Wikipedia:Good article reassessment/Attachment therapy/1

Attachment therapy

 * • Watch article reassessment page
 * Result: Delist per consensus below. Geometry guy 18:00, 3 December 2008 (UTC)

I believe this article fails to meet 3b of GA criteria. Its subject, Attachment therapy is a pseudoscience. However, the article contains large sections that either are about mainstream medically accepted material, diagnoses, etc., or sections that are focused on the pseudoscience. There are also sections that combine mainstream medical information with the pseudoscience.

The structure of the article is confusing and also mixes science and pseudoscience.

Many of the references are unreliable. I have listed these under Talk:Attachment_therapy or are not accessible, so it is difficult at times to disentangle whether real science or pseudoscience is being referenced.

The many wikilinks in the article are mostly to mainstream psychology/psychiatry information, although some are to "alternative therapies".


 * Note: There have been four GA reviews: See:
 * Failed "good article" nomination failed by Sandstein October 9, 2007
 * GA fail failed by Nikki311 April 9, 2008
 * GA Review failed by Jclemens  September 1, 2008
 * Second Review passed by Dana boomer (which should be labeled "Fourth Review" for clarity) October 22, 2008.
 * Also, Michael Devore, a very good copy editor, has given considerable help. See: Article question(s) September 3-6, More questions and issues September 13

A single editor has worked on the article, putting in over 900 edits.. I do not believe this editor has the perspective to sort out the article alone.

I believe this needs a group effort to bring it to GA status. &mdash; Mattisse (Talk) 03:52, 23 October 2008 (UTC)

Outline of article sections and why they are confusing

In the section on Treatment characteristics of attachment therapy (the pseudoscience), there is a section on Traditional attachment theory based methods.

Under the section Theoretical basis (presumably of Attachment therapy), there is a section on Attachment theory with no indication if this applies to Attachment therapy or not (presumably not, as it is not considered pseudoscience) and a section on Theoretical principles of attachment therapy which is about the pseudoscience.

The sections Historical roots and Range of attachment therapies both seem to be about Attachment therapy.

The section Diagnosis and attachment disorder has as mainstream wikilinks under the heading Attachment disorder and Reactive attachment disorder which is a legitimate medical diagnosis and not pseudoscience. The section talks about "current official classifications of RAD under DSM-IV-TR and ICD-10 are largely based on this understanding of the nature of attachment." These link and the body of this section refers to mainstrean diagnostic categories used by mental health professions and has nothing to do with pseudoscience. It refers to attachment styles (piped) appears to be mainstream looking at the references.

Under this section (Diagnosis and attachment disorder) are two sub sections: The first is Diagnosis lists and questionnaires contains some mainstream diagnostic tools, and some instruments whose status is unclear and has wikilinks to mainstream disorders and the second is Patient recruitment which appears to apply only to the controversial pseudoscience.

A section on Prevalence - appears to be about mainstream medical science

A section on Evidence basis and controversial therapies is apparently on the pseudoscience

There is a section on Mainstream therapies with mainstream information and links.

The last section is Cases - notorious cases.

&mdash; Mattisse (Talk) 03:58, 23 October 2008 (UTC)

Just Wait I was the 2nd opinion GA reviewer on this article, after it had had a 2nd opinion tag on it on the GAN page for over a month, with no one (including Mattisse) offering a second opinion and taking the review through to conclusion. I thoroughly read through the article, copyediting as I went, and made several suggestions on the talk page. When these had been completed to my satisfaction, I passed the article to GA status. Immediately after this passing, Mattisse posted a long list of issues (similar to the list above), as well as a message on my talk page notifying me that he was thinking about initiating a GAR. I read his comments, compared them to the article, and found that I agreed with several of them. I posted a message to this effect on the talk page, as well as a message asking the main editor (Fainite) to respond ASAP. Fainite responded within a day, asking for a little more time as they were busy with RL, and responding positively to our comments. I figured that this time would be given, as Fainite appeared willing to make the changes we've asked for, or at least discuss them, but then I see that Mattisse has initiated a community GAR.

My view on the article is that it is well written and well referenced, and that it provides a comprehensive overview of the subject, with good distinctions between the pseudoscience of attachment therapy and the mainstream therapies that are more commonly (and properly) used. I agree with Mattisse that there is perhaps a little extra weight in the article on mainstream therapies that could be removed, but I do not see the article in its current form as harmful to anyone. IMO, it makes a clear distinction between pseudoscience and mainstream therapies, and, with a little bit of work by Fainite, which that editor seems willing to do, the extra weight can easily be cut out. I see nothing about this article that is ethically wrong, as Mattisse has claimed, and I ask that other editors give Fainite a chance to get a break from RL to work on the article (this weekend was what we were told). Dana boomer (talk) 12:56, 23 October 2008 (UTC)


 * Comment. It seems that all are agreed that their are genuine GA concerns with the article. It makes sense to me to see if Fainite can address them by this weekend, but if Matisse's view is borne out and further work and the involvement of other editors is needed, then it may be better to delist with a view to future renomination. Geometry guy 19:54, 23 October 2008 (UTC)


 * That would be fine with me. I am simply asking to give Fainite the time that they asked for, due to RL busy-ness, rather than summarily delisting the article. Mattisse seems to be taking a fast-track approach on this article, which IMO may lead to un-necessarily hurt feelings and an un-necessarily delisted article.  It won't hurt anything to give Fainite a few days to work on the article, so there's no need to rush things along. Dana boomer (talk) 20:11, 23 October 2008 (UTC)


 * I will see you later in the weekend. In the meantime here is a copy of the review page (the link seems to have gone) which contains the matters referred to above if anyone is interested. And perhaps given this and this  its time for a little WP:AGF around here.  Fainites barley 20:46, 23 October 2008 (UTC)


 * Talk:Attachment therapy/GA1 (It cannot be transluded here. Geometry guy 22:09, 23 October 2008 (UTC))

Hi guys. Thanks for waiting.


 * Dealing with the main point - what I was attempting to do was make clear the distinction between attachment therapy (AT) theoretical base, diagnosis and practices and those within the mainstream. I did this because attachment therapists claim that AT is based on attachment theory and claim that they are treating "reactive attachment disorder" as well as "attachment disorder". Often what are in fact attachment styles are described as attachment disorders. Therefore it seemed to be appropriate, for the sake of clarity, to set out the article so it says effectively attachment theory says this whereas AT says this. The DSM/ICD definition of RAD is this whereas ATers use "symptoms lists" which say this. AT cklaims to be able to diagnose this whereas mainstream says you can't. And so on. The first point is - is this either not an appropriate way of approaching the material, or it is appropriate but just hasn't been done well enough. If the answer is the former then I can remove the paragraphs that set out the brief description of attachment theory, the classification of RAD from DSM and ICD and mainstream diagnosis tools. If it is the latter then I can rearrange or reduce the material as suggested by Dana. Probably the severe reduction approach is the best - given that Dana has said s/he did not find the comparisons between mainstream and pseudoscience confusing.
 * The Taskforce Report itself, which is a significant source in this article, takes the approach of setting what the mainstream position is on attachment theory, classification, diagnosis and treatment. Then it sets out what the AT position is and how it differs. I have not seen any criticism of this report as being misleading as a consequence of this.
 * If people agree I would propose to reduce of the sections describing mainstream classifications, diagnosis and treatment but I think a brief description of attachment theory ought to remain. Otherwise the significance of the fact that its claimed to be based on attachment theory but isn't is lost.
 * If it is being suggested that because this article is about a pseudoscience then there should be no meantion of mainstream science at all then I don't agree with this. Where a pseudoscience claims quite specifically to be "evidence-based", based on a mainstream theory and to be within the mainstream when it is not, it is inevitable that there has to be some discussion of the distinctions between the two.Fainites barley 13:36, 25 October 2008 (UTC)


