, 19 April 2007 (UTC)

No. Having a peer-reviewed study is not the same as 'evidence based'. A peer reviewed study is a verified and credible source for Wiki purposes so we can cite it. There's alot more than that to calling a therapy 'evidence based' which is a term used in the scientific world, not a 'Wiki' term. This is set out in many places but for now I'll just give you Chaffin;"In general, we believe that designating a treatmentas evidence based is a job for an independenttreatment review panel (e.g., AmericanPsychologicalAssociation,Substance Abuse and Mental HealthServices Administration , Office forVictims of Crime Task Force, Cochrane Collaborative,etc.) applying accepted and established scientificreview criteria. The fact that most editors agree is irrelevent if most editors are in fact, wrong.Fainites 21:23, 19 April 2007 (UTC)

Heres another bit of Chaffin for you;"Moreover, the sides do not agree on the rules for determining the risks and benefitsof psychological treatments or how questions about risks and benefits should be resolved. Critics" (of attachment therapy) "tend to rely on the well-established and accepted principlesof clinical science. Central to the clinical science perspective is testing outcomes using rigorous scientific research designs and methods that control for well-known confounds such as spontaneous recovery, the placebo effect, patient expectancy effects, investigator effects, and other forces that may influence the perceived outcomes of any clinical intervention. Critics tend to rely on scientific peer-review of research findings, publishing results in the scientific literature for wider scrutiny and review, and independent replication of findings before labeling a treatment as efficacious with an acceptable level of risk."Fainites 21:59, 19 April 2007 (UTC)

The materials and statements meet Misplaced Pages standards for being verifiable and that is all that matters here. The articles are published in PROFESSIONAL PEER-REVIEWED JOURNALS and that makes the material evidence based as it has had blinded independent professional review. Regardless, the material and statements are verifiable and so can be included. Since wikipeidis operates on consensus, it is VERY RELEVANT to a discussion if there is consensus and most editors agree on a point and on the inclusion or exclusion of an item. That's how Misplaced Pages works. You just are not the final decider and you have not "veto" power if the consensus is against your view. Wikkipedia is sort of ruthless that way. JohnsonRon 02:12, 20 April 2007 (UTC) On the other hand, if there is no agreement, then it is best to leave the section as is without any changes. JohnsonRon 02:13, 20 April 2007 (UTC)

I'm not objecting to citations from peer reviewed journals. I'm objecting to the use of the term 'evidence-based' which does not mean 'published in a peer reviewed journal'. Presumably if you agree relevent citations from verified and credible sources you don't object to everything Chaffin et al say on the subject of 'attachment therapies' claiming to be evidence based when they are not going in? Fainites 06:45, 20 April 2007 (UTC)

If the material has been peer-reviewed and the article is empirical in nature, then it is, by definition, evidence-based. You may have some other definition or criteria in mind, but that is not the only view. Other views are valid and acceptable. So, the various treatments, if they have evidence-based articles to support the efficacy of the approach, can be cited as such. Again, we can disagree, and see that other editors think and then what will go into this article is the consensus, even if the consensus is not what you, or I, prefer...This is how Misplaced Pages works. JohnsonRon 13:10, 20 April 2007 (UTC)

Actually Misplaced Pages is not a democracy and there are rules about sources. Chaffin et al is a verified and credible source and they have a great deal to say on the subject of attachment therapies claiming to be evidence based. You will not be able to remove such evidence by 'consensus'. So both views will have to go in, yours (if you have a source for it) and Chaffins, and Prior and Glasers, and any other verified and credible source. I'm quite happy to put in all views. Fainites 14:35, 20 April 2007 (UTC)

Yes, of course. I find it surprising that this needs to be said. There is a strong difference between "some papers concerning this therapy made it past a referee" and "this therapy is evidence-based". shotwell 15:03, 20 April 2007 (UTC)

'YES' It is fine for Chaffin et al to be included and the other references to evidence-based material. Empirical evidence in a peer-reviewed professional publication is evidence-based...so including both is fine. Again, we'll see what other editors have to say and the consensus will determine the outcome. JohnsonRon 17:47, 20 April 2007 (UTC)

No. Wiki policies will determine the outcome. That includes sources and NPOV and all the policies designed to achieve a measure of accuracy and common sense. Lets go over this again. Peer reviewed studies are appropriate sources to be referred to in Wiki. Science/therapies etc being 'evidence based' is a completely different thing. For a newish therapy to be accepted as evidence based it needs (amongst other things) to have been the subject of rigorous clinical trials and it's results need to have been replicated by others (which means it's methods, theories etc must have been fully explained) and then be accepted as evidence based by the wider scientific community. Not being evidence based doesn't mean a therapy is crap! It can take a long time to become evidence based and some never do. What propnents of new therapies usually hope is that their propsals are sufficiently sound, and their preliminary studies are sufficiently promising for others in the field to want to attempt to replicate their findings, thus hopefully leading towards 'evidence based'. Describing therapies as evidence based when they are plainly not probably has the opposite effect so it's quite important not to bandy these words around lightly. My proposal to get away from this problem is not to list any therapies at all in this way. It's not necessary for the article. The article is about 'attachment therapy' ie, as described. We can put in what Chaffin/Glaser etc say about what mainstream therapy as opposed to attachment therapy is, and the underlying principles, but it is not necessary to then try and list all the therapies that are considered evidence based and such a process would be fraught with difficulty. (We could I suppose contact the bodies listed by Chaffin and ask them for lists of what they have verified as evidence based)Fainites 11:59, 21 April 2007 (UTC)

Including the material is fully within wiki policies. The references are clearly WP:verifiability. The sources and statement meet wP:NPOV as NPOV. And the citations are accurate. You present one view...which is fine. Evidence-based does mean that there is scientific evidence for a statement. In this instance empirical studies in professional peer-reviewed journals is evidence-based support. I really don't understand what is the AX you are grinding here. Publication in a professional peer reviewed journal is clear evidence of acceptabnce by a wider scientific community. The material should be included as written and the consensus here seems to be for it's inclusion. JonesRD_talk 22:05, 21 April 2007 (UTC)

I'm not against including the material. Peer reviewed sources are includable. Its the naming of therapies as 'evidence based' when they are not that I object to. This has a specific meaning within science. Chaffin is very specific on this point. If therapies are to be quoted as evidence based that needs to be from a verified and credible source, not self report or OR. If therapies are put in as evidence based on a self report then it is inevitable that what Chaffin has to say about that claim will also be cited, and properly so under Wiki policies. I repeat that one way out of this dilemma is not to attempt to list therapies as evidence based or not in this article, it being entirely unecessary.Fainites 00:19, 22 April 2007 (UTC)

The therapies are evidence based for the reasons I, and others, stated above. You seem to be assuming that only your view is correct and that is just not so. The therapies are evidence based. Chaffin may be specific, but that is not the end all and be all in this regardd. The citations are from a "verified and crredible source; peer reviewed blind reviews in professional publications. These are not "self-reported," but independent studies. So, we just don't agree and the final decison will be based on whatever consensus develops here based on all reviewer comments. As I said before, you do not own this article nor have veto power if the consensus is against you. JonesRD_talk 02:14, 22 April 2007 (UTC)

Please stop altering my edits. We are writing an encyclopaedia. There are policies and aims. Are you suggesting that if enough accounts could gang up and vote on one site to say that eg the Bible was first written on an Amstrad in Wrexham in 1979 and there is no record of it's existence before that date that everybody would have to accept that 'consensus' ?Fainites 10:32, 22 April 2007 (UTC)

I am 'NOT alterning your edits. Indenting to keep threats togther if just format and is makes all this easier to follow. Randomly placing comments makes it impossible to follow the tread of the conversation. Your example is interesting, but silly. It is a RED HERRING as "they" say. Misplaced Pages operates on consensus and when then large marjority agree, that is the tack to be taken. Agreement does not have to be 100% and that is not what 'CONSENSUS' means anyway. wikipedia articles are built on consensus. JonesRD_talk 12:28, 22 April 2007 (UTC)

Threads don't need to be indented to be 'kept together'. They follow on from each other, only in your case, more and more thinly.Fainites 22:13, 22 April 2007 (UTC)

That is the "form" uses on Misplaced Pages Talk pages and the convention suess. Please WP:Assume good faith and try to avoid 'No Personal Attacks'. Your sarcasim is not conducise to developing consensus or a collaboration. JonesRD_talk 02:57, 23 April 2007 (UTC)

I haven't made any personal attacks. I have politely asked you not to keep interfering with my edits, yet you continue to do so. I merely took your indentophilia to it's logical conclusion. Shall we get back to the subject in hand? Fainites 20:21, 23 April 2007 (UTC)

The evidence basis is provided by the several empirical studies in professional peer-reviewed journals and in the article by Craven & Lee in Research on Social Work Practice, vol 16, May 2006, 287-304...This is the most current article on the subject. DPeterson 19:11, 13 May 2007 (UTC)

amended proposed new article

'LETS COMMENT IN ONLY ONE PLACE. THE FIRST VERSION IS THE BEST PLACE TO DO SO...ALL MY COMMENTS ARE THERE. WE CAN BEGIN LOOKING AT THIS SECTION BY SECTION. SEE MY FIRST STAB AT CONSENSUS BELOW'JonesRD_talk 18:35, 15 April 2007 (UTC) Another attempt.Fainites 12:34, 15 April 2007 (UTC)

I agree...see my comments above.DPeterson 19:47, 15 April 2007 (UTC)

"Attachment Therapy", ”attachment therapy,” holding therapy, rebirthing therapy, or ‘’corrective attachment therapy’’ is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder, which is itself an ambiguous term.DPeterson 15:39, 15 April 2007 (UTC) (see previous comment. There is nothing ambiguous about holding or rebirthing. It's the term 'attachment therapy that's ambiguous. Your version makes no sense factually or grammaticallyFainites 17:53, 15 April 2007 (UTC))

"Attachment Therapy", ”attachment therapy” or ‘’corrective attachment therapy’’ is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder. The term has little commonly agreed upon meaning in the professional literature and is not a term found in the American Medical Association's Physician's Current Procedural Manual. In a report for the ASPAC, Chaffin et al state 'controversies have arisen about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners, techniques that have been implicated in several child deaths and other harmful effects.' They attempt to define this subset of therapies (see below) and state that 'popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” Care should be taken to distinguish between the subset of 'therapies' covered by this article and more mainstream therapies, particularly as what is and was is not legitimately described as an 'attachment therapy' within the meaning of this article is controversial and advocacy groups and commentators such as ACT and Quackwatch include a broad range of therapies in their 'list' who's proponents would vehemently deny such a charge.

The 'treatments' often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies have codes of practice against these practices and some American States have outlawed rebirthing.

(phrases like 'offer some guidance' are POV and non-encyclopaedic. ACT are not offering guidance. They make a plain statement about what they sya AT is, which we can either quote or accurately summarise, and we can put in opposing views provided they're from a verified and credible source and not our own views.Fainites 18:26, 15 April 2007 (UTC))

Definitions of Attachment Therapy

There is no generally accepted definition of "Attachment Therapy", with or without capital letters. It is not a term found in the American Medical Association's Physician's Current Procedural Manual nor in generally recognized texts on treatment modalities, such as Bergin & Garfield's Handbook of Psychotherapy and Behavior Change, nor is there any specific text that describes this "treatment" approach. Chaffin et al describe the polarization between the proponents of ‘Attachment Therapy’ and mainstream therapies stating ‘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.’

The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder and Attachment Problems (Chaffin et al 2006), having said 'The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions', attempt to describe this subset as follows; "The attachment therapy controversy has centred most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge. Variants of these treatments have carried various labels that appear to change frequently. They may be known as “rebirthing therapy,” “compression holding therapy,” “corrective attachment therapy,” “the Evergreen model,” “holding time,” or “rage-reduction therapy” (Cline, 1991; Lien, 2004; Levy & Orlans, 1998; Welch, 1988). Popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” (If this is a direct quote, we need a pg #DPeterson 15:43, 15 April 2007 (UTC)) (p83 Fainites 18:20, 15 April 2007 (UTC))

Speltz (2002) in a paper for the APSAC was this for APSAC or merely published in the journal Child Maltreatment? DPeterson 15:45, 15 April 2007 (UTC) (it's headed 'Speltz, Matthew L. (2002). Description, History, and Critique of Corrective Attachment Therapy. The APSAC Advisor, 14(3), 4-8 Reprinted by permission of the American Professional Society on the Abuse of Children' Fainites 17:56, 15 April 2007 (UTC)) describes ‘corrective attachment therapy’ as follows; ‘… the holding therapies included in “corrective” attachment therapy do not address safety needs. They differ in that a therapist or parent initiates the holding process for the purpose of provoking strong, negative emotions in the child (e.g., fear, anger), and the child’s release is typically contingent upon his or her compliance with the therapist’s clinical agenda.

Prior and Glaser (2006) describe ‘Attachment therapy’ as a combination of ‘loose’ diagnosis of attachment disorders and a variety of treatments offered to desperate carers of troubled, maltreated children which often include variants of holding, eg holding time (Welch 1998), therapeutic holding (Howe and Fearnley 2003), rage reduction therapy (Cline 1991) and rebirthing. They also cite age regression as ‘key to the holding therapy approach.’ p265.

