ATTACh Position Statement on Coercive Therapy

ATTACh believes a central focus of attachment therapy is to create an environment for the individual to safely work through and integrate previously unmanageable or traumatic information and emotions that interfere with the capacity to develop secure attachment relationships.

This position paper is a response to recent statements based on misperceptions about attachment therapy. Some of these statements refer to, but do not define, “coercive therapy” or “coercive restraint therapy.” The dictionary definition of “coerce” includes “the use of force.” ATTACh is opposed to the use of force* in therapy.  However, the term “confrontation” is widely used in therapeutic literature as a technique to help the client resolve maladaptive defenses. ATTACh believes that there are circumstances in which therapeutic confrontation is appropriate, within the parameters outlined below: 

1. ATTACh opposes abuse in any form at any time.

2. ATTACh opposes any intervention or activity that endangers a person’s physical or emotional wellbeing. 

3. ATTACh believes all therapeutic interventions should be conducted in a respectful manner.

4. ATTACh believes a confrontational approach should be taken only when it is the best available option to help a client meet treatment plan goals.

5. ATTACh supports therapeutic interventions that use the least amount of confrontation possible; where clients are encouraged to face issues that may be difficult for them (e.g., maladaptive strategies) with the following caveats:

   1. The intervention is developmentally appropriate, guided by the client’s best interests, and based on a thorough diagnostic assessment,

   2. Client (and parents) have given informed consent,  

   3. Less confrontational approaches have been tried and proven ineffectual,

   4. The safety of all participants is ensured,

   5. The intervention does not overwhelm the client’s resources for coping, and

   6. Sufficient time and resources are available to support the intervention and ensure resolution.

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

* Force is defined for purposes of this statement as using verbal or physical means that overwhelm an individual’s resources, or interfere with or risk breaking the therapeutic alliance.

For further theoretical rationale for this position statement, see “Theoretical Rationale for the Treatment of Disorders of Attachment” by Victoria Kelly, Psy.D.  This article will be available soon on the ATTACh website.