I believe this article fails to meet 3b of GA criteria. Its subject, Attachment therapy is a pseudoscience. However, the article contains large sections that either are about mainstream medically accepted material, diagnoses, etc., or sections that are focused on the pseudoscience. There are also sections that combine mainstream medical information with the pseudoscience.
The structure of the article is confusing and also mixes science and pseudoscience.
Many of the references are unreliable. I have listed these under Talk:Attachment_therapy#Serious_problems_with_article or are not accessible, so it is difficult at times to disentangle whether real science or pseudoscience is being referenced.
The many wikilinks in the article are mostly to mainstream psychology/psychiatry information, although some are to "alternative therapies".
A single editor has worked on the article, putting in over 900 edits. [1]. I do not believe this editor has the perspective to sort out the article alone.
I believe this needs a group effort to bring it to GA status. — Mattisse ( Talk) 03:52, 23 October 2008 (UTC)
Outline of article sections and why they are confusing
In the section on Treatment characteristics of attachment therapy (the pseudoscience), there is a section on Traditional attachment theory based methods.
Under the section Theoretical basis (presumably of Attachment therapy), there is a section on Attachment theory with no indication if this applies to Attachment therapy or not (presumably not, as it is not considered pseudoscience) and a section on Theoretical principles of attachment therapy which is about the pseudoscience.
The sections Historical roots and Range of attachment therapies both seem to be about Attachment therapy.
The section Diagnosis and attachment disorder has as mainstream wikilinks under the heading Attachment disorder and Reactive attachment disorder which is a legitimate medical diagnosis and not pseudoscience. The section talks about "current official classifications of RAD under DSM-IV-TR and ICD-10 are largely based on this understanding of the nature of attachment." These link and the body of this section refers to mainstrean diagnostic categories used by mental health professions and has nothing to do with pseudoscience. It refers to attachment styles (piped) appears to be mainstream looking at the references.
Under this section (Diagnosis and attachment disorder) are two sub sections: The first is Diagnosis lists and questionnaires contains some mainstream diagnostic tools, and some instruments whose status is unclear and has wikilinks to mainstream disorders and the second is Patient recruitment which appears to apply only to the controversial pseudoscience.
A section on Prevalence - appears to be about mainstream medical science
A section on Evidence basis and controversial therapies is apparently on the pseudoscience
There is a section on Mainstream therapies with mainstream information and links.
The last section is Cases - notorious cases.
— Mattisse ( Talk) 03:58, 23 October 2008 (UTC)
Just Wait I was the 2nd opinion GA reviewer on this article, after it had had a 2nd opinion tag on it on the GAN page for over a month, with no one (including Mattisse) offering a second opinion and taking the review through to conclusion. I thoroughly read through the article, copyediting as I went, and made several suggestions on the talk page. When these had been completed to my satisfaction, I passed the article to GA status. Immediately after this passing, Mattisse posted a long list of issues (similar to the list above), as well as a message on my talk page notifying me that he was thinking about initiating a GAR. I read his comments, compared them to the article, and found that I agreed with several of them. I posted a message to this effect on the talk page, as well as a message asking the main editor (Fainite) to respond ASAP. Fainite responded within a day, asking for a little more time as they were busy with RL, and responding positively to our comments. I figured that this time would be given, as Fainite appeared willing to make the changes we've asked for, or at least discuss them, but then I see that Mattisse has initiated a community GAR.
My view on the article is that it is well written and well referenced, and that it provides a comprehensive overview of the subject, with good distinctions between the pseudoscience of attachment therapy and the mainstream therapies that are more commonly (and properly) used. I agree with Mattisse that there is perhaps a little extra weight in the article on mainstream therapies that could be removed, but I do not see the article in its current form as harmful to anyone. IMO, it makes a clear distinction between pseudoscience and mainstream therapies, and, with a little bit of work by Fainite, which that editor seems willing to do, the extra weight can easily be cut out. I see nothing about this article that is ethically wrong, as Mattisse has claimed, and I ask that other editors give Fainite a chance to get a break from RL to work on the article (this weekend was what we were told). Dana boomer ( talk) 12:56, 23 October 2008 (UTC)
Hi guys. Thanks for waiting.
(multiple edit conflicts)
Comments from Casliber
One of the issues I feel most strongly about is misinformation on articles. I have not studied the former version, only the one at time of writing. I haven't looked at the sourcing. I think Matisse is right to be extremely wary of how mainstream science material can and may be interpreted in this article. However, this is an agonisingly difficult path - leaving enough material of mainstream practice and theory to provide context, yet not mislead the reader into validating what is clearly a fringe/pseudoscience practice:
Suggestions from Mattisse
Comments from Mattisse
Having reduced the mainstream material considerably I have now put it in two sections - both headed in a way that make it clear these are contrasting mainstream methods/diagnosis/classifications. Hopefully this will enable the reader to be absolutely clear about the basic but essential differences between attachment therapy claims and beliefs and the mainstream. One is here
[6] and the other is here
[7]. I am also adding the ACT list of "attachment therapy by another name" as proposed above. As it is a very long list I've put it in the notes as a quote.