 * I don't understand Matisses point on the prevalence section at all. It gives what mainstream sources I could find about the prevalence of AT and lists major organisations that have taken a position against all or part of AT. Is it being suggested this is not relevent? Fainites barley 13:57, 25 October 2008 (UTC)
 * When you focus on the subject of the article, you do not have to worry about mainstream prevalence of the disorder, unless you want to change the article title to "Comparison between mainstream and pseudo scientific treatment of attachments disorders in children". The article is not about the disorder; it is about a pseudo scientific treatment. Prevalence of a disorder is really not a main issue in an article on a treatment for a disorder that is a pseudoscience, unless you mean prevalence or frequency of the use of this pseudo scientific treatment. If you want to work in a sentence some where about real world prevalence of the disorder, you can do that. But I don't see the point of the Prevalence section when the article is not about the disorder. &mdash; Mattisse (Talk) 15:51, 25 October 2008 (UTC)
 * The prevalence section is not about prevalence of the disorder. It is about prevalence of attachment therapy. I'll change the title to make it easier to understand.Fainites barley 16:10, 25 October 2008 (UTC)


 * I recommend that you start with the lead sentence that clearly focuses on the subject of the article. Current first sentence: "Attachment therapy is the most commonly used term for a controversial category of alternative child mental health interventions intended to treat attachment disorders." - Attachment therapy is not an "alternative child mental health intervention."
 * Maybe something like: "Attachment therapy is the common term for a pseudo scientific treatment of  attachment disorders in children. It is considered pseudoscience because it is not based on medical evidence that it is effective. Attachments disorders are common in children. In the 1970s  attachment therapy became popular and gained a cult following (or whatever you want to say) but has since been discredited by blah and blah. Currently the most effective treatments  for these disorders in children are considered to be blah. - or something along these lines.
 * Perhaps if you write a clear lead, then the rest of the article will follow. Or you could start with the sections of the article that pertain to attachment therapy and remove the rest.  &mdash; Mattisse  (Talk) 15:51, 25 October 2008 (UTC)


 * a)It is considered a pseudoscience for a variety of reasons, not just because its not evidence based. The line about pseudoscience currently carefully follows the source. I have put a summary of the main criticisms in the lead. Are you suggesting they be removed?
 * b)There is no "official" diagnosis of "attachment disorder". This is a diagnosis used by attachment therapists. Within mainstream it is sometimes used as a shorthand for reactive attachment disorder and sometimes people mix it up with attachment syles. I have a section in the article briefly describing the difference between RAD, attachment disorder and styles. I believe it is one of the sections you want removed.
 * c)Attachment disorders are not common in children. RAD is comparatively rare. It is attachment therapists that claim "attachment disorder" is common and indeed that it affects nearly all if not all adopted or fostered children - their primary market. It is very important that this article does not repeat attachment therapy propaganda.
 * d) I had a section about mainstream therapies in the article. You complained about it. I took it out.
 * e) Whilst I would agree that its following can certainly seem "cultlike" ("Awesome Moms"), I have as yet found no notable source that describes it as such.
 * f)I'm not fussed about the word "alternative" one way or the other. It simply means outside conventional medicine. (Though I would agree that it never seems quite fair to mix up mild unharmful airy fairy therapies with aggressively marketed pseudosciences like this one). I have one source (albeit a pretty notable one) which uses the word pseudoscience. The others say things like unvalidated, controversial, potentially dangerous, potentially abusive. There was some discussion about the use of the word "controversial" on the basis that pretty much all the mainstream commentary on this subject points one way so the "controversy" is over so to speak. The choices really are "pseudoscientific" or "unvalidated" of people don't like alternative.
 * g)On the issue of the use of the words "Attachment therapy" - the lead is quite carefully worded because AT is largely a USA thing therefore a UK person hearing the term might just think it meant any therapy aiming to address attachment issues. Therefore I have endeavoured to make it clear what is being described - ie the phenomenon for which the most common tern is "Attachment therapy".Fainites barley 16:32, 25 October 2008 (UTC)


 * I've removed the section on mainstream therapies. The sentence that said all mainstream interventions are based on increasing carer sensitivity I added to the the brief description of attachment theory methods - now retitled "contrasting....". I have also removed the brief description of attachment theory. I am still puzzling over the second two paragraphs in diagnosis as it is a feature of AT to claim reliance on DSM and to mix insecure attachment styles with disorders and the distinction needs to be made clear. However - if generally other editors think it is better removed I can do that. I have also found the new site for the one dead link to Hughes old site. Unfortunately he's changed his content! I have an alternative source for the point though. Fainites barley 17:09, 25 October 2008 (UTC)

(multiple edit conflicts)
 * Comments Whatever. All I am saying is this article is on Attachment therapy. Focus on that and not the disorders that it supposedly treats. You can check the Alternative medicine article and the pseudoscience article and see which it fits. However, your last section Cases is rather ominous. Someone put this article in the Category:Pseudoscience. If it is alternative medicine, then Category:Alternative medicine would be appropriate. There is also Category:Fringe science.
 * Also you have a number of references that are questionable that I list on the talk page. What makes these reliable sources? (Some of these you can probably justify but the copyvio links must go. And the dead link)
 * http://www.caica.org/Krystal_Tibbetts_attachment_therapy_death.htm?
 * Quote from website:"DISCLAIMER, WARNINGS, AND NOTICE TO READERS: This website does not represent or endorse the accuracy or reliability of any of the information, content collectively, the "Materials") contained on, distributed through, or linked, downloaded or accessed from any of the services contained on this website (the "Service"). None of the contributors, sponsors, administrators or anyone else connected with this website in any way whatsoever can be responsible for the appearance of any inaccurate or libelous information or for your use of the information contained in these web pages. All information provided using this website is only intended to be general summary information to the public.


 * FAIR USE NOTICE: These pages may contain copyrighted (© ) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available to advance understanding of ecological, political, human rights, economic, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior general interest in receiving similar information for research and educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted material for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner."
 * Same disclaimer as above
 * http://www.childrenintherapy.org/victims/marr.html
 * http://www.childrenintherapy.org/victims/gravelle.html
 * http://www.quackwatch.com/01QuackeryRelatedTopics/at.html - written by a "Ph.D. student from Texas who earned a Master of Arts in Counselor Education from Sam Houston State University in 1995. She also holds a Master of Divinity from Brite Divinity School at Texas Christian University."
 * http://web.archive.org/web/20030820043048/www.theadoptionguide.com/complaints/Polreis.html
 * http://www.stolaf.edu/people/leming/soc260fam/news/April_18.html#A1817.html - this is a copyvio from the Boston Globe but you :have incorrectly attributed it to the Boston Globe in the references. The site has the disclaimer quoted above.
 * http://www.caica.org/Krystal_Tibbetts_attachment_therapy_death.htm - copyvio of The Salt Lake Tribune article. The site has the disclaimer quoted above.
 * http://www.childrenintherapy.org/victims/ciambrone.html
 * http://www.childrenintherapy.org/victims/swenson.html
 * http://www.center4familydevelop.com/http://www.childrenintherapy.org/proponents/hughes.html
 * http://danielahughes.homestead.com/Model.html - this link is dead
 * http://www.attach.org/position.htm
 * http://www.childrenintherapy.org/proponents/cline.html
 * http://www.skepticreport.com/pseudoscience/attachmenttherapy.htm
 * http://www.childrenintherapy.org/essays/index.html
 * http://www.childrenintherapy.org/essays/abuses.html&mdash; Mattisse (Talk) 17:11, 25 October 2008 (UTC)


 * Comment Overlinking. Please see MOS:Overlinking and underlinking which states that any one term is to be linked once per article as a general rule. You have Attachment theory linked twice in the lead alone.
 * You say in the lead: "This form of therapy, including diagnosis and accompanying parenting techniques, is scientifically unvalidated and is not considered to be part of mainstream psychology or, despite its name, to be based on attachment theory, with which it is considered incompatible." Therefore, that should be the end of it, except for the place in the article body where you explain this. No more wikilinking to attachment theory; you have already said it does not apply and also per MOS:Overlinking and underlinking. It is misleading to continually wikilink to mainstream articles. This article is about a pseudoscience, or whatever you have decided it is. The same with repeated wikilinking to other mainstream articles like Reactive attachment disorder. This includes the See also. If it is wikilinked in the article, you have to be able to justify putting it in See also. FAC, for example, do not normally allow any see alsos.&mdash; Mattisse (Talk) 18:13, 25 October 2008 (UTC)


