Restraint Therapy: Treatment, Effects & Risks

Holding therapy is a special form of psychotherapy designed to correct attachment disorders. According to this method, two people hold each other intensely in an embrace until negative feelings have passed. It was originally developed for the treatment of children suffering from autism, mental retardation, psychological disorders or behavioral problems. Today, holding therapy is also used with adults.

What is restraint therapy?

The method of restraint therapy was founded by the US psychologist Martha Welch, born in 1944. It was further developed and introduced into family therapy, beginning in the 1980s, by Czech therapist Jirina Prekop (born 1929). Although Welch and Prekop emphasize the non-aggressive nature of restraint therapy, according to critical psychologists, it can involve violence toward the persons being treated and thus may be traumatizing. However, Welch and Prekop, the founders, stipulate that restraint must not result in punishment or chastisement. In addition, they prohibit the activity of any person who is internally disposed to the behavior of the child being treated with aggression or rejection. Previous maltreatment of the child in question also precludes the therapeutic work of an adult. The basis of the restraint therapy is the mutual embrace, during which the persons involved look into each other’s eyes. In this direct confrontation, painful feelings first come to light. Subsequently, aggressive impulses and massive fears may emerge, which may be clearly expressed. Nevertheless, the intense holding continues until all negative feelings have dissipated. Then the holding has changed to a more or less loving embrace. Towards children, the holding therapy should always be completed only by a close confidant or, in exceptional cases, by a therapist. This person has the task of accompanying and, if necessary, reinforcing all states of agitation and aggressive emotional expressions that appear. According to Jirina Prekop, the detained person is to be encouraged to scold and cry out if he/she wants to do so himself/herself. The whole therapy should not be under any time limit. Only when the agitation has completely subsided, the treatment can be terminated. Preference should be given to a comfortable position for the persons involved, usually sitting or lying down.

Function, effect and goals

Primarily due to legal concerns, restraint therapy is denied recognition in professional circles. The intensive or sometimes even violent restraint of a child against his or her will can very quickly reach the limits of the legally prescribed framework of interpersonal relationships. Legally, holding a person against his or her express will constitutes deprivation of liberty and bodily harm. The German Child Protection Association has criticized restraint therapy as a justification for violence that is unacceptable. Renowned educationalists and psychotherapists speak out against detention therapy because it reinterprets punitive measures as therapy in the interests of the child. Under the guise of family love and also pedagogical intentions, the use of psychological violence is justified. Often one parent and the child held each other for hours, mostly to the reluctance of the child. Thus, the restraint therapy is unsuitable for the treatment of psychological disorders. Again and again, those affected and their relatives complained that traumatization had been caused or intensified by it. The procedure cannot be reconciled with scientific and psychotherapeutic principles. Proponents of restraint therapy, on the other hand, argue that the treatment is primarily about love, a better bond and a feeling of security. For these reasons, however, quite a few pediatricians and occupational therapists repeatedly resort to restraint therapy and also recommend it to parents for use. In these cases it is pointed out that in a responsible procedure the right of the stronger never applies and no physical as well as linguistic force is used. The restraint therapy should not be misunderstood as a means of pressure.After all, practicing child psychologists argue that children can also perceive therapy as a form of being lovingly held. It is not desirable, however, if older children in particular have to endure violent sessions over several hours.

Risks, side effects and dangers

Therapy co-founder Jirina Prekop defends holding as an opportunity to resolve conflicts “heart to heart and bile to bile.” If hurt feelings could be cried out and shouted out in the course of therapy, love would eventually reemerge. In many cases, parents and children would come out of the attachment sessions very relaxed. Jirina Prekop recommends holding for mental anxiety, depression, hyperactivity, addictions and compulsive behavior. Especially restless and aggressive children could regain confidence in the support of their parents. This view is also strongly contradicted by experienced child psychologists. Family therapists report feelings of guilt in parents and behavioral problems in children who have undergone restraint therapy. Children are not able to develop strength and the ability to deal with conflict, as Jirina Prekop states, but on the contrary suffer from self-esteem problems and contact disorders, some of which are considerable. A child psychologist who is opposed to restraint therapy describes her experience that children treated in this way often have great problems with closeness and distance in their friendships and later love relationships. Some of those affected would take over the personality of other children or adolescents or, on the contrary, were impaired in their ability to tolerate touch. In addition, a very dismissive relationship with one’s own parents or even other family members often remains.