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Suffer the Children

Three kids with attachment disorder have died in Colorado -- but according to Foster Cline, their parents and therapists are the ones most in need of help.

Rage-reduction therapy was controversial in the psychotherapy community then, and it still is. Zaslow's California medical license was revoked in 1974; Cline says he believes it was after an adult patient complained about Zaslow's use of holding therapy. In 1976, Cline's own center was accused of abusing a young patient who was bruised during holding therapy.

While many therapists agree that traditional "talk therapy" simply does not work with kids suffering from attachment disorder, rage-reduction therapy "was fairly rough and could even be abusive to a child," says Steven Gray, a neuropsychologist with offices in Colorado and Texas.

In 1992, Houston psychologist Mark Wernick, who was trained in attachment therapy by a woman who'd trained under Cline, was suspended after conducting holding therapy. The patient in question was a birth child who'd exhibited a lot of symptoms of reactive attachment disorder, Wernick says. He'd had the boy placed in a psychiatric hospital and was treating him there. Wernick was suspended while hospital officials investigated whether he violated the restraint policy.

Psychiatrist Foster Cline has become an advocate for 
parents of children with attachment disorder.
Psychiatrist Foster Cline has become an advocate for parents of children with attachment disorder.

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"They were very hysterical," Wernick said of hospital administrators' reaction to rage therapy. "They were afraid I may have traumatized him psychologically." The hospital suspended Wernick's privileges and refused to let him see the boy.

Administrators eventually offered to return his privileges, but with stipulations attached. "They didn't want me to do [holding therapy] again, but also, in any case in which I put a patient there, I was to have on-site supervision. I thought that was pretty much unnecessary. I resigned my privileges," Wernick says.

That incident made Wernick realize that there needed to be more training in attachment therapy -- both in dealing with patients and in dealing with hospital administrators. "I decided that if we believe in these methods, we'd better get some standards of practice," he says. And so he came up with standards of care for ATTACh, the Association for the Treatment and Training in the Attachment of Children, which fifty health-care professionals had formed in 1990.

Those standards do not restrict or eliminate rage-reduction therapy. They do, however, encourage practitioners to clarify to parents and follow-up therapists their role in the process, with assurances of physical safety and nurturing. And Wernick continues to stand by the controversial therapy.

"Raging is very much a part of the therapy process," he says. "I frequently do things that some people easily could construe as provocative. Some people may want to distance themselves from that, but I don't believe in the 21st century we will be able to be comprehensively therapeutic without room for some types of provocation...Some children are so severely disturbed that they cannot be helped unless there's some provocation."

In 1993, a former Evergreen patient complained to the Colorado Board of Medical Examiners that he'd been abused in therapy. The boy, who was eleven at the time he was treated, said he was held down and that his mouth was covered. The therapists continued the treatment even after he was cried out and exhausted, he told the board.

Although Foster Cline had not treated the patient, he was the supervisor of the therapist who did: Connell Watkins. Cline himself was accused of "grossly negligent medical practice," received a letter of admonishment from the board, and was ordered to stop using therapy that used verbal abuse and unpleasant physical stimulation.

After the case was settled, Cline moved to Idaho.

Cline claims not to have done any attachment work in about ten years. In Idaho, he specializes in family therapy. And while he helped establish the Golden-based Cline/Fay Love and Logic Institute with Jim Fay, a former educator, Cline says the institute is not connected with attachment therapy in any way. Instead, it conducts seminars around the country designed to put parents in control and teach children responsibility."I reached a time in life where it became tiresome to always be the point man," Cline says of abandoning his former specialty.

But while Cline abandoned Evergreen, Evergreen did not abandon Cline. At least not completely.

Today there are at least four attachment clinics and fourteen attachment specialists in Evergreen; rather than the rage-reduction therapy of two decades ago, they employ a more nurturing offshoot of attachment therapy, one that involves a combination of therapies. Many of the Evergreen therapists offer two-week "therapeutic intensives" in which they work closely with the patient and the patient's family.

"Evergreen continues to be a major player in various residential treatment centers," says psychologist Gray. "I wouldn't hesitate to refer a patient there."

Other practitioners, however, are extremely critical of the work done by Evergreen therapists.

Ronald Federici, a developmental neuropsychologist from Virginia, makes no attempt to hide his contempt for "the Evergreen people," whom he paints with a broad brush. After Evergreen therapists "fail and rip off a family, [the families] come to see me for proper treatment," Federici charges. "There's no such thing as 'attachment therapy.' It's an offshoot of family therapy. [The children] need to work on how to become emotionally attached to the family, and that's something that occurs over the course of time. They have to learn this process. It can't be shoved down their throats...it can't be cured in three weeks and $24,000.

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