Fainites
barley 14:06, 28 October 2008 (UTC)
Comment Mattisse, do you still have things that you would like to see Fainites working on? If you don't, this review can probably be closed as a keep, but I didn't want to do this without making sure you were satisfied. I think that Fainites has done a good job in responding to your comments, and the changes have been beneficial to the article. Let me know your thoughts. Dana boomer ( talk) 14:44, 5 November 2008 (UTC)
Comment - I stand by my comments above. My specific complaints:
— Mattisse ( Talk) 15:47, 5 November 2008 (UTC)
If the net result of this is no GA - then so be it. I don't need a gong. If you have any explicit issues capable of being addressed then by all means set them out - but frankly otherwise, this is a waste of time. Fainites barley 21:56, 5 November 2008 (UTC)
Comments from Montanabw I hate to weigh in this late in the process, especially to take the position I am about to take, especially when many of you don't know me at all, but someone asked for an outside eye over here. I think it is important to note that the entire article is fundamentally flawed in that it categorically lumps too many things in as "attachment therapy" and includes relatively mainstream uses with the most fringe versions, dismissing it all as "pseudoscience." I do not say this as an advocate of AT, I am personally rather critical of the concept. Nor am I confusing this article with attachment theory, I know the difference. But for GA, an article has to be NPOV, and this one paints with too broad a brush. On one hand, there are the very legitimate concerns with fringe theories such as "rebirthing," which has resulted in fatalities. Then there are individuals such as Foster Cline (Evergreen model) who certainly gets a cult of personality going and has been in trouble with licensing boards -- the controversy attached to his techniques, particularly the models as they were advocating a decade ago, is well-founded. That said, even Cline himself has modified his techniques from some of his earlier concepts. Coercive Restraint Therapies are definitely a problem, and as such this article does well enough to explain the problems.
But the article goes too far: Coercive Restraint Therapies are not the only form of "Holding therapy." On the other side of the issue are appropriate uses of holdings in the treatment of RAD children. For example, a highly respected mainstream program that uses "attachment principles," including some holdings, is Intermountain Children's Home, which is a Joint Commission on Accreditation of Healthcare Organizations ( JCAHO)-approved facility that has operated under the sponsorship of the United Methodist Church. I suspect they use the term "principles" on purpose to avoid the negative AT label, but they definitely use holdings and do not consider them a form of restraint. Here is a review of their program, which was not entirely laudatory and expresses some criticism of holdings, but as such, is pretty NPOV. Judging by Attachment-based_therapy_(children)#Differentiation_from_attachment_therapy, this article here has been written with language that is similar to that in an article which is quite dismissive of the whole concept elsewhere, thus this creates serious NPOV problems. As an aside, the tone here is also very dismissive of the contributions of Milton Erickson, labeling him a "hypnotherapist," when the broader picture is that he was one of the leading early theorists promoting family therapy, who yes, happened to also work with hypnotherapy (as did Freud). In short, while there is a need to point out the dangers of fringe programs, this article reads more like an expose than a GA.
I guess at the end of the day, for this to be a GA, it needs to get the overall tone off the soapbox and more accurately reflect the entire spectrum from mainstream to fringe. I looked at the abstract of the Task Force report and this sentence mirrors my own view: "...Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists." (my emphasis) It is a fundamental NPOV flaw to imply, as this article does, that there are only "good" attachment theory-based programs and "bad" AT-based programs, when the reality is that a middle ground exists. As in the example above there is work being done to use attachment theory with some holdings and related tactics when dealing with truly RAD children. And RAD is a genuine disorder, maybe over-diagnosed by the fringe in order to make guilty parents give them money, but if you have ever dealt with the real thing... =:-O So when I look at all of the above, my thought is that the article is in form not too bad, but definitely too POV for GA. Montanabw (talk) 07:02, 6 November 2008 (UTC)
Dealing with the concerns one at a time:
I shall have a go at the lead to make the distinction clearer. Fainites barley 16:34, 6 November 2008 (UTC)
I was one of the original contributors to this article, have not been much involved lately, but would like to respond to Montanabw's remarks. I'm going to do this in bits, as I typed for 45 minutes earlier and the whole thing disappeared after "save page." Jean Mercer ( talk) 17:46, 6 November 2008 (UTC)
1. Terminology: I believe that one of the problems triggering Montanbw's response is the name given the practices in question. When I initially contributed on this topic, I used the term Attachment Therapy (with caps), to indicate that this was a special usage, not necessarily associated with "attachment", not necessarily a "therapy", and not necessarily a member of a category loosely termed "attachment therapies". In other contexts, I have also used the term Coercive Restraint Therapy, which i would prefer as more descriptive, but which is not as well-known to the public as Attachment Therapy.
