February 10, 2009: Specialists in childhood trauma and therapy from the Leadership Council have grave concerns about the ethics of deprogramming treatment described in a recent article published in the Globe and Mail (see: Judge Blocks Sending Teen for Deprogramming Treatment, Feb 7, 2009).
We support the decision of the judge who refused to court-order deprogramming treatment (sometime called Reunification Therapy) overturning a 2008 arbitrator's order that the 14-year-old boy be coercively treated. The controversial treatment is designed to “deprogram” children who are “alienated” from one of their parents during divorce.
Various forms of this type of “treatment” have sprung up over the last decade. The therapy usually involves confining the child in a location away from home, and isolating the child from the parent to whom the child is most attached. The attachment to the favored parent is challenged, while encouraging the child with intensive sessions to re-accept the rejected parent.
Some children have reported receiving treatment involving threats and coercion. The child may be told that he or she may not return home until they have accepted a more favorable view of the denigrated parent. One child the LC has interviewed described recurrent nightmares of the de-programming episodes that were used on him. In addition, there have been several lawsuits related to this type of approach. (see: http://rachel-foundation-lawsuit.com)
This so-called “therapy” is reminiscent of the kind of brainwashing techniques used in prison camps where deprivation and isolation are used to coerce false confessions and to force ideological changes in captives. While these techniques can produce changes in belief and in behavior, we are concerned that these techniques are harmful to the mental health of children.
We are also concerned that deprogramming treatments may violate basic ethical principles that guide practice. According to the American Psychological Association's ethical standards, the goals of psychologists are the welfare and protection of individuals. We question whether deprogramming treatment protects the welfare of the children involved. We have listed some of our concerns at the end of this release. (see: Concerns)
Deprogramming treatment raises philosophical and legal questions which remain unresolved in our approach to children. Are children simply the property of adults whose legal interests can control what children think and believe? In what sense does the child's intellectual and emotional freedom have precedence over these legal interests? While these complex issues are not yet resolved, the controversial nature of this deprogramming treatment would argue for caution in safeguarding the mental health of children while we wrestle with these complex questions.
One of the concrete dangers of this type of therapy is that it has been used to force children into reunification with adults that have committed violent crimes against them, thus putting the children at risk of further victimization.
The Leadership Council has spoken with several victims of this type of therapy who were traumatized by the treatment. One young man says he continues to have flashbacks from his forced isolation from his mother and from continually being confronted by a therapist who told him his beliefs were wrong. After reunification with the parent he had been coerced to accept (in this case his father), he discovered that this parent was indeed abusive, his previous beliefs had been correct, and he felt betrayed and maltreated by the courts that had ordered this therapy. This case clearly illustrates that therapy that stems from the agenda of an interested legal party may be detrimental to the autonomy and welfare of the child for whom it is ordered.
Sometimes reunification therapy does not involve confinement and separation from the primary parent, but involves forced therapy sessions with a rejected parent. Many of the same ethical questions apply to this type of therapy as well, as the child is often forced to attend these sessions against his/her will. If the child is being forced to reunify with a parent he has clearly stated was abusive to him or her, the child may react with increased symptoms, suicidal ideation, or even suicide attempts.
Does this mean that children shouldn't receive therapy in situations where a child is estranged from one of their parents? No.
There are respectful and accepted techniques available that do not involve coercion or confinement that can help children in these situations. For example, one technique involves listening to children and helping them sort through their often conflicted feelings about their parents. This form of therapy, when done with a neutral therapist who is committed to safeguarding the interests of the child, is a more humane and appropriate approach. In addition, this is the approach that is most likely to be effective.
For all of these reasons, the LC strongly supports the judge's decision described in the Globe and Mail article, and advises parents seeking remedies for children from whom they are estranged to seek less coercive and more ethical forms of treatment. Also, courts should resist ordering children into any treatment that is coercive and experimental. Instead, any court-ordered treatment should abide by APA ethical guidelines and be based on empirical evidence.
Children have a right to their thoughts, beliefs, feelings, and opinions. The legal interests of warring adults should not be the agenda that drives the mental health approach used for vulnerable children.
1. Being Confined and Isolated from Family and Friends in an unfamiliar Setting May be a Traumatic Experience for Children Leading Them to Feel Trapped, Helpless, and Powerless.
Isolating a child from everyone they are familiar with and attempting to force a new view of their parents, especially by strangers who know little about the child's experiences with their parents can be traumatic. This is of particular concern as many children being exposed to these techniques have reported a history of abuse from the very individuals they are being forced to reunify with.
One girl subjected to this treatment was placed in a treatment facility by her father. The therapists adopted the father''s viewpoint and the child was repeatedly told that her father who had abused her on a numerous occasions, hadn't. She finally parroted what she was told to say in order to get out the facility where she was being held. When returned to her father, she ran away from home and lived on the streets until she was able to get a judge to listen to listen to her. She was finally allowed to return to her mother after a hearing in which the young teen's concerns were finally listened to.
Coercive and punitive “therapies” are especially inappropriate when used on children who have already been traumatized. These children may find this kind of setting a “trigger” for further post-traumatic reactions. Forced reunification against a child's will and without taking into consideration the child's point of view and emotional well-being, can be expected to reinforce a sense of helplessness and powerlessness in an already vulnerable child. Such “treatment” can be expected to do more harm than good, and could potentially cause lasting emotional harm.
2. According to APA Ethical Standards, Psychologists Respect and Protect Civil and Human Rights (Preamble to the APA Ethical Guidelines)
The right to one's belief system is considered the most basic of human rights. The confinement of a child who has committed no wrong doing away from parents and friends in unfamiliar surroundings in order to force them to adopt a new belief system may violate a child's basic civil rights.
3. According to APA Ethical Principles, Individuals have a Basic Right to Self-Determination (Principle E: Respect for People's Rights and Dignity)
Being forced to change one's belief system may violate the principle of self-determination.
4. According to APA Ethical Principles, Psychologists Avoid Multiple Relationships to Avoid Conflicts of Interest (APA Ethics code: 3.05)
According to ethical standards set forth by the APA, "a psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists."
A psychologist who has contracted with a parent to force a child against his will into a relationship is engaged in a dual relationship. One with the contracting parent and one with the client-child. The child's goals and interests may be in direct conflict to those of the parent that has engaged the therapist. This dual role presents an unavoidable conflict that would keep the child's feelings, beliefs, and desires from being central during treatment.
5. According to APA Ethical Principles, Psychologists Must Engage in Therapeutic Services Only After Obtaining Informed Consent – Even when a Client is Not Legally Capable of Giving Informed Consent, The Psycologist Still Must Explain the Procedures, Consider the Individual's Preferences and Gain Their Assent Prior to Treatment. (APA Ethics code: 3.10).
According to ethical standards set forth by the APA, "For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests.."
It is not possible to obtain meaningful informed consent from children who are isolated from family and friends, confined in a facility and subjected to coercive treatment.