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You've Got to Know When to Hold 'em
Excerpt from When a Stranger Calls You Mom
By Katharine Leslie Ph.D., CFLE

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Holding is often referred to as a therapy, but in fact it is a technique and is often incorporated into a treatment plan that includes many of the other techniques stated above. The idea of holding is not new to therapeutic interventions. It is a long-standing assumption that a therapist psychologically “holds” the client by providing a safe and nurturing environment that is consistent, and that encourages and affirms the client’s sense of wholeness (see Winnecott, 1965-1989). Holding is also not new in terms of parent-child relationships. Parents hold their children to nurture them and to c ontrol them, and in so doing provide undivided attention, empathy, protection, and care that reassures the infant/child in an ever changing world and self. What is new about holding, in the therapeutic sense, is the blending of psychological holding with the physical holding that natu rally occurs in the parent-child relationship. James (1994) describes inappropriate coercive holding as that which restrains the child for other than protective reasons, stimulates by poking, prodding, tickling, tapping, or moving parts of the body, and interferes with body functions by covering eyes or inhibiting breathing. James is referring to techniques also known as “rage reduction therapy.” The goal of this therapy is to provoke a high level of arousal in the child in hopes he will release the repressed rage that is interfering in his attaching to caregivers.
Rage-reduction therapy was derived in part from learning theory. According to John Watson, the founding father of learning theory, there are only three innate emotions: fear, rage, and love. He suggested that rage is elicited by the restriction of bodily movements. Therefore, it was assumed that because traumatized children are filled with rage from unrequited needs, provoking rage by holding the child against his will should free the child to love again. Some therapists still use this method, but it is not a popular method. Other therapists use a method that entails holding a raging child (or adult) after the child has became evoked from something in the therapy. The therapist is sometimes unsure of what might bring on such a rage for a particular client, and is caught unaware and must contain the client.
When a known person restricts a non-traumatized child’s bodily movement, the child feels rage, but not fear. However, when a known person restricts a traumatized child’s bodily movement, the child feels rage and fear. Fear mediates flight. But the fear may be a paratactic distortion, so the therapist must hold the child to assure the child he has nothing to fear from her and no need to run away. Therefore, what seems intuitive - don’t hold a traumatized child against his will, is actually counterintuitive - you need to hold a traumatized child who is raging or he will go on believing he has something to fear. Holding an angry child also t ells him that he is safe and the adults can control him (protect him) when he cannot control himself. And the holding may induce a bonding event that can enhance attachment.
Although the therapeutic techniques James describes sound offensive, particularly when perpetrated on a child who was traumatized, most of them can be explained within the context and purpose of the treatment plan. For example, tapping (EMDR) and moving the body (somatic therapy) are accepted techniques in relieving symptoms of PTSD and for processing preverbal memories. Usually the therapist incorporates EMDR with story telling while the caregiver is holding the child in a loving non-coercive manner. Somatic work is often done in the form of games, and rough and tumble play with the therapist or parent. And it is also used while holding the child to identify and release stored trau ma in the body. Many practitioners are beginning to incorporate massage (clothes on) into their therapeutic plans for the same reason.
Interestingly, many professionals and society at large don’t seem to mind parents “holding” their children to control them and condone “holding” children wi th medication and lockdown facilities. Yet, they believe physically “holding” a child for therapeutic purposes, even when the child doesn’t seem to mind and even enjoys it, is offensive and violates his human rights.
Three of my children have been involved in therapy with trauma specialists with varying degrees of success. The therapists, my husband, and I have practiced holding techniques with these three children and rarely were the techniques used against their will. On the contrary, they enjoyed being held (much more so during the therapy than at other times). It was actually during this therapy that one of my children revealed his sexual abuse history. Some practitioners may be alarmed by this declaration, assuming that holding a child may cause him to make false allegations of abuse. However, in our case, the abuse was real and appeared only to be revealed because of this therapeutic process; it was never revealed during the three years we had already lived with this child. Because talk and play therapies are less confrontive, they may be less successful in creating the type of change, conducive atmosphere often needed by traumatized children.
I have observed other families in therapy with trauma specialists and have been impressed by some of the results. Some of these therapists do not hold the child, but encourage the parents to hold the child, and some use no holding techniques at all. Although I know there is still much to learn regarding therapeutic interventions with traumatized children, I am convinced that traditional play or talk therapy alone is not an effective treatment course for most of these children.

Katharine Leslie Ph.D., CFLE
 Author of "When a Stranger Calls You Mom"

Deborah Hage, MSW

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