There are quite a number of problems about the best term to use here. The term Attachment Therapy has a history, having developed as a replacement for the term Holding Therapy and having been offered by ATTACh in that organization's change of course following incidents such as the death of Candace Newmaker. However, examination of the belief system behind this approach shows that it is in no way based on attachment theory, and that its stress is on child compliance, not on attachment relationships. Employing a term that has no meaningful connection with the referent seems a specious strategy at best. In addition, we have the problem that the great majority of therapies are indeed "attachment therapies" (lower-case) in that they focus on relationships. The APSAC report used this category, defined it very loosely, and did not provide a list of treatments that should be described this way. Among treatments for children that might fit an "attachment therapy" (lc-lc), most refer to their specific names (e.g. Circle of Security) rather than saying they are among the attachment therapies.
So, what are we talking about when we talk about Attachment Therapy? For clarification in the present article, I would propose the term Coercive Restraint Therapy, which could be further described in the text as sometimes called Attachment Therapy or Holding Therapy. Alternatively, the earlier name Holding Therapy could be employed. Jean Mercer ( talk) 18:03, 6 November 2008 (UTC)
2.Scope of the article: Montanabw seems to be suggesting that Attachment Therapy be considered only as part of a larger discussion of attachment therapies (lc-lc). I would oppose this on two grounds: a.considering the number of treatments that would be included as the lc-lc version, such an article would be overwhelming to contributors and to readers. b. I object strongly to the idea that Attachment Therapy be included as just one rather different type of treatment that fits into a broad category consisting primarily of legitimate treatments. Jean Mercer ( talk) 18:08, 6 November 2008 (UTC)
3. The "middle ground" approach: Montanabw appeals to a general wish to be tolerant of others' ideas and to make compromises. Such compromises in behavior may be socially appropriate, but in many cases, like this one, compromise in thinking leads to confusion and compromises (in its other sense) intellectual integrity. If Attachment Therapy is without empirical support and has no acceptable theoretical basis, why would we wish to allow it to contaminate legitimate thinking about childhood interventions?
I believe Montanabw is attempting to base this argument on the well-known attempts by Intermountain to re-define holding as a therapeutic intervention. This re-definition is in no way substantiated by Intermountain's accreditation status or by its association with the United Methodists. To demonstrate that holding, as practiced at Intermountain, is an effective treatment, someone must provide empirical evidence in the form of a well-designed and well-analyzed study. This has not been done, and regrettably David Ziegler's attempts to bring previous research to bear on this question were vitiated by his citation of claims about holding therapy, as well as by his failure to reference various studies he cited as support in his text. These problems of support for therapeutic holding (or whatever term Intermountain chooses)would probably be apparent only to readers thoroughly versed in this literature, but they are there. If Montanbw is considering the Intermountain approach as the desired middle ground, he or she will have to deal with the fact that there is no more empirical evidence for the Intermountain approach than for Holding Therapy. Jean Mercer ( talk) 18:21, 6 November 2008 (UTC)
4. Foster Cline: To say that Foster Cline has modified his approach is rather like saying that George Bush is modifying his approach to the presidency. Foster Cline surrendered his medical license following a disciplinary hearing and has not written for public consumption since that time. If Montanabw has materials that are acceptable for Wiki and that support his or her claim, M. should bring those forward-- this would be a most interesting revelation. Cline's brilliantly-named proprietary intervention, which has resulted in the Love & Logic empire, is said not to employ Attachment Therapy in any way-- again, if Montanabw can show otherwise, many people would like to know about this. Jean Mercer ( talk) 18:26, 6 November 2008 (UTC)
5. Milton Erickson: I don't consider reference to Erickson as a hypnotherapist to be dismissive-- of course he was a seminal figure. What is "dissed" here is Erickson's 1960 paper, quoted in its entirety by Foster Cline, in which he describes a case where a mother was advised to sit on her child for hours at a time and to feed him on cold oatmeal; Erickson also noted with apparent approval an outcome in which the child trembled when the mother spoke to him. Montanabw may want to compare these maternal actions with behaviors described under NIS-4 categories.
