What? Shame?

The past twenty years have seen increased interest in the concept of shame and how shame affects the behavior of the human being. “Shame Theory” as seen by this author emerged as a result of the work of Silvan Tompkins in the mid-twentieth century followed by the work of Gershen Kaufman in the 1990’s. This work is now being carried forward by a number of theorists and authors, the most notable of which is Brené Brown.

 Basically, shame is seen as one of nine basic feelings that motivate human beings to act (Kaufman 1996). This theory differs from Freud’s “drive theory” which states that humans are motivated by basic internal drives. According to Kaufman, “shame is the most poignant of all feelings… unlike terror and distress, shame is a wound made from the inside that separates us from ourselves and others…a sickness of the soul.”

 Shame and affect theories afford practitioners the capability of developing healing strategies that are rooted in Cognitive Behavioral theory.

 What follows is a systematic presentation of how shame is originally revealed within human development, and how shame can become debilitating and unhealthy. This brief paper is an attempt to inform the reader as to how shame, which is natural and adaptive, can be turned into the most avoided feeling within the human condition.

 The material presented in the following paper is based in three major theories within the history of psychological study: Affect Theory (Tompkins and Kaufman); Developmental Theory (Erikson); and Object Relations Theory (Fairbairn, Klein, Winnincott, Mahler, and others). It is intended that this paper be written in simple, common sense language that will represent processes that are taken for granted by adult human beings with regard to developing children.

 Please note that throughout the descriptions of parent-child interactions, the word mother is used to denote the developing child’s most significant caretaker. This reference to mother is kept for two reasons: first, in the great preponderance of cases it is the actual mother to whom a child first attaches, and second, it is more convenient than using the term “primary caretaker.”

 Origins of Shame:

The feeling of shame is ubiquitous and universal; the manner in which shame affects an individual “evolves” within the context of each being’s developmental environment, and, thus, will be unique to each.

Shame, as it has come to be known (i.e., a deep painful experience of the self as flawed, bad and unworthy; see Gershen Kaufman, Brene´ Brown) has it origins in infancy. Kaufman claims that shame is present in the early life of infants (Kaufman, 1992), but it is the opinion of this writer that this is not likely. The neonatal infant has no cognitive capacity, and thus can perceive no meaning to external stimuli. Infants can certainly react to their environments, but they cannot intuit meaning, and thus cannot feel shame. The experience of the “feeling” of shame requires an understanding of failure.

How infancy sets the stage:

The infant’s emotional world is limited to reflexive, systemic reactions recognized by observers as either pleasure or pain. These states are manifest either by distress (anger and tears) or the opposite (peaceful repose or smiling).

D.W. Winnincott, a 20th Century Object Relations Analyst and theorist, put forth the idea that there is such a thing as a “good enough mother.” This notion implies that the mother (or primary caretaker) does a “good enough” job of supplying sustenance, shelter and safety to a child within an attitude of love, so as to promote satisfactory emotional growth. John Bowlby notes this in his volume, Attachment.  All ensuing theories of human development agree that a firm, healthy attachment to the mother (or mother substitute) is required for the formation of a psychologically healthy human being. Neurobiologist, Allan Schore (1994), revealed that the neurological structure of the brain is different in well-attached versus poorly-attached human beings. A notion that implies that early emotional damage leaves the child “hard-wired” to have future difficulty with mental illness, attachments and intimacy.

The essence of infancy and the notion of healthy attachment are grounded in the satisfaction of the infant’s needs. These needs are signaled to the mother by way of crying and angering. An infant will experience a need as pain, and reveal this pain by way of outward behavior (crying). The mother will assess the root of this pain and take steps to alleviate it. In the “good enough” mother-child system, this process cycles repeatedly throughout infancy.

If, it is accepted that the infant has no cognitive understanding or his or her situation, then it can be inferred that the infant, experiencing relief for the act of crying, will undergo a variation of operant conditioning. The process is as thus: the infant’s need gives rise to discomfort, discomfort gives rise to crying, crying alerts the mother, mother assesses and addresses the need, the child experiences relief; over time the child “learns” to reproduce the relief by way of crying. For the infant, however, the conditioning is simpler: in the “good enough” environment the child experiences pain, the child cries, the pain goes away. Thus, in the first months of life, the infant learns to trust that when he or she cries, relief will ensue. In simple terms, infants, as they mature, are trained to cry to get what they need, and later as toddlers, to get what they want.

Erik Erikson’s developmental theory posits that the emotional milestone of infancy will be resolved as either Trust or Mistrust. When the above process of needs’ gratification is repeated again and again in an attitude of love, Trust is learned. When not satisfactorily performed, Mistrust will exist in its place.  Mistrust will result in manifestations of various forms of dis-ease throughout the child’s development, and later throughout that his or her adult experience. Additionally, the presence of Mistrust over Trust will make it more likely for the developing child to internalize greater amounts shame in toddlerhood and beyond.

The toddler:

There is a simple observation that differentiates an infant from a toddler: an infant will throw food on the floor and look at the food; a toddler will throw food on the floor and look at the parent. This very simple distinction demonstrates the notion that the “mind” of an infant is internal and self-contained, while the mind of the toddler is one of emerging awareness of self in relationship to the world.

It is in toddlerhood that, according to Erikson, Shame will emerge as the antithesis to Autonomy (i.e., healthy sense of self). Since the time of Erikson’s formulation, this “fact” has been taught in nearly every developmental psychology course that has been offered. It is left to the imagination as to how much or how little emphasis instructors have placed upon the importance of such a simple statement, but in the experience of this author, the above “fact” was taught, memorized as a test item, and then forgotten. It was only later in middle adulthood that this “fact” was recognized as one of the most important concepts in understanding the human condition.

Erikson observed that children who develop a healthy sense of self (what he labeled “Autonomy”) exhibit good eye contact, independent play, smiling, and experimentation; while children who experience increased shame and self-doubt exhibit poor eye contact, lethargy, irritability, and lack of interest in healthy exploration.