See comments in your first version...this still does not address what was said.DPeterson 15:45, 15 April 2007 (UTC) The entire quote is 'There are many ways in which holding therapy/attachment therapy contradicts Bowlby's attachment theory, not least attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity. Moreover, Bowlby (1988)explicitly rejected the notion of regression, which is key to the holding therapy approach: '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' '. This is on p.265. Also Chaffin includes age regression as a feature of these therapies. They obviously didn't feel the need to refine it further but the Glaser passage encapsulates it rather neatlyFainites 18:14, 15 April 2007 (UTC))

The campaigning group, Advocacy group```` Advocates for Children in Therapy define, "Attachment Therapy (AT)..’ as ‘…a growing, underground movement for the treatment of children who pose disciplinary problems to their parents or caregivers. AT practitioners allege that the root cause of the children’s misbehavior is a failure to 'attach' to their caregivers. The purported correction by AT is — literally — 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."

history and underlying principles

You'v not included all the comments and suggestions from above. DPeterson 15:51, 15 April 2007 (UTC) I don't agree with them allFainites 18:01, 15 April 2007 (UTC))

In a paper for the APSAC by Speltz (2002) the roots of ‘Attachment Therapy’ are traced to Robert Zaslow in the 1970’s. Zaslow attempted to force attachment in those suffering from autism by creating pain and rage whilst enforcing eye contact. He believed that holding someone against their will would lead to a breakdown in their defence mechanism’s making them more receptive to others. Speltz point’s out that these ideas have been dispelled by research into autism and that, conversely, techniques based on behavioural principles have proved effective.

Speltz cites Martha Welch and ‘holding time’ (1984 and 1989) as the next significant development. 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 bonding process was believed to begin. Similar techniques were subsequently promoted by Foster Cline and associates at the Attachment Centre at Evergreen, Inc. (now renamed the Institute For Attachment and Child Development) and duplicated elsewhere in other clinics.

According to Prior and Glaser (2006) ‘there is no empirical evidence to support Zaslows theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children’s behaviour (Cline 1991)’.

Chaffin et al describe the underlying principles as follows; “In contrast to traditional attachment theory, the theory of attachment described by controversial attachment therapies is that young children who experience adversity (including maltreatment, loss, separations, adoption, frequent changes in child care, colic or even frequent ear infections) become enraged at a very deep and primitive level. As a result, these children are conjectured to lack an ability to attach or to be genuinely affectionate to others. 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. The children are described as failing to develop a conscience and as not trusting others. They are said to seek control rather than closeness, resist the authority of caregivers, and engage in endless power struggles. From this perspective, children described as having attachment problems are seen as highly manipulative in their social relations and actively trying to avoid true attachments while simultaneously striving to control adults and others around them through manipulation and superficial sociability. Children described as having attachment problems are alleged by proponents of the controversial therapies to be at risk for becoming psychopaths who will go on to engage in very serious delinquent, criminal, and antisocial behaviors if left untreated’.

Prior and Glaser cite the one published study which ‘purports to be an evaluation of holding therapy’ by Myeroff et al (1999). The methodology of this study is heavily criticised. This study covers the ‘across the lap’ type holding therapy, described as ‘not restraint’ by Howe and Fearnley (2003) but ‘being held whilst unable to gain release.’ According to Prior and Glaser, regression is key to the holding therapy approach, but was explicitly rejected by Bowlby (1988) who stated 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.’ p263

Attachment Disorder

Prior and Glaser (2006) describe ‘two discourses’ on attachment disorder. One science based, found in academic journals and books with careful reference to theory, international classifications and evidence. They list Bowlby, Ainsworth, Tizard, Hodges, Chisholm, O’Connor and 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’.

Attachment disorders are classified in DSM-IV-TR and ICD-10. DSM describes Reactive Attachment Disorder of Infancy or Early Childhood, divided into two subtypes, Inhibited Type and Disinhibited Type. The ICD classification describes two types, Reactive Attachment Disorder of Childhood and Disinhibited Attachment Disorder of Childhood. Both classifications are under constant discussion and both 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.

DSM and ICD are limited and some researchers in the field of attachment such as Zeannah have proposed alternative diagnostic criteria to describe broader disorders of attachment but the exact parameters are not yet established.

Chaffin et al and Prior and Glaser describe the proliferation of alternative ‘lists’ and diagnoses, particularly on the Internet, by proponents of Attachment Therapies that do not accord with either DSM or ICD classifications and which are partly based on the unsubstantiated views of Zaslow and Menta (1975) and Cline (1991). Neither do these lists accord with alternative diagnostic criteria as proposed above. According to Chaffin et al 'These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain.' Prior and Glaser 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.

Treatment characteristics

According to Chaffin et al 'although focused primarily on specific attachment therapy techniques, the controversy also extends to the theories, diagnoses, diagnostic practices, beliefs, and social group norms supporting these techniques, and to the patient recruitment and advertising practices used by their proponents. The controversy deepened after the death of 10-year-old Candace Newmaker during a therapy session in 2000 (Crowder & Lowe, 2000), and a number of child deaths occurring at the hands of parents who claim that they acted on attachment therapists’ instructions (Warner, 2003). Criminal charges have been brought against some attachment therapists and against parents who claimed to be using what is known as attachment parenting.'

'Traditional attachment theory holds that caregiver qualities such as environmental stability, parental sensitivity, and responsiveness to children’s physical and emotional needs, consistency, and a safe and predictable environment support the development of healthy attachment. From this perspective, improving these positive caretaker and environmental qualities is the key to improving attachment. From the traditional attachment theory viewpoint, therapy for children who are maltreated and described as having attachment problems emphasizes providing a stable environment and taking a calm, sensitive, nonintrusive, nonthreatening, patient, predictable, and nurturing approach toward children (Haugaard, 2004a; Nichols, Lacher,&May, 2004).' (Chaffin et al p77).

Prior and Glaser (2006) describe evidence based treatments, all of which revolve around enhancing caregiver sensitivity, or change of caregiver if that is not possible. See comments in prev version....listing names and using very old date (Welch 1998, for example) may not reflect current practice. I suggest leaving all that out unless you can verify that this is the current practice eight or ten years later!!!!!DPeterson 15:56, 15 April 2007 (UTC) Prior and Glaser was first published August 2006. Chaffin is also 2006. These are up-to date sources about the provenance, sourcers and practices of this type of therapy. That's what they're about!Fainites 18:03, 15 April 2007 (UTC))

The focus of non-evidence based Attachment Therapies is somewhat different. According to Prior and Glaser ‘These include work directed at parents interactions with the children such as behaviour management, life story work and work on the meanings of the child’s experience, and some approaches are directed at the child and may or may not include the child’s primary carer. Attachment therapy often however, also includes some other interventions including a number of variants of holding, eg holding time (Welch 1998) and therapeutic holding (Howe and Fearnley) as well as others such as rage-reduction therapy (Cline 1991) and rebirthing.’ They also refer to the ‘Handbook of Attachment Interventions’ (Levy 2000), Levy and Orlans and the ‘Holding Nurturing Process.’

According to O’Connor and Zeanah (2003 p235) "The holding approach would be viewed as intrusive and therefore non-sensitive and counter therapeutic".

Chaffin et al (2006) describe how the conceptual focus of these treatments is the childs individual internal pathology and past caregivers rather than current parent-child relationships or current environment, to the extent that if the child is well behaved outside the home this is seen as manipulative. It was noted that this perspective has its attractions because it relieves the caregivers of responsibility to change aspects of their own behavior and aspirations. Proponents of the controversial therapies emphasize the child’s resistance to attachment and the need to break down the child’s resistance (Institute for Attachment and Child Development, n.d.).'

Speltz describes a typical treatment taken from a clinic's material as follows; ‘Like Welsh (1984, 1989),' the clinic '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 ...... 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 evenutally the parent. According to the ...... 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.

Often parents are required to follow programmes 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 (Thomas, 2001). Also requiring children to submit totally to adult control over all their needs and barring children’s access to normal social relationships outside the primary parent or caretaker.

ACT’s site contains descriptions of the more extreme versions of these attachment therapies, including a link to the transcript of the ‘rebirthing’ process that lead to the death by suffocation of Candace Newmaker at the hands of her ‘therapists’. According to ACT "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."

Prevalence

It is difficult to ascertain the prevalence of these therapies but they are sufficiently prevalent to have prompted reactions as outlined by Chaffin et al as follows;

‘The practice of some forms of these treatments has resulted in professional licensure sanctions against some leading proponents of the controversial attachment therapies. There have been cases of successful criminal prosecution and incarceration of therapists or parents using controversial attachment therapy techniques and state legislation to ban particular therapies. Position statements against using coercion or restraint as a treatment were issued by mainstream professional societies (American Psychiatric Association, 2002) and by a professional organization focusing on attachment and attachment therapy (Association for Treatment and Training in the Attachment of Children , 2001). Despite these and other strong cautions from professional organizations, the controversial treatments and their associated concepts and foundational principles appear to be continuing among networks of attachment therapists, attachment therapy centers, caseworkers, and adoptive or foster parents (Hage, n.d.-a; Keck, n.d.)’.

A particular concern of both Chaffin et al and Prior and Glaser is the use of the Internet to advertise these therapies and the use of unscientific and 'wildly inclusive' lists of 'symptoms' (Prior and Glaser). According to Chaffin et al 'These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain. Posting these types of lists on Web sites that also serve as marketing tools may lead many parents or others to conclude inaccurately that their children have attachment disorders.' 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 perjorative and 'demonising'. According to Chaffin et al 'Proponents of controversial attachment therapies commonly assert that their therapies, and their therapies alone, are effective for children with attachment disorders and that more traditional treatments are either ineffective or harmful’. They also express concern over claims by therapies to be 'evidence based' or indeed the 'only' evidence based therapy when the Task Force found no credible evidence base for any such therapy so advertised.

The report of Chaffin et al, which contains proposed guidelines for therapies, was endorsed by was endorsed by the American Psychological Association’s Division 37 and the Division 37 Section on Child Maltreatment.

Prior and Glaser (2006) state ‘The practice of holding therapy is not confined to the USA.’ And give an example of a center in the UK practising ‘therapeutic holding’ of the 'across the lap' variety.

The advocacy group ACT claim "Attachment Therapy is a growing, underground movement for the 'treatment' of children who pose disciplinary problems to their parents or caregivers."

There are no reliable statistics on how many professionals actually practice "Attachment Therapy" as described in this article. However the practices it often involves are now prohibited by a large number of professional organizations such as the following: American Psychological Association30, National Association of Social Workers31, American Professional society on the Abuse of Children (APSAC) 32, Association for the Treatment and Training in the Attachment of Children, American Academy of Child and Adolescent Psychiatrry ("Practice Parameter for the Assessment of Children and Adolescent with Reactive Attachment Disorder of Infancy and Early Childhood" in the Journal of the American Academy of Child and Adolescent Psychiatry, vol 44, Nov 2005 and at 33), and the American Psychiatric Association. 34. Members of those organizations are prohibited from using methods and techniques proscribed by those organizations codes of ethics and practice parameters. Violations of those standards would result in expulsion of the organization. Furthermore, several states have outlawed "rebirthing," and anyone using such methods would be guilty of malpractice.

Fainites 12:34, 15 April 2007 (UTC)

References

Becker-Weidman, A., & Shell, D., (2005) Creating Capacity for Attachment. Oklahoma City, OK: Wood 'N' Barnes.

Becker-Weidman (2006a) Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy, Child and Adolescent Social Work Journal. 23(2), April 2006

Becker-Weidman, A., (2006b) Dyadic Developmental Psychotherapy: a multi year follow-up. in Sturt, S., (ed) New Developments in Child Abuse Research. NY: Nova

Becker-Weidman, A., (2006c) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” Child and Adolescent Mental Health Published article online: 21-Nov-2006 doi: 10.1111/j.1475-3588.2006.00428.x.]

Berliner, L. (2002).Why caregivers turn to "attachment therapy" and what we can do that is better. APSAC Advisor, 14(4), 8-10.

Bowlby, J. (1982). Attachment. New York: Basic.

Chaffin M, Hanson R, Saunders BE, Nichols T, Barnett D, Zeanah C, Berliner L, Egeland B, Newman E, Lyon T, LeTourneau E, Miller-Perrin C. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems. Child Maltreat. 2006 Feb;11(1):76-89. PMID 16382093

Cline, F. (1994). Hope for high risk and rage-filled children. Evergreen, CO: EC Publications.

Hughes, D., (2003). Psychotherapeutic interventions for the spectrum of attachment disorders and intrafamilial trauma. Attachment and Human Development 5-3, 271-279.

Hughes, D. (2004). An attachment-based treatment of maltreated children and young people. Attachment & Human Development, 3, 263–278.

Krenner, M. (1999). Ein Erklaerungsmodell zur "Festhaltetherapie" nach Jirina Prekop. Retrieved Oct. 25, 2000, from http://wwwalt.uni-wuerzburg.de/gbpaed/mixed/work/mkrenner1.html.

Levy, T.M., Ed. (2000). Handbook of attachment interventions. San diego: Academic.

Lieberman, A., (2003). The treatment of attachment disorder in infancy and early childhood. Attachment and Human Development 5-3, 279-283.

Marvin, R., & Whelan, W., (2003) Disordered attachment: toward evidence-based clinical practice. Attachment and Human Development 5-3, 284-299.

O'Connor, C., & Zeanah, C., Attachment disorder: assessment strategies and treatment approaches, Attachment and Human Development 5, 223-244.

Schechter, D.S. (2003). Intergenerational communication of maternal violent trauma: Understanding the interplay of reflective functioning and posttraumatic psychopathology. In S.W. Coates, J.L. Rosenthal, & D.S. Schechter (Eds.), September 11: Trauma and Human Bonds. New York, NY: The Analytic Press, pp. 115-143.