5. Conclusion: I believe the present article would be much clarified by the use of different terminology, as any of the terms using the word "attachment" are confusing at best. In addition, I think that-- whatever this is we're talking about-- is historically and theoretically vastly different from other child mental health interventions, and should be discussed by itself, not in a way that suggests it's simply a variant of a mainstream approach. I consider the "middle ground" and the "therapeutic holding" controversy to be red herrings, and I caution other editors not to be persuaded that there would be a positive effect of blurring definitions in this case. Jean Mercer ( talk) 18:36, 6 November 2008 (UTC)
Several things here: I did not mean to encourage the idea of delisting, nor am I in agreement with Montanabw's comments. I consider the article to be generally appropriately organized, written, and sourced. But as I noted, and as Fainites agrees above, I believe the terminology is a problem. To discriminate between a broad category of attachment-focused therapies, and the system discussed in the present article, I have called the latter Attachment Therapy (caps) or put the term in quotation marks. I would find either of these appropriate, or of course both caps and quotation marks could be used just in case anyone missed the point. The label Holding Therapy has been criticized because there is much more to the treatment than holding, and I've always felt uneasy with the term Attachment Therapy because attachment is not involved. Fainites' added lead material seems quite suitable, but i would also suggest stressing the difference between attachment therapies and Attachment Therapy, and noting that the latter is not one of the former. This might be done best by giving a couple of examples of attachment therapies.
It certainly would have been useful if APSAC had been more careful about terms. Before that report, people generally said "attachment-related" or "attachment-focused" interventions-- now we have this "attachment therapies" category. Anyway, I agree, forget Coercive Restraint-- only about 6 people in the world know what that means. Jean Mercer ( talk) 00:19, 7 November 2008 (UTC)
By the way, with respect to sources, I don't understand the problem with Bridget Mahoney's education, or why disclaimers on web sites are a problem. Jean Mercer ( talk) 00:22, 7 November 2008 (UTC)
Comment on comments: I have no time and insufficient interest to become a contributor to the article, I was mostly just weighing in on the GA issue because an outside opinion was requested. In short, I agree with the clarification of the terminology and the tweak of the lead. I'm also not defending Foster Cline or any coercive model, I am merely questioning the tone of the article that suggests that that AT means only coercive therapies or that all holding therapies are always coercive and bad. I use Intermountain because it's simply an example of a mainstream, non-whacko program that is successfully using attachment theory AND happens to also include holdings. I'm sure someone could contact them and ask for cites to research that supports their program and evaluate it from there. (I don't have the time, personally) I fully agree that AT is controversial, but so were most new psychotherapy approaches at first; over time some were kept, others discredited. This one is still relatively new, so as far as peer-reviewed studies and such go, I haven't the time or inclination to dig into research on this topic, though anything that is cutting edge will inevitably have a limited amount of research out there. It doesn't mean it is good or bad, just new. Also, many of these therapies start out in ways that can be pretty hair-raising, and over time become refined and greatly improved (look at psychotropic drugs, the differences between the old MAOI-class drugs and the modern SSSRI-class drugs are phenomenal). But basically, this article is not really ready for GA due to all of the above issues, and that is really my only real position here: Delist GA. Montanabw (talk) 00:33, 7 November 2008 (UTC)
Regrettably, the treatment continues to be used in spite of evidence that discredits it. That's why the article exists. And, of course, it would be most interesting to know why people are willing to go for these things, but there is no useful evidence about the matter-- in addition, that would be a different topic.
As for Montanabw's statements about holding therapies, it's excessively naive to believe that Intermountain must have research supporting its choices-- this is exactly what I was commenting on yesterday. The literature in this area is quite complex, and it doesn't pay to jump to conclusions about it. You have to really know the literature to make reasonable decisions here. This isn't rocket science, it's a lot harder than that.
If Montanabw believes there is empirical evidence supporting holding therapy in any form, he or she should present it-- keeping in mind what I said about David Ziegler's work (and the same goes for Howard Bath). 72.73.196.59 ( talk) 13:32, 7 November 2008 (UTC)
Ooops, sorry, that was me. Jean Mercer ( talk) 13:38, 7 November 2008 (UTC)
I do, I do propose that change, to Attachment Therapy with caps, and I always use that form in my own writing. I would even propose using quotation marks in addition to caps, but I suppose this would confuse searches. I would also suggest that mainstream interventions be described as attachment therapIES as a group, and by their own specific names if discussed individually. If it weren't for the confusing precedent established by APSAC, I'd argue that we go back to "attachment-focused" or "attachment-related", which used to be standard.
"Attachment Therapy On Trial" (Mercer, Sarner, & Rosa) discusses some of the background in popular thought which is being described as the sociological context.
One comment on the "middle ground" business: it's important to remember that "holding" as alluded to by Montanabw is probably not equivalent to "rage reduction" therapy. Instead, this is a mthod that involves restraint as an assurance of safety in crisis situations, followed by continued restraint (called "therapeutic holding") after calm is restored-- proponents of this technique believe that the holding of the now-calm individual has therapeutic value. This is obviously different from holding methods that incite distress and loss of control; however, there is no adequate evidentiary foundation to support the effectiveness of either method. (Please comment if you disagree with my definition, Montanabw.)In fact, little has been published about "therapeutic holding" in peer-reviewed journals, and the definition seems to have been subject to criterion creep. I would speculate that "therapeutic holding" is based primarily on assumptions about "age regression" rather than on beliefs about catharsis. Jean Mercer ( talk) 17:43, 7 November 2008 (UTC)
I believe this article fails to meet 3b of GA criteria. Its subject, Attachment therapy is a pseudoscience. However, the article contains large sections that either are about mainstream medically accepted material, diagnoses, etc., or sections that are focused on the pseudoscience. There are also sections that combine mainstream medical information with the pseudoscience.