It is the strongly held position of this writer that the feeling of shame first emerges in toddlerhood when the developing child obtains the ability to intuit that he or she has failed to achieve some goal. That goal can be anything from getting a piece of candy to being allowed to write on a wall. When the parent interferes with the desires of a child, the child will experience a feeling of frustration that will result in tears and anger (i.e., frustration).   It is posited that this feeling of frustration is the raw experience of the feeling of shame (i.e., the “bad feeling” associated with refutation…i.e., failure).

Simply stated, shame is the feeling (i.e., visceral response) that is experienced when a person (child or adult) perceives a failure to achieve some goal; in the case of the developing child, shame is experienced when the child is refused or refuted in pursuit of a desired object.

As was learned in infancy, the toddler child will cry in response to pain (except now in toddlerhoood it is the pain of refutation), at first because it hurts, in time to gain relief by way of gratification. Thus, crying is the manner in which a developing child copes with the feeling of raw shame. It is from this point forward that the child will learn that this feeling will be experienced either as a painful, yet natural response to refusals, or as the even more painful notion that the child is inherently flawed.

Three Basic Responses to Crying:

The crying child is bad:

One of the most noticeable parental responses to the crying toddler is the tendency for a parent to take coercive action to stop a child from crying. In these cases crying is seen as an undesirable behavior. The parent believes that the child must be stopped from crying in order for the parent to feel as though he or she is not a “bad” parent, and that he or she has a “good” child. These parents will publicly threaten, intimidate, scold, spank, and/or hit their crying children.   Many people, men and women alike (but certainly more so men), are familiar with the phrase “you keep crying, and I am going to give you something to cry about.” Phrases such as this had become part of our society’s lexicon through to the late twentieth century, and revealed, at least in part, our culture’s attitude about crying children. There appears to be movement away from this stance with modern parenting, but residual elements of this way of thinking remain.

These harsh responses to the crying child can be seen as a function of a parent’s own embarrassment (i.e., shame). The process will promote a lack of self worth within the developing child by way of the parent’s negative “projections” and the child’s subsequent “introjections” of the parent’s emotional messages. It can also be seen that these responses work to create a child who will have difficulty coping with the huge disparity between what is natural (i.e., crying as the emotional release of pain), and what is expected from the parent (i.e., to be a well behaved child).

Early manifestations of failures are not laden with the child’s notion that the child is flawed, but rather that crying and angering are natural responses to not getting one’s way. It is when the parent begins to assign some negative meaning to the child’s crying that he child will begin to internalize the parent’s attitude toward the crying child (and unconsciously, the feeling that produced the crying). Thus, the feeling of shame (the natural response to disappointment and failure) becomes associated with the notion that the child is “bad” (i.e., spoiled, being a big baby, a brat, or a sissy).

Very quickly, a toddler child can learn that there is something wrong within due to the simple act of crying. The child discovers that it is not a good idea to cry when he or she feels like crying, because punishment or belittlement will ensue. In order to avoid or minimize these insults, the child must stop, or not start, crying. It is believed that a toddler child can act only as well as he or she feels, and therefore, in order to not cry (and thereby avoid unpleasant parental or societal responses), the child must learn to stop feeling. This results in the suppression of feelings and internal buildup of natural emotion. Then, from that the formation of a character in which the more outgoing child will sporadically burst forth with anger (display brittle character), or the more inward child to sink into depression and despair (i.e., display decompensating character).

It should be remembered that only a few months earlier, this same child was gratified nearly every time he or she cried, and from this process the very necessary experience of Trust was learned. Yet, for many children (and their parents), the period of toddlerhood becomes a trying time in that the child has to break a habit of crying which was happily and graciously reinforced by the parent during infancy. This shift in the attitude of the parent (and society) toward the developing child is experienced as something akin to being a king for a year, and then, virtually over night, a servant.

What’s worse, this shift in attitude is experienced as a break in trust.

It is surprising that for all the love and good intentions held by so many mothers and fathers, there can be such a lack of empathy and understanding for a child going through this phase of development.   Many parents lose patience with their crying children only to see their children redouble their tendency to cry, and they, the parents, redouble their efforts to stop it.   The process of escalation between child and parent results in an emotional loss of the child’s experience of love from the parent, and yields a break in the trust that was acquired during the first year of life. This ultimately results in parents who unwittingly sacrifice the emotional health of their progeny in an effort to produce well behaved little children.

 It is bad for the child to be crying:

There is another situation that is often observed at the grocery store: parental indulgence of the crying child.  Crying is still seen as an undesirable behavior, but the parental response is in line with it is undesirable to experience the crying child.  This parent is also trying to avoid feelings of failure and embarrassment, but does so by giving-in to the child’s wants in order to quiet the child. These parents are usually of two types: the anxious/guilty parent who cannot tolerate seeing his or her child in pain, or the more self-centered parent who is concerned about image or gaining the child’s acceptance.

This method of quieting the crying child is highly effective in the moment, but severely damaging over the long-term in that the processes of infancy are perpetuated far longer than are considered healthy. The way these situations usually evolve is as such: the child will see something that he or she desires, the child will make some sort of overture to show the parent the desire, the parent will at first deny the child’s wish in that it is unnecessary, too costly, or simply not desirable or acceptable to the parent; the child will cry; the parent will insist; the child will get angry and cry more loudly; the parent will give in due to either internal fears or perceived social pressure.

The above dynamic results in children who develop a “fragile” character. They develop an internalized understanding that crying loudly enough will cause the world to yield to them. Eventually, these children often fail to adapt well to the demands of the world, and can grow to be manipulative, victim-oriented personalities. They learn to expect indulgence, and they seek and find people who will accommodate them throughout their lives, or at least until their world is fed up with them.

This style of parenting also results in a breaking of trust within the developing child. However, it is a more subtle for of trust-breaking.  Here the parent does not maintain his or her initial stance in relationship to a child, and the child experiences see the parent as untrustworthy in that the parent is not keeping his or her word, in spite of the fact that the child experiences the pleasure of being gratified. This process not only breaks trust with the child, but serves to give the child the idea that he or she has emotional power in the world; at first over parents, later over others. Additionally, many of these children fail to learn healthy respect for authority, because they have not been taught their place in relationship to adults in their world.