Thomas, N. (2001). Parenting children with attachment disorders. In T.M. Levy (Ed.), Handbook of attachment interventions. San Diego, CA: Academic.

Verny, T., & Kelly, J. (1981). The secret life of the unborn child. New York: Dell.

Welch, M.G. (1989) Holding time. New York:Fireside.

Welch, M.G., Northrup, R.S., Welch-Horan, T.B., Ludwig, R.J., Austin, C.L., & Jacobson, J.S.(2006). Outcomes of prolonged parent-child embrace therapy among 102 children with behavioral disorders. Complementary Therapies in Clinical Practice, 12, 3-12.

Zaslow, R., & Menta, M. (1975) The psychology of the Z-process: Attachment and activity. San Jose, CA: San Jose University Press.

Zeanah, C., (1993) Infant Mental Health. NY: Guilford. Added also see and reference section so that other editors can easily see material to be in article.

Comments on Revised article

A lot of this is very good. However, it is difficult to read it since it does not address all the concerns raised in the previous version. I suggest we stick with that one since it has all the relevant comments until consensus is reached. Maybe go section by section and create a new section below this for the consensus sections. I'd suggest beginning at the beginning.DPeterson 16:02, 15 April 2007 (UTC)

I've just noticed that you've changed my post. Please don't do this! Talk pages should not be refactored. It's my post. I shall now have to replace it as it was, either by posting my version AGAIN or by reverting your edits of my post. Do you have any preferences? You can always insert italicised suggestions.Fainites 17:12, 15 April 2007 (UTC)

It is too difficult to follow the "new" "new" article by Fainites. So, I agree, let's stick with commenting on the first Fainites and DPeterson proposals and go line by line to get a consensus among those and the current article. I'll take a stab by suggesting a first new section below. JonesRD_talk 18:30, 15 April 2007 (UTC)

Yes, I'll keep my comments to the first version so that if it is deleted, we don't loose comments. Also, this way, all the comments and suggestions will be in one place and not spread over the ballpark.DPeterson 19:38, 15 April 2007 (UTC)

SUGGESTION FOR THIS PAGE

This page is getting too long. I'd suggest deleting the "new" new version above, and one of the two DPeterson versions and then working on the last section in this page to discuss each paragraph.JonesRD_talk 19:06, 15 April 2007 (UTC)

Are we allowed to delete items from the talk page? If so, I'll be glad to delete one of my versions to simplify things. DPeterson 19:37, 15 April 2007 (UTC)

We should never mess about with talkpage contributions. It's meant to be a record. However, what we can delete is the reference list that keeps being put in. It's only being copied from the main page so we all know where to find it to look something up. I really don't understand why it keeps appearing here.Fainites 21:49, 15 April 2007 (UTC)

Actually the reference list has more materials on in than are in the article. Also, it is helpful to see the full citations.DPeterson 00:01, 16 April 2007 (UTC)

Only once surely. Whats the point of filling up the talkpage with the same list over and over again. This is the talkpage! Fainites 06:58, 16 April 2007 (UTC)

I just thought that it should be part of an proposed article since it is different than what is in the article...otherwise, by that logic, whatever is the same in a proposal as is already on this talk page would be left out...there seems to be at least one section that has not had any disagreements; at least among those few editors who have commented so far.DPeterson 12:44, 16 April 2007 (UTC)

Everything in the article must be properly sourced and referenced. All of my edits are sourced. It's silly to keep listing the same sources. When we have an agreed version the ref list naturally follows. I have already said that this ref list is not properly set up. Fainites 10:51, 17 April 2007 (UTC)

You only list names and dates, not the citation. Furthermore, as you pointed out, this page is to be a record and so we should not delete any entries. DPeterson 12:16, 17 April 2007 (UTC)

I have given you my citations. I just don't keep repeating them on the talkpage.Fainites 22:24, 19 April 2007 (UTC)

CONSENSUS VERSION

INTRODUCTION/FIRST SECTON

"Attachment Therapy", ”attachment therapy” "holding therapy," "rebirthing therapy," or "corrective attachment therapy" is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning, in the professional community, its actual definition is unclear. The term is not a term found in the American Medical Association's Physician's Current Procedural Manual. A number of advocacy groups, such as Advocates for Children in Therapy and Quackwatch have undertaken to label a large number of treatments for children with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies. The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing.

In a report for the ASPAC, Chaffin et al state 'controversies have arisen about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners, techniques that have been implicated in several child deaths and other harmful effects.' They attempt to define this subset of therapies (see below) and state that 'popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” (We need a page number if this is an acutal direct quoteJonesRD_talk 18:50, 15 April 2007 (UTC))

Care should be taken to distinguish between the subset of 'therapies' covered by this article and more mainstream therapies, particularly as what is and was is not legitimately described as an 'attachment therapy' within the meaning of this article is controversial and advocacy groups and commentators such as ACT and Quackwatch include a broad range of therapies in their 'list' who's proponents would vehemently deny such a charge.

Comment on Intro section

I think this captures the essential elements of what is being proposed.JonesRD_talk 18:50, 15 April 2007 (UTC)

It may need a little work...but I think this is a very good start. I'll wait to see what other editors suggest here. If there is agreement, I'll support this as is.DPeterson 19:36, 15 April 2007 (UTC)

The content is fine but I think it needs a little rearranging. Including 'holding' and 'rebirthing' in the first line is confusing. Neither are ambiguous terms. It is attachment therapy that's the ambiguous term. How about putting (sometimes called holding or rebirthing therapy) in brackets. On the AT point 'large number' is better than 'nearly all'. Good idea! It's still not quite right though as alot of the therapies in it's list actually are variants of holding or Zaslow type therapies. This is a very tricky sentence to get right without getting too involved in irrelevancies. Also, how about putting this sentence at the end of the first para.? We ought to paraphrase people as accurately as possible and the line 'Attachment Therapy and attachment therapy actually come from the beginning of Chaffin and corrective attachment therapy comes from Speltz. The ACT line where it is sort of cuts the para in half. We ought to do the description first, then outline the ACT controversy.Fainites 20:05, 15 April 2007 (UTC)

I think that is the point. Attachment therapy is an ambigious term for which a lot of other terms are used. How about the following:

"Attachment Therapy", (also know as ”attachment therapy” "holding therapy," "rebirthing therapy," or "corrective attachment therapy") is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder which is itself an ambiguous term.

. I like the term "large number." I think it accurately caputures ACT's view. In addition not all those on their list are Z-therapies or related to Zaslow. I'd vote to keep the suggestion of "large number." DPeterson 20:13, 15 April 2007 (UTC)

I didn't say they were all Z therapies. I don't mind 'large number' that much. Fainites 20:32, 15 April 2007 (UTC)

I think it flows ok as is. The intro paragraph includes references to all those who will be cited/used later. How would you reword it?DPeterson 20:16, 15 April 2007 (UTC)

I'd put both ACT bits with the sentence that starts 'care should be taken...' because that's really partly on the same point. We're warning our readers AND giving an example of why they are being warned. It would then read :

Instead of: DPeterson 21:26, 15 April 2007 (UTC))"Attachment Therapy", ”attachment therapy” or "corrective attachment therapy" (also sometimes called rebirthing or holding therapy)is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning, in the professional community, its actual definition is unclear. The term is not a term found in the American Medical Association's Physician's Current Procedural Manual.

(Use this:

)DPeterson 21:26, 15 April 2007 (UTC)

The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing. In a report for the ASPAC, Chaffin et al state 'controversies have arisen about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners, techniques that have been implicated in several child deaths and other harmful effects.' They attempt to define this subset of therapies (see below) and state that 'popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” Care should be taken to distinguish between the subset of 'therapies' covered by this article and more mainstream therapies, particularly as what is and was is not legitimately described as an 'attachment therapy' within the meaning of this article is controversial and advocacy groups and commentators such as ACT and Quackwatch have undertaken to label a large number of therapies as 'Attachment Therapy' to discredit them (end here...or, instead state, "while the proponents of some of these approaches have presented evidence that the approaches are not corcive and do not use prohibited methods DPeterson 21:23, 15 April 2007 (UTC)) when their proponents deny using coercive or prohibited methods.

Or actually your version of putting them all in brackets except 'Attachment Therapy' is pretty good. I'd be happy with either. On the other point, did you mean just end the last sentence after '...discredit them'. ? Fainites 20:34, 15 April 2007 (UTC)

I'd suggest changing "who's proponents would vehemently deny such a charge." from the last line in either of the following two ways. First, "that (or some of which) are not coercive or use prohibited methods. Or, Second, just leave it out and end with a period after list, without quotes.DPeterson 20:20, 15 April 2007 (UTC)

Yes, put all the terms in brackets, since the article is just about Attachment Therapy and those are just other terms used for it. See belowDPeterson 21:20, 15 April 2007 (UTC)

What do you mean when you say 'this article is just about Attachment Therapy'? Fainites 21:45, 15 April 2007 (UTC)

That is what this article is about, what is Attachment Therapy? Yes? DPeterson 12:46, 16 April 2007 (UTC)

No. It's about 'what is this subset of non-mainstream therapies popularly called attachment therapy, Attachment therapy, Attachment Therapy, coercive attachment therapy or what ever other names proponents think up in order to keep on the move'! Fainites 14:09, 16 April 2007 (UTC)

Yes, just what I said, the article is about what is Attachment Therapy...What do you mean, "whatever other names proponents think up in order to keep on the move?" Are you suggesting something we should consider in this article?DPeterson 12:22, 17 April 2007 (UTC)

Suggestion for Intro

"Attachment Therapy", (also known as attachment therapy, holding therapy, rebirthing therapy, or corrective attachment therapy) is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning, in the professional community, its actual definition is unclear. The term is not a term found in the American Medical Association's Physician's Current Procedural Manual. A number of advocacy groups, such as Advocates for Children in Therapy and Quackwatch have undertaken to label a large number of treatments for children with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies. The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing.

In a report for the ASPAC, Chaffin et al state 'controversies have arisen about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners, techniques that have been implicated in several child deaths and other harmful effects.' They attempt to define this subset of therapies (see below) and state that 'popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” (We need a page number if this is an acutal direct quoteJonesRD_talk 18:50, 15 April 2007 (UTC))

Care should be taken to distinguish between the subset of 'therapies' covered by this article and more mainstream therapies, particularly as what is and what is not described as an 'Attachment Therapy' within the meaning of this article is controversial and advocacy groups such as ACT and Quackwatch include a broadly defined range of therapies in their description of Attachment Therapy, some of which are not coercive or intrusive as described in this article. DPeterson 21:20, 15 April 2007 (UTC)

comment

It's fine apart from the Quackwatch ACT bit. We're saying the same thing twice in two paragraphs in what is meant to be a brief descriptive opening which is stylistically horrible. I invented the second form of words to be used instead of the first, not as well as. It sounds wierd to say the same thing twice in different words. The first bit doesn't fit at all where it is in the opening paragraph and is merely confusing. It gives the impression that the word 'treatments' in the following sentence refers to the 'treatments' described by ACT which I don't think is the effect you meant to achieve but the opposite. The opening paragraph should be a brief description of it's subject. There should be no more than one brief description of a main controversy. I don't mind if you take out the first sentence or amalgamate it with the second or replace the second but as an example of encyclopaedic English we can't leave it as it is.Fainites 21:41, 15 April 2007 (UTC)

I made a small change. I don't see how we can not have both references in. The first reference describes how ACT defines many trts as AT while the last para is a cautionary para that also needs to be present. So, we are not saying the same precise thing twice. I think it reads ok and suggest we leave it as is and move on the the next section...Alternatively we could do nothing, wait a week or so and see what others think before closing this section and moving on to the next section....Now that I put it like that, it is probably best to leave this as is for a week or so and see what others think...but I am certainly willing to continue working with you on the next section, if you wish. DPeterson 01:50, 16 April 2007 (UTC)

OK we'll leave it for a bit. I don't mind having both sentences in although I think it's unecessary but I don't think it reads OK. I think its disjointed and confusing to have a bit of the controversy slap bang in the middle of what is meant to be a description. I don't understand your reason for wanting it there. Saying 'it reads OK' is not a reason. It would 'read OK' if it were moved to join the other ACT sentence. Anyway, lets move on.Fainites 06:38, 16 April 2007 (UTC)

OK, maybe a week or ten days would allow sufficient time. To exaplain my thinking a bit more on this question. It seems that the conecept or definition of Attachment Therapy is not only vague, but is fraught with controversary. Therefore, that belongs in the description of the term. The three leaders of ACT are vocal spokespersons on the subject and have produced a lot of material, therefore, their words or salient. Since the two lines about ACT are pointed in different directions, I'm not sure joining the two lines would work. Regards. DPeterson 12:50, 16 April 2007 (UTC)

They're not pointing in different directions. If the controversy is too complicated to explain in one simple line then it's too much for the intro. The intro should not create terminal confusion for the reader. We should say simply what AT is, and then outkine briefly the main controversy. At the moment, the main controversy cuts the description in half. I don't understand why you're so keen to keep it as I'm not proposing removing any lines.Fainites 14:06, 16 April 2007 (UTC)

I support replacing the existing article intro with the intro proposed above. I the material in this intro about the disagreements and ACT is fine. Let's move on, if we can.MarkWood 14:59, 16 April 2007 (UTC)

The first reference lays out ACT's position. The second reference is part of a cautionary statement. Having both is fine, it's only two lines, and it really does not dilute anything here. If anything, it lays out the disputed points. Since ACT is such a major contributor to this debate I don't think two lines is over the top. I support the intro section as above. MarkWood 15:02, 16 April 2007 (UTC)