The structure of the article is confusing and also mixes science and pseudoscience.
Many of the references are unreliable. I have listed these under Talk:Attachment_therapy#Serious_problems_with_article or are not accessible, so it is difficult at times to disentangle whether real science or pseudoscience is being referenced.
The many wikilinks in the article are mostly to mainstream psychology/psychiatry information, although some are to "alternative therapies".
A single editor has worked on the article, putting in over 900 edits. [1]. I do not believe this editor has the perspective to sort out the article alone.
I believe this needs a group effort to bring it to GA status. — Mattisse ( Talk) 03:52, 23 October 2008 (UTC)
Outline of article sections and why they are confusing
In the section on Treatment characteristics of attachment therapy (the pseudoscience), there is a section on Traditional attachment theory based methods.
Under the section Theoretical basis (presumably of Attachment therapy), there is a section on Attachment theory with no indication if this applies to Attachment therapy or not (presumably not, as it is not considered pseudoscience) and a section on Theoretical principles of attachment therapy which is about the pseudoscience.
The sections Historical roots and Range of attachment therapies both seem to be about Attachment therapy.
The section Diagnosis and attachment disorder has as mainstream wikilinks under the heading Attachment disorder and Reactive attachment disorder which is a legitimate medical diagnosis and not pseudoscience. The section talks about "current official classifications of RAD under DSM-IV-TR and ICD-10 are largely based on this understanding of the nature of attachment." These link and the body of this section refers to mainstrean diagnostic categories used by mental health professions and has nothing to do with pseudoscience. It refers to attachment styles (piped) appears to be mainstream looking at the references.
Under this section (Diagnosis and attachment disorder) are two sub sections: The first is Diagnosis lists and questionnaires contains some mainstream diagnostic tools, and some instruments whose status is unclear and has wikilinks to mainstream disorders and the second is Patient recruitment which appears to apply only to the controversial pseudoscience.
A section on Prevalence - appears to be about mainstream medical science
A section on Evidence basis and controversial therapies is apparently on the pseudoscience
There is a section on Mainstream therapies with mainstream information and links.
The last section is Cases - notorious cases.
— Mattisse ( Talk) 03:58, 23 October 2008 (UTC)
Just Wait I was the 2nd opinion GA reviewer on this article, after it had had a 2nd opinion tag on it on the GAN page for over a month, with no one (including Mattisse) offering a second opinion and taking the review through to conclusion. I thoroughly read through the article, copyediting as I went, and made several suggestions on the talk page. When these had been completed to my satisfaction, I passed the article to GA status. Immediately after this passing, Mattisse posted a long list of issues (similar to the list above), as well as a message on my talk page notifying me that he was thinking about initiating a GAR. I read his comments, compared them to the article, and found that I agreed with several of them. I posted a message to this effect on the talk page, as well as a message asking the main editor (Fainite) to respond ASAP. Fainite responded within a day, asking for a little more time as they were busy with RL, and responding positively to our comments. I figured that this time would be given, as Fainite appeared willing to make the changes we've asked for, or at least discuss them, but then I see that Mattisse has initiated a community GAR.
My view on the article is that it is well written and well referenced, and that it provides a comprehensive overview of the subject, with good distinctions between the pseudoscience of attachment therapy and the mainstream therapies that are more commonly (and properly) used. I agree with Mattisse that there is perhaps a little extra weight in the article on mainstream therapies that could be removed, but I do not see the article in its current form as harmful to anyone. IMO, it makes a clear distinction between pseudoscience and mainstream therapies, and, with a little bit of work by Fainite, which that editor seems willing to do, the extra weight can easily be cut out. I see nothing about this article that is ethically wrong, as Mattisse has claimed, and I ask that other editors give Fainite a chance to get a break from RL to work on the article (this weekend was what we were told). Dana boomer ( talk) 12:56, 23 October 2008 (UTC)
Hi guys. Thanks for waiting.
(multiple edit conflicts)
Comments from Casliber
One of the issues I feel most strongly about is misinformation on articles. I have not studied the former version, only the one at time of writing. I haven't looked at the sourcing. I think Matisse is right to be extremely wary of how mainstream science material can and may be interpreted in this article. However, this is an agonisingly difficult path - leaving enough material of mainstream practice and theory to provide context, yet not mislead the reader into validating what is clearly a fringe/pseudoscience practice:
Suggestions from Mattisse
Comments from Mattisse
Having reduced the mainstream material considerably I have now put it in two sections - both headed in a way that make it clear these are contrasting mainstream methods/diagnosis/classifications. Hopefully this will enable the reader to be absolutely clear about the basic but essential differences between attachment therapy claims and beliefs and the mainstream. One is here
[6] and the other is here
[7]. I am also adding the ACT list of "attachment therapy by another name" as proposed above. As it is a very long list I've put it in the notes as a quote.