Too bad, the child is crying:

There is a middle ground between the two positions outlined above: the parent can be “okay” with the crying child. This parent sees crying as natural, and responds to the crying child in a neutral, disengaged, yet compassionate manner. This parent is not embarrassed by the child’s crying, and thus is neither indulgent, nor coercive, but rather accepting of the child’s struggle to cope with the disappointments of life. This parent has the ability to “hold the line” with the child, while being able to have empathy for that child’s struggle.

Sometime ago (more than 40 years) Readers Digest (volume unknown) published a story about a woman pushing a grocery cart through a store with a crying child in it. Throughout the woman’s time at the store she kept chanting: “calm down Jessica, calm down.” When the mother got to the checkout, an elderly woman who had been watching mother and her child said to the mother: “You know dear, I admire the way you’ve kept your patience with little Jessica.” After a pause and a sigh, the mom replied, “thank you, but I’m Jessica.”

There is a school of thought (Object Relations) that maintains it is imperative that the mother, or mother substitute, be able to contain both her own emotions and the emotions of her crying child, especially when that child is at his or her emotional worst. When a mother manages her toddler child’s actions against her (i.e., crying, angering, protesting, blaming and etc.) without retaliation, abandonment or indulgence, the child will eventually accept his or her situation, let go of the negative emotions, and reconnect with mother in a more positive manner (Slipp, 1990). On the other hand, when a mother (or other caretaker) responds to a crying child with aggression, rejection, or disdain, the mother becomes an undesirable object, and it is less likely the child will experience a desire to reconnect, and more likely that the child will go on to retaliate or exhibit increased bouts of negative behaviors.

Ongoing repetition of one or the other of the above processes will eventually lead to a child who will learn that he or she is loved and can thereby develop concern for others, or a child who internalizes anger, rejection and shame, and becomes ever more greatly self-absorbed.

This middle-ground style of parenting prepares the growing child to accept a world that will not change because of the child’s emotional state. The child will build on the trust that was acquired in infancy, and there will be far less chance of serious mental health issues later in life because rational and reasonable responses were provided in response to the child’s aggressive and disorderly actions in early childhood.

These children will have the greatest chance of developing a “tempered” character. One in which they will acquire the ability to regulate strong emotion rather than lean on aggression or sink into depression when confronted by life’s hardships.

In conclusion:

It can be seen from the above examination of the developmental process, that many human beings come in contact with the destructive familial and societal influences of shame very early in their lives. Shame, as described within this paper, is as natural as sadness, fear, excitement and joy. It is the root feeling of the experience of the human conscience. Because shame emerges so early in life, it resides at the very core of the human experience (Kaufman 1996). Yet, in spite of its ubiquitous presence, and its huge contribution to mental illness, it has remained in the shadows of the western human experience, and out of the foreground of rational, systematic examination.

What can be seen from the above analysis is this: the presence of shame, and the tendency to reinforce its presence by way of parental and societal reactions must be taken into greater consideration within western life, especially by treatment providers, teachers, doctors and clergy. It can be concluded that the lack of awareness of how shame works within the human being, has led to vast numbers of people taking psychotropic medications for mental illnesses, as well as huge numbers of men and women who populate our nation’s jails.

One solution to the dilemma presented by shame is relatively simple. The processes of human development need to be universally taught in our public school systems.   Simple understandings of human development could be taught in elementary schools by way of stories about character and caretaking. Human Developmental theory, Affect theory, Object Relations theory and Cognitive Behavioral theory should be taught as science on a quarterly basis beginning in the freshman year of high school, and continued throughout the high school experience.

There are those who claim that modern Americans are growing soft and preoccupied with technology. This may well be true, but every adult American will have at one time been an infant and a toddler, and every infant and toddler will soon be an adult American. It just makes good sense that teaching us what we are and how we get this way will have the effect of increasing the odds that more of our offspring will have a better chance at healthy adulthood, and healthier future generations.

Bibliography to be completed later.

Erikson, E.,

Kaufman, G., The Psychology of Shame: Theory and Treatment of Shame-Based Syndromes, Second Edition, Springer Publishing, NY, 1996

Kaufman, G., Shame: The Power of Caring, Schenkman Books Inc., NY, 1992
Mahler, M., et al, Psychological Birth of the Human Infant, Basic Books, 387 Park Avenue South, New York, New York, 1975

Slipp, S.,  Object Relations: A Dynamic Bridge Between Individual and Family Treatment, pp. 48-9

Exercise Restraint

Overview

Physical restraint is a necessary element to parenting that is often not employed, either because parents and practitioners are unaware of its value, or because they are afraid to use it.  Many people (parents and practitioners alike) hold to the notion that complete physical restraint is a form of abuse, and as such, it should be avoided.  What follows is a comprehensive description of the process of therapeutic physical restraint that will greatly improve the effectiveness of  parenting strong-willed-aggressive children in early development.

Introduction

Imagine being a parent of a four year child who has just disrespectfully called you an undesirable name.   You instruct the child to go to time-out, but he refuses, stating “you can’t make me.”  You insist, but the child remains adamant that he will not go to the time-out chair.  What to do?

Most all parents face this conundrum throughout the early years of their child’s development, and many come away from such occurrences with less than optimal results.  Often parents become angry or anxious, lose self-control, yell, threaten, cajole, intimidate, grab, carry, and/or physically force children to comply;  or parents give up or give-in, and allow the child to get away without following through with the parent’s original demand. Afterward, many parents are likely to feel defeated and guilty because of their loss of control to their child.

Aggressive parents must realize that each time they lose their temper with their children two things occur: first, the child experiences emotional rejection from the parent due to the parent’s anger and aggression (or the fact that the parent gives up on the child and does nothing) and second, the child gains power over the parent’s emotions and behavior.  Parents who do not lose their tempers, but instead give in to their children, must realize that they are creating children of weak character.

