It's time for another look at an 18-year-old book on repairing the attachment between mother and child.
When Martha G. Welch wrote Holding Time in 1989, the idea of attachment -- the bond between mother and baby -- was something intuitively understood, but not scientifically proven. Since then, studies of rodents, mammals and humans using functional MRI have begun to show how early nurturing shapes the brain, and how the lack of it harms brain development.
Welch treats attachment disorder using holding therapy at her treatment centers in New York City, Chautauqua and Greenwich, Conn. She's a psychiatrist at Columbia University's Department of Neuroscience, and she's studying both the role of oxytocin and secretin in autism and possible therapeutics using these two peptides. (Secretin is a gastric hormone that prompts the pancreas, stomach and liver to release digestive enzymes.)
Welch's method aims to repair the bond between mother and child. A baby's nervous system and brain aren't fully formed at birth, and development takes place in response to interactions with her mother.
Holding, nursing and nurturing develop the oxytocin response and they seem to determine the amount and sensitivity of oxytocin receptors in the brain, especially the parts of the brain that deal with social interaction. Oxytocin also is critical in moderating the fight-or-flight response.
If a baby experiences fear or abuse, she develops a strong and oversensitive stress response. If she is neglected, or doesn't get enough holding and attention, her brain won't learn to release oxytocin when she does have physical contact -- and contact, even soft nurturing, may seem intense and scary to her deprived body.
The diagnosis of reactive attachment disorder is a catchall similar to autism spectrum disorder. But, no matter the symptoms, its roots are trauma, neglect and the lack of a secure bond with a mother. (I'm using mother here to describe a role; anyone who is the primary caregiver and nurturer of a baby is acting as her mother.)
In Welch's method, the mother takes the child into her lap and attempts to make and keep eye contact. Welch's holding therapy typically goes through three stages: confrontation, rejection and reconciliation. In the first stage, holding often means restraining the child on her lap. In the second stage, the child may reject not only being held but also his mother, telling her he hates her, she smells, she's bad. The mother may express her own feelings, saying, "It makes me feel bad that you won't look at me," for example.
Finally, all the negative feelings having been expressed, the child and mother feel peaceful and can connect lovingly. According to Welch, this process is a more expressive version of the gentle cycling between arousal and calm that ideally happens when a mother interacts with her newborn. Being restrained on Mommy's lap gets the child's adrenaline going; that leads to the expression of rage, fear and sorrow, leading to release of those feelings and a new kind of arousal, that of pleasure in being close to Mommy.
Welch writes, "As the struggle continues, the child usually experiences a whole range of emotions but in the safety of his mother's arms. This time the state of arousal is associated with being held lovingly, resolutely, and closely."
It's important for the mother to also be able to release some of her frustration and anger, Welch believes. She writes, "Holding time allows both of you to discharge your pent-up aggression in a safe way."
Welch's method has much in common with Theraplay: The child being controlled and kept in therapist's or mother's lap; the therapist or mother taking charge of the interaction (designed to let the child know there is an adult in control); the goal of mutual gazing and intimacy; and the theory of consciously recreating the experiences that lead to healthy brain development in the infant.
While Theraplay uses activities to distract the child from her distress and engage her less directly with therapist or parent, the holding time method asks mother and child to stay with their feelings and work through them.
The book and Welch's treatment have come in for criticism because of the enforced holding, especially in light of the horrible cases where RAD kids have died during different types of holding therapy, when they were covered in blankets of grownups laid on top of them.
But her work makes sense in light of attachment theory. Children who aren't well attached to their mothers may be either anxious -- desperately craving attention -- or avoidant. Avoidant kids have learned that being close to Mommy means being hurt -- either being rejected or being yelled at. So, they've decided the safest course is to cut themselves off from anyone else.
I grew up avoidant. I still remember the moment when I consciously decided, "I'm not going to let them hurt me anymore." I still craved love and connection, but when it was offered to me, I froze. I desperately needed someone to break through the ice, take hold of me and love me. I kept waiting for someone to do that, but of course, since I couldn't reach out or ask for it, no one ever did.
From my own experience, I think holding therapy may be just what an avoidant kid needs.
Holding Time explains how to use this method; however, I'm not so sure parents should try it without training. The key to holding therapy is that the mother accept the child's rage, letting him know she loves him no matter what. This is easier said than done.
In the examples in the book, the mothers always respond by expressing their needs or feelings in non-judgmental ways. "I know you are angry at me, but I still love you." "I feel upset when you scream and fight. I am going to hold you until we both feel better."
This kind of response is tough for any of us to do; and, to be brutally honest, if this kind of interaction comes naturally to a mom, her kid is not likely to be in need of holding time. (In the book, Welch doesn't discuss the special needs of adopted children, who may have been traumatized or deprived before being adopted; this was before adoption became as widespread as it is today.)
A parent who hasn't been trained in how to respond could end up damaging the child more. As one Amazon.com reviewer, a self-described survivor of forced hugging, put it, "I found it punitive and abhorred it. Who wants to be yelled at and told to look at somebody while being subdued by force?! Who wants to be the recipient of false accusations with no recourse or defense?!"
If the mother hasn't learned how to give love, if she uses holding time to express herself in ways that frighten or hurt her kid, it will damage the bond even worse, by denying the child the one defense he has: withdrawal.
But if mother and child learn to do this with the support and guidance of a therapist, it could be that revelation that Welch promises: "a closer, more satisfying and truly wonderful relationship with your child."
Theraplay to Shape a Child's Brain
Interview: Dafna Lender, Theraplay Institute