This paper applies the concept of potentially harmful psychotherapies (PHTs; Lilienfeld, Perspectives on Psychological Science 2(1):53–70, 2007) to concerns about potentially harmful treatments for children and adolescents (PHTCs). I propose that such treatments can be identified by methods derived from the Adverse Childhood Experiences (ACE) Study and from the NIS-4 study of abuse and neglect, as well as by their plausibility or congruence with established child development theory and research. Five psychological treatments for children and adolescents that have been reported as harmful are examined, using evidence from published materials, journalists’ reports, legal documents and Internet sites. Details of treatment and outcomes are compared to relevant ACE and NIS-4 criteria and to plausibility, and empirical support for the treatments is examined. The examined treatments use methods that would be considered adverse childhood experiences or abusive or neglectful care events if they occurred outside a therapeutic setting. Most, but not all, lack empirical support of effectiveness and are incongruent with established information about child development. Risks associated with PHTCs can thus be identified through close examination before children are exposed to them and harmed. Prevention or reduction of PHTC use may be possible. Public and professional education about PHTCs are essential parts of child protection in this context and are arguably an ethical obligation of both social workers and psychologists.
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“Advanced parenting for challenging children: Meet Kali” (n.d.). Retrieved January 7, 2016, from http://www.advancedparenting4kids.com/oregon-trainers/kali-miller/.
Amended Complaint.(2014). Anna Kouns vs. Blue Sky, Inc., Circuit Court for Knox County, TN; Docket Number 3-668-14. Unpublished document.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th edn. Washington, DC: American Psychiatric Association.
American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). Report of the task force on appropriate therapeutic responses to sexual orientation. Washington, DC: American Psychological Association.
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved January 18, 2016, from http://www.apa.org/ethics/code/index.aspx.
American Psychological Association Presidential Task Force on Evidence-based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285.
“Attachment therapist Neil Feinberg terrorizes adopted child”. (n.d.). Retrieved January 17, 2016, from https://www.youtube.com/watch?v=tNollwOulk.
“ATTACh Position Statement Against Coercive Treatment”. (2006). Retrieved February 1, 2016, from https://attach.org/about-us/attach-position-statement-regarding-coercive-treatment/.
Barlow, D. H. (2010). Negative effects from psychological treatments: A perspective. American Psychologist, 65, 13–20.
Beaudet, A. L. (2012). Preventable forms of autism? Science, 338, 342–343.
Benz, U. (2013a). Festhaltetherapien. Giessen: Psychosozial-Verlag.
Benz, U. (2013b). Langzeitfolgen des Festhaltetherapie. In U. Benz (Ed.), Festhaltetherapien (pp. 121–143). Giessen: Psychosozial-Verlag.
Bethell, C. D., Newachek, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33, 2106–2115.
Bowlby, J. (1982). Attachment. New York: Basic.
Bowman, R., & Baker, J. (2014). Screams, slaps, and love: The strange birth of applied behaviour analysis. Pediatrics, 133(3). Retrieved Nov. 17, 2016 from http://www.pediatrics.aappublications.org/content/133/3/364.
Burchard, F. (1988). Verlaufsstudie zur Festhaltetherapie: Erste Ergebnis bei 85 Kindern. Praxis der Kinderpsychologie und Kinderpsychiatrie, 37, 89–98.
Burkholder, A. (2014). Controversy over shocking people with autism, behavioural disorders. Retrieved November 14, 2016, from http://www.cbsnews.com/news/controversy-over-shocking-people-with-autism-behavioral-disorders/.
Butterfield, W. (1975). Electric shock hazards in aversive conditioning of humans. Behavioral Engineering, 3, 1–28.
“CBS 48 Hours: ‘Afraid of our children’ ”. (n.d.). Retrieved January 17, 2016, from https://www.youtube.com/watch?v=NaUqeMrkQU.
Chaffin, M., Hanson, R., Saunders, B., Nichols, T., Barnett, D., Zeanah, C., & Miller-Perrin, C. (2006). Report of the apsac task force on attachment therapy, reactive attachment disorder, and attachment problems. Child Maltreatment, 11, 76–89.
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82, 217–225.
“Christian movements and denominations”. (2011). Retrieved May 20, 2016, from http://www.pewforum.org/2011/12/19/global-christianity-movements-and-denominations/.
