Harris therapy controversial 

But DHS site recommends it.

CRITICAL OF 'EXPERT' CITED BY HARRIS: Jean Mercer is a psychologist who has concerns about "Attachment Therapy."
  • Greg Haygood
  • CRITICAL OF 'EXPERT' CITED BY HARRIS: Jean Mercer is a psychologist who has concerns about "Attachment Therapy."

Chelsey Goldsborough, a babysitter for state Rep. Justin Harris (R-West Fork) and his wife, Marsha, said last week that the Harrises believed their adopted girls, ages 2 and 5 at adoption, were possessed by demons and that they turned to exorcism to cure the older girl. Goldsborough and other sources said the Harrises often locked the girls in their rooms and would isolate the older girl from the rest of the family for hours at a time, communicating only through a video monitor. The Harrises eventually removed the girls from their home and placed them with a man who, in turn, raped the older girl.

On Tuesday, Goldsborough said she had been contacted by state police regarding a child maltreatment investigation. When we asked the Department of Human Services last week whether locking a child in a room for extended periods of time would constitute abuse or maltreatment, spokesperson Amy Webb said, "That situation would likely result in a call being placed to the child abuse hotline for possible investigation. It would then be up to the hotline to determine whether an investigation would be pursued. The outcome of such an investigation would be dependent on what the circumstances were surrounding that situation. Context is critical in child maltreatment investigations."

Some context for the circumstances in the Harris home was provided by the Harris family lawyer, Jennifer Wells, when the Times asked about the girls' treatment. She said the couple relied on techniques found in a book called "When Love Is Not Enough, A Parent's Guide to Reactive Attachment Disorder" by Nancy Thomas, who Wells described as a "recognized expert on therapeutic parenting techniques." Wells also told the Times that exorcisms "are not part of the Harrises' religious practice."

But Thomas' book might have put ideas about demonic possession in the Harrises' heads.

Here is what "When Love Is Not Enough" has to say about children with Reactive Attachment Disorder, which Justin Harris says the girls were diagnosed with:

"The infant rage they often internalize that first year, instead of internalizing a loving parent, makes them fascinated with destruction, fire, blood, gore and evil. They often identify with the devil."

In fact, Thomas paints a bleak picture of children with RAD, describing them as "sneaky," potentially dangerous liars who should not be let out of their rooms at night lest they harm family members.

There is much popular confusion about RAD, and for good reason. Reactive Attachment Disorder is a very specific condition recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM), the definitive (if imperfect) resource for mental health diagnosis, published by the American Psychiatric Association. Children with RAD typically either fear and avoid social relationships or develop social bonds inappropriately quickly, according to the DSM. Although RAD is often associated with abused or neglected children, who commonly have other behavioral problems, the diagnosis does not necessarily indicate a violent individual.

But Thomas and other proponents of what they call "Attachment Therapy" define a broader range of negative child behaviors as symptoms of "Attachment Disorder," a diagnosis that is not recognized by the DSM. Adding to the confusion, Thomas and others often use the terms "RAD" and "Attachment Disorder" interchangeably.

The diagnosis and therapy have come under fire from the APA's Division on Child, Youth and Family Services and child psychologists as not based in science and potentially harmful to children

Jean Mercer of the Institute for Science in Medicine, a retired professor who earned her doctorate from Brandeis University, says the practitioners of "Attachment Therapy" label young children as potential psychopaths, a diagnosis that mental health professionals say cannot be made in children.

"Attachment Therapy" insists on absolute obedience to the parents as the way to engender feelings of attachment in the child. An APA task force described the philosophy this way in a 2006 report: "Proponents of the controversial therapies emphasize the child's resistance to attachment and the need to break down the child's resistance ... the conceptual focus for understanding the child's behavior emphasizes the child's individual internal pathology and past caregivers, rather than the current parent-child relationship or current environment."

Mercer said therapists who use "Attachment Disorder" as a diagnosis "are saying, 'We're going to imitate what normally happens with babies, babies being totally dependent. ... Parents must have total authority and they think that emotional attachment happens because the child recognizes the power of the adult. What they think [parents] have to do is display their power, and the way you know [children] are attached is they are very obedient and grateful." Children must acknowledge parental authority, show affection and gratitude "and into the bargain they have to be fun to be around. The goal here is vastly different from what the goal would be in a genuine family."