I don't object to the two lines for the sake of compromise even tho' it's clearly POV. It's the obfuscation created by it's position that is nonsensical. It's about time this article grew up and away from the feud with ACT and concentrated on it's subject. I've added a tag at the top in the hope of attracting more editors. Fainites 22:08, 16 April 2007 (UTC)

I don't see how it is POV to have material included by a group that has written so extensively on the subject...if anything, excluding their views might be seen as POV. Feud with ACT? I don't understand. Including their material hardly seems to be indicative of a feud with their view and materials. DPeterson 22:58, 16 April 2007 (UTC)

This is a nonsensical reply. You know very well I am not talking about excluding their views. I am talking about moving a wrongly and confusingly placed sentence about 2cms. What is you reason for wanting to leave that sentence where it is?Fainites 08:52, 17 April 2007 (UTC)

Hold on...let's try to keep the dialogue WP:Civil. Again, what is the feud with ACT you reference? I think the material is relevant and belongs...there are two points being made in that section...I don't understand your vehemanceDPeterson 12:25, 17 April 2007 (UTC)

Looks ok to me. Go ahead and use it. SamDavidson 14:24, 19 April 2007 (UTC)

I agree. JonesRD_talk 22:06, 21 April 2007 (UTC)

OK I agree with the prev two comments. It's ok to use. RalphLender 16:16, 27 April 2007 (UTC)

Tag removal

I removed the tag because in order to put the tag on certain criteria must be met: "Drive-by tagging is not permitted. The editor who adds the tag must address the issues on the talk page, pointing to specific issues that are actionable within the content policies, namely Misplaced Pages:Neutral point of view, Misplaced Pages:Attribution, and Misplaced Pages:Biographies of living persons. Simply being of the opinion that a page is not neutral is not sufficient to justify the addition of the tag. Tags should be added as a last resort." "The accuracy of an article may be a cause for concern if: it contains a lot of unlikely information, without providing references." There are other criteria too. The relevant criteria can be found at WP:NPOVD and WP:AD Once those are met, then the tag can be added. In addition, there is the tag at the top of this page. DPeterson 23:04, 16 April 2007 (UTC)

There is a clear dispute and this is made evident above. Since we lack a "this article is best read while drinking purple kool-aid" template, {{totallydisputed}} is a good choice. shotwell 03:25, 17 April 2007 (UTC)

This is not a drive by tagging. I am an existing editor. I have read the entire talkpage of this and related articles. I have made it clear that I dispute the neutrality of this article which has been distorted by a dispute between two polarised parties. I have attempted to edit by consensus but some of the main areas of disputed neutrality appearing are

claiming that the two main authorities in this field, Chaffin et al, and Prior and Glaser, both published in 2006 and both still much discussed and not superceded by new scientific research or thought or peer reviwed report, are 'out of date'.

claiming that one of the main conclusions of the lead comprehensive verified and credible sources is 'POV'!

claiming that substantial conclusions of the credible authorities and important issues addressed by these authorities, (such as marketing on the internet, age regression etc) are 'irrelevant', when on any reading of the materials they are central.

I could in fact carry on in this vein for some time, but hopefully this is sufficient to justify a tag. A tag is not an attack on anybody. It is a way of alerting other editors. We need fresh editors to help on this article. Adding a tag is advised as a method of attracting new editors. You do not own this article. I am replacing the tag.Fainites 08:55, 17 April 2007 (UTC)

APSAC & 'Attachment Therapy' vs. 'attachment therapy'

The article says "The American Professional Society on Abuse of children (APSAC) (Chaffin et al.,2006, PMID 16382093) does not use the term 'Attachment Therapy'", but then links to an abstract that uses the term. Using the citation in this way will probably confuse an ordinary reader. The article goes on to say that they use the term 'attachment therapy' without capitals. This wins the "ridiculously trivial distinction" award. Is there a difference between the definitions of 'Attachment Therapy' and 'attachment therapy'? shotwell 03:06, 17 April 2007 (UTC)

It seems that ACT specifically uses the term Attachment Therapy while more mainstream groups use the term attachment therapy. It seems to be a salient point in the debated literature that we should keep consistent with in our writing here. DPeterson 12:31, 17 April 2007 (UTC)

The purpose of the Chaffin report is to address the whole phenomenon of what is, according to them, popularly known as 'attachment therapy'. They have it with capitals in the title, but so what? They clearly do not limit themselves to with or without capitals. ACT happen to use capitals but are clearly discussing the same issue, as are Prior and Glaser who use capital A, small case t. There is nothing remotely confusing about this. Attempts to prioritise this merely obfuscates the subject, as does so much of the existing article. The most obvious way to deal with it is to list the variations in the opening sentence, something I proposed many inches above. It is an ambiguous term, not because different authors may or may not use capitals, but because it may loosely be used to cover mainstream therapies as well as this subset. That is why the opening paragraph needs to make it very clear what the article is about. That is why interupting the description s given by the prime authorities in the field with a loose sentence about a controversy is inappropriate and obfuscating.Fainites 09:02, 17 April 2007 (UTC)

I figured as much. The current revision puts a rather large emphasis on ACT's writings. This obscures the broadly accepted research by the likes Chaffin. The artificial distinction concerning capitalization doesn't help. shotwell 10:14, 17 April 2007 (UTC)

Actually this should be an easy article to write as there are so many good quality up-to-date sources. Chaffin et al were commissioned to write their report and the many authors contain a very fair chunk of the known experts in this field (people like Zeannah for example). It's a comprehensive review of what was obviously percieved to be an issue. It wasn't the first either. Speltz, an APSAC advisor wrote a history and description for the ASPAC a couple of years earlier. Chaffin have included a comprehensive list of guidelines. Alot of associations now have guidelines but I haven't yet researched which ones are pre Chaffin and which ones are a consequence of Chaffin. There was alot of correspondance after Chaffin came out with those who took issue with Chaffin. The report on the issues raised and the response of the authors is also published in Child Maltreatment. The Prior and Glaser book was only recently published over here in the UK. It's from the Royal Psychiatric Research Unit. Glaser is a big noise over here in child psych. There are concerns that AT is making it's way into the UK. Glaser also deals with what treatments are evidence based. Of course it takes along time to become evidence based as your studies have to fufil the criteria and need to be replicable by others and you need the wider scientific community to acknowledge your work as evidence based. It's very difficult to do RCT's on children. We're very lucky on this article to have so many good authorities. The problem is getting them into the article in a coherent form. I don't have problem with using ACT's material but they are not the primary source. Fainites 10:31, 17 April 2007 (UTC)

Again, we cannot leave out the ACT material as they have written the most on this subject and have the largest inventory of materials about the subject. For example, their definition is probably the most clear and specific of all those floating around. This article is about what is Attachment Therapy; it's definition, maybe some history, and a description in context of its component parts.DPeterson 12:31, 17 April 2007 (UTC)

Nobody is suggesting leaving out their material so I don't know why you keep replying as if somebody is. Anyway the disputed sentence is not their material but is in fact an OR POV statement about them.This article is about a subset of therapies commonly called attachment therapy, with or without capital letters. Fainites 12:43, 17 April 2007 (UTC)

Please don't interpose your comments on the talk page when another editor is replying to the first editor as you did at 12.31 above. Also, what do you mean by 'more mainstream groups'? Do you mean mainstream as in not targeted by Chaffin as in the subset or a more mainstream version of AT?Fainites 13:59, 17 April 2007 (UTC)

I agree with Fainities and others that the ACT material should be included. Since the article is about AT, all views about what this is should be represented. I don't follow the dispute about "mainstream," but, regardless, Speltz's article in the APSAC advisor (not sure he is an "Apsac advisor"), the Chaffin paper, Glaser, and ACT material all have a place here. We don't need to belabor points...let's just make the points clearly and to the point...making a concise, complete, and relevant article. RalphLender 14:10, 17 April 2007 (UTC)

Can we all accept that we are writing an article about the phenonmenon of a subset of non-mainstream therapies as described by Chaffin, Glaser and ACT whether we or they use capital letters or not? Fainites 14:32, 17 April 2007 (UTC)

Hasn't that been clear? As I read all the various editors comments, that seems to cearly be the focus here. The article is about what is this thing called A(a)ttachment T(t)heray, and all the other names it goes by: rebirthing, holding, coercive restraint therapy. RalphLender 15:39, 17 April 2007 (UTC)

It hasn't been clear in the past but if it's clear now then jolly good! Fainites 16:06, 17 April 2007 (UTC)

Oh. It seems clear from reading the comments in this section, at least. I don't have a lot of time to devote to idle chatter, so I do hope you, I, and others who wish to contribute, can focus on writing and gettinig some level of consensus. RalphLender 18:04, 17 April 2007 (UTC)

It's not idle chatter. It's been a major part of the talkpage from the outset that some editors have pushed the POV that AT with capitals is really just an ACT thing, and they can't be trusted, and that Chaffin et al are talking about something different. If we no longer have to waste our time with that then hooray! But we do need to be clear. Fainites 18:30, 17 April 2007 (UTC)

'INTRODUCTION READY?'

"Attachment Therapy", (also known as attachment therapy, holding therapy, rebirthing therapy, or corrective attachment therapy) is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning, in the professional community, its actual definition is unclear. The term is not a term found in the American Medical Association's Physician's Current Procedural Manual. A number of advocacy groups, such as Advocates for Children in Therapy and Quackwatch have undertaken to label a large number of treatments for children with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies.]. The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing.

In a report for the ASPAC, Chaffin et al state 'controversies have arisen about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners, techniques that have been implicated in several child deaths and other harmful effects.' They attempt to define this subset of therapies (see below) and state that 'popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” . p77(We need a page number if this is an acutal direct quoteJonesRD_talk 18:50, 15 April 2007 (UTC))

Care should be taken to distinguish between the subset of 'therapies' covered by this article and more mainstream therapies, particularly as what is and what is not described as an 'Attachment Therapy' within the meaning of this article is controversial and advocacy groups such as ACT and Quackwatch include a broadly defined range of therapies in their description of Attachment Therapy, some of which are not coercive or intrusive as described in this article.

(I think this is ready now. Let's get some comments on this over the next week or two and then we can move on to the next sectionDPeterson 12:35, 17 April 2007 (UTC)

COMMENTS ON INTRO AS WRITTEN

Let's see what various editors think about this paragraphy and see if we have a consensus, or at least a broad and large group agreeing, even if not all agree. DPeterson 12:50, 17 April 2007 (UTC)

1. OKWith addition of the page number requested by Jones. DPeterson 12:35, 17 April 2007 (UTC) ACT is a major writer on the subject and and produced significant amounts of material on this topic and so should be given substantial weight as they do offer a clear definition and specific materials. DPeterson 21:53, 17 April 2007 (UTC)
2. Don't agree with the placement of the first sentence about ACT. Fainites 12:44, 17 April 2007 (UTC)
3. Acceptable I've read all the comments and suggestions and think this version represents a concensus (My Webster's defines this as "...a general agreement...the judgment arrived at by most of those concerned."). I think it is time to move along to next sections. RalphLender 14:05, 17 April 2007 (UTC)
4. The ACT bit doesn't deserve such prominence. shotwell 21:40, 17 April 2007 (UTC)
5. It's done now and just fine. MarkWood 14:10, 18 April 2007 (UTC)

No it isn't done. We're not agreed. It's not fine. I could live with that disputed sentence in an appropriate place even though it's OR, POV and inaccurate (although it's not as bad as it was) but it's absurd to have an attack like that in the middle of the introduction. The point it's trying to make is better made in the last sentence, ie, be careful of ACT's list. Chaffin does a much better job of discrediting some of those therapies than ACT. Shall we put him in instead? We can't deal with all the controversies and arguments in the Intro. and we certainly shouldn't be prominently taking sides with out of place POV statements there. Fainites 22:12, 18 April 2007 (UTC)

Let's see how others feel about this. Remember, no one owns this editing and concensus means consensus among most individuals who have an interest here. Attack? The intro does a very good job of sketching out, briefly, the controversaries and arguments that are later expanded upon. DPeterson 23:21, 18 April 2007 (UTC)

I am waiting to see how others feel. MarkWood was indicating it was all sorted. Fainites 06:18, 19 April 2007 (UTC)

I think EVERYONE should wait and see what other editors think and what may be contributed. DPeterson 12:42, 19 April 2007 (UTC)

6. Use it This is ok with me as written. SamDavidson 14:25, 19 April 2007 (UTC)

7. Fine with me' This section is ok. JohnsonRon 20:46, 19 April 2007 (UTC)

8. Good as writtenJonesRD_talk 22:53, 20 April 2007 (UTC)

proposed second section Definitions of Attachment Therapy

There is no generally accepted definition of "Attachment Therapy". It is not a term found in the American Medical Association's Physician's Current Procedural Manual nor in generally recognized texts on treatment modalities, such as Bergin & Garfield's Handbook of Psychotherapy and Behavior Change. There is not any specific text that describes this "treatment" approach. Chaffin et al (2006) describe the polarization between the proponents of ‘Attachment Therapy’ and mainstream therapies stating, "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." p85 (We need a page number hereRalphLender 20:04, 17 April 2007 (UTC))

