Boundaries · 1970
Coercive Attachment Therapy / Holding Therapy
The bond was to be produced through confrontation, restraint and the breaking down of the defences of a child construed as resistant to attachment.
Coercive Attachment Therapy, also known as Holding Therapy, coercive restraint therapy, rage-reduction therapy, corrective attachment therapy or the Evergreen model, designates a set of historical practices directed above all at adopted, fostered or institutionalised children to whom a broadly defined attachment disorder was attributed, frequently formulated well beyond the strict diagnostic categories. Its central premise held that certain children rejected the bond, manipulated their environment, avoided emotional contact or harboured a deep rage derived from early experiences of abandonment, neglect or abuse. On that logic, the intervention sought to force a corrective relational experience through imposed physical contact, bodily restraint, demanded eye contact, emotional confrontation, the provocation of rage, symbolic regression, submission to adult authority and a subsequent affective surrender towards the caregiver. Its historical development is associated with the line running from Robert Zaslow and his Z-process, the clinical milieu of Foster Cline in Evergreen, Colorado, and formulations such as Martha Welch's Holding Time. In its most coercive variants, the model became tied to intensive, aversive and physically restrictive practices that were the object of wide professional condemnation for their lack of a sound empirical basis, their distortion of attachment theory and their clinical, ethical and physical risks, especially with vulnerable minors.
Theory of change
Change is conceived as the breaking of defences against the bond and the emotional acceptance of the caregiver's authority through confrontation, restraint and induced relational dependence.
Core ideas
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The central problem is formulated as resistance to attachment
Coercive Attachment Therapy holds that many children with histories of abandonment, neglect, institutionalisation or early adoption present a deep resistance to receiving care and to establishing affective dependence on their caregivers. Behaviours such as opposition, coldness, lying, gaze avoidance or rejection of contact are interpreted as defences against the bond, sustained by fear, early rage or a need for control. On this logic, treatment is aimed at breaking through that resistance so that the child can accept a relational position as a cared-for and dependent son or daughter. (Cline, 1992; Chaffin et al., 2006).
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Attachment is conceived as an active acceptance of parental care
The model translates attachment into an observable willingness to accept proximity, authority, protection, emotional contact and adult direction. The therapeutic and family relationship is organised around the idea that the child needs to stop controlling the bond in order to be able to receive care. Progress is therefore formulated in terms of greater dependence on the caregiver, willingness to be held, eye contact, relational obedience and explicit acceptance of belonging to the family. (Cline, 1992; Welch, 1988).
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Early rage blocks the possibility of forming a bond
A central doctrinal idea is that the child retains a deep rage derived from early experiences of abandonment, abuse, separation or neglect. That rage is held to be encapsulated beneath behaviours of control, defiance or affective disconnection, preventing emotional surrender to the present caregiver. The therapy attempts to activate and express that rage so that the defensive system loses its force and a more primary need for care, comfort and belonging can emerge. (Zaslow & Menta, 1975; Cline, 1992).
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The child's principal defence is relational control
The model interprets many problematic behaviours as forms of relational control: manipulating, dividing the adults, lying, refusing help, avoiding the gaze, defying instructions or remaining emotionally inaccessible. That control is understood as a learned defence against depending on anyone and against further experiences of abandonment or vulnerability. The intervention seeks to reverse this position, restoring the caregiver's authority and placing the child in a structured relationship of dependence. (Cline, 1992; Speltz, 2002).
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Confrontation seeks to break through the defences of the bond
Confrontation occupies a central place because the model holds that the child's defences do not yield to explanation, gentle persuasion or ordinary support. The therapist confronts control, lying, avoidance and resistance in order to bring the child to a point of more direct emotional contact. This confrontation is understood as a means of breaking through the defensive organisation and opening up an experience of vulnerability, dependence and acceptance of the caregiver. (Cline, 1992; Mercer, Sarner & Rosa, 2003).
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Holding functions as a device for remaining within the bond
Holding is conceived as a way of preventing the child from escaping the scene of the bond, physically or emotionally. By sustaining contact, proximity and adult presence, the procedure aims to keep the child within a relationship that activates fear, rage or rejection until those defences turn into crying, exhaustion, need or acceptance. On this logic, being held by the adult symbolises the impossibility of continuing to avoid the bond. (Welch, 1988; Cline, 1992).
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Reparenting attempts to create a corrective experience of dependence
Coercive Attachment Therapy holds that some children need to relive early forms of care in order to repair original failures in the attachment relationship. It therefore uses scenes of feeding, rocking, physical contact, comfort, symbolic dependence and acceptance of the caregiver as a parental figure. These experiences seek to reorganise the child's position: from defensive self-sufficiency and control to the reception of care, family belonging and emotional dependence on the adult. (Welch, 1988; Cline, 1992).
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The family is reorganised through clear parental authority
The model gives a central place to the family hierarchy. It holds that a child with severe attachment problems may have occupied a position of control over the family system through defiance, manipulation or affective resistance. The intervention seeks to return the caregivers to a position of firm authority, to reduce negotiation, to establish strict limits and to create an everyday structure in which the adult directs and the child receives care, rules and protection. (Cline, 1992; Speltz, 2002).
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Obedience is interpreted as a sign of trust within the bond
Within this tradition, obedience is understood not merely as behavioural compliance but as a sign that the child is beginning to trust the adult and to abandon defensive control. Accepting instructions, asking permission, receiving help or following limits is interpreted as a reorganisation of the attachment relationship: the child ceases to position themselves as self-sufficient or dominant and accepts the caregiver as a protective and regulating figure. (Cline, 1992; Speltz, 2002).
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Affective closure consolidates the sequence of rupture and repair
The model's ideal therapeutic sequence culminates in a scene of affectionate contact following confrontation, emotional discharge or holding. Having gone through rage, resistance or control, the child receives care, an embrace, parental affirmation or a promise of belonging. This structure dramatises a logic of rupture and repair: first the defence that blocks the bond is broken, and then an experience of acceptance by the caregiver is offered. (Welch, 1988; Cline, 1992).
Influences
- Attachment theory
- Cathartic/abreactive therapies
- Popularised psychoanalysis of ego defences
- Models of parental behavioural control
- The attachment treatment movement in adoption and fostering
- Regressive and reparenting therapies
Key references
- Chaffin, M., Hanson, R., Saunders, B. E., Nichols, T., Barnett, D., Zeanah, C., Berliner, L., Egeland, B., Newman, E., Lyon, T., LeTourneau, E., & Miller-Perrin, C. (2006). Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems. Child Maltreatment, 11(1), 76–89.
- Cline, F. W. (1992). Hope for High Risk and Rage Filled Children. EC Publications.
- Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment Therapy on Trial: The Torture and Death of Candace Newmaker. Praeger.
- Mercer, J. (2005). Coercive Restraint Therapies: A Dangerous Alternative Mental Health Intervention. The Scientific Review of Mental Health Practice, 4(1), 46–58.
- Speltz, M. L. (2002). Description, History, and Critique of Corrective Attachment Therapy. APSAC Advisor, 14(3), 4–8.
- Welch, M. G. (1988). Holding Time. Simon & Schuster.
- Zaslow, R. W., & Menta, M. (1975). The Psychology of the Z-Process. Z-Process Publications.