 * The attachment therapy versions of what they say attachment theory is and attachment disorder is is part of attachment therapy. And - its not up to me to decide whether its a pseudoscience or not. This has to be sourced - and it is. I suspect that there are many who would argue in any event that "alternative" and "pseudoscience" are not mutually exclusive.Fainites barley 19:19, 25 October 2008 (UTC)


 * a)In relation to the links regarding the cases - these cases are largely reported in newspapers - often with a degree of reasonably in depth investigative reporting, and some have judgments/appeals. Advocates for Children in Therapy use news reopoirts and in some cases personal attendance to compile their individual case reports. Similarly CAICA. These are the best sources there are. Apart from Candace Newmaker on whom there is a book, these cases are not reported into peer reviewed journals or the like although they are referred to in peer reviewed sources - for example the one that cites "at least 6 deaths" and the Taskforce report.
 * b)I understand Quackwatch is frequently cited in articles on pseudosciences as is skepticreport.
 * c)The chair or president of the professional board of advisors of ACT is a professor of psychology (child development I believe) and published in peer reviewed journals on the subject of attachment therapy. Fainites barley 19:32, 25 October 2008 (UTC)
 * Copyvios removed. Fainites barley 21:14, 25 October 2008 (UTC)
 * Fainites, any website, such as CAICA, that has the above quoted disclaimer (DISCLAIMER, WARNINGS, AND NOTICE TO READERS) that is it not responsible for the material on the website and that some of the website material may be in violation of copyright law (FAIR USE NOTICE: These pages may contain copyrighted (© ) material the use of which has not always been specifically authorized by the copyright owner.) is not considered a reliable source by wikipedia. Additionally, it puts Wikipedia at risk for violation of copyright law.  &mdash; Mattisse  (Talk) 15:51, 26 October 2008 (UTC)
 * I've already removed the CAICA ones. Fainites barley 22:17, 26 October 2008 (UTC)

Comments from Casliber

One of the issues I feel most strongly about is misinformation on articles. I have not studied the former version, only the one at time of writing. I haven't looked at the sourcing. I think Matisse is right to be extremely wary of how mainstream science material can and may be interpreted in this article. However, this is an agonisingly difficult path - leaving enough material of mainstream practice and theory to provide context, yet not mislead the reader into validating what is clearly a fringe/pseudoscience practice:


 * e.g paragraphs 3 and 4 of Diagnosis and attachment disorder provide some context (which is a good thing (?) ), however they focus on the unclear nature of the DSM diagnoses and their relation (or lack thereof) to styles of attachment theory. Now part of me reading this (though happy to get some context) could construe this as a direct criticism of mainstream therapy and hence validation of this therapy by its mere presence. This is my impression anyway. I can also see why it is there so this is why it is so difficult. Casliber (talk · contribs) 23:18, 26 October 2008 (UTC)


 * I find this a really tricky one myself. It would be easy to just remove those two paragraphs - but then there's no context. Its complicated by the fact that when RAD came out in DSM, attachment therapists seized on it. They also do things like quote papers on attachment styles in support of their diagnosis of "attachment disorder". Suppose I take those two paragraphs out and then look at it afresh. On the article - it hasn't really changed much. Just some bits removed. I took out a section titled "mainstream therapies" and a paragraph titled "attachment theory" which was intended to help explain the difference between attachment theory and the theoretical base of attachment therapy. Here's the pre-GAR version Fainites barley 22:45, 26 October 2008 (UTC)
 * I've removed it all except this bit Within mainstream practice, disorders of attachment are classified in DSM-IV-TR and ICD-10 as reactive attachment disorder, (generally known as RAD) and Disinhibited attachment disorder. Both classifications warn against automatic diagnosis based on abuse or neglect. Many symptoms are present in a variety of other more common and more easily treatable disorders. There is as yet no other accepted definition of attachment disordersFainites barley 23:23, 26 October 2008 (UTC)


 * PS: The prose could do with a copyedit (I am trying to do some) as it is repetitive in places and could be pruned (see my edits). Casliber (talk · contribs) 23:18, 26 October 2008 (UTC)


 * OK.Fainites barley 22:34, 26 October 2008 (UTC)


 * I feel uneasy about the heading Proponents claims to evidence base but have no alternative off the top of my head other than the succinct Claims, which I actually think works ok. I get worried that scanning thrgouh may give folks the wrong idea if their eyes settle on evidence base here. Casliber (talk · contribs) 23:18, 26 October 2008 (UTC)


 * 'cept once you read it there is no evidence base of substance. Claims is OK. Or how about "Lack of Validation" ? Fainites barley 22:34, 26 October 2008 (UTC)
 * OK, let's make it Claims as it most accurately portrays content of section. I am not keen on Lack of Validation as it is a negative and doesn't encapsulate how these therapies claim to do XYZ. Cheers, Casliber (talk · contribs) 23:18, 26 October 2008 (UTC)


 * I share Casliber's concerns about the Diagnosis and attachment disorder section. It seems to be a general discussion of the problems in classifying attachment disorders  in DSM-IV-TR and ICD-10 and their  diagnostic categories  (Disinhibited attachment disorder, Reactive attachment disorder) and is irrelevant to this article, as is the description of "four attachment styles ascertained and used within developmental attachment research."   The section implies that "mainstream" research and practice is confusing and contradictory, thereby offering a rationale for nonstandard classification and treatment. I also agree that attachment therapy is clearly a fringe/pseudoscience practice. Why is "symptoms" is quotes? It seems to suggest that the word is being used incorrectly in the diagnostic manuals


 * I agree that Claims is better than Proponents claims to evidence base. &mdash; Mattisse (Talk) 16:59, 26 October 2008 (UTC)

Suggestions from Mattisse
 * Write the Diagnosis and attachment disorder section in a manner  similar to the  section on Diagnosis lists and questionnaires. In this section you seem concentrate only on the methods used by Attachment therapy, without unnecessary links to mainstream articles. You do not introduce at this point Measuring attachment in children and do not compare/critique these mainstream measures. There are no links under the section heading to main articles.


 * Linking to mainstream articles must be done only with care and thought as to the consequences. For example, in the section discussed by Casliber, Diagnosis and attachment disorder you have listed under the section heading as main articles: Attachment disorder and Reactive attachment disorder. You have wikilinked each of these a second time in the section itself. ICD-10 and DSM-IV-TR twice. Remember, this whole article is on a pseudoscience.


 * You say Advocates for Children in Therapy "give a list of therapies they state are attachment therapies and a list of additional therapies used by attachment therapists which they consider to be unvalidate." Perhaps the rest of the article could expand on this.
 * Oh blimey they list about 10 assorted therapies ranging from EDMR to NLP to Feldenkrais to neurofeedback. Everyone a minefield. How about linking to the list and then people can look them up if they want. They probably all have articles on Wiki but whether they're any good or not I don't know. Fainites barley 22:34, 26 October 2008 (UTC)
 * But isn't this what the article is about? I am confused now as to the subject of this article. &mdash; Mattisse  (Talk) 17:06, 27 October 2008 (UTC)
 * This article is about attachment therapy - not EMDR etc etc etc. I'm confused now as to what you want in. Do you want the list of what ACT say are unvalidated therapies in the article? Or just a link? I don't see how this article can go into each unvalidated therapy in any depth. Also - we could list them all but would you want them linked to all the articles on these unvalidated therapies on Wiki? I can certainly do that. Fainites barley 17:29, 27 October 2008 (UTC)
 * Hold on a second. Fainite - is the list you're talking about the "list of therapies they state are attachment therapies" or the "list of additional therapies used by attachment therapists which they consider to be unvalidate"?  Mattisse - how about you?  Also to Fainite, what's the difference between these two lists (the quick and dirty version, please)?  If we're talking about the second list, I see no reason to list these therapies - just because some Acupressure practitioners also practice Breema doesn't mean that breema should be discussed in the acupressure article.  However, if we're talking about the first list, anything that ACT calls "attachment therapies" should be listed in the article, since the article is called "Attachment therapy".  Make sense? Dana boomer (talk) 20:23, 27 October 2008 (UTC)
 * Ah I'm with you now. Sorry. There is a a list of "attachment therapies". These are attachment therapy by another name. The practitioners keep on changing the name of what critics say is essentially the same therapy most commonly known as "attachment therapy". I have included in the article a list of the alternative names the Taskforce give but did not include the entire list ACT give. It ranges from the original Z-process of Zaslow, through rage-reduction and holding time right up to dyadic developmental psychotherapy. The other list is a list of adjnctive therapies used by some attachment therapists which ACT say are unvaklidated. I can easily include the list of "attachment therapies by another name" - except at the moment as of yesterday, for some reason my computer is not accessing the ACT links. I e-mailed one of ACT about this but they say its working. Is anybody else having a problem with ACT links? Fainites barley 21:44, 27 October 2008 (UTC)
 * No problem with the links and I've added the list in the notes. Fainites barley 20:05, 28 October 2008 (UTC)