The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder and Attachment Problems (Chaffin et al 2006), having said "The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions", (p 83) (Need page #DPeterson 21:58, 17 April 2007 (UTC)) it's got oneFainites 22:00, 17 April 2007 (UTC) (page numbers go after each discrete quoteDPeterson 22:07, 17 April 2007 (UTC)) attempt to describe this subset as follows: "The attachment therapy controversy has centred most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge. Variants of these treatments have carried various labels that appear to change frequently. They may be known as “rebirthing therapy,” “compression holding therapy,” “corrective attachment therapy,” “the Evergreen model,” “holding time,” or “rage-reduction therapy” (Cline, 1991; Lien, 2004; Levy & Orlans, 1998; Welch, 1988). Popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions." p83

Speltz (2002) in a paper published by the APSAC (not for APBSAC, but in one of it's pubs RalphLender 20:04, 17 April 2007 (UTC)) (are you sure? It says ASPAC advisor on the paper or is that the name of their pub? Fainites 21:05, 17 April 2007 (UTC)) (The APSAC Advisor is a newsletter of that organization...not peer reviewed.DPeterson 22:00, 17 April 2007 (UTC)) it looks like the name of the pub.On what basis do you say it's not peer reviewed?Fainites 22:07, 17 April 2007 (UTC) (changed itFainites 23:04, 18 April 2007 (UTC)) describes ‘corrective attachment therapy’ as follows: "… the holding therapies included in “corrective” attachment therapy do not address safety needs. They differ in that a therapist or parent initiates the holding process for the purpose of provoking strong, negative emotions in the child (e.g., fear, anger), and the child’s release is typically contingent upon his or her compliance with the therapist’s clinical agenda." p4.(if a quote need pg num.RalphLender 20:04, 17 April 2007 (UTC))

Prior and Glaser (2006) describe ‘Attachment therapy’ as a variety of treatments offered to desperate carers of troubled, maltreated children which often include variants of holding, eg holding time (Welch 1998), therapeutic holding (Howe and Fearnley 2003), rage reduction therapy (Cline 1991) and rebirthing. They state, (If this is a direct quote, quotes " are needed and page number listed...DPeterson 22:07, 17 April 2007 (UTC)) "There are many ways in which holding therapy/attachment therapy contradicts Bowlby's attachment theory, not least attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity. Moreover, Bowlby (1988)explicitly rejected the notion of regression, which is key to the holding therapy approach: '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." p265. (if a direct quote...need a page number...it's unclear here what are quotes and what are your statements...try using " "RalphLender 20:04, 17 April 2007 (UTC))

(This seems out of place...either delete or put with Chaffin material maybe.DPeterson 22:07, 17 April 2007 (UTC))Chaffin et al also cite 'encouraging children to regress to infant status'as a feature of these therapies at p83 and include 'age regression' as a technique to avoid in their guidelines at p86.(page # and direct quoteRalphLender 20:04, 17 April 2007 (UTC)) (it goes OK now with the expanded Glaser bitFainites 23:08, 18 April 2007 (UTC))

The advocacy group Advocates for Children in Therapy define, "Attachment Therapy (AT).. as …a growing, underground movement for the treatment of children who pose disciplinary problems to their parents or caregivers. AT practitioners allege that the root cause of the children’s misbehavior is a failure to 'attach' to their caregivers. The purported correction by AT is — literally — 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." They state "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 group identify rebirthing as a form of "attachment therapy". Fainites 23:08, 18 April 2007 (UTC) The group also uses the terms "rebirthing" and "holding therapy" as terms for "Attachment Therapy."] (Their book uses the terms frequentlyDPeterson 11:51, 18 April 2007 (UTC)) ] (now proposed this be replaced by "The group identify rebirthing as a form of attachment therapy". Fainites 20:04, 18 April 2007 (UTC))

Comments on second section

I've put in the bits about it not being defined in various manuals from your version. I've also put in the full quote from Glaser and Prior about age regression that you requested and added that Chaffin includes it in his list. On p83 he calls it 'encouraging children to regress to infant status'. On p86 in his 'guidelines' he just calls it 'age regression'. ACT include it in their definition as well somewhere I think. If you want that too I'll look it up. The polarization bit from Chaffin of course explains why there's nothing in professional manuals about this thing. Fainites 18:42, 17 April 2007 (UTC)

Does this mean we are done with the intro and that the version above, with the requested page notation is to go in? I guess we should wait a bit to see what other editors think too. Agreed? RalphLender 19:12, 17 April 2007 (UTC)

No we're not done with the intro. I don't agree with the weird line in the middle, but DP suggested leaving it there for a while (actually he said 2 weeks I think) to see what other editors think. We haven't even left it a day yet! That needn't stop us having a bash at the other sections.Fainites 19:16, 17 April 2007 (UTC)

I've put the page number in the intro. Do you not have Chaffin? Fainites 19:19, 17 April 2007 (UTC)

OH, good. Ok then. I'll take a look at the second section when I get some time. RalphLender 19:58, 17 April 2007 (UTC)

I added some material and made a few edits. I'm ok with this section now as it stands...maybe as DP suggested, we can leave it for a week or two and see what other editors think...hopefully we will have consensus and can move on...I do hope so. RalphLender 20:08, 17 April 2007 (UTC)

I've added the page numbers. I've put the Glaser as just the full quote and also the actual words from Chaffin. On the issue of your additions, is that last sentence a quote? Can we have the page number or link? It's not my understanding of how they state their information, but if it's a direct quote then fair enough. Otherwise best leave it out or find a direct quote of some kind.Apart from this it's fine as a compromise. Fainites 21:54, 17 April 2007 (UTC)

On your last sentence again Ralph, just looking at the AT site, they list 22 therapies which they call attachment therapy and specifically do not include rebirthing and indeed explain why. I think it's best to stick to direct quotes if we're saying various people or organisations say things. Fainites 22:10, 17 April 2007 (UTC)

Very nice work, Fainites. As I read the very last line it is a direct quote with a cite. As I surf the net, rebirthing is a term used and it is the procedure used in the Candace Newmaker case, in which ACT was quite involved. DPeterson 22:13, 17 April 2007 (UTC)

Thanks. But on the last line, either it is or it isn't a direct quote. If it is a direct quote, lead us to it! I clicked on the link which I understood related to the previous passage (and indeed does). I could not find the last line as a quote. I'm quite happy to be proved wrong if you produce it! On the age regression point, it's obviously important but I don't mind whether it goes in this section or the 'underlying principles' section. Leave it here for now and see what other editors say. Also, when we're trying to write a paragraph we can all agree on, do you guys have to keep cluttering the page up with headmistressy remarks about quotation commas. If you think it should have " instead of ' just do it! Fainites 22:19, 17 April 2007 (UTC)

I just looked at the diffs and there was a quotation mark round Glaser. You removed it DP to put in your bit about quotation marks! Cheers Fainites 22:25, 17 April 2007 (UTC)

Well, one quote from them is "who taught that re-enactment of the birth process might be a useful script for some holding sessions. That script he and others called “rebirthing” for short.)" DPeterson 22:43, 17 April 2007 (UTC)

However, if you think it better to just say, "sometimes also called rebirthing" and leave out the attribution, that's fine too. The media and on the web we see the term used alot. DPeterson 22:47, 17 April 2007 (UTC)

I'm sorry but your missing the point here. The introduction properly says that it's also sometimes called rebirthing, which in the media it is. But you added a sentence in the definition section that states specifically that ACT specifically call it rebirthing and holding. When queried you state this is a quote. Well if it is, provide the source. If you can't provide the source then it isn't a quote. If you are saying it's a paraphrase you still need to provide the source. You also said the previous link was the source. I looked at it and it says the opposite. How can we reach consensus if you just put in OR statements, claiming they're quotes then refusing to give the source? As I say, I am, quite willing to be proved wrong if you provide the source. After all, you're very keen to demand exact quotes, page numbers, descriptions and names of publications from me all of which I have provided. As for the script quote you put above, this is interesting material but doesn't support the end sentence. It could go in in it's own right but who is 'He' ? Source or direct link please! I've put in a citation needed so we don't forhet and so other editors can easily see what we're talking about. Fainites 06:55, 18 April 2007 (UTC)

I'd given citations above in this very section! From their book. "Both bills follow on the 2000 death in Colorado of a North Carolina girl, Candace Newmaker, during a “two-week intensive” in Attachment Therapy (AT)." They describe rebirthing as Attachcment Therapy.] DPeterson 11:51, 18 April 2007 (UTC)

They consider rebirthing to be a form of attachment therapy, but they do not use the term 'rebirthing' as a term for all attachment therapies. There should be no confusion concerning ACT's definition given that it's explicitly stated at http://www.childrenintherapy.org/essays/overview.html under the heading "Varying Nomenclature". This is rather confusing because you have previously claimed their definition is too broad. Now you are stating that they have this very narrow definition of attachment therapy. It can't be both. shotwell 16:50, 18 April 2007 (UTC)

The other confusing thing is that you're so insistent on giving ACT such prominence in this article. On the Advocates for Children in Therapy article, you have described them as a fringe group that receives no serious attention from the professional community. You have portrayed the leaders as being unqualified with respect to attachment therapy. If this is what you truly believe, it seems that you would want to avoid giving their voice undue weight in this article. shotwell 16:58, 18 April 2007 (UTC)

You did not provide this link above for this line. I have now looked at the link you provide in yoiur reply now. Here is the exact quote "Though its preamble (to the bill)correctly identifies “rebirthing” as a form of Attachment (Holding) Therapy....." Therefore it is inaccurate to say they call rebirthing attachment therapy as if the two terms were synonymous. An accurate quote would be to put in that they identify rebirthing as a form of AT. They in fact list 22 different names for AT and in that essay they more or less say they specifically do not consider rebirthing synonymous with AT. Again, here is the quote,

"Note may be taken that the list above does not include “rebirthing” or “rebirthing therapy.” This is a label that the press and others put on the procedure that Connell Watkins and Julie Ponder supposedly used to kill Candace Newmaker. Watkins and Ponder were trained in the approaches of Douglas Gosney, an Attachment Therapist practicing in California, who taught that re-enactment of the birth process might be a useful script for some holding sessions. That script he and others called “rebirthing” for short.)" Unless you provide a specific quote, I do not agree to inaccurate, OR, POV statements suddenly appearing and being put in in this way. To what end? For what purpose? There's loads of real material. Fainites 17:03, 18 April 2007 (UTC)

ACT seems to use holding therapy and rebirthing as elements, aka's, or the same as Attachment Therapy. DPeterson 23:26, 18 April 2007 (UTC)

Sometime elements of; yes. Same as; no. This is plainly obvious from their literature. Quotes have been provided above. Specific source and quote for your contention please. Fainites 20:11, 19 April 2007 (UTC)

My reading of the ACT website is that, in fact, they use a variety of terms, including rebirthing and holding therapy as synon. with AT. The links provided in this long thread support that reading, so I support the statement as written. JohnsonRon 21:19, 19 April 2007 (UTC)

SECOND SECTION DONE?

Editors: is the second section acceptable for inclusion now? Please limit your comments to yes or no and one or two lines. Longer comments can go above. DPeterson 12:24, 18 April 2007 (UTC)

1. _'OK' with me. It is fine with me and can replace the existing second paragraph in the article. MarkWood 14:10, 18 April 2007 (UTC)
2. Yes This is fine to go in as it has been edited up to this point. I agree it can replace the existing second paragraph. RalphLender 15:16, 18 April 2007 (UTC)

Hey Ralph! You're back! You were the one that put in the quote about ACT calling rebirthing AT. DP's been defending it for you but he hasn't been able to show us the exact quote of hwere it comes from. Please can you give us the exact quote and source so we can resolve this problem.Fainites 17:26, 18 April 2007 (UTC)

The support is provided above via the links. However, your suggestion below is also fine, "ACT identifies rebirthing as a form of AT." I'd support that. RalphLender 18:52, 18 April 2007 (UTC)

3. No Unless the inaccurate and unecessary last phrase is removed or replaced by an accurate and sourced quotation. I would accept "ACT identify rebirthing as a form of AT". Do I take it that you all agree to the bit on regressing to infancy remains in ? Fainites 17:07, 18 April 2007 (UTC)

See my comment in number 2 above. RalphLender 18:52, 18 April 2007 (UTC)

OK. I'll change it unless anyone else objects.Fainites 20:00, 18 April 2007 (UTC)

Sounds good to me. Without the change, however, I do not think the second section is "done". shotwell 20:13, 18 April 2007 (UTC)

OK, I like, "ACT identifies rebirthing and holding therapy as terms for "Attachment Therapy."...so can we go with that?DPeterson 23:26, 18 April 2007 (UTC)

Perhaps I'm just extremely pedantic, but that is still not correct. I would agree with "ACT identifies rebirthing and holding therapy as types of attachment therapy". How's that sound to you? shotwell 07:54, 19 April 2007 (UTC)

They use rebirthing and holding as terms for AT...what is the difference between writing this is AKA that and this is a type of that. A pine is a type of tree and pines are AKA trees.DPeterson 12:46, 19 April 2007 (UTC)

Sorry DP but with all due respect you've missed the point. They do not use rebirthing and holding as terms for AT. They identify rebirthing and holding as forms or types of AT. In other words not synonymous. Ralph, Shotwell and I can see a clear difference. If you can't what is your objection to Shotwells version going in? Fainites 15:52, 19 April 2007 (UTC)

I have to agree that my reading is that the terms are used at terms for AT. rebirthing and holding therapy as types of AT and are AT. JohnsonRon 02:04, 20 April 2007 (UTC)

Still waiting for a direct quote from a verified and credible source showing that ACT treat the terms rebirthing and AT as synonymous. Fainites 11:46, 21 April 2007 (UTC)

The quotes have already been provided as links to their page and a reading makes it very clear that ACT treats the terms as synonymous. 'KEEP'JonesRD_talk 22:08, 21 April 2007 (UTC)

The links given show the opposite to what you claim on rebirthing. Still waiting for a direct quote that ACT use Rebirthing and AT as synnonymous. Happy to accept an actual quote.Fainites 00:28, 22 April 2007 (UTC)

No, the links show that they see all these are similiar terms for similiar procedures. As I said before, we may disagree, so we'll just have to go with the consensus that develops and follow that; which seems to be that the terms are all similliar and used by ACT as largely the same. Remember, although you wrote a lot of this, you do not own the article, nor do you have veto power if the consensus is not your view. JonesRD_talk 02:17, 22 April 2007 (UTC)

4. 'YES' This section is fine to go in as written. SamDavidson 14:26, 19 April 2007 (UTC)

What do you mean 'as written'? DP's last line or the one agreed by the others? Fainites 15:56, 19 April 2007 (UTC)

5. FINE with the line as DP has it. I read the ACT material and their website as using the various terms there, including rebirthing and holding therapy as synonymous with AT. JohnsonRon 20:48, 19 April 2007 (UTC)

6. Yes I agree the section is ok as written (with the line that rebirthing/holding therapy/Attachment Therapy are synonymous. For all the reasons stated above, I won't repeat arguments already presented.JonesRD_talk 22:55, 20 April 2007 (UTC)

Proposed Third Section

history and underlying principles--Third section

Speltz (2002) states that the roots of "Attachment Therapy" are traced to Robert Zaslow in the 1970’s. Zaslow attempted to force attachment in those suffering from autism by creating pain and rage whilst enforcing eye contact. He believed that holding someone against their will would lead to a breakdown in their defence mechanism’s making them more receptive to others. Speltz point’s out that these ideas have been dispelled by research into autism and that, conversely, techniques based on behavioural principles have proved effective.

