Holding therapy

To understand why more than three decades ago a behavior correction method, holding therapy, appeared in child psychotherapy, it is worth recalling: autism spectrum disorders are a serious pathology that first appears in early childhood.

And people who had early childhood autism or Kanner syndrome have major problems with speech, imagination and social connections throughout their lives: they do not establish close relationships with other people, preferring to remain in their “inner space”.

Holding therapy for autism in children is aimed at solving the problem of alienation and lack of contact in this condition.

Advantages and Disadvantages of Holding Therapy

The unconditional advantages of holding therapy are that it can stabilize some reflex reactions of the central nervous system of children suffering from autism, positively influence the development of the child’s speech skills, expand the range of his emotional perception and correct changes in behavior.

On the other hand, the disadvantages of holding therapy noted by experts include excessive stress on the child's psyche. After all, autistic children initially suffer from unwanted touching and eye-to-eye contact, and their increased level of negative experiences can cause irreversible changes in behavior and worsen mental retardation.

In addition, opponents of this method claim that holding therapy, by violating the child's personal space, creates confusion in children's ideas about the rules of safe touching and contact with other people. There have also been cases where children have suffered serious injuries during this treatment.

Moreover, holding therapy in the US and UK has been compromised by so-called attachment therapy, which began to be practiced in the 1990s for so-called reactive attachment disorder, especially in adopted children. Foster Kline and his colleagues at the Evergreen Psychotherapy Center in Colorado and a number of other American clinics have succeeded in promoting this method.

There, children (and younger adolescents) were physically restrained in a prone position (sometimes tied up with two medics standing next to them), demanding that they look into the eyes of one of the medics and provoking a fit of rage. And when the helpless child gave in, quieted down and complied with the demand, they were calmly and thoroughly explained that “his parents love him, and he must respond to them with obedience and love.”

As it turned out later, according to the “treatment protocol,” if a child refused to comply, he or she could be detained in the clinic or forcibly given to another family for a while. Reactive attachment disorder in children in Great Britain was “treated” in the same way.

Although Reactive Attachment Disorder is included in the ICD-10 (and has the code F94.1), according to the American Academy of Child and Adolescent Psychiatry (AACAP), the question of whether attachment disorder can be reliably diagnosed in older children remains open. And thanks to the efforts of the American Professional Society Against Cruelty to Children (APSAC), after a number of court cases related to the tragic consequences of attachment therapy, in 2007 this method was placed on the list of procedures potentially dangerous for children.

Indications

Autism in children is the main diagnosis for which treatment is applied by holding the child in the mother's arms or, in American terminology, holding therapy.

The author of this applied psychotherapeutic method is considered to be child psychiatrist, professor of Columbia University (USA) Martha Grace Welch. In 1975-1997, while still a practicing child neuropsychiatrist, Dr. Welch specialized in the treatment of emotional, behavioral and mental disorders, including autism. Then she began to use the method of contact rapprochement of an autistic child with his closest people, primarily his mother. Her practice was based on the attachment theory of John Bowlby formulated by him in the 1930s, as well as on the theory of ethologist Nikolas Tinbergen, who later (in 1983) wrote the book "Autistic children: New hope for a cure". Both researchers saw the causes of autism in the insufficient connection between mother and child.

In 1988, Welch's book about this method, Holding Time, was published, which was reprinted twice in English over the course of five years and was translated into German, Italian, Finnish and Japanese. The subtitle of the book was: "how to eliminate conflicts, tantrums and rivalries and raise happy, loving and successful children." Incidentally, it so happened that in the same year, the film Rain Man, which won four Oscars, was released, in which Dustin Hoffman brilliantly played an autistic adult...

As one of the behavioral methods, holding therapy is aimed at correcting the behavior of autistic children and such symptoms of this disorder as disruption of the child's emotional ties with parents, avoidance of close contacts, including visual ones. Overcoming the alienation of a child "with special needs" is extremely important for developing a sense of safety and security, without which proper emotional development in childhood and adequate socialization in the future are impossible.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

The treatment protocol

The developed technique of conducting daily sessions of holding therapy, each of which lasts about an hour and a half, includes certain, consistently implemented actions. All of them have one goal - through stress and subsequent relaxation to destroy the psycho-emotional "barrier" between the child and the parents.

Without proper preliminary preparation of parents, holding therapy is doomed to failure, since all autistic children resist physical contact and usually begin to resist, break free and scream. Therefore, a child neuropsychiatrist should give parents instructions on their behavior during sessions, tell them how to properly establish contact with the child and build relationships after their completion.

First, the mother should take the child in her arms, hug him and hold him close to her and - despite the child's desperate attempts to free herself from the hug - calm him down with tender words, telling him how much she loves the baby and how much he means to her. As psychiatrists note, the main task is to hold the child until he relaxes, that is, stops feeling afraid, calms down and cuddles up to the mother. During the sessions, the child's father should help the mother and support her morally, as well as calm the child (with quiet words and tender touches).

As therapy progresses (after several sessions), the mother should teach the child to look at her, and directly in the eyes. During eye contact, it is recommended to talk to the child, recite nursery rhymes, and sing songs.

According to experts, most children with autism spectrum disorders get used to such actions quite quickly. And holding therapy can be used by parents at any time and regardless of the circumstances - when their child feels anxious, confused or afraid (that is, you need to pick up the baby, hug him and calm him down).