 * You wrote the article Attachment-based therapy (children). The section in the article, Differentiation from attachment therapy seems a more succinct and accurate description.
 * Everything in that paragraph is already in this article in various places I think. Where did you have in mind putting it? Fainites barley 22:42, 26 October 2008 (UTC)
 * I was just noting that you wrote a clear, succinct description there, whereas this article has balloon up. On October 21, the article was 86,595 bytes and the explanation was not as clear to me as your simple summary in the other article. &mdash; Mattisse  (Talk) 23:53, 26 October 2008 (UTC)

Comments from Mattisse
 * Your comments above are over my head. I am just becoming more confused about what the article is about. I do not know about "EMDR etc etc etc." This discussion is only confusing me more, as my knowledge base is mainstream and I do not know what should go in this article about a pseudoscience. Casliber said, "I think Matisse is right to be extremely wary of how mainstream science material can and may be interpreted in this article." Maybe you could get some input from other editors. Ask Casliber if he would provide some more input as he has expressed discomfort about some issues. Has this article been to peer review? The article definitely needs fresh eyes, input from others who are knowledgeable about mainstream medical issues and how they should be presented in an article about pseudoscience but who are  not so involved in the topic of this article. &mdash; Mattisse  (Talk) 19:50, 27 October 2008 (UTC)


 * Casliber is still involved.Fainites barley 13:50, 28 October 2008 (UTC)

Having reduced the mainstream material considerably I have now put it in two sections - both headed in a way that make it clear these are contrasting mainstream methods/diagnosis/classifications. Hopefully this will enable the reader to be absolutely clear about the basic but essential differences between attachment therapy claims and beliefs and the mainstream. One is here and the other is here. I am also adding the ACT list of "attachment therapy by another name" as proposed above. As it is a very long list I've put it in the notes as a quote.Fainites barley 14:06, 28 October 2008 (UTC)
 * I have removed the Quackwatch refs. I can remove the Skeptic Report article material. It provides a few added historical details about the roots of AT, and where and by who it was practised in the early days. I asked at the Sources noticeboard here. If the consensus is to remove I can do that easily. Fainites barley 21:58, 31 October 2008 (UTC)

Comment Mattisse, do you still have things that you would like to see Fainites working on? If you don't, this review can probably be closed as a keep, but I didn't want to do this without making sure you were satisfied. I think that Fainites has done a good job in responding to your comments, and the changes have been beneficial to the article. Let me know your thoughts. Dana boomer (talk) 14:44, 5 November 2008 (UTC)

Comment - I stand by my comments above. My specific complaints:
 * This article needs vetting by editors knowledgeable in the field. I recommend a peer review at the very least.
 * This is an extremely long article, even by FAC standards (72 kB of readable prose when FAC informal cutoff is 50 kB), that is about a pseudoscience. That is almost twice as long as the article on Attachment theory (43 kB of readable prose).
 * Is it appropriate to have such an extensive article on a pseudoscience, when all the material that is not on the pseudoscience itself is repeated in the many articles on attachment, attachment theory etc. on Wikipedia?
 * This is a pseudoscience that had been discredited - my impression is that it is not widely used now anyway. What are the statistics as to its current use in 2008? How recent was the last "dead child"?
 * I think the entire article should be whittled down to a focused description on the pseudoscience itself. For example, since it is a pseudoscience, is an extensive treatment of its "Historical roots" necessary, when in the end we are talking about a pseudoscience? The length and depth and repetition in the article are unnecessary and inappropriate, in my opinion.
 * The article should start out by explaining that this therapy is considered a pseudoscience and explain why.
 * As it is, the article lacks focus.
 * I would really like to hear the opinions of more editors. I am uncomfortable that such a weighty article's content is being determined by two editors, the article's sole editor (with over 900 edits) and one GA reviewer who admits not being expert in the field. &mdash; Mattisse (Talk) 15:47, 5 November 2008 (UTC)

&mdash; Mattisse (Talk) 15:47, 5 November 2008 (UTC)


 * There has already been extensive involvement in this article by Jean Mercer - an expert in this field.
 * There is no rule that says pseudosciences have to have short articles. There is very little material that is not on the pseudoscience itself - which is plain to see.
 * What is the basis for your impression that it is not widely used now anyway? Have you googled "attachment therapy". Would you recognise it if proponents changed its name? Do you realise the Taskforce only reported in 2006? Why would APSAAC so recently seek the expertise of most of the known names in the attachment world for this taskforce for something that was a dead duck?
 * The article is a focussed description of the pseudoscience itself. If you troubled to look at it you would see that there are only two very short sections giving the contrasting mainstream position.
 * An extensive treatment of its historical roots is necessary. Thats why so many mainstream commentators have troubled to publish material on this in peer reviewed journals. This is a pseudoscience that does a good job of pretending to be mainstream and based on attachment theory. Public money and insurance money pays for this therapy.
 * It is clearly stated in the lead that this is a pseudoscience and why. Other editors do not appear to have had the trouble you have had in understanding why and how it is a pseudoscience and how it differs from the mainstream.
 * I can't help your discomfort, frequently expressed. I have endeavoured to address every concern you have raised - but there has been no response to this from you. Just repetition of vague expressions of concern and discomfort.
 * I do not accept your basic premise that there is something inherently unethical or dodgy in one editor playing a major role in the writing of an article. Neither has there in fact been only one editor involved. If you look in the history you will see that this page - along with the other attachment pages, was "owned" for over a year by attachment therapists and half a dozen sock-puppets. After they were disposed of by an arbitration, the articles were rewritten. This process involved a number of those editors who had sought to edit when the pages were owned by the sockmaster, not just me. I have been the main editor involved in the process necessary to achieve GA - much of which has little to do with basic content but relates to citations, copy edits and the like.
 * I am puzzled that on the one hand you seem to wish to reduce the article to little more than a stub because its "just" a pseudoscience that you think nobody practices any more - yet on the other hand you express concern that such a "weighty article" is being determined by two editors.
 * As I say - I have endeavoured to address all your explicit concerns - but it really is impossible to deal with, satisfy or address vague implications and slurs based on number of editors or edits, unspecific expressions of "discomfort" and statements about the articles subject which are unfounded.
 * As for getting in other editors - GA, peer review or FA is the only way to do this on obscure psychology topics. Three editors went separately to the psychology project asking for help when it perpertrated dangerous nonsense for over a year. No response was ever received. Nor to RfC's. There are no other editors interested apart than those who do GA's, peer reviews etc. Casliber came - but he is obviously very busy at the moment on MDD. If you sit and wait for interested psychologists to come and take an interest you'll sit and wait for ever.