Fainites
barley 14:06, 28 October 2008 (UTC)
Comment Mattisse, do you still have things that you would like to see Fainites working on? If you don't, this review can probably be closed as a keep, but I didn't want to do this without making sure you were satisfied. I think that Fainites has done a good job in responding to your comments, and the changes have been beneficial to the article. Let me know your thoughts. Dana boomer ( talk) 14:44, 5 November 2008 (UTC)
Comment - I stand by my comments above. My specific complaints:
— Mattisse ( Talk) 15:47, 5 November 2008 (UTC)
If the net result of this is no GA - then so be it. I don't need a gong. If you have any explicit issues capable of being addressed then by all means set them out - but frankly otherwise, this is a waste of time. Fainites barley 21:56, 5 November 2008 (UTC)
Comments from Montanabw I hate to weigh in this late in the process, especially to take the position I am about to take, especially when many of you don't know me at all, but someone asked for an outside eye over here. I think it is important to note that the entire article is fundamentally flawed in that it categorically lumps too many things in as "attachment therapy" and includes relatively mainstream uses with the most fringe versions, dismissing it all as "pseudoscience." I do not say this as an advocate of AT, I am personally rather critical of the concept. Nor am I confusing this article with attachment theory, I know the difference. But for GA, an article has to be NPOV, and this one paints with too broad a brush. On one hand, there are the very legitimate concerns with fringe theories such as "rebirthing," which has resulted in fatalities. Then there are individuals such as Foster Cline (Evergreen model) who certainly gets a cult of personality going and has been in trouble with licensing boards -- the controversy attached to his techniques, particularly the models as they were advocating a decade ago, is well-founded. That said, even Cline himself has modified his techniques from some of his earlier concepts. Coercive Restraint Therapies are definitely a problem, and as such this article does well enough to explain the problems.
But the article goes too far: Coercive Restraint Therapies are not the only form of "Holding therapy." On the other side of the issue are appropriate uses of holdings in the treatment of RAD children. For example, a highly respected mainstream program that uses "attachment principles," including some holdings, is Intermountain Children's Home, which is a Joint Commission on Accreditation of Healthcare Organizations ( JCAHO)-approved facility that has operated under the sponsorship of the United Methodist Church. I suspect they use the term "principles" on purpose to avoid the negative AT label, but they definitely use holdings and do not consider them a form of restraint. Here is a review of their program, which was not entirely laudatory and expresses some criticism of holdings, but as such, is pretty NPOV. Judging by Attachment-based_therapy_(children)#Differentiation_from_attachment_therapy, this article here has been written with language that is similar to that in an article which is quite dismissive of the whole concept elsewhere, thus this creates serious NPOV problems. As an aside, the tone here is also very dismissive of the contributions of Milton Erickson, labeling him a "hypnotherapist," when the broader picture is that he was one of the leading early theorists promoting family therapy, who yes, happened to also work with hypnotherapy (as did Freud). In short, while there is a need to point out the dangers of fringe programs, this article reads more like an expose than a GA.
I guess at the end of the day, for this to be a GA, it needs to get the overall tone off the soapbox and more accurately reflect the entire spectrum from mainstream to fringe. I looked at the abstract of the Task Force report and this sentence mirrors my own view: "...Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists." (my emphasis) It is a fundamental NPOV flaw to imply, as this article does, that there are only "good" attachment theory-based programs and "bad" AT-based programs, when the reality is that a middle ground exists. As in the example above there is work being done to use attachment theory with some holdings and related tactics when dealing with truly RAD children. And RAD is a genuine disorder, maybe over-diagnosed by the fringe in order to make guilty parents give them money, but if you have ever dealt with the real thing... =:-O So when I look at all of the above, my thought is that the article is in form not too bad, but definitely too POV for GA. Montanabw (talk) 07:02, 6 November 2008 (UTC)
Dealing with the concerns one at a time:
I shall have a go at the lead to make the distinction clearer. Fainites barley 16:34, 6 November 2008 (UTC)
I was one of the original contributors to this article, have not been much involved lately, but would like to respond to Montanabw's remarks. I'm going to do this in bits, as I typed for 45 minutes earlier and the whole thing disappeared after "save page." Jean Mercer ( talk) 17:46, 6 November 2008 (UTC)
1. Terminology: I believe that one of the problems triggering Montanbw's response is the name given the practices in question. When I initially contributed on this topic, I used the term Attachment Therapy (with caps), to indicate that this was a special usage, not necessarily associated with "attachment", not necessarily a "therapy", and not necessarily a member of a category loosely termed "attachment therapies". In other contexts, I have also used the term Coercive Restraint Therapy, which i would prefer as more descriptive, but which is not as well-known to the public as Attachment Therapy.