Mercer said established therapies, on the other hand, focus on symptoms and work with parents to address those symptoms. "I'm not saying the parent is bad or wrong, but parents must learn to do things that work with [a] particular child for [a] particular problem," Mercer said. Therapies that focus on nuance — is a child you think is ignoring you really ignoring you? Or just paying attention in a different way? — "can really help parents change behavior expectations in a way that fosters the child's appropriate maturation," she said.

Thomas' "Attachment Disorder" diagnosis says children with "act superficial and phony ... they feel they can manipulate"; "avoid eye contact with people who love them unless they are lying, or conning, and then they make excellent eye contact"; are "trust bandits" who are "not cuddly"; "very sneaky"; and are without a conscience. The checklist of behaviors is derived from something called the Randolph questionnaire, an unscientific instrument developed by a practitioner who lost her license, Mercer said.

Those symptoms are not included in the DSM-5's diagnosis of Reactive Attachment Disorder. Instead, the DSM-5 describes children with RAD as being emotionally withdrawn toward caregivers, sad, fearful and irritable. It is not a predictor of "a terrible outcome," Mercer said, and is a rare diagnosis.

In a press conference he called to address the Arkansas Times' revelations of his rehoming, Harris said he relied on Ozark Guidance, a respected mental health provider in Northwest Arkansas, for help with his children's therapy. A spokesperson for Ozark Guidance asked the Times to submit its inquiry into the use of "Attachment Therapy" by email for a response, but none was received by press time.

Nancy Thomas does not have any formal training in child psychology, something she herself acknowledges. Instead, she writes, "I have a mom's heart and a mom's hands." Before she got into "Attachment Therapy" she was a dog groomer, according to the Advocates for Children in Therapy in Loveland, Colo. (In "When Love Is Not Enough," Thomas describes a child's basic skills as "come, go, no, sit and stay.")

Thomas tells tales of mayhem, of parents whose 9-year-old "hacked up stairs, furniture and paneling, preparing to hack up her newly adopted mom!" and another 9-year-old who crept out at night to molest dozens of children.

Goldsborough, the former babysitter, said the girls' rooms were outfitted with cameras and alarms, and that the older girl was not allowed to play with the Harris boys or her biological sister, with whom she'd lived since birth and who the babysitter said was also believed to be possessed by the Harrises. Goldsborough said Marsha Harris showed her a video that Harris believed showed a demon interacting with one of the girls, and that the girls were kept apart because the Harrises believed they could communicate telepathically.

Thomas writes that a child with "Attachment Disorder" "should never share a room with another child. If a child with attachment disorder can physically or sexually abuse another child, they will." She writes that they should not be allowed to play with other children because "it is very easy for them to grab a crotch or poke out an eye."

Goldsborough also reported there were locks on the girls' rooms, which is something Thomas does not advocate: "It is not safe or legal to lock a child in their room. Don't do it." She does advocate for alarms, however, and says, "parents must open the child's bedroom door rather than allow the child to do it until the alarm is no longer needed."

Thomas says children with RAD enjoy lying, and that a "fun thing" to help "a falsehood filled fiend" overcome lying is to offer them cereal when they ask for ice cream and "when they question, you say 'Oh, I thought you were lying.' " Have fun with it, she says.

In its 2006 report, the APA task force writes that Thomas' definition of RAD behavior — that all RAD children have deeply suppressed anger, have no conscience and will become psychopaths if untreated — is unsupported by "most" attachment researchers. The task force was particularly critical of holding therapy, in which the child is held down by a therapist or parent until he or she stops resisting. Holding therapy came under scrutiny in 2000, when 10-year-old Candace Newmaker was suffocated by therapists in Evergreen, Colo., who held and lay on her as she was wrapped in a sheet to simulate the birth canal. They did not let up despite her protests that she was dying. Thomas now says she doesn't recommend holding. (Her book does, however, suggest a book by another author on holding therapy.)

Another unconventional recommendation by Thomas is to feed disobedient children sugar, which she believes is a pain reliever. She recommends giving children warm milk sweetened with sugar or caramels and vanilla to "reinforce the bonding process."

