logo

Holding Therapy and Autism Ranking: Mildly Hazardous Insufficient/Mixed evidence

Introduction

Holding therapy is a type of psychological intervention used to help children who find it difficult to form a relationship with their mother.

The therapy consists of forced holding by a therapist or parent until the child stops resisting or until a fixed time period has elapsed. The carer does not usually release her or his hold until the child ‘surrenders' and looks into the carer's eyes. The carer then returns the child's gaze and exchanges affection.

Holding therapy is based on the idea that intense physical and emotional contact between the mother and child will repair the broken bond between them and form the foundation for normal development.

The therapy is used to treat a wide range of children with an attachment disorder, including children with autism, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, learning disabilities, depression etc.

Holding therapy is different to simply hugging or cuddling a child, where no force and no coercion are used.

Our Opinion

The theory behind holding therapy is weak and unproven.

There is no high quality research evidence to suggest that holding therapy is effective as a treatment for people on the autism spectrum.

There have been numerous accounts of the damage caused by holding therapy to people on the autism spectrum or with other conditions.

We cannot recommend holding therapy as an intervention for people on the autism spectrum.

Disclaimer

Please read our Disclaimer on Autism Interventions

Audience

Holding therapy was designed to help children with a disturbed attachment (failure to form normal relationships) to their mother.

The supporters of holding therapy claim that children with a disturbed attachment to their mother include some children with autism, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, learning disabilities, attachment disorder, depression, developmental disorders, and other affective disorders.

Aims and Claims

Aims

Holding therapy is based on the idea that intense physical and emotional contact between the mother and child will repair the broken bond between them and form the foundation for normal development.

The therapy is based on the work of Tinbergen and Tinbergen (1983) who claimed that autism is caused by "an anxiety dominated emotional imbalance, which leads to social withdrawal and “... a failure to learn from social interaction”.

Some commentators, such as Temple Grandin and Bernard Rimland, have argued that holding therapy may actually be providing a form of sensory stimulation and that it is this which is beneficial rather than mending the broken relationship between mother and child.

Claims

There have been various claims made for holding therapy, up to and including complete recovery.

According to Welch and Chaput (1988)

“Based on our experience, regardless of etiology, when early childhood autism is the symptom complex, intact families achieve significant to dramatic improvement in the symptoms, in the child’s relatedness to the parents, and in the quality of life of the family, provided they participate in a rigorous program of mother-child holding that is supervised to insure continuity of effort.”

According to Simpson et al (2005)

“Welch claims that some children with ASD have fully recovered from their disability and achieved normal development, and that all others showed some cognitive, emotional, and/or physiological improvement after being treated with her version of mother-child holding therapy”.

Key Features

Holding therapy (also known as Hug therapy; Holding time; Attachment holding therapy; Cuddle time; Gentle containment; Holding-nurturing process; PPCE Therapy and Prolonged Parent–Child Embrace Therapy) is a type of psychological intervention used to help children who find it difficult to form a relationship with their mother.

The therapy consists of forced holding by a therapist or parent until the child stops resisting or until a fixed time period has elapsed. The carer does not usually release her or his hold until the child ‘surrenders' and looks into the carer's eyes. The carer then returns the child's gaze and exchanges affection.

Holding therapy is different to simply hugging or cuddling a child, where no force and no coercion are used.

According to Simpson (2005)

“There are three parts to the Holding Time sequence: (1) confrontation, (2) rejection, and (3) resolution. During the confrontation stage, the mother and child position themselves so that they can easily make contact and 'hold' each other. The mother insists on eye contact, sometimes physically forcing it. Thus, the mother begins to elicit and express communication about feelings. This leads to child resistance, known as the rejection stage. During this stage, the mother continues to hold the child, no matter how vigorously the child fights, with intent to communicate the message ‘nothing can come between us - not your anger and not even my anger'. The rejection stage continues until avoidance behavior gives way to physical and verbal closeness (the resolution stage), with the development of a strong, loving, enduring bond being the ultimate goal.”

Cost and Time

Cost

The costs of using holding therapy will depend to a large extent on whether the mother uses the services of a facilitator and/or purchases any support materials. We have been unable to identify the costs of using a facilitator or purchasing support materials.

Time

Holding can be as short as a few minutes, but it can also last for hours at a time, depending on how long it takes the child to surrender.