In order for a child to achieve healthy growth, parents must win crucial battles.  However, these “wins” must be conducted in a manner that is not humiliating nor indulgent.  When a child is overwhelmed by a parent’s anger, the child experiences the parent’s authority, but is reduced to nothing.  When a parent gives in, the child experiences the parent’s indulgence, but not the parent’s authority. Each of these situations results in a repeated dynamic in which the child is resistant to the parent’s authority, the parent reacts ineffectively, and the child experiences emotional power over the parent.

Often, (although not always) aggressive parents will feel guilty after a temper loss, and wish to reconcile with their child.  They will supply some indulgence, either material or emotional, to the aggrieved child in an effort to “make up” for the parent’s angry behavior. These parents must understand that doing so will usually serve to foster the tendency for increased feelings of power within the child, rather than achieve reconciliation, acceptance and/or forgiveness.

The less aggressive, more indulgent parents may often eventually find themselves regretting their parenting techniques in later years when their children become depressed or anxious because the world no longer indulges them, or they resort to threats of harm to themselves or others, or turn to substances and weaker people in order to obtain their need for indulgence.

The short statement to to be made here is this: it is in the best interest of the developing child to be managed and contained by effective parents.

Theory/Rationale

Samuel Slipp in his book “Object Relations: A Dynamic Bridge Between Individual and Family Treatment, pp. 48-9, notes that as a child develops out of infancy into toddlerhood, the child will become disillusioned and angry with the mother when she is no longer caring for the child as she did in infancy (i.e., offering complete indulgence).   This gives rise to anger directed at the mother because the she is seen as “bad,” as she will not yield to the child’s demands.  Slipp clearly states in his analysis that the mother must provide a holding environment in which the child is not abandoned,, treated with aggression, nor indulged.  In the extreme this means: effective, measured, physical containment (i.e., restraint).

Physical restraint, as described within this piece, should be applied only when a child loses behavioral control, becomes aggressive toward the parent, and the parent has no other option except to assume total control of the situation.  At such times, the parent must be prepared to be “in for a penny, in for a pound,” and execute the restraint to its fullest conclusion.

The result of effective restraint will be a child who has expended a great deal of negative energy within the confines of benevolent parental control.  The child will learn that the parent is not “bad,” but rather that the parent is compassionate, moderate and loving.  This gives rise to the child’s learned awareness that the parent is steady in temperament, and that the child is responsible for the behavior that led to the restraint.   These facts will result in the emergence of the child’s conscience.

Practice

The Beginning:

A typical situation would proceed as follows:

A four year old child is instructed to put away her toys.  She tarries and begins to show resistance to the parent’s request.  At this point the parent might insist that, before having lunch or before getting to watch a video, the child must pick up her toys.  She continues to refuse.  She goes to the TV and turns on her video.  The parent turns it off.  The child walks to the kitchen and gets into the pantry, the parent blocks her entry.  The child decides that it is time to push further, and calls the parent a name.  The parent maintains a neutral attitude, and tells the child that she must now go to time-out.  The child walks away from the parent toward another part of the house.  The parent directs the child to the time-out area.  The child continues in the other direction.  The parent ultimately tells the child that she has the choice to go to time-out or go to her room.  She sticks her tongue out at the parent.  The parent is getting frustrated over the child’s actions.  Now what?

The parent can, at this point, tell the child to go to her room, either on her own, or with the parent’s assistance.  Most often, by this time, the child is dug in and will not give in to any demand or suggestion given by the parent.  The parent now has no choice except to put hands on the child to help the child go to the room.  Here, the child is likely to physically resist by striking at the parent.  This loss of control is the signal for the use of physical restraint to subdue to the child.  The parent “wraps” up the child in an approved holding technique.  (Holding techniques should be learned from a professional who is well versed in their use.)

The Middle:

The child will respond to this by escalating his or her resistance and will start to rage in a manner that may be very stressful for the parent.  The parent must keep in mind that it is the child who is out of control, not the parent.  The parent must remember that the child must now be held until the child has expended the rage, and reaches a state of calm within the confinement.  This could take several minutes, or it may take hours (depending upon the nature of the child, the child’s age, and the number of times the child has been or should have been restrained in the past).

Restraints of this type will proceed as follows:  The parent will initiate the restraint and will immediately begin to tell the child three things: one, “I love you;” two, “go ahead and be as angry as you can be right now, get your anger out;” and three, “I will let you go when I think we are finished.”   The child will likely rage and resist with a great amount of determination.  The parent will often feel anxiety, and want to release the child because of the fear that the restraint is not working.  This is to be avoided at all cost.

It is at this point that parents need to remind themselves that once a child starts raging within the confines of the parent, the child has but one viable thing to do, and that is to calm down.  The parent must hold on for the duration of the child’s rage, must be certain not to hurt the child in the restraint, and must maintain an attitude of confidence,  and steadfastness throughout the experience.

It is crucial to understand that, if a parent gives up before the full completion of a restraint, the child will have defeated the parent at the worst possible time for both child and parent.  The child will have won the ultimate battle with the parent, and the parent will be at a loss for effective resolutions to critical situations from that point forward (unless the parent recovers from the mistake and refuses to give up the next time a restraint would be required).

The End:

The parent must anticipate the possibility that physical restraint could last a long time (for many children, especially those who are adopted and suffer symptoms of Reactive Attachment Disorder, the restraint could last much longer than an hour).  Knowing this at the outset will give a parent the strength and determination to hold out long enough for the child to return to a sense of calm.  At the conclusion of a restraint, the child should be a great deal more pliable and compliant.  However, the restraint should not “just stop” just because the child is calm.

A parent must keep in mind that restraint is the response to only one aspect of the child’s behavior, i.e., the fact that the child lost self-control and became physically aggressive toward the parent.  The matter of go-to-your-room and time-out still have to be addressed.

The very first thing that a parent should do when ending a physical restraint is to prolong it a few minutes.  The parent will state to the child that it appears that the need for restraint is over, but “we’ll wait a few more minutes.” If the child can tolerate that wait, it is very likely that the restraint has been effectively completed, if the child argues or begins to get angry again, it is a sign that the restraint is not complete, and more time is required.