Cohen, R. (2006). Coming out straight. Winchester, VA: Oakhill.
Conn, A.-M., Szilyagi, M., Alpert-Gillis, C., & Baldwin, S. (2016). Mental health problems that mediate treatment utilization among children in foster care. Journal of Child and Family Studies, 25, 969–978.
Dimidjian, S., & Hollon, S. (2010). How would we know if psychotherapy were harmful? American Psychologist, 65, 21–33.
Dishion, T., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755–764.
Falk, A. (2012). Woman convicted in her daughter’s death by “water intoxication” released from prison. Salt Lake: Tribune. Retrieved January 18, 2016, from http://archive.sltrib.com/story.php?ref=/sltrib/news/53270884/killpack-board-child-drink.html.csp.
Fallon, B., Trocme, N., & MacLaurin, B. (2011). Should child protection services respond differently to maltreatment, risk of maltreatment, and risk of harm? Child Abuse & Neglect, 35, 236–239.
FDA-2016-N-1111. (2016). Retrieved November 15, 2016, from https://www.regulations.gov/docket?D=FDA-2016-N-1111.
FDA Executive Summary: Electrical Stimulation Devices for Aversive Conditioning. (2014). Retrieved November 15, 2016, from http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevicesAdvisoryCommittee/UCM394256.pdf.
“FDA proposes ban on electrical stimulation devices intended to treat self-injurious or aggressive behavior”. (2016). Retrieved November 15, 2016, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm497194.htm.
Federici, R.S. (2005). Help for the hopeless child. Alexandria, VA: Dr. Ronald S. Federici Associates.
“Find a therapist in your area”. (2015). Retrieved May 22, 2016, from http://www.attachment.org/find-a-therapist-in-your-area/.
“Finding a counselor or life coach.” (2016). Retrieved May 20, 2016, from http://www.peoplecanchange.com/support/counselor.php.
Forbes, H., & Dziegielewski, S. (2002). Reactive attachment disorder. In S. Dziegielewski (Ed.), DSM-IV-Tr in action (pp. 143–168). New York: Wiley.
Gray, E. (2015). Advocates hopeful Obama’s support will end gay “conversion therapy”. Time. Retrieved January 19, 2016, from http://time.com/3815996/gay-conversion-therapy-barack-obama-lgbt/.
Grebenik, D. (2016). A new definition of attachment/regulation. Retrieved May 24, 2016, from http://www.focusonthefamily.com/parenting/adoptive-families/attachment-and-bonding/new-definition-of-attachment-regulation.
Grzadzinski, R., Luyster, R., Spencer, A., & Lord, C. (2014). Attachment in young children with autism spectrum disorders: An examination of separation and reunion behaviors with both fathers and mothers. Autism: The International Journal of Research and Practice, 18, 85–96.
Haldeman, D. C. (2003). The practice and ethics of sexual orientation conversion therapy. In L. D. Garnets & D. C. Kimmel (Eds.), Psychological perspectives on lesbian, gay, and bisexual experiences (2nd edn., pp. 681–698). New York: Columbia University Press.
Hammond, F., & Hammond, I. M. (2010). Pigs in the parlor. Kirkwood, MO: Impact Christian Books.
Hicks, K. (1999). “Reparative” therapy: Whether parental attempts to change a child’s sexual orientation can legally constitute child abuse. American University Law Review, 49, 505–547.
Iacbini, A., Petiwala, A., & DeHart, D. (2016). Examining adverse childhood experiences among students repeating the ninth grade: Implications for school dropout prevention. Children and Schools, 38, 218–226.
“In the matter of Debra (Kali) Miller, Ph.D.” (2012). Retrieved January 7, 2016, from http://www.obpe.alcsoftware.com/files/miller.debra%20(kali)%20a.f._559.pdf.
Israel, M., Blenkush, N., von Heyn, R., & Rivera, P. (2008). Treatment of aggression with behavioral programming that includes supplementary skin-shock. Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention, 1, 119–166.
James, B. (1994). Handbook for treatment of attachment-trauma problems in children. New York: Simon and Schuster.
Jongsma, A.E., Peterson, L.M., McInnis, W.P., & Bruce, T.J. (2014). The child psychotherapy treatment planner, 5th edn. New York: Wiley.