The state Department of Human Services' website includes many links to websites advocating "Attachment Therapy," including fosterparents.com, where you can find this caveat attached to Nancy Thomas Parenting training sessions:

"Some of the strategies outlined in this workshop may be considered unethical by many child protective agencies and can result in an investigation and loss of foster care license. Though we feel the praise strategies and many of the other strategies in this workshop are appropriate, helpful and make this course well worth taking, we do not endorse all strategies discussed in this workshop. Please keep in mind that Ms. Thomas is working with and discussing children who are severely behaviorally impaired."

LITTLE ROCK THERAPIST JEAN CRUME: Says Thomas "has done a lot of good" for parents but her book is not to be used in place of professional therapy image
  • Brian Chilson
  • LITTLE ROCK THERAPIST JEAN CRUME: Says Thomas "has done a lot of good" for parents but her book is not to be used in place of professional therapy.

In defense

Jean Crume, an MSW and licensed clinical social worker who has a contract with DHS to treat children with RAD, has a different take on Nancy Thomas' and other "Attachment Therapy" methods.

"I know Nancy Thomas is extremely controversial. However, I know she is very effective, trains worldwide and has done a lot of good for parents," Crume said.

Crume, who is listed as an "Attachment Therapist" on the Nancy Thomas Parenting website, does not recommend that parents simply use the book, but use the book in combination with working with a licensed therapist.

Crume said there are many methods that have been developed to treat children with "Attachment Disorder." Nancy Thomas' "is one method and what you read in her method is the extreme of everything. It doesn't have to be that rigid." Crume said that "When Love Is Not Enough" does not stress what she knows to be an important part of Thomas' therapy: "unconditional love, all the time."

Crume uses a therapy called "Theraplay" for her patients 6 and under. She said Theraplay uses the play setting to teach parents how to help their children gain a sense of self, self-esteem and understand that " 'I don't have to control the situation all the time.' "

"A lot has evolved since Nancy Thomas. She [developed her theories in] the '80s and early '90s and there was nothing else out there. She was a voice in the wilderness," Crume said.

What about Thomas' description of a child with RAD as "sneaky" and having other negative characteristics? "Frankly," Crume said, "they probably are going to do all [the behaviors described] if they are seriously attachment disordered. ... The child doesn't know the difference between a want and a need, and doesn't trust the adult to provide what they need. So [the parents] have asked a child not to do something six times and the child does it anyway ... parents are going think the child is being sneaky."

The older of the Harrises' two adopted girls was kept in a room stripped of toys and books, Harris confirmed at his news conference. He said they were taken away and would be reintroduced slowly: Thomas recommends children earn their toys.

Though that seems punitive, Crume was not critical of such a technique.

"The reason that positive reinforcement doesn't work so well is there is nothing to build on," Crume said. If they learn to see a connection between good behavior and reward, they'll gain a sense of self-worth, she said.

Crume said she believed Thomas was addressing the behavior of very disturbed adolescents, rather than 4- and 2-year-olds. "It's not something I think I'd recommend" for younger children, she said. (In the introduction to the book, however, Thomas writes "the tools in this book are most effective with children from toddlers to the onset of puberty.")

It is essential, Crume said, that parents seeking to correct behaviors are not acting out of "anger, meanness, a place of dominance, a place of 'I want to show you who is boss.' " They must not be harsh. If a child has been given a choice to act in a way that is good for him and refuses, the parent must feel "genuinely disappointed" and let the child know that.

"It is extremely difficult. It takes a lot of thought and intention, and it takes training. I don't think all parents can do this," Crume said.

Though DHS links to books and other sites that advocate "Attachment Therapy," spokesperson Amy Webb described the agency's focus as "evidence-based trauma training — Trauma Focused Cognitive Based Therapy (TF-CBT)."

"We have been working with [the University of Arkansas for Medical Sciences] Psychiatric Research Institute to provide training for DCFS [DHS' Division of Children and Family Therapy] staff on Trauma Informed Care. Training also has been provided to a number of foster parents. We think a trauma-informed approach is critically important and we'll be working with UAMS on how we can accomplish training for all foster parents."

TF-CBT, according to the U.S. Department of Health and Human Services is a short-term treatment developed for children who've been sexually abused, exposed to domestic violence or suffered other traumatic experiences. The training involves both parents and children.

Webb also said the agency advocates Parent-Child Interaction Therapy, "an evidenced-based practice that is available through UAMS Child Study Center and Mid South Health Systems in Northwest Arkansas, which has certified mental health therapists who directly address the attachment issues between child and family."


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