Against Coercion

Against Coercion
Arthur Becker-Weidman, Ph.D.
Director,
Center For Family Development

The APSAC Report on Attachment Therapy offers ATTACh and all in the field an opportunity to state unequivocally and clearly our opposition to coercive methods in treatment. Another set of excellent standards are the recommendations of the American Academy of Child and Adolescent Psychiatry, “Practice Parameter for the Assessment and Treatment of Children and Adolescents with Reactive Attachment Disorder of Infancy and Early Childhood.”

I think that all clinicians in the field should be very clear and specific about what methods they use and what methods they do not use or condone. At The Center For Family Development we have an informed consent document that clearly spells out our practice and methods and that clearly spells out our opposition to coercion in therapy and parenting. In addition we have statements on our website clearly stating our acceptance of and adherence to the recommendations of the APSAC report and the Academy’s report in addition to our adherence to the Association for the Treatment and Training in the Attachment of Children's White Paper on Coercion and ATTACh's new Professional Practice Manual.. The central component in our treatment and in what we teach parents, is attunement; the ability to develop and maintain an emotionally positive, sensitive, engaged, and responsive relationship. It is based on Attachment Theory and what occurs in the normal parent-child relationship during development. I find nothing in Attachment Theory that would support or condone the use of coercion or intrusive methods in child rearing or treatment. In fact, I defy anyone to find me anything to the contrary in the writings of John Bowlby, Micheal Rutter, Mary Ainsworth et. al., Mary Main, Erik Hesse, Jude Cassidy, Philip Shaver, Thomas O’Conner, Howard Steele, Charles Zeanah, Daniel Siegel, or any of the other well known names in the fields of attachment theory and research, developmental psychology, or infant mental health. It is my opinion and recommendation that all practitioners of attachment-based treatment state their acceptance of and adherence to the APSAC and Academy recommendations.

Coercion has usually been defined in terms of the therapist’s or parent’s behaviors. This is not a useful approach because it ignores intention, effect, and process. Coercion is the result of interplay among the actor’s behavior and intentions; the recipient’s perceptions and experience; power differentials in the relationship; and the nature and quality of the relationship between the persons involved. For this reason, a better approach may be to focus on the effects of the behavior on the recipient.

Within this context, coercion can be described as behavior that continues to increase the dysregulation of the other. Dysregulation is never a goal in treatment; indeed, it may well undermine progress. Increasing the distress of another without their consent and without actively working to reduce dysregulation when encountered is coercive. Helping the client to explore a trauma for sake of integration is the goal. Some degree of dysregulation may occur along with the processing, but dysregulation is never sought. Any dysregulation occurring needs to be immediately and sensitively addressed to help the child move toward greater regulation. If the goal of therapy is to actively assist the child to move toward greater degrees of regulation, while preventing or limiting experiences of further dysregulation, then there would be no place for the repetitive kicking/screaming and other abusive “techniques” that have caused controversary.

There are three types of coercion:
1. Behavior that continues to increase the dysregulation of the other.
2. Behavior that unintentionally causes dysregulation without then following with efforts to assist the child in re-attaining regulation.
3. Behavior that is likely to cause distress (addressing trauma, shame, or other intense affects/conflicts/losses, etc.) without incorporating interventions that will assist the child in remaining regulated and managing the distress. These interventions include: empathy/comfort from therapist and/or attachment figure, slow pace, frequent breaks, allowing child to stop the exploration, providing information, encouraging child to participate in the control of the process, teaching self-regulation skills.

Distress may be defined as perceived discomfort. Dysregulation is an overwhelming of the client’s ability to function, resulting in dissociation or other extreme defensive manifestations. When the client responds with discomfort and distress, the therapist uses empathy and emotional support to help co-regulate the client’s affect so that it does not move into dysregulation. While experiencing discomfort and distress, the client maintains the ability to be regulated in affect, cognition, and behavior. However, when a client shows terror, rage, or dissociative features, the client requires our help to become regulated. So, for example, in a therapeutic situation a client may willingly discuss an event that is upsetting and increases the client’s discomfort and distress. However, if the client then indicates a desire to stop, yet the therapist or parent ignores this signal, so that the client is forced to continue, this is coercive. It is also coercive to maintain or increase a client’s dysregulated state until the client is exhausted or has a “break through.” In addition, if a client becomes dysregulated and the therapist or parent does not act to decrease the client’s dysregulation that is coercive. Increasing a client’s dysregulation is never acceptable. Whenever a client exhibits such dysregulation, the therapist must act to decrease dysregulation and act to restore the client to a more regulated emotional state.

A therapist or parent may say or do something that unintentionally dysregulates the child, perhaps by not anticipating the power of a conditioned emotional response or missing the child’s cues. What is imperative is that the therapist or parent immediately engages in behaviors or uses words to decrease the child’s dysregulation. In summary, any actions or words that shame, provoke, or sustain interactions that increase a child or other’s dysregulation are coercive and clearly counter-therapeutic.

Another aspect of coercion is using force to require compliance with physically painful commands, such as forced jumping jacks, “power” sitting, prolonged and forced kicking until the child “decides” to answer a question or comply. The key issue in these instances is the use of power and coercion to force compliance for the sake of compliance with a command, which has no basis in safety. Remember, it is about connections not compliance.

ATTACh believes that all attachment-based therapy should be based on sound theory and principle, and that therapists should practice within their competence and training, and with appropriate supervision/consultation.

To review ATTACh's White Paper, Parent Manual, and Professional Practice Manual, go to