('DELETE THIS PARAGRAPH' JohnsonRon 20:54, 19 April 2007 (UTC)) Speltz cites (provide a direct quote instead of paraphrasingDPeterson 23:32, 18 April 2007 (UTC)) (actually theres nothing wrong with a paraphrase if it's accurate and sourced. Wiki deprecates articles that are long lists of quotes. I'll post the full quote below so you can see if you think its a fair paraphrase.Fainites 16:23, 19 April 2007 (UTC) Martha Welch and "holding time" (1984 and 1989) as the next significant development. 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 bonding process was believed to begin. Similar techniques were subsequently promoted by Foster Cline and associates at the Attachment Centre at Evergreen, Inc. and duplicated elsewhere in other clinics. (you need a citation for this last sentance if you name names and a specific quoteDPeterson 23:32, 18 April 2007 (UTC)) OK the specific quote is "Foster Cline (1991) and associates at the Attachment Center at Evergreen, Inc. (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 (not to be confused with DSM-IV’s reactive attachment disorder)." Is this OK? Fainites 16:23, 19 April 2007 (UTC)

(WOW! Speltz is old, 2002. I think this section should not be here. Incuding such a large amount of material that is probably seven or more years old (and 18 to 16 in two other cases) is just bad...it may even be an inaccurate represesntation of what those people are doing now. Either delete it completely, or cite the current works of those involved. I'd suggest just leaving it out. The paragraph really is unneeded.JohnsonRon 20:53, 19 April 2007 (UTC))

Its a history section. See title above.Fainites 22:17, 19 April 2007 (UTC)

According to Prior and Glaser (2006) "there is no empirical evidence to support Zaslows theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children’s behaviour (Cline 1991)." p263. (page numberDPeterson 23:32, 18 April 2007 (UTC))

Chaffin et al describe the underlying principles of Attachment Therapy as follows; “In contrast to traditional attachment theory, the theory of attachment described by controversial attachment therapies is that young children who experience adversity (including maltreatment, loss, separations, adoption, frequent changes in child care, colic or even frequent ear infections) become enraged at a very deep and primitive level. As a result, these children are conjectured to lack an ability to attach or to be genuinely affectionate to others. 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. The children are described as failing to develop a conscience and as not trusting others. They are said to seek control rather than closeness, resist the authority of caregivers, and engage in endless power struggles. From this perspective, children described as having attachment problems are seen as highly manipulative in their social relations and actively trying to avoid true attachments while simultaneously striving to control adults and others around them through manipulation and superficial sociability. Children described as having attachment problems are alleged by proponents of the controversial therapies to be at risk for becoming psychopaths who will go on to engage in very serious delinquent, criminal, and antisocial behaviors if left untreated." p 78 page #DPeterson 23:32, 18 April 2007 (UTC)

Prior and Glaser cite the one published study which "purports to be an evaluation of holding therapy" by Myeroff et al (1999). The methodology of this study is heavily criticized. (please do not remove other peoples talk page posts DPeterson. This is the third time I have had to ask you. If you disagree with this line, don't just silently remove it. Say you disagree and why and we'll discuss it below. Now we don't know whether the other editors are agreeing to my post or my post as altered by you.Fainites)This study covers the "across the lap" type holding therapy, described as "not restraint" by Howe and Fearnley (2003) but "being held whilst unable to gain release."

Prior and Glaser also state, "There are many ways in which holding therapy/attachment therapy contradicts Bowlby's attachment theory, not least attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity. Moreover, Bowlby (1988)explicitly rejected the notion of regression, which is key to the holding therapy approach: "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." " p265. Chaffin et al also cite "encouraging children to regress to infant status" as a feature of these therapies (p83) and include "age regression" as a technique to avoid in their guidelines at p86. Fainites 22:54, 18 April 2007 (UTC)

Comments

I think this covers all the comments made. I've put the full 'age regression' bit in here aswell. I don't mind if it goes in here in 'underlying principles' or in 'definition'. It's arguably both but there's no point repeating ourselves unless necessary for the sake of clarity.Fainites 22:57, 18 April 2007 (UTC)

1. 'GOOD'I made a few minor changes...as it is now I could support this as our third section. But, as I've said before, no one or two editors own this article, so let's give it a week or two for others to comment and edit and build consensus before we act. DPeterson 23:34, 18 April 2007 (UTC)
2. 'YES' This section is fine as written and, as far as I am concerned, can go in. It is balanced and includes verifiable references/sources. SamDavidson 14:27, 19 April 2007 (UTC)
3. 'YES' including the line removed by DP about Myeroffs study being heavily criticised (which I've put back. How can other editors comment on it if it's been removed?). See comment below. I'll do the page numbers and things in a moment.Fainites 16:05, 19 April 2007 (UTC)
4. 'YES' With the paragraph with the extensive quote from an article five years old quoting material nearly twenty years old. Leave out the line about the Meyeroff study...JohnsonRon 20:56, 19 April 2007 (UTC) I re-read it a couple of more times, and I take back what I sais....the line about the Meyeroff study being heavy criticized, as Fainites has it is fine. It is accurate, and brief. So, 'YES' but with the paragraph I noted deleted or severely edited to reflect how out of date the material is. JohnsonRon 20:59, 19 April 2007 (UTC)
5. (#'YES' if we leave Myeroff in. Also put in a direct quote from Speltz re Foster Cline as suggested by DP. Leave paraphrase of martha welch. On the old material point, this is a history section!!!! It starts by saying things like 'the roots are traced back to...' Howmuch clearer can it be? Fainites 22:20, 19 April 2007 (UTC)) I agree with u that the Myeroff line can stay in...it's relevant. But I still object the the outdated material being present. I actually don't think it is necessary for this article and it is too misleading. Maybe if you rewrote it so that it wasn't so misleading and provocative it might be ok...JohnsonRon 02:06, 20 April 2007 (UTC)
6. I thought it was fantastic when first posted. This nonsense about things being "out of date" is absurd. shotwell 14:43, 20 April 2007 (UTC)

You are entitled to your view. However, it appears that your view is in the minority here. As others have said, no one ownes the articles on Misplaced Pages. JohnsonRon 17:52, 20 April 2007 (UTC)

7. Yes It is fine with the Meyeroff material. I do think the paragraph under dispute in the history section could be deleted. I can see how the material could be misinterpreted, so let's just leave it out...It doesn't add much to an article whose purpose is to define attachment therapy. JonesRD_talk 22:57, 20 April 2007 (UTC)

8. Yes The disputed paragraph in the history section is best left out. The Meyeroff stuff is fine. MarkWood 17:47, 24 April 2007 (UTC)

'9.' 'Yes' The material is good to go with the Myeroff material and it's fine to leave out the disputed paragraph so we can move this along. That paragraph really doesn't add anything that is essential and vital to this article. RalphLender 16:18, 27 April 2007 (UTC)

Re Myeroff. This is the only 'holding therapy' study. The Prior/Glaser full quote is as follows;

"Only one published study which purports to be an evaluation of holding therapy was found (Myeroff et al. 1999). In this study the comparison sample was inadequate (families who contacted the Attachment Centre at Evergreen, Colorado, but did not attend), the children were not randomly assigned to treatment conditions, and the pre- and post-treatment assessment of the children depended on a questionnaire (the Child behaviour Checklist) completed by mothers. This paper clearly illustrates the leap proponents of holding therapy make from Bowlby's theory to their advocated treatment." I can give you the rest about how it's not really based on Bowlby if anyone wants it.

A similar criticism is made by Chaffin et al:

"For example, perhaps the most widely cited study in the holding therapy literature, and possibly the only empirical study on the topic available in a mainstream peer-reviewed journal, suffered from a number of major limitations. The study used a very small sample (12 in the treatment group, 11 in the comparison group), participants were selfselected into treatment and comparison groups, and the statistical analysis did not include any direct test of group differences in change over time (Myeroff, Mertlich, & Gross, 1999)."

I'm quite happy to reduce all this to an accurate paraphrase, but removing it altogether creates a misleading impression of why Prior and Glaser cited this study.Fainites 16:16, 19 April 2007 (UTC)

Re martha welch. DP has asked for the full quote from Speltz. Here it is:

"A decade later, Martha Welsh (1984, 1989) described a technique for children with attachment problems called holding time. Mothers were instructed to take hold of their defiant child at these times, holding them tightly to the point of inducing anger. Mothers were told to expect that the child may spit, scream, swear, attempt to get free, bite, and try to cause alarm by saying that he is in pain, cannot breathe, will vomit, is going to die, or needs to urinate. In this approach, parents were encouraged to accept these behaviors calmly and silently. Welsh described a subsequent stage (marked by the child’s weeping and wailing) in which parents were encouraged to resist the temptation to feel sorry for the child or to feel guilty about what they are doing. Mothers were told that if they could successfully resist these temptations, the child would enter an acceptance stage in which the child would fight less and become relaxed and tired. The mother was then instructed to loosen her hold on the child, at which point a bonding process was believed to begin, in which the child would find comfort from the mother in this relaxed state. To my knowledge, no evidence for the efficacy of this method has ever been provided." Fainites 16:25, 19 April 2007 (UTC)

This material is 'VERY OUT OF DATE' It is not needed in this article. JohnsonRon 20:56, 19 April 2007 (UTC)

Its in a history section! It's the history of AT. ie where it comes from. That implies the past. This section traces the provenance of underlying theories behind AT. Also its clearly still being practised! Are we going to leave out everything about attachment in this article because Bowlby is 1988 and therefore very out of date? (By the way, there's no need to SHOUT). Fainites 22:13, 19 April 2007 (UTC)

Leave it out then. It is way to OUT OF DATE to be meaningful...or, as I suggested above, rewrite it substantially so it is not as misleading as it currently is. In any event, the best course is to just leave it out...but we can take a vote and build consensus that way. JohnsonRon 02:15, 20 April 2007 (UTC)

Out of date? This is the history section. In the history section, we need to write about notable developments since the beginnings of attachment therapy. These papers are still earning citations in major works by leading experts -- this establishes notability. Your argument here is too bewildering to take seriously. shotwell 14:38, 20 April 2007 (UTC)

Yes, the material cited is out of date and 'MAY' misrepresent the approaches....'BETTER' is to just leave out the section in full as suggested above...Concensus will determin what will occur and a vote seems like a good idea now. JohnsonRon 17:52, 20 April 2007 (UTC)

VOTE ON DELETING THE PARAGRAPH DISCUSSED ABOVE

1. 'YES'Just delete it and move on. JohnsonRon 17:52, 20 April 2007 (UTC)
2. Yes I agree. JonesRD_talk 22:59, 20 April 2007 (UTC)
3. Actually that makes DPeterson, Samdavidson, Shotwell and me in favour of this paragraph! But as Shotwell says, this argument that the history is too out of date can't really be taken seriously. Why don't you pop along and delete the Hitler page on the grounds that he's now dead! The history is from a credible and verified source that is still being cited. It's not even an old paper. 2002 is nothing in science terms! Are you suggesting that history has changed retrospectively in the last 4 years? Lastly, Wiki is not a democracy. You can't just vote to remove verified and credible sources. As for the suggestion by Ralph, that we leave in tthe history the Myeroff study on holding therapy but leave out development of holding therapy, can anybody explain this? I am quite happy to attempt a different paraphrase of Speltz on Martha Welch, or indeed put in the entire quote, but we cannot in all seriousness leave it out of a history section.Fainites 11:31, 21 April 2007 (UTC)
4. It's ok to delete the paragraph under dispute. I can see why it might be confusing as written and if it is included needs significant explainations. DPeterson 16:47, 24 April 2007 (UTC)