According to Welch and Chaput (1988),

“A typical holding session takes at least one hour to progress from the beginning through the rejection phase and on through the resolution. “

They go on to say that, in their study, the children were held an average of five times per week for average of 11 months.  They also reported,

“The degree of improvement correlates with the amount of mother-child holding performed at home in between regular therapy sessions with the therapist.”

Risks and Safety

Hazards

According to Boris (2003),

“There were at least two deaths in the USA in 2002 attributed to interventions designed to address the specific 'attachment problems' of children. The forensic details suggest that the treatments employed in these cases were somewhat different; however, in both instances forcible restraint (e.g., a form of holding therapy) was used in an effort to “promote re-attachment. “

According to Simpson et al (2005),

'Any intervention that involves force is potentially physically and psychologically harmful. Numerous critics of Holding Time have made many arguments against its use. These arguments include

1) disturbingly, children who experience holding therapy may learn to feign attachment behavior;

2) forced holding may potentially cause extreme discomfort when used with children who have tactile defensiveness, hypersensitivity, and /or difficulty making and maintaining eye contact;

3) forced holding at the hand of an adult that a child loves and trusts may be psychologically damaging rather than beneficial;

4) parents who used holding therapy may have the unrealistic hope that their child can be cured of autism or another disorders, which may have devastating effects on the family if their efforts prove to be futile.'

Contraindications

The potential hazards listed above make holding therapy contraindicated (something which makes a particular treatment or procedure potentially inadvisable) for anyone including people on the autism spectrum.

Suppliers and Availability

Suppliers

Holding therapy was originally made available through "Mothering Centres" in the US and the UK. However we have been unable to determine whether those centres still exist or whether any other organisations are currently providing holding therapy.

Credentials

According to Simpson et al (2005)

'”Holding therapy is performed by the mother with support from the father or other family members under close supervision and facilitation of a trained therapist”. However we have been unable to identify the qualifications or credentials of the therapist.

History

Holding therapy is based on the work of Niko Tinbergen, a Dutch ethologist (animal behaviouralist) and ornithologist who developed the concept in the 1980s.

Dr Martha Welch, a child psychiatrist in New York, popularised the therapy with her book, 'Holding Time' and went on to found Mothering Centres in the US and the UK.

Current Research

Current Research Studies

We have identified 3 studies of holding therapy used on people on the autism spectrum published in English-speaking, peer-reviewed journals.

The three studies (Lindt, 1988; Welch and Chaput, 1988; Welch 1989) included a total of 14 children and all reported positive benefits.

 Status of Current Research Studies

There are significant methodological issues with the research studies identified to date, meaning that the quality of the evidence is extremely poor.

One is a case study of a single child. The other two are small case series undertaken by/with the creator of the intervention, Martha Welch.

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’

Ongoing Research

We have been unable to identify any studies into holding therapy that are currently underway.  If you know of any other studies we should include please email info@researchautism.net with the details.

Future Research

Summary of Existing Research

There is no high quality research evidence to suggest that holding therapy is effective as a treatment for people on the autism spectrum.

There have been numerous accounts of the damage caused to people on the autism spectrum or with other conditions.

Recommendations for Future Research

Although holding therapy was first introduced as an intervention in the 1980‘s there is still little evidence to support its value for people on the autism spectrum.

Many anecdotal reports from individuals subjected to this intervention suggest that that there is a significant risk of physical and emotional harm.

Consequently we believe that further research into this intervention would pose serious ethical issues and should not be undertaken.

Other Reading

This section provides details of other publications on this topic. If you know of any other publications we should include please email info@researchautism.net with the details. Thank you.

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Studies and Trials

This section provides details of scientific studies into the effectiveness of this intervention for people with autism which have been published in English-language, peer-reviewed journals. If you know of any other studies we should include please email info@researchautism.net with the details. Thank you.

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Personal Accounts

This section provides details of personal accounts of the use of holding therapy for people on the autism spectrum.

Personal accounts can be useful sources of information about the intervention but are not as scientifically valid or reliable as research trials. This may be especially true where the accounts are published by an organisation which might gain a financial advantage from the take-up of the intervention.

Please note that the views expressed in these personal accounts do not necessarily represent the views of Research Autism.


There are numerous personal accounts about the use of holding therapy for people on the autism spectrum on the internet, almost all of them entirely negative.

Updated
31 Oct 2017
Last Review
01 Oct 2016
Next Review
01 Oct 2019