The Origins of Holding Therapy in the UK

When all the information is assessed and one takes a step back, it is astonishing how systematic and audacious the (sole) programme of Holding Therapy in the UK is. It is useful just to highlight the main features of the project. The forty children within the programme at any one time seem to be mainly subject to Care Orders or Interim Care Orders. This means that they will have been through the court process and been subject to multi-professional meetings involving social workers, teachers, health professionals etc. They will have been represented by solicitors, barristers and Guardian ad Litems and had expert reports written about them by psychologists and psychiatrists. Their current placements will have been paid for by tri-partite funding from health, education and social care and, at a conservative estimate, cost the taxpayer several thousand pounds a week per placement. This means that it is entirely possible that millions of pounds of public money has been spent on a highly-intrusive treatment on our most vulnerable children which few people have heard of. Faced with such a situation, it may be helpful to look at the origins of Holding Therapy in the US and in the UK.

Holding Therapy in the US generally has its foundations in Robert Zaslow’s rage-reduction therapy in the 60s and 70s and psychoanalytic theories of rage reduction. The therapy was frequently used in a number of clinics around the Evergreen area of Coloradoafter Foster Cline founded his first clinic there in the 70s and was, in its early stages, used as a treatment for autistic children. The practice was later used as a treatment for Reactive Attachment Disorder and, following the collapse of the Soviet Union, frequently used with Russian and other Eastern European children who often had been raised in orphanages and adopted by parents in the US.

In the UK it seems that a key event in the introduction of Holding Therapy was a visit by the American psychologist Martha Welsh in the 80s. Welsh had written a book called Holding Time which advocates the use of HT on autistic children, she later adapted the treatment for children diagnosed with RAD. It appears that, during this visit she was initially supported by a number of influential academics, notably Nikolaas Tinbergen and his wife Elisabeth, My understanding is that a small number of clinics started using HT as a treatment for autism at this time but these gradually ceased to operate as the theory that autism was caused by attachment failures with the mother was discredited. A small number of HT therapists also started to use the treatment on children diagnosed with Reactive Attachment Disorder but these also soon started to reduce in number particularly, it seems, after the publication of the British Association of Adoption and Fostering Position Statement (4) which effectively called for the treatment to be banned.

By far the largest, most systematic and sophisticated programme of Holding Therapy in the UK began in about 1996 and was started in the North of England by a foster carer and her social worker. The programme began as a non-profit making project but was soon reinvented into a private company. One of the founders who for many years was the head of therapy is now a consultant employed by the company. It has been reported that she remains the only trainer of therapists the company has ever had. In 2002 this company commissioned a local university to undertake an evaluation of its therapeutic practices. The university website records that it was paid £31,000 to undertake the study which consisted of a number of semi-structured interviews with staff and children. This study was generally positive but vague in terms of the therapy itself – it reported only a few negative “outlier responses”.

Following the commissioning of this report in 2002/3, a number of articles appeared in the national press. These appeared to simply reproduce the claims of the company and strikingly failed to question, in any way, the nature of the therapy. There was even a feature on the BBC woman’s Hour which essentially seemed to advertise the service. However, after 2003 there were significantly fewer items in the media and by 2006 the company seems to have been in significant financial trouble – items in local news papers confirm this. It may not be a coincidence that the highly critical (against AT) BAAF Position Statement 4 appeared around this time.

What happened next is extensively recorded in the financial press and can be researched on the Companies House website. This, still relatively small, company was bought by a much bigger parent company, based outside the country. This may be significant for a number of reasons. It was around this time that a number of concerns were raised around private equity firms buying up small groups of children’s homes and foster care companies in, so-called “distressed sale” buyouts. A common theme was that these, sometimes family owned businesses, were being stripped of any elements that did not clearly contribute to profit-making. The effect on this particular company may have been that the owners were much further removed from what was going on and may not have cared about it as long as it didn’t affect the balance sheet. Indeed, it has been said that high-level supervision of practice within the homes may have been conducted by the Chief Financial Officer.

There is a theme that runs through the recent history of HT in the UK like the letters in a stick of Brighton Rock. It is simply that the people responsible for ensuring the safety and well-being of these Looked After Children don’t seem to have asked any questions – they appear to have simply turned a blind eye. The inspectors responsible for its governance don’t even mention the words Holding Therapy or Attachment Therapy, the social workers don’t seem to even know, or say they don’t know, that this kind of therapy is taking place. In truth, it could have always been said that, as Fainities (a commentator on a previous post) has highlighted, we never really knew the detail of what was going on – academics such as Prior and Glaser presumed it was a nuturing form of HT that was being practised in theUK. It could always be glossed over in this way. This get-out clause is precisely why first-hand accounts of HT, such as the description published on 5th April on this blog, are so vitally important.

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