Kaufman, L. (2007). Parents defend school’s use of shock therapy. Retrieved November 14, 2016, from http://www.nytimes.com/2007/12/25/nyregion/25shock.html.
Kazdin, A. (1990). Conduct disorders. In A. Bellack, M. Hersen, & A. Kazdin (Eds.), International handbook of behavior modification and therapy (2nd edn., pp. 669–706). New York: Plenum.
Koocher, G. (1976). Civil liberties and aversive conditioning for children. American, Psychologist, 31, 94–95.
Lehmann, S., Havik, O., Havik, T., & Heiervang, E. (2013). Mental disorders in foster children: A study of prevalence, comorbidity and risk factors. Child and Adolescent Psychiatry and Mental Health, 7, 39–63.
Lester, V. S. (1997). Behavior change as reported by caregivers of children receiving holding therapy. Retrieved February 28, 2013, from http://bellsouthpwp.net/e/i/eiseles/research_lester.html.
Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53–70.
Linden, M. (2013). How to define, find, and classify side effects in psychotherapy from unwanted events to adverse treatment reactions. Clinical Psychology and Psychotherapy, 20, 286–296.
Linscheid, T. R., Iwata, B. A., Ricketts, R. W., Williams, D. E., & Griffin, J. C. (1990). Clinical evaluation of the self-injurious behavior inhibiting system (SIBIS). Journal of Applied Behavior Analysis, 23, 53–78.
Lipsey, M. (1992). Juvenile delinquency treatment: A met-analytic inquiry into the variability of effects. In T. Cook, H. Cooper, D. Cordray, H. Hartmann, L. Hedges, R. Light, … F. Mosteller (Eds.), Meta-analysis for explanation: A casebook (pp. 83–127). New York: Russell Sage.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
Marie-Mitchell, A., Struder, K., & O’Connor, T. (2016). How knowledge of adverse childhood experiences can help pediatricians prevent mental health problems. Journal of Collaborative Family HealthCare, 34, 128–135.
Marlan, T. (2000). A most dangerous method. Chicago: Chicago Reader. Retrieved November 17, 2016, from http://www.chicagoreader.com/chicago/a-most-dangerous-method/Content?oid=903012.
“Martha Welch ‘Mothering Center’ Clip”. (n.d.) Retrieved January 17, 2016, from https://www.youtube.com/watch?v=GPaNe0g9_-ww.
McCabe, J., Brewster, K., & Tillman, K. (2011). Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults. Perspectives on Sexual and Reproductive Health, 43, 142–150.
McKeachin, J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 373–391.
Mercer, J. (2001). “Attachment therapy” using deliberate restraint: An object lesson on the identification of unvalidated treatments. Journal of Child and Adolescent Psychiatric Nursing, 14, 105–114.
Mercer, J. (2013). Holding therapy: A harmful alternative mental health intervention. Focus on Alternative and Complementary Therapies, 18, 70–76.
Mercer, J. (2015). Attachment therapy. In S. O. Lilienfeld, S. J. Lynn, & J. M. Lohr (Eds.), Science and pseudoscience in clinical psychology (2nd edn., pp. 466–499). New York: Guilford.
Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment therapy on trial. Westport, CT: Praeger.
Morrison, L., Duryea, P. B., Moore, C., & Nathanson-Shinn, A. (2002). The lethal hazard of prone restraint: Positional asphyxia. Retrieved January 17, 2016, from http://www.disabilityrightsca.org.pubs/701801.pdf.
Myeroff, R., Mertlich, G., & Gross, G. (1999). Comparative effectiveness of holding therapy with aggressive children. Child Psychiatry & Human Development, 29, 303–313.
Neumann, D., & Waters, A. (2006). The use of an unpleasant sound as an unconditional stimulus in a human aversive Pavlovian conditioning procedure. Biological Psychology, 73, 175–185.
Neumann, D., Waters, A., & Westbury, H. R. (2008). The use of an unpleasant sound as the unconditional stimulus in aversive Pavlovian conditioning experiments that involve children and adolescent participants. Behavior Research Methods, 40, 622–625.
Nock, M., Kazdin, A., Hiripi, E., & Kessler, R. (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: Results from the National Comorbidity Survey Replication. Journal of Child Psychology and Psychiatry, 48, 703–713.