If the net result of this is no GA - then so be it. I don't need a gong. If you have any explicit issues capable of being addressed then by all means set them out - but frankly otherwise, this is a waste of time. Fainites barley 21:56, 5 November 2008 (UTC)


 * Weighty, meaning size-wise. I have suggested peer review at least twice before and I suggest it again. &mdash; Mattisse  (Talk) 22:22, 5 November 2008 (UTC)


 * Comment &mdash; Just of note, this article contains only 49 kb of prose, which is within Wikipedia's length recommendations. I believe it's necessary for Mattisse to explain what the article lacks, exactly. I know little about the article's subject, but after I read quite a bit of the article, I don't see anything of terrible concern. –Juliancolton Tropical Cyclone  23:31, 5 November 2008 (UTC)
 * Reply - My concerns are listed above at great length here and on the article talk page. But if you find nothing wrong, you are free to pass the article for GA. I am done giving any more explanations and reading through the reams of answers by the editor. This has required an enormous amount of time on my part. I am no longer willing to dwell on this longer. It is not "necessary" for me to explain more.
 * I recommend peer review because of its psychological content. However, you are free to disregard that also.
 * Casliber above, who also expressed reservations, is busy with his FAC Major depressive disorder and will not weight in again.
 * You can make whatever decision/recommendation you want.  &mdash; Mattisse  (Talk) 00:05, 6 November 2008 (UTC)⋅

Comments from Montanabw  I hate to weigh in this late in the process, especially to take the position I am about to take, especially when many of you don't know me at all, but someone asked for an outside eye over here. I think it is important to note that the entire article is fundamentally flawed in that it categorically lumps too many things in as "attachment therapy" and includes relatively mainstream uses with the most fringe versions, dismissing it all as "pseudoscience." I do not say this as an advocate of AT, I am personally rather critical of the concept. Nor am I confusing this article with attachment theory, I know the difference. But for GA, an article has to be NPOV, and this one paints with too broad a brush. On one hand, there are the very legitimate concerns with fringe theories such as "rebirthing," which has resulted in fatalities. Then there are individuals such as Foster Cline (Evergreen model) who certainly gets a cult of personality going and has been in trouble with licensing boards -- the controversy attached to his techniques, particularly the models as they were advocating a decade ago, is well-founded. That said, even Cline himself has modified his techniques from some of his earlier concepts. Coercive Restraint Therapies are definitely a problem, and as such this article does well enough to explain the problems.

But the article goes too far: Coercive Restraint Therapies are not the only form of "Holding therapy." On the other side of the issue are appropriate uses of holdings in the treatment of RAD children. For example, a highly respected mainstream program that uses "attachment principles," including some holdings, is Intermountain Children's Home, which is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-approved facility that has operated under the sponsorship of the United Methodist Church. I suspect they use the term "principles" on purpose to avoid the negative AT label, but they definitely use holdings and do not consider them a form of restraint. Here is a review of their program, which was not entirely laudatory and expresses some criticism of holdings, but as such, is pretty NPOV. Judging by Attachment-based_therapy_(children), this article here has been written with language that is similar to that in an article which is quite dismissive of the whole concept elsewhere, thus this creates serious NPOV problems. As an aside, the tone here is also very dismissive of the contributions of Milton Erickson, labeling him a "hypnotherapist," when the broader picture is that he was one of the leading early theorists promoting family therapy, who yes, happened to also work with hypnotherapy (as did Freud). In short, while there is a need to point out the dangers of fringe programs, this article reads more like an expose than a GA.

I guess at the end of the day, for this to be a GA, it needs to get the overall tone off the soapbox and more accurately reflect the entire spectrum from mainstream to fringe. I looked at the abstract of the Task Force report and this sentence mirrors my own view: "...Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists." (my emphasis) It is a fundamental NPOV flaw to imply, as this article does, that there are only "good" attachment theory-based programs and "bad" AT-based programs, when the reality is that a middle ground exists. As in the example above there is work being done to use attachment theory with some holdings and related tactics when dealing with truly RAD children. And RAD is a genuine disorder, maybe over-diagnosed by the fringe in order to make guilty parents give them money, but if you have ever dealt with the real thing... =:-O So when I look at all of the above, my thought is that the article is in form not too bad, but definitely too POV for GA.   Montanabw (talk) 07:02, 6 November 2008 (UTC)
 * I thank Montanabw for clarifying the issues that I, not being a specialist in the field of attachment-related treatments, could only sense but not articulate so clearly. Hopefully, this ends the discussion, unless someone weighs in with an opposite view that is put forward as clearly as this one is.
 * My concern was also that if you Google Attachment therapy, this article comes up first or second, meaning most people searching for info on Attachment therapy will read most likely read this, one of the reasons Wikipedia must take care to avoid misinforming.   &mdash; Mattisse  (Talk) 14:33, 6 November 2008 (UTC)
 * Actually Matisse, Montanabw's concerns are almost diametrically opposed to yours. I shall respond to them a little later. Fainites barley 15:40, 6 November 2008 (UTC)
 * That's kind of what I was thinking. Montanabw wants the article to give more legitimacy to AT by describing some of the things that are accepted by mainstream practitioners, while Mattisse wants to cut mainstream stuff out and make the article say that there is no mainstream acceptance of this therapy and that it is completely pseudoscience.  There are some side trips to their arguments, but this is the basic premise, as I see it. Dana boomer (talk) 16:14, 6 November 2008 (UTC)


 * I agree - but I can see the point about making it very very clear what the article relates too. (Perhaps I should also mention that what used to come up first on Google was a whole load of dyed in the wool AT sites of the CRT/Nancy Thomas parenting type).

Dealing with the concerns one at a time: I shall have a go at the lead to make the distinction clearer. Fainites barley 16:34, 6 November 2008 (UTC)
 * The article contains the sentence at the beginning of the second section Controversies arose about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners. It then describes the features of this particular "subset".
 * The Taskforce use the phrase "controversial attachment therapy" to refer to the attachment therapy techniques about which the controversy arose. However, they also examine the whole underlying theory/belief system. They generally use "attachment -related" or "attachment-based" to refer to everything else. They do however make the point - which is in the article, that there are differences within attachment therapy. If you think the distinction is insufficiently clear, then this point can be moved to the lead. The naming of attachment therapy is problematical as some (usually not in the USA) may take the name to mean anything attachment based whereas this article is aimed at the controversial, non-mainstream version which is generally simply called "attachment therapy". The other mainstream sources who criticise it tend to refer to it as attachment therapy. However, I shall endeavour to adjust the lead to make it clearer what is being addressed in the article - ie the controversial/Zaslow based efforts as described by the Taskforce and other mainstream commentators.
 * This article does not suggest RAD is not a genuine disorder. Indeed there was more information in it highlighting the distinction between RAD as per DSM/ICD and RAD as promulgated by the attachment therapists in question. This was largely removed at the suggestion of Matisse.
 * In relation to Milton Erickson, it is Cline himself who cites him as a significant source. Indeed he quotes the paper on that case at great length in his book and explains why he thinks it supports his theory. I don't know if Erickson ever replied to this or was even aware of it.
 * No disrespect is meant to Milton E. by describing him as a hypnotherapist. (I thought hypnotherapists considered him as one of the all time greats). However, if its thought preferable to describe him as a family therapist then thats fine.
 * As for the middle ground - I have put in a section - derived from the Taskforce about recent pronouncements and changes within attachment therapy. However, the Taskforce itself points out the difficulties as those practicing serious coercive restraint holding will call it gentle and nurturing just as much as the gentle nurturing ones. However - Wiki requires appropriate sources. The plain fact of the matter is - the substantial sources, published in peer reviewed journals and respectable books - are agin AT theories, beliefs, diagnoses and methods. The Taskforce contrasts it with the "traditional" "attachment theory based" approaches. Are you aware of any peer reviewed publications supporting these therapies other than those already in the article?
 * In relation to holding and the centre you describe - they do not call themselves attachment therapists nor claim to diagnose attachment disorder or reactive attachment disorder - certainly they don't produce a "symptoms list". However, the second link you provide shows that they undertake scheduled holding for therapeutic, not safety purposes. One of the stated purposes for this is to "recreate attachment cycles". You have already seen in the article what a variety of mainstream sources say about this idea. The Taskforce recommendations state Treatment techniques or attachment parenting techniques involving physical coercion, psychologically or physically enforced holding, physical restraint, physical domination, provoked catharsis, ventilation of rage, age regression, humiliation, withholding or forcing food or water intake, prolonged social isolation, or assuming exaggerated levels of control and domination over a child are contraindicated because of risk of harm and absence of proven benefit and should not be used. In other words - firstly there is no credible peer reviewed material showing the benefits of either enforced holding or age regression techniques and secondly a significant swathe of mainstream researchers and commentators in the field consider it to be either potentially or actually harmful. In the circumstances, given that Wiki is supposed to present the mainstream view - albeit fairly, it is difficult to see exactly what the "middle ground" is and how it can be fairly presented other that by reference to Taskforce material (and a better distinction made as to which therapies exactly this article deals with).
 * (ec) Final statement I don't want anything other than a clear, accurate article.  Other than that, I am disinterested.  Please stop implying my motives were otherwise. Casliber and I agreed that there was an unacceptable confusion of mainstream and pseudoscience at the time it was passed as GA. Geometry guy agreed there were problems at that time   My comments on pseudoscience were based purely on the existing  assessment by Fainites on the article talk page  that Attachment therapy  was a pseudoscience. Please read the comments of Fainites stating this under More questions and issues. I accepted Fainites' statement.  I was concerned about the interweaving of any pseudoscience with mainstream findings. I tried to answer the questions addressed to me but I admitted I knew nothing about the specific subject. I found the article very confusing, as I mentioned many times, and could not distangle the information. I also could not make my way through the editor's voluminous replies, using terminology that I did not understand. That is why I repeatedly recommended peer review.
 * I tried to help since no one else seemed to be willing. But that was obviously a mistake. Only more confusion has resulted.
 * Montanabw appears to know the subject well. It was not GA when I was involved. I have not read the article for quite a while, as its confusion makes my head explode. If you think I and Casliber misled you or Fainites, revert to a previous version and request Montanabw's opinion.  Go by Montanabw's opinion and the opinions of other qualified persons. I still recommend peer review.
 * I have tried to clarify Casliber's comments, as when Fainites interrupts threads, as Fainites has, it makes it almost impossible for editors coming after to figure out who said what. &mdash; Mattisse (Talk) 17:29, 6 November 2008 (UTC)
 * Casliber did not agree anything of the sort. Please read his comments. Fainites barley 20:19, 6 November 2008 (UTC)


