Holding Therapy Essay
Holding Therapy What is Holding Therapy? Holding therapy was developed by Dr.
Martha Welch in the late 1970s. Dr. Welch was a psychiatrist in New York who began using it with children with autism. Later, she outlined her form of therapy in a book titled, Holding Time (Welch, 1988). Originally, Dr. Welch discovered holding therapy with autistic children.
Later, however, she began using this therapy with typical children as well and, in her opinion, discovered equally satisfying results. Welch currently refers to her therapy as Regulatory Bonding Therapy.Holding therapy is a technique that requires the mother of a child with autism to hold her child for a period of time, even if the child is resisting. The mother holds on to the child until the child accepts contact.
Once acceptance is reached, the mother may start to place demands on the child before he or she is released. For example, eye contact may be demanded. Welch suggests that a soft couch or mat is the best place to carry out therapy as there will “usually be a violent physical resistance by the child” (Tinbergen & Tinbergen, 1983, p 325). Below, she outlines some of the practical details of therapy:The mother is asked to hold the child on her lap, face to face. The father is asked to sit beside and put his arm around the mother. The child sits astraddle the mother with knees bent, one on each side of the mother.
The mother places the child’s arms around her and secures them under her arms. She then is free to hold the child’s head with her hands in order to make eye contact. This position is not necessarily comfortable for either person (Tinbergen & Tinbergen, 1983, p 325). During holding therapy, the therapist acts as an observer and a facilitator.
The therapist plays no physical role in the therapy session.Instead, he or she facilitates the “bonding” between mother and child. The therapist confronts the parents about their feelings and encourages the mother to hold tightly and securely. The mother is encouraged to examine her feelings and try to resolve them. Also, it is appropriate to work on conflicts between the two marriage partners and between the father and child during the therapy. Below, are the therapist’s six primary responsibilities, according to Welch (Tinbergen & Tinbergen, 1983): 1. To encourage, exhort or impel the mother to hold the child despite her child’s resistance or her own reservations or inhibitions. .
To observe and translate the signals the mother and child give, but which each fails to understand. 3. To analyze and interpret the conflicts, first between mother and child, and then between mother and the other important family members. 4. To tolerate the rage and depression the mother and child experience without withdrawing, thus providing an important role model. 5. To engage the father’s help. The mother and father must hold each other.
The father at times holds the mother while she holds the child. He must learn to hold the child himself. He must hold the other children while the mother holds the autistic child. . To work through the mother’s problems in relating, particularly with her own mother and with her husband.
In addition to holding during therapy times, the parents must be committed to having holding sessions at home. Welch suggests that the mother must hold the child at least once a day and whenever the child seems to be feeling distress. The holding sessions should typically last for one hour.
The Theory Behind Holding Therapy It is not surprising that holding therapy is rooted firmly in the belief that autism is created by a lack of bonding between mother and child.Martha Welch firmly believed that the mother-child relationship was at the heart of autism. She believed that mothers lacked normal instincts toward their children with autism and that these instincts could be developed through therapy. She said that the mother’s inability to relate to the child in a normal fashion was a result of the years of rejection she had experienced from this child. Therefore, therapy is beneficial to both mother and child. It provides much needed positive reinforcement for the mother so that she can overcome her aversion to the child.
For the child, it provides the much needed love and attention that is required for normal development. Supporting Research Welch originally supported her idea based on a collection of case studies. She did not use any empirical evidence to support holding therapy. In Tinenberg & Tinenberg (1983), she discusses six case studies, involving children who have made successful recoveries from autism through holding therapy.
She asserts that “the cases of autism suited and treated by this author demonstrate that it is possible to restore an autistic child to normal development” (p. 34). Despite an extensive search of professional journals, I was unable to find any empirical evidence to support holding therapy. Similar to Welch, most authors discussed case studies and anecdotal evidence of the merits of this therapy (Luvaas, www.
geocities. com/luznmymind2/autism2. html). Perhaps one of the most interesting and recent discussions of holding therapy has been taking place in Utah. Larry VanBloem, Director of the Cascade Center in Utah, has been at the center of a legal case involving the death of a four year old girl in 2002.The Cascade Center in Orem, Utah provides psychotherapy for a wide range of children, including children with autism.
Among their various therapies, they still use holding therapy for children who “are detached, incapable of expressing love and affection and oftentimes violent” (VanBloem) Media and legal attention was directed at the Cascade Center, when a four year old girl, Cassandra Killpack, died of water intoxication. Her parents report that she was forced to drink a lot of water as a punishment for taking a soft drink without permission.They claim that the Cascade Center gave them this discipline advice as part of their holding therapy program. The Cascade Center vehemently denies that such advice was given. However, as a result, the practices of holding therapy have come under considerable scrutiny and may be outlawed in Utah legislature (Hunt, Herrick & Hyde).
On the Cascade Center website, VanBloem states that holding therapy is supported by research. However, he does not cite any of this research and later claims that “the best proof of the effectiveness of holding therapy is the people who show up at town meetings to defend it” (Hunt).Again, anecdotal evidence seems to be the best evidence cited for this form of therapy. Evidence Against the Effectiveness of Holding Therapy Perhaps the best evidence against holding therapy is in the very basic presumptions about the aetiology of autism itself. If holding therapy is rooted in the belief that the mother-child relationship is dysfunctional, then current knowledge about the aetiology of autism has understandably brought the effectiveness of holding therapy into question.