Once assured that the restraint has been successful, the parent can outline the terms for the child’s release from the restraint.  The parent will present the entire series of events that will transpire before being released from the parent’s control.  The parent will state that first, the child’s legs will be freed, then after a minute, the arms will be released, then they will hug each other for a bit, and, after another minute, the child will go to his room and await instructions to go to time-out.  When the child agrees to these terms, the parent will execute them.  If, at any point during the release, the child begins to return to anger, the process of release will be stopped and the restraint will be rejoined.

When time-out has been successfully and agreeably completed, the entire matter is considered to be resolved and life goes on.

What NOT to do!:

A RESTRAINT SHOULD NEVER BE EMPLOYED TO FORCE OR COERCE A CHILD TO COMPLY WITH PARENTAL REQUESTS OR DEMANDS.  Parents should never use the threat of a restraint to get the child to do something that the child does not want to do.  Restraints should be employed ONLY when a child goes goes out of control, and as noted above, the restraint will end with the child resuming emotional balance.  Although to some parents it may appear otherwise, compliance should be a “by-product” of a restraint, not its aim.

What to expect after a successful restraint:

A successfully applied restraint will result in a “rebonding” between the parent and child.  If the parent maintains a sense of steadfast reserve throughout the effort, the child will ultimately feel the parent’s concern and compassion.  Many parents report that a child’s attitude will improve for days or even weeks.

It must be remembered that restraint is the last resort in a parent’s arsenal of tools for combating anger and rage in children.  How a parent relates to a child throughout each day will go a long way to determining whether a restraint be needed five times or fifty times during a child’s development.

Cautions

  • Obtain the help of a professional proficient in holding and restraining techniques; preferably someone with awareness of the attachment aspects of holding.
  • Attempt restraints with smaller children between ages of three and nine.  Do not attempt to restrain a child who can physically dominate you, or escape your grasp.
  • Employ physical restraint only when a child is out of control and hurting self, others or property.
  • Maintain emotional self-control, and do not give into anger or fear.
  • Never restrain or threaten to restrain to gain or force compliance
  • Avoid using the threat of restraint to get the child to calm down; either use or don’t use it, but do not threaten.
  • Once started, do not stop until the anger within the child has dissipated.
  • Before initiating a restraint, remove items that could hurt a child (watch, belt, jewelry, eyeglasses, etc.).
  • Remember to hold the raging child close; trying to keep distance between you and the raging child could result in enough room for the child to head-butt.
  • Be prepared to allow the child to urinate on him or herself during a restraint rather than allow to fake the need, and gain control of the situation.
  • Remember, parenting is a process.  What is done or not done today, will either reward or haunt a parent the next.

A Personal History … “Attachment Therapy”

This submission is a brief history of my involvement within the attachment and bonding treatment “community.”  What I will represent is a reflection my experience as a treatment provider, and make an attempt to demonstrate how fear and prejudice have affected the development of science as it relates to mental health treatment of a complex disorder.  This piece is the first in a series dedicated to presenting a model for repairing the damage that is caused by parental abandonment at birth or early in a child’s life.

This Blog and ensuing submissions are intended to refute many of the claims about attachment therapy as presented at www.childrenintherapy.org/essays/, as well provide a model for effective interventions based on accepted theoretical principles.  

In April 2000 a little girl named Candace Newmaker (see: https://en.wikipedia.org/wiki/Candace_Newmaker) died as a result of a treatment provided by an attachment therapist, an assistant, the child’s adopted mother, and therapeutic foster parents.  Candace’s death led the way to an uprising against the use of “intrusive” therapies to promote attachment and bonding with children who are adopted.  Since that time the use of “Intensive Therapy” (sometimes referred to as Attachment Therapy) has been abandoned by attachment therapists, and any type of “intrusive” therapy is forbidden by licensing agencies and third party payers for work with adopted children.

The truth, however, with regard to Attachment Therapy is this:  Candace’s death had nothing to do with Intensive Therapy.  Candace Newmaker died because of neglect; the procedure which she had undergone was only loosely related to intensive therapy.  Ms. Watkins was a skilled and experienced interventionist who made a serious mistake; she failed to take seriously the pleas of a child who was deemed “attachment disordered.”  Sadly, it was and is common for adults and even treatment providers to suspect that children who are attachment disordered are either lying about or faking various symptoms and complaints.

So, after devoting her career to working with high risk children, Connell Watkins served seven years of a sixteen year prison sentence.  The rest of us (Attachment Therapists) were more or less forced to stop “Intensive Therapies.”  This had the effect of preventing the possibility of scientifically examining the practice of Intensive Therapy, and developing accepted protocols for its use.

It is interesting to note that Connell Watkins was third in a line of therapists who were  sanctioned by governing bodies for use of high risk approaches to high risk patients.

The first was Robert Zaslow, a California psychologist who pioneered holding therapies through the advocacy of the “Z Process.”  Such was Zaslow’s popularity and acceptance within the treatment community, that he supervised scenes in the movie “Change of Habit” starring Elvis Presley (a young doctor) and Mary Tyler Moore (a nun).  In the movie a mother brings an unruly, out-of-control child to Presley who uses holding techniques (i.e., rage reduction) to work the child through the child’s aggression, and returns a “healed” child to his mother.  Zaslow had to surrender his license due to allegations of impropriety in treating a patient with his technique.

Following Zaslow was Foster Cline.  Cline dedicated his book Hope for High Risk Children to Zaslow indicating that Zaslow’s genius was not appreciated.  After founding and heading the Attachment and Bonding Center in Evergreen, Colorado, Cline was ordered to stop using [intensive therapy] methods as a result of allegations made against him.  He moved to Utah where he continued to write books and give lectures to up-and-coming therapists and parents of attachment disordered children.

Connell Watkins was Cline’s protége´ and supervisee at Evergreen; it is my understanding that she was, at one point, the clinical director of the Attachment Center.  She was mentioned as a practicing therapist in Cline’s book mentioned above.   She was never licensed by the state, but had a Masters degree in Social Work.  She left the Attachment Center and went into private practice.  She conducted intensive therapies in the basement of her home in Evergreen.