If you don't like a paraphrase, (and nobody else seems willing to attempt one), I would propose a direct quote from Speltz (published in the ASPAC publication). :"A decade later, Martha Welsh (1984, 1989) described a technique for children with attachment problems called holding time. Mothers were instructed to take hold of their defiant child at these times, holding them tightly to the point of inducing anger." p 4. "Foster Cline (1991) and associates at the Attachment Center at Evergreen, Inc. (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 (not to be confused with DSM-IV’s reactive attachment disorder)." p 4.Fainites 11:39, 21 April 2007 (UTC)

Really? I don't see the comments that way. We certainly should give others a chance to comment. While you have written the material underdiscussion here, you do not OWN it and there must be broad and generally agreement, but no one person has a veto. Maybe if you put something in the clearly indicate that the statements are based on material over a decade and half old and that this may not reflect current practice it could be ok...See, now, that would be a good compromise. JonesRD_talk 22:12, 21 April 2007 (UTC)

The material comes from an article that specifically states it deals with the history. It all states it comes from this article. How much clearer can it be? Speltz writes the article which deals with the history. We cite and quote Speltz. Speltz is a verified and credible source. it's not rocket science! Fainites 00:23, 22 April 2007 (UTC)

This is the fourth time of asking, please don't mess around with other peoples edits. Fainites 00:27, 22 April 2007 (UTC)

I am merely formating so that your comments are in the proper form...indentented and with the thread they apply to. I think a good compromise would be for you to clearly indicte that the statements are based on material that is fifteen or more years old and that it may not reflect their current practice. That seems like a reasonable request. What is your problem with doing that? If you just don't have the time, then let's just leave it out. JonesRD_talk 02:21, 22 April 2007 (UTC)

If it clearly states that Speltz is describing the history and development that should be sufficient. Fainites 10:27, 22 April 2007 (UTC)

Please don't mess around with or refactor my edits.Fainites 10:28, 22 April 2007 (UTC)

I am not '"MESSING AROUND"' or "refactoring" your edits. It is custom and form to keep the threads of a conversation together on a talk page by progressivly indenting the comments. Makes it easier to read. Placing comments randomly and all over the place makes it impossible to follow a conversation here. It isn't sufficient since I and others find it misleading. Why not just add a line. Why object to a little suggetion that would build consensus here. Compromise is an important value on wikipedia. Remember, although you did write a lot of the above, you don't own it and it is 'CONSENSUS' that will the the ultimate decider of what goes in or does not and what is edited how. JonesRD_talk 12:33, 22 April 2007 (UTC)

It does make it easier to follow discussion threads if we stick with the Misplaced Pages practice of indentation. DPeterson 16:47, 24 April 2007 (UTC)

'5' 'YES' Let's get rid of it or have it clarified...I think it is fine to just leave it out and move on. It's doesn't add much to the article. MarkWood 17:47, 24 April 2007 (UTC)

6. Yes For all the reasons stated above, it can be excluded. RalphLender 16:21, 27 April 2007 (UTC)

Well we're obviously not going to be able to agree on history. We seem to be stuck between "History is bunk" (H.Ford), and "Those who do not learn from history are condemned to repeat it", (can't remember). Or perhaps it's "History is the propaganda of the victors", (can't remember). Lets move on. (unsigned comment by 'User:Fainites')

I can appreciate your unhappiness with how this has developed and the outcome. We don't have to all agree to move forward. It seems we have five editors in favor of deleting the paragraph in question so that constitutes a consensus on that. DPeterson 23:59, 2 May 2007 (UTC)

I'm not unhappy and I don't have to accept your 'consensus', particularly not when you originally called it 'good'! One more go!

history and underlying principles--Third section

Speltz (2002) states that the roots of "Attachment Therapy" are traced to Robert Zaslow in the 1970’s. Zaslow attempted to force attachment in those suffering from autism by creating pain and rage whilst enforcing eye contact. He believed that holding someone against their will would lead to a breakdown in their defence mechanism’s making them more receptive to others. Speltz point’s out that these ideas have been dispelled by research into autism and that, conversely, techniques based on behavioural principles have proved effective.

According to Speltz, "a decade later, Martha Welsh (1984, 1989) described a technique for children with attachment problems called holding time. Mothers were instructed to take hold of their defiant child at these times, holding them tightly to the point of inducing anger." p 4. "Foster Cline (1991) and associates at the Attachment Center at Evergreen, Inc. (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 (not to be confused with DSM-IV’s reactive attachment disorder)." p 4.

According to Prior and Glaser (2006) "there is no empirical evidence to support Zaslows theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children’s behaviour (Cline 1991)." p263.

Chaffin et al describe the underlying principles of Attachment Therapy as follows; “In contrast to traditional attachment theory, the theory of attachment described by controversial attachment therapies is that young children who experience adversity (including maltreatment, loss, separations, adoption, frequent changes in child care, colic or even frequent ear infections) become enraged at a very deep and primitive level. As a result, these children are conjectured to lack an ability to attach or to be genuinely affectionate to others. 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. The children are described as failing to develop a conscience and as not trusting others. They are said to seek control rather than closeness, resist the authority of caregivers, and engage in endless power struggles. From this perspective, children described as having attachment problems are seen as highly manipulative in their social relations and actively trying to avoid true attachments while simultaneously striving to control adults and others around them through manipulation and superficial sociability. Children described as having attachment problems are alleged by proponents of the controversial therapies to be at risk for becoming psychopaths who will go on to engage in very serious delinquent, criminal, and antisocial behaviors if left untreated." p 78

Prior and Glaser cite the one published study which "purports to be an evaluation of holding therapy" by Myeroff et al (1999). The methodology of this study is heavily criticized. This study covers the "across the lap" type holding therapy, described as "not restraint" by Howe and Fearnley (2003) but "being held whilst unable to gain release."

Prior and Glaser also state, "There are many ways in which holding therapy/attachment therapy contradicts Bowlby's attachment theory, not least attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity. Moreover, Bowlby (1988)explicitly rejected the notion of regression, which is key to the holding therapy approach: "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." " p265. Chaffin et al also cite "encouraging children to regress to infant status" as a feature of these therapies (p83) and include "age regression" as a technique to avoid in their guidelines at p86.

Fainites 23:56, 2 May 2007 (UTC)

Proposed Fourth Section

Attachment Disorder

Prior and Glaser (2006) describe ‘two discourses’ on attachment disorder. One science based, found in academic journals and books with careful reference to theory, international classifications and evidence. They list Bowlby, Ainsworth, Tizard, Hodges, Chisholm, O’Connor and 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’.

Attachment disorders are classified in DSM-IV-TR and ICD-10. DSM describes Reactive Attachment Disorder of Infancy or Early Childhood, divided into two subtypes, Inhibited Type and Disinhibited Type. The ICD classification describes two types, Reactive Attachment Disorder of Childhood and Disinhibited Attachment Disorder of Childhood. Both classifications are under constant discussion and both 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.

DSM and ICD are limited and some researchers in the field of attachment such as Zeannah have proposed alternative diagnostic criteria to describe broader disorders of attachment but the exact parameters are not yet established.

Chaffin et al and Prior and Glaser describe the proliferation of alternative ‘lists’ and diagnoses, particularly on the Internet, by proponents of Attachment Therapies that do not accord with either DSM or ICD classifications and which are partly based on the unsubstantiated views of Zaslow and Menta (1975) and Cline (1991). Neither do these lists accord with alternative diagnostic criteria as proposed above. According to Chaffin et al 'These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain.' Prior and Glaser 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.

Please do not alter this and then vote on a Bowdlerised version. This is my post. Comment below or in italics.Fainites 23:45, 2 May 2007 (UTC)

'COMMENTS ON FOURTH SECTION PROPOSAL'

1. Probably ok Let's see what other editors have to say. DPeterson 00:08, 3 May 2007 (UTC) Change to 'Good', let's go with this version. DPeterson 22:15, 4 May 2007 (UTC)

'CONSENSUS VERSION FOR PARAGRAPHS ONE, TWO, AND THREE

The following represents the consenus on the first three paragraphs. I think we can now agree to put this into the article and replace the first three paragraphs

"Attachment Therapy", (also known as attachment therapy, holding therapy, rebirthing therapy, or corrective attachment therapy) is an ambiguous term often used to describe a variety of controversial, non-mainstream "treatments" for children allegedly suffering from attachment disorder which is itself an ambiguous term. However, because the term has no common meaning, or generally accepted meaning, in the professional community, its actual definition is unclear. The term is not a term found in the American Medical Association's Physician's Current Procedural Manual. A number of advocacy groups, such as Advocates for Children in Therapy and Quackwatch have undertaken to label a large number of treatments for children with disorders of attachment as "Attachment Therapy" and attempt to discredit those therapies.]. The treatments often involve coercive and intrusive methods including variants of holding therapy or rebirthing or rage-reduction. According to Prior and Glaser (2006), ‘these therapies are not based on an accepted version of attachment theory and there is no objective evaluation of them’. Many professional bodies and some American States have outlawed rebirthing.

In a report for the ASPAC, Chaffin et al state 'controversies have arisen about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners, techniques that have been implicated in several child deaths and other harmful effects.' They attempt to define this subset of therapies (see below) and state that 'popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions.” . p77 Care should be taken to distinguish between the subset of 'therapies' covered by this article and more mainstream therapies, particularly as what is and what is not described as an 'Attachment Therapy' within the meaning of this article is controversial and advocacy groups such as ACT and Quackwatch include a broadly defined range of therapies in their description of Attachment Therapy, some of which are not coercive or intrusive as described in this article.

Defination of Attachment Therapy There is no generally accepted definition of "Attachment Therapy". It is not a term found in the American Medical Association's Physician's Current Procedural Manual nor in generally recognized texts on treatment modalities, such as Bergin & Garfield's Handbook of Psychotherapy and Behavior Change. There is not any specific text that describes this "treatment" approach. Chaffin et al (2006) describe the polarization between the proponents of ‘Attachment Therapy’ and mainstream therapies stating, "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." p85

The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder and Attachment Problems (Chaffin et al 2006), having said "The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions", (p 83) attempt to describe this subset as follows: "The attachment therapy controversy has centred most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge. Variants of these treatments have carried various labels that appear to change frequently. They may be known as “rebirthing therapy,” “compression holding therapy,” “corrective attachment therapy,” “the Evergreen model,” “holding time,” or “rage-reduction therapy” (Cline, 1991; Lien, 2004; Levy & Orlans, 1998; Welch, 1988). Popularly, on the Internet, among foster or adoptive parents, and to case workers, they are simply known as “attachment therapy,” although these controversial therapies certainly do not represent the practices of all professionals using attachment concepts as a basis for their interventions." p83 Chaffin et al also state, "encouraging children to regress to infant status" as a feature of these therapies and as a technique to be avoided. p83

Speltz (2002) in a paper published in the APSAC newsletter APSAC Advisor and describe ‘corrective attachment therapy’ as follows: "… the holding therapies included in “corrective” attachment therapy do not address safety needs. They differ in that a therapist or parent initiates the holding process for the purpose of provoking strong, negative emotions in the child (e.g., fear, anger), and the child’s release is typically contingent upon his or her compliance with the therapist’s clinical agenda." p4.

Prior and Glaser (2006) describe ‘Attachment therapy’ as a variety of treatments offered to desperate carers of troubled, maltreated children which often include variants of holding, eg holding time (Welch 1998), therapeutic holding (Howe and Fearnley 2003), rage reduction therapy (Cline 1991) and rebirthing. They state, "There are many ways in which holding therapy/attachment therapy contradicts Bowlby's attachment theory, not least attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity. Moreover, Bowlby (1988)explicitly rejected the notion of regression, which is key to the holding therapy approach: '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." p265.

The advocacy group Advocates for Children in Therapy define, "Attachment Therapy (AT).. as …a growing, underground movement for the treatment of children who pose disciplinary problems to their parents or caregivers. AT practitioners allege that the root cause of the children’s misbehavior is a failure to 'attach' to their caregivers. The purported correction by AT is — literally — 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." They state "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 group identify rebirthing as a form of Attachment therapy.

History and underlying principles Speltz (2002) states that the roots of "Attachment Therapy" are traced to Robert Zaslow in the 1970’s. Zaslow attempted to force attachment in those suffering from autism by creating pain and rage whilst enforcing eye contact. He believed that holding someone against their will would lead to a breakdown in their defence mechanism’s making them more receptive to others. Speltz point’s out that these ideas have been dispelled by research into autism and that, conversely, techniques based on behavioural principles have proved effective.

According to Prior and Glaser (2006) "there is no empirical evidence to support Zaslows theory. The concept of suppressed rage has, nevertheless, continued to be a central focus explaining the children’s behaviour (Cline 1991)." p263.