 * POV - I think Montanabw is justified in concerns about POV, per Fainites statements here: Quackwatch etc &mdash; Mattisse  (Talk) 18:48, 6 November 2008 (UTC)

I was one of the original contributors to this article, have not been much involved lately, but would like to respond to Montanabw's remarks. I'm going to do this in bits, as I typed for 45 minutes earlier and the whole thing disappeared after "save page." Jean Mercer (talk) 17:46, 6 November 2008 (UTC)

1. Terminology: I believe that one of the problems triggering Montanbw's response is the name given the practices in question. When I initially contributed on this topic, I used the term Attachment Therapy (with caps), to indicate that this was a special usage, not necessarily associated with "attachment", not necessarily a "therapy", and not necessarily a member of a category loosely termed "attachment therapies". In other contexts, I have also used the term Coercive Restraint Therapy, which i would prefer as more descriptive, but which is not as well-known to the public as Attachment Therapy.

There are quite a number of problems about the best term to use here. The term Attachment Therapy has a history, having developed as a replacement for the term Holding Therapy and having been offered by ATTACh in that organization's change of course following incidents such as the death of Candace Newmaker. However, examination of the belief system behind this approach shows that it is in no way based on attachment theory, and that its stress is on child compliance, not on attachment relationships. Employing a term that has no meaningful connection with the referent seems a specious strategy at best. In addition, we have the problem that the great majority of therapies are indeed "attachment therapies" (lower-case) in that they focus on relationships. The APSAC report used this category, defined it very loosely, and did not provide a list of treatments that should be described this way. Among treatments for children that might fit an "attachment therapy" (lc-lc), most refer to their specific names (e.g. Circle of Security) rather than saying they are among the attachment therapies.

So, what are we talking about when we talk about Attachment Therapy? For clarification in the present article, I would propose the term Coercive Restraint Therapy, which could be further described in the text as sometimes called Attachment Therapy or Holding Therapy. Alternatively, the earlier name Holding Therapy could be employed. Jean Mercer (talk) 18:03, 6 November 2008 (UTC)

2.Scope of the article: Montanabw seems to be suggesting that Attachment Therapy be considered only as part of a larger discussion of attachment therapies (lc-lc). I would oppose this on two grounds: a.considering the number of treatments that would be included as the lc-lc version, such an article would be overwhelming to contributors and to readers. b. I object strongly to the idea that Attachment Therapy be included as just one rather different type of treatment that fits into a broad category consisting primarily of legitimate treatments. Jean Mercer (talk) 18:08, 6 November 2008 (UTC)

3. The "middle ground" approach: Montanabw appeals to a general wish to be tolerant of others' ideas and to make compromises. Such compromises in behavior may be socially appropriate, but in many cases, like this one, compromise in thinking leads to confusion and compromises (in its other sense) intellectual integrity. If Attachment Therapy is without empirical support and has no acceptable theoretical basis, why would we wish to allow it to contaminate legitimate thinking about childhood interventions?

I believe Montanabw is attempting to base this argument on the well-known attempts by Intermountain to re-define holding as a therapeutic intervention. This re-definition is in no way substantiated by Intermountain's accreditation status or by its association with the United Methodists. To demonstrate that holding, as practiced at Intermountain, is an effective treatment, someone must provide empirical evidence in the form of a well-designed and well-analyzed study. This has not been done, and regrettably David Ziegler's attempts to bring previous research to bear on this question were vitiated by his citation of claims about holding therapy, as well as by his failure to reference various studies he cited as support in his text. These problems of support for therapeutic holding (or whatever term Intermountain chooses)would probably be apparent only to readers thoroughly versed in this literature, but they are there. If Montanbw is considering the Intermountain approach as the desired middle ground, he or she will have to deal with the fact that there is no more empirical evidence for the Intermountain approach than for Holding Therapy.Jean Mercer (talk) 18:21, 6 November 2008 (UTC)

4. Foster Cline: To say that Foster Cline has modified his approach is rather like saying that George Bush is modifying his approach to the presidency. Foster Cline surrendered his medical license following a disciplinary hearing and has not written for public consumption since that time. If Montanabw has materials that are acceptable for Wiki and that support his or her claim, M. should bring those forward-- this would be a most interesting revelation. Cline's brilliantly-named proprietary intervention, which has resulted in the Love & Logic empire, is said not to employ Attachment Therapy in any way-- again, if Montanabw can show otherwise, many people would like to know about this. Jean Mercer (talk) 18:26, 6 November 2008 (UTC)

5. Milton Erickson: I don't consider reference to Erickson as a hypnotherapist to be dismissive-- of course he was a seminal figure. What is "dissed" here is Erickson's 1960 paper, quoted in its entirety by Foster Cline, in which he describes a case where a mother was advised to sit on her child for hours at a time and to feed him on cold oatmeal; Erickson also noted with apparent approval an outcome in which the child trembled when the mother spoke to him. Montanabw may want to compare these maternal actions with behaviors described under NIS-4 categories.

5. Conclusion: I believe the present article would be much clarified by the use of different terminology, as any of the terms using the word "attachment" are confusing at best. In addition, I think that-- whatever this is we're talking about-- is historically and theoretically vastly different from other child mental health interventions, and should be discussed by itself, not in a way that suggests it's simply a variant of a mainstream approach. I consider the "middle ground" and the "therapeutic holding" controversy to be red herrings, and I caution other editors not to be persuaded that there would be a positive effect of blurring definitions in this case. Jean Mercer (talk) 18:36, 6 November 2008 (UTC)


 * Delist per comments of Montanabw and Jean Mercer. Recommend peer review and help from Montanabw and Jean Mercer, if those editors are willing, and from other editors knowledgeable on the subject and on mainstream articles. Use Reliable sources (medicine-related articles) standards for sourcing  if this is to be considered an article on a legitimate issue in psychology. Article can be resubmitted to GAN when it's many problems are remedied. &mdash; Mattisse  (Talk) 17:29, 6 November 2008 (UTC)