I worked with Connell Watkins on several cases in the mid-1990’s.  We worked intensive therapies together; I copied her technique and brought it back to Ohio.

Upon my return from Colorado I attempted to use intensive therapies with the Attachment cases I had been treating.  After a relatively short time, I abandoned the practice because I did not see the outcomes I believed should have been possible, nor did I feel comfortable deliberately antagonizing children into rage.  What I did do was this: I developed a treatment strategy that used a variation of the US Military model for training and transforming recruits.  I named it “modified intensive experiential therapy.”  I worked with children in individual and group therapies by employing the persona of a military Drill Sergeant with an empathetic heart (i.e., therapeutic sensitivity to thoughts and feelings).  This therapy gained me a local reputation of being a therapist who got results.  Children’s parents were calling years after treatment indicating that their children were thriving.  I received graduation announcements from kids who hated me at the time of their treatments.  Several of the kids I treated in the late 1990’s went on to serve in the military.  In early June of 2016 I was notified by one mother that her adopted son had the RAD diagnosis removed from his mental health profile.

The model included the use of written assignments, push-ups as penalties, physical discomfort, bold talk, and most importantly, empathy.  Parental involvement and education were mandatory.  The interventions brought forth emotions that became the springboard to the children’s inner worlds.  The goal was to humanize children who had no sense of conscience nor concern for anyone other than themselves, and to simultaneously give parents a more compassionate and confident way to view their damaged children.  Through the interventions, the children were coming alive.  It was a beautiful thing to do and see.

I quietly employed my techniques for nearly twenty years.

As fate would have it, in March of 2014 I became the fourth in that line of therapists who were sanctioned for the manner in which they treated High Risk Children.  A disgruntled, divorced father reported me to the State Board for employing a technique that had no empirical evidence to back up its use (i.e., push-ups as penalties for rule infractions).  The child had been asked to do five push-ups in the presence of his mother (the custodial parent) for forgetting to sign his summary for the previous session.  Fortunately for me, there were no formal actions brought by the Board, however, I was instructed to “cease and desist” the use of punitive push-ups in my treatment of children.

The efficacy of my treatments diminished immediately.  I petitioned the Board with testimonials from parents (current and past cases), and I provided various rationale for the continued use of the push-ups.  I asked the Board to allow me to develop and initiate a study of the practice.  In the end my pleas were futile.  Gym teachers, athletic coaches, martial arts instructors, and the USMC can continue doling out penalty push-ups, but, alas, I cannot, at least not without risking my license.  “Modified Intensive Therapy” is no more.

It is my belief that working with unconscionable children is a highly complex affair that requires knowledge and skill in the area of employing strong limits and controls in an attitude of compassion and acceptance.   Parents and providers must understand that these are damaged CHILDREN, not young criminals.

Reactive Attachment Disorder is a real malady in our society., and to date, there appears to be no science for implanting a conscience where none exists.    Standardized treatment protocols are needed to address the problem, and expertly skilled treatment providers are necessary for employment of such protocols.  As I see it, there should be no real difference for getting treated for a medical condition and receiving effective treatment for RAD.

I am nearing the end of my career.  It is my intention to generate enough practical and theoretical material that someone will contact me with a desire to formally develop treatment strategies that can be scientifically evaluated, then presented to the National Institute for Mental Health for universal implementation.  A treatment protocol for a childhood malady that is effective, and can be learned and applied with safety and confidence.

Reactive Attachment Disorder… A Systems Perspective

A More Encompassing View

by Ray Messer, MSW, LISW

Reactive Attachment Disorder (RAD) has been defined in the Diagnostic and Statistical Manual of Mental Disorders since 1980.  The current diagnostic criteria (DSM-5) can be found at http://behavenet.com/node/21499.  In all of my research, I have not been able to find how RAD got its name.  Also, it should be noted that little is said in the DSM about the nature of the interactions that result in the RAD situation. The diagnostic criteria listed in the DSM focus wholly upon the characteristics of the child with the disorder, not upon the system in which the child resides.  What follows is a developmental approach to Reactive Attachment Disorder as it exists within an adoptive environment.

An observational examination of the dynamics of RAD reveals the following:  The disorder presents as the undesirable interactions of a child with adult caretakers and authority figures.  These interactions become reactions between the child and the parent(s).  A severely corrosive and unhealthy feedback loop is established between the child and the caretakers that results in the ultimate assignment of the disorder to the child.  Yet, the disorder in the child is also revealed in the very deep negative feelings that are experienced by those who are charged with providing care.  Most non-attachment therapists are unaware of the reciprocal nature of the disorder, and often see the child as the sole problem.  Children who have been unloved, abandoned, abused and/or neglected by their biological mothers from birth (or very early in their lives) often find themselves living in homes with people who feel like hating, abandoning, abusing, and/or neglecting them in a manner similar to their birth mothers.  It can be supposed that the anger in the adoptive and surrogate parents somehow has been transferred to them by the children.

RAD children are often brought into the foster care system by way of Children’s Protective Services and are subsequently placed for adoption.  Many adults (couples and individuals) take in these children with the expectation of giving love and sustenance to a needy child (or children), and getting some measure of love in return.  These adults tend to believe that providing love and security will resolve whatever deficits or difficulties these children may have endured or experienced earlier in their lives. Often, although not always, these kind and caring adults find themselves at extreme odds with the very child they had attempted to take into their hearts.

Many of these parents discover parts of themselves they have not routinely experienced in their lives prior to the adoption experience.  They come to find themselves overwhelmed with extreme anger, emotional exhaustion, guilt and regret.  They lose their sense of personal freedom and sometimes they lose touch with their own identity.  Some of these parents become so disenchanted with raising these children that they give them back to the system, often having to pay the system monthly child support payments until the child is adopted by another unsuspecting, naive someone with a big heart.  One woman went so far as to put her adopted child on a jet airplane bound for Russia, and made international news by doing so.