Norcross, J., Koocher, G., & Garofalo, A. (2006). Discredited psychological treatments and tests: A Delphi poll. Professional Psychology: Research and Practice, 37, 515–522.
Perou, R., Bitsko, R., Blumberg, S., Pastor, P., Ghandour, R., Gfroerer, J. … Huang, L. (2013). Mental health surveillance among children—United States, 2005–2011. MMWR: Morbidity & Mortality Monthly Report, 62, 1–35.
Petrosino, A., Turpin-Petrosino, C., & Buehler, J. (2005). Scared Straight and other juvenile awareness programs for preventing juvenile delinquency. Scientific Review of Mental Health Practice, 4, 48–54.
“Portland therapist loses license after prescribing bottle feeding, confinement for 11-year-old boy.” (2015). Retrieved January 7, 2015, from http://www.oregonlive.com/portland/index.ssf/2015/03/portland_therapist_loses_licen.html.
Prekop, J. (1983). Das Festhalten als Therapie bei Kindern mit Autismus-Syndrom. Anwendung der Therapie durch ‘Festhalten’ nach Welch/Tinbergen. Teil 1. Fruehfoerderung Interdisziplinaer, 2, 54–64.
Prekop, J. (2006). Der kleine Tyrann [The little tyrant]. Muenchen: Goldmann.
Prekop, J., & Hellinger, B. (2010). Wenn ihr wuestet, wie ich euch liebe [If you knew how much I love you]. Muenchen: Knaur TB.
Prekop, J., & von Stosch, T. (n.d.). Festhaltetherapie in Urteil von Eltern—eine Nachuntersuchung zur Wirksamheit ein psychotherapeutischen Vehrfahrens. Retrieved February 28, 2013, from http://www.prekop-festhalten.de/festhaltetherapie.html.
Reber, K. (1996). Children at risk for reactive attachment disorder: Assessment, diagnosis, and treatment. Progress: Family Systems Research and Therapy, 5, 83–98.
“Recognition of psychotherapy effectiveness”. (2012). Retrieved January 19, 2016, from http://www.apa.org/about/policy/resolution-psychotherapy.aspx.
Rohmann, U. H., & Hartmann, H. (1985). Modifizierte Festhaltetherapie (MFT). Eine Basistherapie zur Behandlung autistischer Kinder. Zeitschrift fuer Kinder- und Jugendpsychiatrie, 13, 182–198.
Salvy, S.-J., Mulick, J., Butter, E., Bartlett, R., & Linscheid, T. (2004). Contingent electric shock (SIBIS) and a conditioned punisher eliminate severe head banging in a preschool child. Behavioral Interventions, 19, 59–72.
Schlanger, Z. (2015). Jonah, the largest Jewish gay conversion therapy organization, takes its last breath. Newsweek. Retrieved January 18, 2016, from http://www.newsweek.com/life-and-death-jewish-exgay-therapy-organization-406898.
Schopler, E. (2012). Changing parental involvement in behavioral treatment. In M. Rutter & E. Schopler (Eds.), Autism: A reappraisal of concepts and treatment (pp. 413–421). New York: Springer.
Schroll, J. B., Penninga, E. I., & Gotzsche, P. C. (2016). Assessment of adverse events in protocols, clinical study reports, and published papers of trials of orlistat: A document analysis. Retrieved August 18, 2016, from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.10021101.
Sedlak, A. J., Mettenberg, J., Basena, M., Petta, I., McPherson, K., & Li, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families.
“Seminars”. (2015). Retrieved May 22, 2016, from http://www.attachment.org/seminars/.
Serovich, J. M., Craft, S. M., Toviessi, P., Gangamma, R., McDowell, T., & Grafsky, E. L. (2008). A systematic review of the research base on sexual reorientation therapies. Journal of Marital and Family Therapy, 34, 227–238.
Soke, G., Rosenberg, S., Hamman, R., Fingerlin, T., Robinson, C., Carpenter, L., … DiGuiseppi, C. (2016). Brief report: Prevalence of self-injurious behaviors among children with autism spectrum disorder: A population-based study. Journal of Autism and Developmental Disabilities, 46, 3607–3614.
State of North Carolina v. Paul Joseph Salvetti. (2010). Retrieved January 19, 2016, from https://appellate.nccourts.org/opinions/?c=2&pdf=5372.