 * OK Jean. If you want to change the name, what too? I see exactly where you're coming from but the trouble is, the sources do tend to call it "attachment therapy" meaning this holding/coercive type of therapy. Thats how most of the proponents publish it. How is somebody looking for "attachment therapy" going to find their way to this article if its called "coercive restraint therapy"? We could make an even more specific statement in the lead as to what this article is about (as obviously it can't be about all attachment related interventions). Fainites barley 20:13, 6 November 2008 (UTC)
 * I've added this para to the lead - This term is not intended to apply to all interventions that are or claim to be based on attachment theory or to deal with attachment relationships and which may, loosely, be called an "attachment therapy". Rather the term as used here applies to a particular controversial subset of attachment therapy techniques developed by a subset of attachment therapy practitioners. These techniques have been implicated in several child deaths and other harmful effects. . However - the most commonly used term for this "subset" is attachment therapy and that is what most mainstream commentators call it. There's noi easy answer to this one. Were you proposing to change all the mentions of AT to caps?Fainites barley 21:53, 6 November 2008 (UTC)

Several things here: I did not mean to encourage the idea of delisting, nor am I in agreement with Montanabw's comments. I consider the article to be generally appropriately organized, written, and sourced. But as I noted, and as Fainites agrees above, I believe the terminology is a problem. To discriminate between a broad category of attachment-focused therapies, and the system discussed in the present article, I have called the latter Attachment Therapy (caps) or put the term in quotation marks. I would find either of these appropriate, or of course both caps and quotation marks could be used just in case anyone missed the point. The label Holding Therapy has been criticized because there is much more to the treatment than holding, and I've always felt uneasy with the term Attachment Therapy because attachment is not involved. Fainites' added lead material seems quite suitable, but i would also suggest stressing the difference between attachment therapies and Attachment Therapy, and noting that the latter is not one of the former. This might be done best by giving a couple of examples of attachment therapies.

It certainly would have been useful if APSAC had been more careful about terms. Before that report, people generally said "attachment-related" or "attachment-focused" interventions-- now we have this "attachment therapies" category. Anyway, I agree, forget Coercive Restraint-- only about 6 people in the world know what that means.Jean Mercer (talk) 00:19, 7 November 2008 (UTC)

By the way, with respect to sources, I don't understand the problem with Bridget Mahoney's education, or why disclaimers on web sites are a problem. Jean Mercer (talk) 00:22, 7 November 2008 (UTC)

Comment on comments: I have no time and insufficient interest to become a contributor to the article, I was mostly just weighing in on the GA issue because an outside opinion was requested. In short, I agree with the clarification of the terminology and the tweak of the lead. I'm also not defending Foster Cline or any coercive model, I am merely questioning the tone of the article that suggests that that AT means only coercive therapies or that all holding therapies are always coercive and bad. I use Intermountain because it's simply an example of a mainstream, non-whacko program that is successfully using attachment theory AND happens to also include holdings. I'm sure someone could contact them and ask for cites to research that supports their program and evaluate it from there. (I don't have the time, personally) I fully agree that AT is controversial, but so were most new psychotherapy approaches at first; over time some were kept, others discredited. This one is still relatively new, so as far as peer-reviewed studies and such go, I haven't the time or inclination to dig into research on this topic, though anything that is cutting edge will inevitably have a limited amount of research out there. It doesn't mean it is good or bad, just new. Also, many of these therapies start out in ways that can be pretty hair-raising, and over time become refined and greatly improved (look at psychotropic drugs, the differences between the old MAOI-class drugs and the modern SSSRI-class drugs are phenomenal). But basically, this article is not really ready for GA due to all of the above issues, and that is really my only real position here: Delist GA.   Montanabw (talk) 00:33, 7 November 2008 (UTC)


 * Delist. This article is way overbalanced in the amount of space describing – too often repeatedly – a discredited form of therapy. It's not until almost the end of the article we learn that "Zaslow's ideas on the use of the Z-process and holding for autism have been dispelled by research on the genetic/biologic causes of autism." There's no explanation at all of why autism was regarded as a model for lack of attachment, and no explanation as to why presumably sane individuals came to be persuaded to treat children in the way that they did. The Milgram experiment comes to mind, for instance. This therapy arose and was promoted within a sociological context which the article does not explain. --Malleus Fatuorum (talk) 00:34, 7 November 2008 (UTC)

Regrettably, the treatment continues to be used in spite of evidence that discredits it. That's why the article exists. And, of course, it would be most interesting to know why people are willing to go for these things, but there is no useful evidence about the matter-- in addition, that would be a different topic.

As for Montanabw's statements about holding therapies, it's excessively naive to believe that Intermountain must have research supporting its choices-- this is exactly what I was commenting on yesterday. The literature in this area is quite complex, and it doesn't pay to jump to conclusions about it. You have to really know the literature to make reasonable decisions here. This isn't rocket science, it's a lot harder than that.

If Montanabw believes there is empirical evidence supporting holding therapy in any form, he or she should present it-- keeping in mind what I said about David Ziegler's work (and the same goes for Howard Bath). 72.73.196.59 (talk) 13:32, 7 November 2008 (UTC)

Ooops, sorry, that was me. Jean Mercer (talk) 13:38, 7 November 2008 (UTC)


 * I'm not discussing these therapies in general, I'm specifically discussing this therapy, so it is very much on topic. --Malleus Fatuorum (talk) 18:15, 7 November 2008 (UTC)


 * Regarding Malleous' comments - if I had sources putting this therapy in its sociological context I'd be delighted. The best I have been able to find are Speltz (who outlines its history) and the Taskforce but neither really put it in its New Age transformational context. The nearest to this is the Skeptic Report article which Matisse has objected to. I can't make stuff up.I will have a look at Eisner though and see if that helps. As for autism - the use of holding therapy for autism is a substantial subject in its own right. I believe there are some European countries where this is still done. It seemed to me though to be a separate subject to this approach which specifically is aimed at so-called RADkids in the world of adoption and fostering but something could be added to explain the Zaslow view (held by a number of professionals) that autism was lack of attachment, "refrigerator mothers" and the like.Fainites barley 14:47, 7 November 2008 (UTC)


 * Regarding Jeans comment - do you propose a change to Attachment Therapy in an effort to distinguish this form of therapy from any passing mainstream effort that may carelessly be referred to as "attachment therapy"? If so I can make that change.Fainites barley 14:47, 7 November 2008 (UTC)
 * Regarding matisses comment - are you suggesting that the article should reflect Montanabw's view that holding therapy is "middle ground" or "cutting edge" in the absence of any sources to that effect and in the light of notable sources contrary to that effect?Fainites barley 14:51, 7 November 2008 (UTC)

I do, I do propose that change, to Attachment Therapy with caps, and I always use that form in my own writing. I would even propose using quotation marks in addition to caps, but I suppose this would confuse searches. I would also suggest that mainstream interventions be described as attachment therapIES as a group, and by their own specific names if discussed individually. If it weren't for the confusing precedent established by APSAC, I'd argue that we go back to "attachment-focused" or "attachment-related", which used to be standard.

"Attachment Therapy On Trial" (Mercer, Sarner, & Rosa) discusses some of the background in popular thought which is being described as the sociological context.