The heart of Reactive Attachment is this:  It is a parent reacting to the undesirable behaviors exhibited by a child, and the child reacting to the parent.  These reactions resonate between both, and most often, it is the child who is blamed for the problems caused in the interaction, and it is the child who is “treated.”  In the final analysis, it is the child who has the ultimate control of the emotional interactions in the family, but it is the parent(s) who bear the responsibility to resolve them.  These parents want to love and be loved,  but the child wants what he or she wants, love be damned.  So when the child is not gratified, the goal is changed to something else, i.e., power in the form of emotional control.  By defying the parent, or by simply not returning the parent’s love, the child gains control of the emotional tenor of the interactions within the family.  Life becomes miserable for all.  The natural thing for a parent to do is to emotionally retaliate and attempt to control the child; this results in more of the same (only worse).

How does this happen?  Why doesn’t love reach these children?

The answer:  ANGER.  Internalized anger that has become part of the child’s character, and subsequently becomes central in the parent-child relationship.  This anger can be overt and openly aggressive or covertly passive-aggressive, but whatever style the child presents, it is hell for the parents.

In order to understand the abnormal development of the RAD child, it is important first to understand the development of a “normal,” healthy child.

“Normal” Healthy Child Development

In the vast preponderance of child births, at least in the United States, the mother is either nervously or excitedly awaiting the birth of her baby.  She begins to prepare for the arrival of her child during the early stages of pregnancy, and often falls in love with her baby months before birth.  When a mother is presented with her baby for the first the first time, she realizes her life will never be the same.  She is no longer an individual, she is mother with child; for most women this is a wondrous event; for some, it is the beginning of an inconvenience that will not go away.

The human infant is completely dependent upon the outer world for survival; usually this outer world is comprised of the mother.  The mother, or some mother substitute, must be available to the infant child on a continual basis for at least the first few years of the child’s life, and it is the first four years of the child’s life that lay the foundation for the rest of the child’s emotional existence.  If those years go well, the likelihood of a healthy emotional life is greatly improved over that of the converse.

Attachment and bonding occur during the first crucial months of a child’s life.  During the first year a cycle is enjoined that results in the emotional attachment of the child to the mother; successful completion of attachment in infancy results in the internalization of trust.  (Consider Erickson’s stages of emotional development.)

This cycle is usually represented as:  Biologic needs give rise to pain or discomfort, this discomfort is expressed by crying (anger, if not gratified soon enough); the crying alerts the caretaker (mother) to the need of the child; the need is gratified and the child experiences relief.  When this cycle is repeated throughout infancy, the child learns that crying will bring relief, which brings forth trust, which is internalized in an attitude of love, and the child becomes bonded to the mother.  As the infant’s cognitive abilities develop, the child is able to recognize the external presence of the mother.  The mother becomes the object of the child’s internalized trust and, eventually, the child’s love.  Naturally, all of this presupposes that mother loves her baby.

Yet, the end of infancy presents an apparent paradox: the more securely bonded, the more likely it is that  the child will separate during the second stage of development, toddlerhood.

Operant conditioning perspective… healthy development

The above process can be viewed as a process of Operant Conditioning in which the child is “conditioned” by way of repetitive experiences of crying and relief.  If one takes this view, it can be seen that, as with any organism with a brain, the infant child is trained to expect the “operator” (i.e., the mother) to continue this regimen indefinitely (consider the process of infancy to be analogous to the conditioning of a pigeon placed in a Skinner’s Box, or a canine who learns to sit for a morsel of kibble).

Operant conditioning proponents don’t really talk about “trust” as an outcome of the training process, but rather they see this as conditioning or training.  In the animal world, there is no concept of trust; there is only stimulus, response and “learned” survival behaviors.  Animals instinctively respond to their environments according to their natures and genetic loading.  It is primarily within the human mind that the product of this process is known as trust.

Thus, it is possible to conclude that the process of trust development is a process of conditioning, and that the internalization of trust is a result of the mother’s unwavering rewarding of the act of the infant’s crying throughout infancy.

Simply stated, healthy infants are trained to cry; crying brings relief; relief yields trust.

However, as infancy gives way to toddlerhood, this conditioning is interrupted by the advent of refutation.

Healthy Toddlerhood

As noted earlier, the paradoxical outcome of healthy attachment is the experience of separation.  The toddler child, now fully attached and expectant of continued love and sustenance from the mother, begins to venture into the world on two legs that now hold the child upright and mobile.

Toddlerhood can present a conundrum for the mother.  She has to be able to gradually let go of her child so that the child can explore its world, yet mother, at the same time, has to deal with the loss of the pleasure that was experienced with her newborn.    She also is taxed with the newfound stress of having to “chase” after her child for the years remaining before the child goes to school, and she has to learn to tame her child when necessary.

Toddlerhood is a time of recognizing, on the part of the child and the mother, that each is separate from the other.  This recognition takes place over time and most often, and most desirably, takes place in an attitude of love.  The emerging toddler, as an infant, had been conditioned to expect that the act of crying would produce the same results as it had in the past, (i.e., gratification/relief), but things are changing for the toddler, and these changes produce a new kind of pain for the child, i.e., emotional pain.  The experience of emotional pain produces crying, as did physical pain in infancy, and the mother (as well as others who care for the child) must be able to deal with these repeated episodes of crying (and angering) so that the child can learn to tolerate the inner feelings that give rise to the anger which is experienced in the refutation process.

Simply stated, the child expects mother to give in to the crying as she had in the past, when this does not happen, the child will unleash aggression upon the mother.  When mother contains this aggression within an attitude of love without retaliating, abandoning or indulging the child, the child will eventually accept the futility of crying and angering, and  move on to whatever is next.  The incident that precipitated the crying, whatever it was, will have passed and the child’s emotional balance is restored.  The end result of this process (i.e., ongoing aggression toward mother met with compassionate limits) will ultimately produce guilt and a sense of conscience within the child.  The child learns that anger does not beget anger, but rather compassion and containment from the mother.

It is the process of loving refutation that gives rise to formation of the child’s ability to tolerate stress and also gives rise to the formation of the human conscience.  By the time most children are four or five years old, they have learned to accept the basic limits imposed by parents, and have developed some measure of empathy and concern for others.

