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PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1498-1498

Warning: Are You Aware of "Holding Therapy"?

To the Editor.

Recent work published in Pediatrics emphasized the growing role of pediatricians as identifiers of children's psychosocial and developmental problems and as sources of referrals for treatment. I am writing to comment on an unconventional treatment of behavioral problems that pediatricians may hear about from parents.

This approach, called "holding therapy" or "attachment therapy," is practiced by a number of social workers, psychologists, physicians, and others. It is recommended by some adoption organizations as a treatment for poor relationships between adopted children and their parents. Unfortunately, "holding therapy," which involves physical restraint, has been associated with >1 death, the most recent one being that of a 10-year-old girl in Colorado in April 2000. There is little evidence of the usefulness of the treatment in any case, and, although its practitioners claim the approach is based on the developmental theory of John Bowlby, there is no logical connection between the two. Concern about "holding therapy" has been expressed by the National Alliance for the Mentally Ill.

Written materials provided by "attachment therapists" tend to be ambiguous about the use of restraint, and a busy pediatrician asked to comment on such material by parents might well miss the reality of this practice. However, materials on the Internet make it clear that physical restraint is frequently used and that it is advocated by "attachment therapists" because of some bizarre beliefs about the nature of early emotional development.

I would like to suggest that pediatricians exercise extreme caution in commenting on "holding therapy" to parents who are concerned about psychosocial problems.

Jean Mercer, PhD
Richard Stockton College of New Jersey
Pomona, NJ 08240-0195

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Pediatrics (ISSN 0031 4005). Copyright ©2001 by the American Academy of Pediatrics
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