Again, the lack of rigorous research on this topic does not provide evidence of its effectiveness but also does not provide solid evidence on which to dispute it. As a result, most conclusions about the therapy rest on its assumption that autism is caused by poor mother-chid bonding. It is this assertion that has been refuted by sound research and developments of our understanding of the neurological and biological basis of autism. Understandably, much time has been devoted to figuring out why some people suggest that holding therapy has been beneficial for their child with autism.
Although most would agree that its basic theory is faulty, there are still people who suggest that the therapy has been beneficial. Writers such as Zappella (1998) and Waterhouse (2000) have suggested that holding therapy may have been useful for a distinct group of children with autism. They have argued against the notion that mother-child relationships caused autism and have suggested that the opposite may have occurred. That is, autism could have adversely affected the mother-child relationship.
In some cases, holding therapy may have been slightly beneficial in the restoration of this relationship.However, holding therapy has generally been disregarded as the cure for autism that Welch once suggested it was. In addition, it could be harmful as outlined below. Is This Treatment Potentially Harmful? Many critics of holding therapy have discussed its potentially harmful side effects. In particular, many people with autism have spoken against holding therapy, stating that it could be detrimental to the self-esteem and emotional state of those being exposed to the therapy. Hunt suggests that holding therapy can be detrimental to children with autism because they receive mixed messages about touch.In society, we spend a lot of time educating children to resist unwanted touch. However, in holding therapy, we force them to endure this kind of touch and label it “love” and “therapy”.
Claire Sainsbury, a woman with Asperger’s syndrome, suggests that holding therapy is a form of abuse. She describes it as “sensory rape” that causes extreme distress and suffering to the child. Therese Joliffe, a woman with autism, writes the following about her experience with holding therapy: To me the suffering was terrible and achieved nothing.Some people who dislike this treatment argue that the children submit out of exhaustion. I think that this is true in many cases. A claim by proponents of this therapy is that the children are much quieter and better behaved for a little while afterwards. My quietness was due to exhaustion and to my being disturbed so much as a result of the experience that I was shocked into a state of terrified quietness, where I could not think of do anything much for a while (Joliffe in Hunt). It should be mentioned that some have confused holding therapy with Temple Grandin’s squeeze machine.
However, the premises of these two “therapies” are very different. Grandin is very clear that the squeeze machine is under the control of the person with autism and that they are never forced to use it, or to endure a certain amount of pressure (Grandin, 1995). Is Anyone Still Using Holding Therapy? Based on accounts from the Cascade Center mentioned previously, it appears that there are still some psychotherapists using classic holding therapy or some form of it. In addition to the Cascade Center, the Martha G.Welch Center for Family Treatment is still using holding therapy (now coined Regulatory Bonding Therapy). Generally speaking, holding therapy is uncommon and certainly not a mainstream approach to intervention for children with autism.
In my conversations with local parents of children with autism and my Internet search of Vancouver associations related to autism, there appears to be nobody using this therapy locally. However, if a parent sought treatment “advice” and ideas through the Internet, they would certainly find holding therapy among the many options! ResourcesBooks Grandin, Temple (1995). Thinking in Pictures and Other Reports from my Life with Autism. New York, USA: Doubleday Dell Publishing Group Inc. Tinbergen, N. ; Tinbergen, E. A.
(1983). ‘Autistic’ Children; New hope for a cure. London, England: George Allen ; Unwin Ltd. Waterhouse, Stella (2000). A Positive Approach to Autism. London, England: Jessica Kingsley Publishers. Welch, M. (1988).
Holding Time. London, England: Century Publishers. Journal Articles Welch, M.
G. (1988). Mother-child Holding Therapy and Autism.
Pennsylvania Medicine, 91(10), 33-38.Zappella, M. (1998). Holding Has Grown Old. European Child ; Adolescent Psychiatry, 7, 119-121. Websites Herrick, Ember (November 15, 2002).
www. newsnet. byu. edu/print/story.
cfm/40906 Compromise Reached on Holding Therapy Bill. Accessed: July 11, 2003 Hunt, Jan. www. naturalchild. com/jan_hunt/holding_therapy.
html The Dangers of Holding Therapy. Accessed: July 3, 2003. Hyde, Jesse. www. deseretnews. com/dn/view/o,1249,415015112,00. html Holding Therapy Defended; Families share success stories at meeting in Orem. Written: October 23, 2002.
Accessed: July 12, 2003.Luvaas, Tanha. www. playtherapycentral. com/hold. html What is Holding Time? Accessed: July 11, 2003. Sainsbury, Claire. www.
nas. org. uk/pubs/archive/hold. html Holding Therapy: an autistic perspective. Accessed: July 3, 2003. VanBloem, L. www. attach-bond.
com/ Cascade Center for Family Growth. Accessed: July 13, 2003. Welch, Martha. www. marthawelch. com Martha G. Welch Center for Family Treatment.
Accessed: July 10, 2003. www. geocities. com/luznmymind2/autism2.
html Treatment Options for Autism; Holding therapy. Accessed: July 13, 2003.