“STOP Jirina Prekopova Attachment Therapy” (n.d.). Retrieved January 17, 2016, from https://www.youtube.com/watch?v=7w3Ihg65HV8.
Stryker, R. (2010). The road to evergreen. Ithaca, NY: Cornell University Press.
Substance Abuse and Mental Health Services Administration. (2015). Ending conversion therapy: Supporting and affirming LGBTQ youth. HHS Publication No. (SMA) 15-4928. Rockville, MD: SAMHSA.
Sudbery, J., Shardlow, S. M., & Huntington, A. E. (2010). To have and to hold: Questions about a therapeutic service for children. British Journal of Social Work, 40, 1534–1552.
The Adverse Childhood Experiences Study. (n.d.). Retrieved January 19, 2016, from http://www.acestudy.org.
Thomas, N. (2000). Parenting children with attachment disorders. In T. M. Levy (Ed.), Handbook of attachment interventions (pp. 67–111). San Diego: Academic Press.
Thyer, B., & Pignotti, M. (2015). Science and pseudoscience in social work practice. New York: Springer.
Tinbergen, N., & Tinbergen, E. (1983). “Autistic” children: New hope for a cure. Hemel Hempstead: Allen & Unwin.
“Trial set in malpractice suit”. (1971). Flagstaff, AZ: Sun, p. 2.
Vandiver, S., & Malcolm, K. (2009). Adoption USA: A chartbook based on the 2007 national survey of adoptive parents. Retrieved November 17, 2016, from http://www.aspe.hhs.gov.
van Oorsouw, W., Israel, M., von Heyn, R., & Duker, P. (2007). Side effects of contingent shock treatment. Research on Developmental Disabilities. Retrieved November 14, 2016, from http://www.effectivetreatment.org/SideEffectsContingent.pdf.
Walsh, C., Reutz, J. R., & Williams, R. (2015). Selecting and implementing evidence-based practices: A guide for child and family serving systems. Retrieved January 17, 2016, from http://www.cebc4cw.org/implementing-programs/guide/.
Waschbusch, D., Bernstein, M., Mazzant, J., Willoughby, M., Haas, S., Coles, E., & Pelham, W. (2016). A case study examining fixed versus randomized criteria for treating a child with conduct problems and callous-unemotional traits. Evidence Based Practice in Child and Adolescent Mental Health, 1, 73–85.
Weaver, J. (2015). The new apostolic reformation. Jefferson, NC: McFarland.
Welch, M. G. (1989). Holding time. New York: Fireside.
Welch, M. G., Northrup, R. S., Welch-Horan, T. B., Ludwig, R. J., Austin, C. L., & Jacobson, J. S. (2006). Outcomes of prolonged parent–child embrace therapy among 102 children with behavioral disorders. Complementary Therapies in Clinical Practice, 12, 3–12.
Wimmer, J., Vonk, M. E., & Bordnick, P. (2009). A preliminary investigation of the effectiveness of attachment therapy for children with reactive attachment disorder. Child and Adolescent Social Work Journal, 26, 351–360.
Young, S. (2006). Does “reparative” therapy really constitute child abuse? Yale Journal of Health Policy, Law, and Ethics. Retrieved January 12, 2016, from http://digitalcommons.law.yale.edu/yjhple/vol16/iss1/3.
Zaslow, R., & Menta, M. (1975). The psychology of the Z-process: Attachment and activity. San Jose, CA: San Jose State University Press.
Zorzela, L., Loke, Y. K., Ioannidis, J. P., Golder, S., Santaguida, P., Altman, D. G., … PRISMA Harms Group. (2016). PRISMA harms checklist: Improving harms reporting in systematic reviews. British Medical Journal, 352. Retrieved February 11, 2016, from http://www.bmj.com/content/bmj/352/bmj.i157.full.pdf.
Conflict of interest
Jean Mercer declares that she has no conflict of interest.
This article does not contain any studies with human participants performed by the author.
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Mercer, J. Evidence of Potentially Harmful Psychological Treatments for Children and Adolescents. Child Adolesc Soc Work J 34, 107–125 (2017). https://doi.org/10.1007/s10560-016-0480-2
- Potentially harmful treatments
- Child and adolescent mental health
- Child abuse
- Professional ethics