There are quite a number of problems about the best term to use here. The term Attachment Therapy has a history, having developed as a replacement for the term Holding Therapy and having been offered by ATTACh in that organization's change of course following incidents such as the death of Candace Newmaker. However, examination of the belief system behind this approach shows that it is in no way based on attachment theory, and that its stress is on child compliance, not on attachment relationships. Employing a term that has no meaningful connection with the referent seems a specious strategy at best. In addition, we have the problem that the great majority of therapies are indeed "attachment therapies" (lower-case) in that they focus on relationships. The APSAC report used this category, defined it very loosely, and did not provide a list of treatments that should be described this way. Among treatments for children that might fit an "attachment therapy" (lc-lc), most refer to their specific names (e.g. Circle of Security) rather than saying they are among the attachment therapies.
So, what are we talking about when we talk about Attachment Therapy? For clarification in the present article, I would propose the term Coercive Restraint Therapy, which could be further described in the text as sometimes called Attachment Therapy or Holding Therapy. Alternatively, the earlier name Holding Therapy could be employed. Jean Mercer ( talk) 18:03, 6 November 2008 (UTC)
2.Scope of the article: Montanabw seems to be suggesting that Attachment Therapy be considered only as part of a larger discussion of attachment therapies (lc-lc). I would oppose this on two grounds: a.considering the number of treatments that would be included as the lc-lc version, such an article would be overwhelming to contributors and to readers. b. I object strongly to the idea that Attachment Therapy be included as just one rather different type of treatment that fits into a broad category consisting primarily of legitimate treatments. Jean Mercer ( talk) 18:08, 6 November 2008 (UTC)
3. The "middle ground" approach: Montanabw appeals to a general wish to be tolerant of others' ideas and to make compromises. Such compromises in behavior may be socially appropriate, but in many cases, like this one, compromise in thinking leads to confusion and compromises (in its other sense) intellectual integrity. If Attachment Therapy is without empirical support and has no acceptable theoretical basis, why would we wish to allow it to contaminate legitimate thinking about childhood interventions?
I believe Montanabw is attempting to base this argument on the well-known attempts by Intermountain to re-define holding as a therapeutic intervention. This re-definition is in no way substantiated by Intermountain's accreditation status or by its association with the United Methodists. To demonstrate that holding, as practiced at Intermountain, is an effective treatment, someone must provide empirical evidence in the form of a well-designed and well-analyzed study. This has not been done, and regrettably David Ziegler's attempts to bring previous research to bear on this question were vitiated by his citation of claims about holding therapy, as well as by his failure to reference various studies he cited as support in his text. These problems of support for therapeutic holding (or whatever term Intermountain chooses)would probably be apparent only to readers thoroughly versed in this literature, but they are there. If Montanbw is considering the Intermountain approach as the desired middle ground, he or she will have to deal with the fact that there is no more empirical evidence for the Intermountain approach than for Holding Therapy. Jean Mercer ( talk) 18:21, 6 November 2008 (UTC)
4. Foster Cline: To say that Foster Cline has modified his approach is rather like saying that George Bush is modifying his approach to the presidency. Foster Cline surrendered his medical license following a disciplinary hearing and has not written for public consumption since that time. If Montanabw has materials that are acceptable for Wiki and that support his or her claim, M. should bring those forward-- this would be a most interesting revelation. Cline's brilliantly-named proprietary intervention, which has resulted in the Love & Logic empire, is said not to employ Attachment Therapy in any way-- again, if Montanabw can show otherwise, many people would like to know about this. Jean Mercer ( talk) 18:26, 6 November 2008 (UTC)
5. Milton Erickson: I don't consider reference to Erickson as a hypnotherapist to be dismissive-- of course he was a seminal figure. What is "dissed" here is Erickson's 1960 paper, quoted in its entirety by Foster Cline, in which he describes a case where a mother was advised to sit on her child for hours at a time and to feed him on cold oatmeal; Erickson also noted with apparent approval an outcome in which the child trembled when the mother spoke to him. Montanabw may want to compare these maternal actions with behaviors described under NIS-4 categories.