One comment on the "middle ground" business: it's important to remember that "holding" as alluded to by Montanabw is probably not equivalent to "rage reduction" therapy. Instead, this is a mthod that involves restraint as an assurance of safety in crisis situations, followed by continued restraint (called "therapeutic holding") after calm is restored-- proponents of this technique believe that the holding of the now-calm individual has therapeutic value. This is obviously different from holding methods that incite distress and loss of control; however, there is no adequate evidentiary foundation to support the effectiveness of either method. (Please comment if you disagree with my definition, Montanabw.)In fact, little has been published about "therapeutic holding" in peer-reviewed journals, and the definition seems to have been subject to criterion creep. I would speculate that "therapeutic holding" is based primarily on assumptions about "age regression" rather than on beliefs about catharsis.Jean Mercer (talk) 17:43, 7 November 2008 (UTC)
 * Note - This is a Good article reassessment. This is not a place for a general discussion of the article. That discussion should take place on the article talk page. This is not a place to argue with other commentors. Please see GAR Cold fusion for a more typical example of the GAR format. To know what the GA criteria are, see Good article criteria and evaluate the article according to these standards. Please register a Keep or a Delist with concise reasons for your position, if you have an opinion regarding this matter.   &mdash; Mattisse  (Talk) 18:37, 7 November 2008 (UTC)
 * Agreed that this is a GAR, so further debate should do elsewhere. My main concern is that to the extent the article is exposing abuses of coercive techniques, it is too soap-boxy and paints with too broad a brush; and to the extent it tries to describe a controversial new therapy that is on the edge of mainstream but has yet to have a lot of empirical research on it, it fails to do an adequate job of doing so. So essentially, yes, I do differentiate between therapeutic holding versus rage reduction or coercing holding.  I also agree that these therapies are not designed for children with autism, they are appropriately applied to children with reactive attachment disorder, two very different things.  I would also agree that there are children who have issues related to attachment styles and are also NOT suitable candidates for attachment therapies.  Perhaps the biggest issue is that "Attachment Therapy" is really two articles -- the nutty, clearly damaging stuff versus the concepts that might be considered state of the art 10 years from now -- and needs to either make these two issues clearer, or needs to be split into two articles.  Hate to throw in a monkey wrench and then leave, but I just don't have the time to wade into the psych articles, too many other fish to fry. But hope my comments are understood as being in good faith and reflecting a legitimate concern.  Good luck all with continued work!  Montanabw (talk) 20:48, 7 November 2008 (UTC)
 * No suggestion it wasn't good faith Momtanabw! Thanks for your input. In saying holding is suitable for children with RAD -you do part company with the mainstream but maybe somebody will do some research one day, but there's none supporting yet and the mainstream remains agin it. Attachment therapy as criticised by the Taskforce includes not only the most extreme coercive versions, but also scheduled holding (ie not for safety) and age regression, which seems to be the Intermountain approach. (Also - the 'nutty stuff' certainly wasn't just as long ago as 10 years. The Taskforce only reported in 2006. ATTACh only issued a definitive statement against the coercive/cathartic stuff in 2006). All the best and thanks again for your input.Fainites barley 21:44, 7 November 2008 (UTC)
 * OK Jean. I can make that change. I'm not sure what I can do about Montanabw's concerns though. I have already put in the article the Taskforce point on variations of therapies and moves away from the more coercive stuff by some leaders in the field. I don't have a source specifically on "therapeutic" holding on non-autistic children other than the Taskforces statement in relation to scheduled holding and age regression. Also - the article quotes ATTACh on this point and they ought to know. Also - there's a reference to this in the lead - about the beginnings of change following Candace Newmaker. Any suggestions? Fainites barley 21:50, 7 November 2008 (UTC)
 * Have made the change. Can't change the title yet though without moving the page. Fainites barley 22:19, 7 November 2008 (UTC)

Consensus summary

 * Proposal to close as delist. GAR has let down this article in the last three weeks, partly because I have been wanting to leave GAR decisions to other editors, but also because this GAR is very demanding in terms of the amount one needs to read in order to make a final decision. Consequently I have now plucked up the courage to read the article carefully. My head is still spinning, and rereading the GAR did not help much.
 * At the moment (excluding my edits), this article is extremely confusing. Confusion starts already in the lead and the first section with statements like
 * This term is not intended to apply to all interventions that are or claim to be based on attachment theory or to deal with attachment relationships and which may, loosely, be called "attachment therapies". Rather the term as used here applies to a particular controversial subset of attachment therapy techniques developed by a subset of attachment therapy practitioners.
 * Controversies arose about a particular subset of attachment therapy techniques developed by a subset of attachment therapy practitioners.
 * It seems that the reader is supposed to understand nuances involving capitals and plurals. So are Attachment Therapists a subset of attachment therapists? Attachment therapies are more general than Attachment Therapy. But what about attachment therapy? Is it a subset of itself? Geometry guy 22:23, 30 November 2008 (UTC)
 * Unfortunately this confusion exists in real life as it were and may not be possible to resolve it.Fainites barley scribs 13:52, 1 December 2008 (UTC)


 * Continuation and conclusion. The confusion continues in the structure of the article. The first section is entitled "Background", but half way through I found myself wading into criticism of things which had not yet been explained. ("It has also been described as potentially abusive and a pseudoscientific intervention..."). Why are there separate "Background" and "Historical roots" sections? Why does the "Treatment characteristics" section discuss "conceptual focus" and other nondescriptive characteristics? What is the reader to make of the "Variations" section? "Diagnosis and attachment disorder" rapidly degenerates into a completely different purpose: discrediting AD websites and practitioners and their methods. I don't have a problem with doing that, but as a new reader, the section disoriented me even more. The "prevalence" section is terrible: it begins with history according to unreliable sources, followed by a bunch of inline links. The next section "claims" proposes to discuss the claims of attachment therapists, but starts deconstructing and criticising them before I had any idea what the claims actually were. Then suddenly, smack, we are hit with the "Cases". The rest of the article, dodging around the main points, unable to focus attention on one aspect, is no preparation for this listy and brutal description of why Attachment Therapy is so controversial. I had to reevaluate the entire article after reading this, and it made even less sense to me other than an overall feeling "Attachment Therapy is badTM".
 * The confusion is in the detail too. With every quotation mark, I found myself asking, "is this a literal quotation, a use/mention distinction, or a scare quote?" In many cases I have no idea. The tense in some sections jumps from past to present and back again with no justification. I have simply been left reeling by an article where editors have got into disputes over what it is about, rather than how can we present an encyclopedic treatment to readers. I found numerous places where I was unsure which source I could check to verify the contents of the article. And page numbers, while not a GA requirement, would be enormously helpful when refering to books with more than 200 pages.
 * The intention behind this article is one I applaud: an encyclopedic medical article should direct readers away from pseudoscience towards good advice. The current article tries to do this and completely fails. A big rethink is needed. Big rethinks are not something GAR can handle, hence the delay. Time to close as delist. Geometry guy 23:35, 30 November 2008 (UTC)


 * Summary. The article fails the criteria as follows: 1(a) the article is unclear with multiple grammar and prose failures; 1(b) The overly long WP:LEAD does not summarize the article, layout is confusing, there are words to avoid, and arguably one listy subsection. 2(b) Does well in general, but this is a controversial subject and the sources for several statements are unclear (see the edit history). 3(a)(b) are much improved, but the scope of the article is still not completely clear, and the article is confusing. 4 The article needs to be reevaluated for an encyclopedic point of view. Geometry guy 23:57, 30 November 2008 (UTC)
 * As the title of this subsection indicates, please add comments if you agree or disagree with the consensus to delist. Geometry guy 23:03, 30 November 2008 (UTC)
 * Delist and close - I'm not sure if I should register my opinion again, as I have voiced my opinion above. However, I agree with your description of the article's problems and think this GAR should close. &mdash; Mattisse  (Talk) 00:13, 1 December 2008 (UTC)
 * Yes this is an invitation to re-register viewpoints concisely or raise objections, just to make sure that after all this time, the conclusion is appropriate and consensus-based. Geometry guy 00:22, 1 December 2008 (UTC)
 * Fair enough GG. It is very difficult to think how to present an encyclopaedic article on a pseudoscience, and protocols for writing articles on proper med/psych topics don't help much in this area. Each review raises different objections and you can please some of the people.... etc. Unlike many pseudosciences there are many peer reviewed articles and commentaries but as they are all agin AT it does produce a sort of soapboxy effect. The confusion over naming is a real problem (added to by the Taskforce) and one to which I have not yet found a comprehensive solution that finds favour with all parties. There have been so many suggestions and arguments on this point in the past and the current effort represents a sort of synthesis of all those discussions. Tricky. In relation to 'directing people to good advice' - there were strong objections to the inclusion of any mainstream material in this article so this is also a tricky one to manouvre. Fainites barley scribs 13:42, 1 December 2008 (UTC)
 * I greatly sympathise with your position, and appreciate the efforts you have made to improve an extremely difficult article to write. Concerning mainstream material, my reading of the objections here are that mixing discussion of mainstream therapies with Attachment Therapy causes confusion and is in danger of legitimising the latter. One also has to stay on topic.
 * Anyway, the article has plenty of good content (indeed it is probably too long) and you have heard many views on how to improve the article. Perhaps this is time to digest them and return refreshed to the article in the New Year? All the best, Geometry guy 19:18, 1 December 2008 (UTC)


 * Delist and close. My opinion has not changed from the one I stated above. --Malleus Fatuorum 13:57, 1 December 2008 (UTC)