Effectively, with regard to Operant Conditioning, toddlerhood is the “breaking” of the conditioning that was instilled during infancy.  When this process is healthily achieved, the child goes on to participate in adaptive relationships with peers and adults.  When this process is not healthily achieved, a variety of emotional and psychological consequences can occur.

Reactive Attachment

The gratification of instincts is happiness, but when the outer world lets us starve, refuses us satisfaction of our needs, they become the cause of very great suffering… Sigmund Freud, Civilization and its Discontents.

What follows is a likely series of events that unfold for a child who is brought into a world in which he or she is not wanted, appreciated, or loved.  The conclusions set forth are based upon primary suppositions which are based in observations of real life case histories for children with the Reactive Attachment diagnosis.

Infancy

It is assumed the mother of an unwanted child will tend to her child in a manner wholly different from that of a loving and caring mother.  This mother will grudgingly care for her child; usually she will tend to the child in an effort to “shut the child up.”  This mother will likely ignore her child until the child screams loudly enough to get her attention so that the child can gain relief from whatever need arose (many times, this occasion of gratification is accompanied with physical or emotional abuse). This implies (one can infer) that this is a process of angering to gain attention.  Thus, over time, the child will be conditioned to get angry in order to be noticed.  (It can be noted here that there is a parallel system that will be experienced by a child who is inhibited {i.e., non-aggressive}, a system that promotes lethargy and disinterest on the part of the child; this system is not the focus of this blog.)

Unlike the loved and wanted child, this child has to get angry to simply be noticed.  Thus, the child is learning to trust anger to gain the necessary attention to get basic physical needs met, as well the human need for affiliation.  However, the affiliation is not by way of love and satisfactory attachment, but rather by way of attention from the caretaker in the form of  anger and resentment (i.e., the Reactive Attachment).  This notion helps to explain why these children are willing to settle for any kind of attention, and seem to have no real preference for loving attention.  The child is accustomed (trained) to use anger to get attention (as well as gratification) in return.  By the time the child is removed from his or her biological parent(s), this process of attention getting is well in place.  The child has been trained to be angry; the anger is internalized.

“Reactive” Toddlerhood: The Adoptive Home

If one accepts the above as a typical illustration of what goes on in the infancy of the unwanted child, then what happens in Toddlerhood will be a much different process than is experienced by the well attached child.   Many children are removed from their derelict birth mothers in or around early toddlerhood.  These children suffer, not only the breaking of what little bond had been formed with the birth parent, but an existence which will be marred by the internalized anger noted above.

It is accepted that the adoptive parent adopts a child out of the desire to love and nurture that child.  Yet, in many families, the parent(s) quickly learn that attempts to soothe, mollify and comfort a child by way of gift of love is rejected.  The child does not accept the parent’s efforts to guide and direct, and the parent begins to feel the pain of failure. Now instead of loving containment, the parent resorts to attempts to get the child to conform (often resorting to anger), and child experiences a process of mutual angering with the mother (or other caretakers).  Whereas in the well-loved situation, the crying child is tolerated, accepted and even soothed, the Reactive Attachment situation sees the crying/angering child receiving ever more anger from the caretakers.  Therefore, instead of learning that the mother or caretaker is accepting of and compassionate toward the child when angry, the child learns that the mother or caretakers are hostile and harsh.   The goal of the parent in the RAD situation becomes similar to that of the mother in the original situation: to get the child to stop being a nuisance.

Probably one of the worst aspects of this process is that the child, who is NOT developing in an attitude of love and acceptance, will acquire more anger from the parent(s), and fail to develop a conscience.  This has consequences, not only for the child and his or her adoptive family, but in a larger sense for society as a whole.  For, if the child has no conscience, the resulting adult will have none as well.  If the child learns that he or she has the power to disrupt the emotional balance of the parent(s), the resulting adult will learn to do the same with intimates and peers.   These conclusions are supported in the case studies of persons who find themselves in marital therapy, mental hospitals, jails and prisons.

Conclusion

Reactive Attachment Disorder is prevalent throughout our society and appears to be ever more on the rise.  The increased numbers of mothers of lower socioeconomic backgrounds who become addicted to drugs and alcohol will produce more children with the makings of the disorder.    The more children with the disorder, the more offspring they will produce.

Those who wish to adopt these children as part of their desire to “give back” or “make up for deficits” in their lives should be mindful of the potential for difficult and miserable times ahead of them.  They should endeavor to get expert assistance from therapists and counselors who are familiar with Reactive Attachment in order to gain insight and skills to manage the difficult days ahead of them.

The intent of this blog has been to give a reasonable explanation for the dynamics of the Reactive Attachment situation with regard to anger and aggression toward adoptive parents and temporary caretakers (i.e., foster parents).  It has been posited that healthy infants are trained to cry to gain relief throughout infancy, whereas poorly attached children are trained to use anger and disruptive behaviors to gain attention.  When infants become toddlers they must be “retrained” to not use crying and emotion to get needs met.  The healthy toddler is typically refuted with a loving attitude from parents, and learns to acquiesce to parental wishes.  However, the poorly attached toddler, craving attention and control, experiences caregivers who become frustrated, rejecting, and hostile; thus, establishing the Reactive Attachment.  Initially, these parents and caregivers put themselves in a position to try to “save” these children from doom, but in the end find themselves suffering their own versions of despair in their failed attempts to love and receive love in return.

References and resources:

Object Relations: A Dynamic Bridge Between Individual and Family Treatment, Samuel Slipp, M.D.,  Jason Aronson, 1991 (Paperback edition)

The Psychological Birth of the Human Infant, Mahler et al,  Basic Books, Inc, NY,  1975

Hope for High Risk and Rage Filled Children: Reactive Attachment Disorder, Theory and Intrusive Therapy, EC Publications, Evergreen CO,  1992

Principles of Psychology: A Systematic Text in the Science of Behavior
Fred S. Keller; William N. Schoenfeld, Appleton-Century-Crofts, 1950

Healing the Hurt Child,  Helping Adoptive Families Heal and Grow, Gregory Keck and Regina Kupecky,  NAVPress, 2002