5. Conclusion: I believe the present article would be much clarified by the use of different terminology, as any of the terms using the word "attachment" are confusing at best. In addition, I think that-- whatever this is we're talking about-- is historically and theoretically vastly different from other child mental health interventions, and should be discussed by itself, not in a way that suggests it's simply a variant of a mainstream approach. I consider the "middle ground" and the "therapeutic holding" controversy to be red herrings, and I caution other editors not to be persuaded that there would be a positive effect of blurring definitions in this case. Jean Mercer ( talk) 18:36, 6 November 2008 (UTC)
Several things here: I did not mean to encourage the idea of delisting, nor am I in agreement with Montanabw's comments. I consider the article to be generally appropriately organized, written, and sourced. But as I noted, and as Fainites agrees above, I believe the terminology is a problem. To discriminate between a broad category of attachment-focused therapies, and the system discussed in the present article, I have called the latter Attachment Therapy (caps) or put the term in quotation marks. I would find either of these appropriate, or of course both caps and quotation marks could be used just in case anyone missed the point. The label Holding Therapy has been criticized because there is much more to the treatment than holding, and I've always felt uneasy with the term Attachment Therapy because attachment is not involved. Fainites' added lead material seems quite suitable, but i would also suggest stressing the difference between attachment therapies and Attachment Therapy, and noting that the latter is not one of the former. This might be done best by giving a couple of examples of attachment therapies.
It certainly would have been useful if APSAC had been more careful about terms. Before that report, people generally said "attachment-related" or "attachment-focused" interventions-- now we have this "attachment therapies" category. Anyway, I agree, forget Coercive Restraint-- only about 6 people in the world know what that means. Jean Mercer ( talk) 00:19, 7 November 2008 (UTC)
By the way, with respect to sources, I don't understand the problem with Bridget Mahoney's education, or why disclaimers on web sites are a problem. Jean Mercer ( talk) 00:22, 7 November 2008 (UTC)
Comment on comments: I have no time and insufficient interest to become a contributor to the article, I was mostly just weighing in on the GA issue because an outside opinion was requested. In short, I agree with the clarification of the terminology and the tweak of the lead. I'm also not defending Foster Cline or any coercive model, I am merely questioning the tone of the article that suggests that that AT means only coercive therapies or that all holding therapies are always coercive and bad. I use Intermountain because it's simply an example of a mainstream, non-whacko program that is successfully using attachment theory AND happens to also include holdings. I'm sure someone could contact them and ask for cites to research that supports their program and evaluate it from there. (I don't have the time, personally) I fully agree that AT is controversial, but so were most new psychotherapy approaches at first; over time some were kept, others discredited. This one is still relatively new, so as far as peer-reviewed studies and such go, I haven't the time or inclination to dig into research on this topic, though anything that is cutting edge will inevitably have a limited amount of research out there. It doesn't mean it is good or bad, just new. Also, many of these therapies start out in ways that can be pretty hair-raising, and over time become refined and greatly improved (look at psychotropic drugs, the differences between the old MAOI-class drugs and the modern SSSRI-class drugs are phenomenal). But basically, this article is not really ready for GA due to all of the above issues, and that is really my only real position here: Delist GA. Montanabw (talk) 00:33, 7 November 2008 (UTC)
Regrettably, the treatment continues to be used in spite of evidence that discredits it. That's why the article exists. And, of course, it would be most interesting to know why people are willing to go for these things, but there is no useful evidence about the matter-- in addition, that would be a different topic.
As for Montanabw's statements about holding therapies, it's excessively naive to believe that Intermountain must have research supporting its choices-- this is exactly what I was commenting on yesterday. The literature in this area is quite complex, and it doesn't pay to jump to conclusions about it. You have to really know the literature to make reasonable decisions here. This isn't rocket science, it's a lot harder than that.
If Montanabw believes there is empirical evidence supporting holding therapy in any form, he or she should present it-- keeping in mind what I said about David Ziegler's work (and the same goes for Howard Bath). 72.73.196.59 ( talk) 13:32, 7 November 2008 (UTC)
Ooops, sorry, that was me. Jean Mercer ( talk) 13:38, 7 November 2008 (UTC)
I do, I do propose that change, to Attachment Therapy with caps, and I always use that form in my own writing. I would even propose using quotation marks in addition to caps, but I suppose this would confuse searches. I would also suggest that mainstream interventions be described as attachment therapIES as a group, and by their own specific names if discussed individually. If it weren't for the confusing precedent established by APSAC, I'd argue that we go back to "attachment-focused" or "attachment-related", which used to be standard.
"Attachment Therapy On Trial" (Mercer, Sarner, & Rosa) discusses some of the background in popular thought which is being described as the sociological context.
One comment on the "middle ground" business: it's important to remember that "holding" as alluded to by Montanabw is probably not equivalent to "rage reduction" therapy. Instead, this is a mthod that involves restraint as an assurance of safety in crisis situations, followed by continued restraint (called "therapeutic holding") after calm is restored-- proponents of this technique believe that the holding of the now-calm individual has therapeutic value. This is obviously different from holding methods that incite distress and loss of control; however, there is no adequate evidentiary foundation to support the effectiveness of either method. (Please comment if you disagree with my definition, Montanabw.)In fact, little has been published about "therapeutic holding" in peer-reviewed journals, and the definition seems to have been subject to criterion creep. I would speculate that "therapeutic holding" is based primarily on assumptions about "age regression" rather than on beliefs about catharsis. Jean Mercer ( talk) 17:43, 7 November 2008 (UTC)