Chaffin et al describe the underlying principles of Attachment Therapy as follows; “In contrast to traditional attachment theory, the theory of attachment described by controversial attachment therapies is that young children who experience adversity (including maltreatment, loss, separations, adoption, frequent changes in child care, colic or even frequent ear infections) become enraged at a very deep and primitive level. As a result, these children are conjectured to lack an ability to attach or to be genuinely affectionate to others. 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. The children are described as failing to develop a conscience and as not trusting others. They are said to seek control rather than closeness, resist the authority of caregivers, and engage in endless power struggles. From this perspective, children described as having attachment problems are seen as highly manipulative in their social relations and actively trying to avoid true attachments while simultaneously striving to control adults and others around them through manipulation and superficial sociability. Children described as having attachment problems are alleged by proponents of the controversial therapies to be at risk for becoming psychopaths who will go on to engage in very serious delinquent, criminal, and antisocial behaviors if left untreated." p 78

Prior and Glaser cite the one published study which "purports to be an evaluation of holding therapy" by Myeroff et al (1999). This study covers the "across the lap" approach, described as "not restraint" by Howe and Fearnley (2003) but "being held whilst unable to gain release." Prior and Glaser also state, "There are many ways in which holding therapy/attachment therapy contradicts Bowlby's attachment theory, not least attachment theory's fundamental and evidence-based statement that security is promoted by sensitivity. 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." p265. DPeterson 00:30, 3 May 2007 (UTC)

Comments on Consensus Version for Paragraphs 1-3

1. GREAT! Ready to be added for all the reasons cited previously. RalphLender 13:30, 3 May 2007 (UTC)
2. OK We're never going to agree on every last little bit but this is a huge improvement on the existing article. Lets stick it in. Any further additions can still be discussed at leisure. we don't have to agree evry last line before putting bits that are agreed into the article. Who knows, a whole bunch of people we've never heard will probably come along in a few weeks and redo the whole thing again! Fainites 17:38, 4 May 2007 (UTC)
3. Good so far...but let's not be hastie...let's be sure to give other editors an opportunity to express their views. I agree with Fainities here. Overall, this is ok, even if I don't agree with every comma and line....Let's keep this moving along. The article does need work and this is a good step forward. DPeterson 22:07, 4 May 2007 (UTC)
4. I like it it's fine to go in as it is now. JohnsonRon 20:13, 5 May 2007 (UTC)
5. OK for all the reasons above. JonesRD_talk 14:48, 6 May 2007 (UTC)
6. 'Yes' flows well, is coherent, reads well, and is focued. SamDavidson 22:30, 6 May 2007 (UTC)

PROPOSED: Treatment characteristics Fourth Section

Attachment theory holds that caregiver qualities such as environmental stability, parental sensitivity, and responsiveness to children’s physical and emotional needs, consistency, and a safe and predictable environment support the development of healthy attachment. From this perspective, improving these positive caretaker and environmental qualities is the key to improving attachment. From the traditional attachment theory viewpoint, therapy for children who are maltreated and described as having attachment problems emphasizes providing a stable environment and taking a calm, sensitive, nonintrusive, nonthreatening, patient, predictable, and nurturing approach toward children (Haugaard, 2004a; Nichols, Lacher,&May, 2004). (Chaffin et al). Prior and Glaser (2006) describe evidence based treatments, all of which revolve around enhancing caregiver sensitivity, or change of caregiver if that is not possible. Based on meta-analyses by Bakermans-Krananburg et al (2003) covering 70 published studies for assessing sensitivity, 81 studies on sensitivity and 29 on attachment security and many further randomised intervention studies involving over 7,000 families, among the methods singled out to have shown good results were 'Watch, wait and wonder' (Cohen et al 1999), manipulation of sensitive responsiveness, (van den Boom 1994 and 1995), modified 'Interaction Guidance' (Benoit et al 2001), 'Preschool Parent Psychotherapy', (Toth et al (2002) and 'Circle of Security' (Marvin et al 2002). Treatment and prevention programs that use methods congruent with attachment theory and with well established principles of child development (American Academy of Child and Adolescent Psychiatry) include: Alicia Lieberman (Parent-child Psychotherapy) (Lieberman & Pawl in Infant Mental Health, 1993 )(Lieberman 2003), Stanley Greenspan (Floor Time), Daniel Hughes (Dyadic Developmental Psychotherapy) (Becker-Weidman & Shell, 2005) (Hughes, 2003), Mary Dozier (autonomous states of mind), Robert Marvin (Circle of Security) (Marvin & Whelan 2003), Phyllis Jernberg (Theraplay), Daniel Schechter (Clinician Assisted Videofeedback Exposure Sessions) (Schechter, 2003), and Joy Osofsky (Safe Start Initiative) (in Infant Mental Health, 1993.

According to O’Connor and Zeanah (2003 p235) "The holding approach would be viewed as intrusive and therefore non-sensitive and counter therapeutic". Chaffin et al (2006) describe how the conceptual focus of these treatments is the childs individual internal pathology and past caregivers rather than current parent-child relationships or current environment, to the extent that if the child is well behaved outside the home this is seen as manipulative. It was noted that this perspective has its attractions because it relieves the caregivers of responsibility to change aspects of their own behavior and aspirations. Proponents of the controversial therapies emphasize the child’s resistance to attachment and the need to break down the child’s resistance. Often parents are required to follow programmes 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 (Thomas, 2001). Also requiring children to submit totally to adult control over all their needs and barring children’s access to normal social relationships outside the primary parent or caretaker.

The APSAC report does not describe "Attachment Therapy", it uses the term "attachment therapy" (no caps or quotation marks). They state, “The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions." Pg 77 (Furthermore, what seems to be focus of this proposed page only addresses a very narrow area,) “Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists.” Pg 76 (Attachment therapy is better discussed in context, especially if the focus is on “a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners” pg 77. The controversy is a narrow one and should be placed in context so that readers understand the full range of issues.) “ The attachment therapy controversy has centered most broadly on the use of what is known as “holding therapy” (Welch, 1988) and coercive, restraining, or aversive procedures such as 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 children’s access to normal social relationships outside the primary parent or caretaker, encouraging children to regress to infant status, reparenting, attachment parenting, or techniques designed to provoke cathartic emotional discharge” pg 83.

ACT’s site contains descriptions of Attachment Therapy, including a link to the transcript of the rebirthing process that lead to the death by suffocation of Candace Newmaker at the hands of her unlicensed ‘therapists’. According to ACT "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."

DPeterson 00:39, 3 May 2007 (UTC)

COMMENTS ON PROPOSED FOURTH SECTION: TREATMENT CHARACTERISTICS SECTION

1. _Yes As is it is just fine...let's keeping moving on. RalphLender 13:31, 3 May 2007 (UTC)
2. The first bits OK except for the list of therapies. This passage is about the treatment characteristics of the AT therapies. We don't need to list other therapies that aren't AT or that claim not to be AT. We only need to quote Chaffin and Glaser on the salient feature of proper therapy, ie carer sensitivity. If we try and devise a list of 'good' therapies we'll just get into a pickle about what to include and what to leave out, and it isn't necessary anyway. I think its confusing. People might read it quickly and come away just remembering 'rebirthing', 'dead children' and 'Circle of Security' if you see what I mean. We could instead provide a link if there's an article on this. How about to 'Attachment theory' ? I don't understand the inclusion of the third paragraph at all. We've already dealt with the lack of precise definition and why that is the case earlier and I don't see what the stuff about capital letters has to do with 'treatment characteristics'. A whole chunk of it is also already in para.2. I think we should keep treatment characteristics precise and identifiable.Fainites 17:45, 4 May 2007 (UTC)
3. Good Since C&G list therapies, we should list these too...Alternatively we can mention none. I think the omission of treatments "damns" them by ommission, and so the listing with the citations to support their inclusion is fine. It's only one long line, so let's let it go. The third para describes treatment characteristics. The lack of defination continues ot make it difficutl to described "treatment characteristics, and so the additional different material is relevant. Without a clear defination of what this thing is, it is difficult to define treatment characteristics. I think as it is written is salient. DPeterson 22:10, 4 May 2007 (UTC)

Actually the only bit in para.3 that's about treatment characteristics is the bit about holding therapy. The rest is partly a repeat from earlier in the proposed article which doesn't need repeating, but if you look carefully DPeterson you'll see that you've included bits and pieces of various commentaries from earlier parts of the talkpage. Ralph's missed this aswell. In relation to the 'list', I'm sorry I wasn't being clear. I meant no list at all, not from Chaffin or Glaser. Just the bits where they describe what proper therapy is so I think we can agree on that Fainites 23:09, 4 May 2007 (UTC)

Gee, I see all in this section as a description of the characteristics of the treatment called Attachment Therapy. How is this material a repeat of what is in sections 1-3 above? I don't see the same quotes or lines in both. Again, since this is such a vague term, some overlap will occur, but I don't see it as substntial.DPeterson 00:51, 5 May 2007 (UTC)

Are you suggesting no treatments or therapies be listed at all? DPeterson 00:51, 5 May 2007 (UTC)

So, the following would be deleted:

Based on meta-analyses by Bakermans-Krananburg et al (2003) covering 70 published studies for assessing sensitivity, 81 studies on sensitivity and 29 on attachment security and many further randomised intervention studies involving over 7,000 families, among the methods singled out to have shown good results were 'Watch, wait and wonder' (Cohen et al 1999), manipulation of sensitive responsiveness, (van den Boom 1994 and 1995), modified 'Interaction Guidance' (Benoit et al 2001), 'Preschool Parent Psychotherapy', (Toth et al (2002) and 'Circle of Security' (Marvin et al 2002). Treatment and prevention programs that use methods congruent with attachment theory and with well established principles of child development (American Academy of Child and Adolescent Psychiatry) include: Alicia Lieberman (Parent-child Psychotherapy) (Lieberman & Pawl in Infant Mental Health, 1993 )(Lieberman 2003), Stanley Greenspan (Floor Time), Daniel Hughes (Dyadic Developmental Psychotherapy) (Becker-Weidman & Shell, 2005) (Hughes, 2003), Mary Dozier (autonomous states of mind), Robert Marvin (Circle of Security) (Marvin & Whelan 2003), Phyllis Jernberg (Theraplay), Daniel Schechter (Clinician Assisted Videofeedback Exposure Sessions) (Schechter, 2003), and Joy Osofsky (Safe Start Initiative) (in Infant Mental Health, 1993.

???DPeterson 00:52, 5 May 2007 (UTC)

Yes. For now it is enough to to quote what Chaffin, Glaser etc. say about the characteristics of non-AT therapy if you see what I mean. Fainites 13:50, 5 May 2007 (UTC)

On the other point " Furthermore, what seems to be focus of this proposed page only addresses a very narrow area" and " Attachment therapy is better discussed in context, especially if the focus is on “a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners” pg 77. The controversy is a narrow one and should be placed in context so that readers understand the full range of issues." are bits of talk page commentary! Fainites 13:51, 5 May 2007 (UTC)

I think the paragraph should list the various therapies that are not coercive...or list none. RalphLender 14:47, 5 May 2007 (UTC)

So, if the first paragraph was only: 'Attachment theory holds that caregiver qualities such as environmental stability, parental sensitivity, and responsiveness to children’s physical and emotional needs, consistency, and a safe and predictable environment support the development of healthy attachment. From this perspective, improving these positive caretaker and environmental qualities is the key to improving attachment. From the traditional attachment theory viewpoint, therapy for children who are maltreated and described as having attachment problems emphasizes providing a stable environment and taking a calm, sensitive, nonintrusive, nonthreatening, patient, predictable, and nurturing approach toward children (Haugaard, 2004a; Nichols, Lacher,&May, 2004). (Chaffin et al). Prior and Glaser (2006) describe evidence based treatments, all of which revolve around enhancing caregiver sensitivity, or change of caregiver if that is not possible.' I'd consider that. RalphLender 14:49, 5 May 2007 (UTC)

'4.' 'I like it as is' As written it is fine. I prefer the listing of therapies so that no mistakes are made in assuming a trt is or isn't attachment therapy as defined in this article. But, if most want this without a listing, I could go for that. JohnsonRon 20:15, 5 May 2007 (UTC)

I'd agree with Ralphs on this one. Lets stick with the broad definition of what proper therapies should be in contrast to what AT is and leave it at that. Its simple, taken from good sources, uncontroversial and easily understood. And lets keep the stuff about the lability of the definition in the definition paragraph. Fainites 20:22, 5 May 2007 (UTC)

It's ok to leave out all therapies, not my preference, but acceptable. I also think the last two paragraphs can and should stay...so that would that be an acceptable compromise for you? In the interests of building consensus, since most editors, so far, are accepting the leaving out of the listing of therapies and the inclusion of the last two paragraphs, I can go along with that; in the spirit of collaboration. DPeterson 21:14, 5 May 2007 (UTC)

I'm sorry DP? Are you seriously saying you want to keep odd ungrammatical remarks from the talkpage accidently included in paragraph 3, in the article? I'm all in favour of compromise but compromise is usually about the substance of the content, not accidental edits! Have you read it? Fainites 09:37, 6 May 2007 (UTC)

My lack of clarity, sorry. I put what I think are the comments in () and those ought not be included. Is this better? If I missed something, just note that, and use the same format to mark it, ok? DPeterson 13:34, 6 May 2007 (UTC)

OK. I still think the stuff about definition is unecessary here but I can live with it :) Fainites 22:08, 6 May 2007 (UTC)

5. 'GOOD' Just as it is above, but with the lines redacted () as DP notes in the comment just previous to this one. JonesRD_talk 14:50, 6 May 2007 (UTC) 6 Yes I agree that the section can go in the marked items deleted. SamDavidson 22:29, 6 May 2007 (UTC)

Actually, looking at it again, apart from the line about capital letters (which I thought we had agreed to abandon earlier) the rest of para 3 of this section is a word for word repeat of a chunk of the definition section. Fainites 17:46, 7 May 2007 (UTC)

Also, looking at Chaffin, they use capitals in the title. They're plainly talking about the same subset of therapies/phenomenon as ACT or indeed anybody else. Can we just agree to get rid of all this weird stuff about capital letters please? See Ralphs comment on this above where he wrote a(A)ttachment t(T)herapy to illustrate the point. Fainites 21:19, 7 May 2007 (UTC)