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Clarifications of Monica Pignotti’s Criticisms of Ronald Federici’s Intervention as Presented in his Book and Media Appearances

October 1, 2010

My criticisms of Ronald Federici have been misportrayed in a number of places. Google searches on “Monica Pignotti” reveal that I have essentially been accused of waging a hate campaign and spreading defamation when there is nothing in my criticisms that have done any of this. My criticisms are not personal, but rather, are about the content of what he has written and promoted through various media. Contrary to the arbitrary assertions that one has to meet someone to criticize them, that is not the case unless someone made a personal statement about someone and I have made no personal statements about Dr. Federici. I have never posted one thing about his personal life and was not in any way involved in any of those discussions. I am a very up front person. When I have something critical to say about someone, I say it in my own name, Monica Pignotti. Unlike my attackers who have engaged in spreading highly personal lies about me, I do not hide behind anonymous remailers. Licensed mental health professionals are responsible for any public statements that they make related to their work and it is legitimate for anyone to criticize them.

Also as an aside, for the record, I want to state that contrary to the malicious lies that have been posted about me, I am completely opposed to the initiation of any form of physical violence. Criticizing a keynote speaker scheduled to appear on an adoption cruise is not tantamount to physical violence and terrorism in any way, shape or form. That being said, the people who were criticizing Ronald Federici and protesting his scheduled appearance on the cruise had no relationship to me or anyone connected with Advocates for Children in Therapy. I did not get involved in the discussion until much later on a different article where still more people unrelated to me or ACT were objecting to Federici and then, only to clarify my position which has been egregiously misrepresented elsewhere on the internet. Federici was eventually canceled as a keynote speaker but he in no way can blame me or anyone connected with ACT for this. The protests came from people who had never even heard of us until Federici himself tried to accuse us of posting there when he jumped to the wrong conclusion mistook the poster named “Linda” for Linda Rosa. By doing this and then attempting to silence critics, he alienated even more people, in my opinion. He cannot blame this on ACT.

The purpose of this posting is to set the record straight by summarizing what exactly my criticisms are. As I have previously stated, if anything I have stated is factually incorrect, my invitation remains open: I invite Dr. Federici or anyone else to provide me with evidence and a rebuttal. I am stating my sincerely held opinions and I have documented any facts I have stated, but if I am wrong, show me evidence to the contrary and I will correct my statements. That is all I ask. My only intent is to tell the truth, the whole truth and nothing but the truth and I have nothing to hide. I do not hate Dr. Federici. My sole concern is about some of the interventions he is recommending in his books and other writings and in his media appearances. So here are the problems I have with that:

  • I am in agreement with what Peter Fonagy stated in the 2002 BBC documentary on Dr. Federici’s intervention, that this intervention is being promoted, yet has no published randomized clinical trials in peer reviewed journals to support its efficacy. That was the case in 2002 and to the best of my knowledge, based on current database searches I have conducted, it is still the case.
  • His intervention, as promoted in the 2003 edition of his book, Help for The Hopeless Child (see p. 111) employs a face-down, prone restraint procedure. Again, based on my own search of the literature on restraints, this form of restraint has been shown to be dangerous and deaths have resulted from it. Although to the best of my knowledge, no deaths have occurred from Dr. Federici’s intervention, deaths have occurred from prone restraints, even in institutions, under highly supervised conditions where it was carried out correctly. Because of this, even though no deaths have occurred directly from Federici’s interventions I nevertheless have concerns about the potential for harm from the prone restraint procedure recommended. In some states, such as Ohio (click here to read in full), it has been banned completely. The Ohio document states:
  • Research has shown that the Prone Position is a Hazardous and Potentially Lethal Restraint Position. Accepted research has shown that there is a risk of sudden death when restraining an individual in the prone position. The prone position occurs when an individual is face-down. The research has led other states to prohibit the use of this restraint technique.

  • I have serious concerns about this form of restraint being employed by parents, even if they were trained by therapists with experience working in psychiatric units. The fact that someone has worked in a psychiatric unit is no guarantee that they can safely train a non-professional person and again, there has been no systematic study of this intervention, so we have no data on safety and adverse events. Interventions like this should not be promoted prior to such testing, in my opinion.
  • Federici has claimed that this restraint procedure is for safety only. However, in his book and media appearances it looks as if it is being recommended for purposes that go beyond immediate physical threats. All current guidelines I have read recommend that restraints be used only when there is an immediate threat to physical safety or damage of expensive property and they should only be used for the duration of the threat. As the document from Ohio indicates, prone restraints should not be used, period because research has shown they are dangerous although as I understand it, they are sometimes used in states where still legal, but then only when there is an immediate danger and only for the duration of the immediate threat. Here are some indications that, to me, indicate his recommendations go beyond that:

Some fair use quotes from the BBC Documentary which support the statement that the restraint procedure is being recommended for uses other than immediate physical safety in jeopardy:

For at least 30 days, the child must stay within three feet of its parents, 24 hours a day. They have to be totally compliant to whatever their parents want and if they refuse to obey they are forced down onto the floor and held there. Their bedrooms are stripped bare; they are never left alone, nor allowed to see friends. Then, through a gradual process of reward and punishment, the child will eventually be reintroduced to their toys, their peers and the outside world. The treatment can last for months.

and

Dr. Federici believes a child will only learn to comply when it realises its parents are dominant. Controversially, Hayley is to be placed face down in a hold every time she disobeys.

and

He goes down for hitting, kicking, spitting, cussing in your face, screaming, breaking property, slamming doors. Where he’s out of control he must go down immediately.

While some of these behaviors are violent and could present an immediate physical threat, not all are. Cussing and screaming do not normally present an immediate physical threat, nor do slamming doors. The statement is made that it is used when the child is disobedient, but disobedience doesn’t necessarily have to mean a physical threat and immediate physical threat is the only condition under which restraints should be used, according to a number of different currently accepted guidelines on restraints I have read.

In the NBC Dateline documentary featuring Federici and his intervention, a child is place in this hold after his parents asked him to go to the bathroom. The boy says he doesn’t have to go to the bathroom and down he goes.

Additionally, in his book, Help for the Hopeless Child, Federici recommends using this hold even if the child backs down and promises to be good. His rationale, as I understand it, is that if the parents do not follow through, they will be allowing the child to manipulate them, hence the parents have to show them that they are the ones in control, not the child. Whether this is true or not, placing a child in such a position even after he or she backs down is using it beyond the purpose of immediate protection. A child backing down is not presenting an immediate physical threat.

Again, I want to make it clear that these are criticisms of what Dr. Federici wrote in a book that he still currently promotes on his website and his media appearances. I cannot comment on what he actually does with his clients. However, he is nevertheless responsible for what he writes in his book (which he currently promotes on his website)  and says to the media and it is perfectly legitimate for me to criticize that. If what he actually practices is any different from what is in the book and his media appearances, then why continue to promote them?

Attempts and threats have been made to silence my criticism, but these kinds of chilling effects present too serious a threat to the freedom to criticize, which is absolutely essential to a profession remaining safe and scientific. Therefore I will not be threatened into backing down. The only way I will back down is if I am presented with a factual rebuttal, not threats. Personal attacks on me, making untrue statements about me and references to my past are not rebuttals. Either this intervention has been tested for safety and efficacy or it has not and based on all the information I have been able to find, there are no published randomized clinical trials demonstrating safety and efficacy for this intervention and on the contrary, there are indications that the prone restraint procedure is potentially dangerous, even when used under highly supervised conditions. That is the issue and all I ask is that these issues be addressed, rather than waging an all out personal smear campaign against me and my colleagues.

P.S. as for the claim made by one of his clients that he is a “researcher” on institutional autism, I would like to see actual citations to any peer review published research that he has conducted. Researchers publish in peer reviewed journals and my own library database searches have failed to turn up any such citations and “institutional autism” is not a diagnosis that is recognized in the DSM. It has been noted in the literature in studies by other people that some children who spent their early years in orphanages have symptoms that resemble autism, but the studies that follow these children through time show that these improve, over time after they are adopted or even if they were moved into a better situation where they got more one-on-one attention.

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26 Comments
  1. You will notice that Federici does not talk up “institutional autism” as much as he did. Since the Rutter studies, he talks more about “quasi-autistic” features, particularly when he is doing education assessment, or “quasi-autistic” behaviour.

    Here is an example: An educational assessment done on the Federici watch and based on his evidence.

    Does this confuse the public more or less?

  2. Dr. Pignotti,

    I cannot comment on the BBC Documentary as I have not seen it. I can tell you that you are way off base with regards to the physical restraint. I have two adoptive children with severe issues. One has been said by Dr. Federici to have, “quasi-autistic patterns” in 2006. To me this indicates that he has a very thick head and has in the past been seen rocking, head banging, etc.

    That being said, both of my children have been to numerous psychiatrists and psychologists and have been on every class of psychotherapeutic drugs with the exception of the first class antipsychotics, “zine’s”. None of the drugs had any effectiveness. They both have been diagnosed with a wide variety of psychiatric diagnoses. At three years old, my son had a tantrum in which he tore the doorframe off of the doorway. Mind you, he was three! My daughter attempted to squash the head of one of our pets. The kids would cut themselves with play knives. These kids were a danger to self and others.

    Finally, I found Dr. Federici with the viewing of a Dateline show, “Saving Dane….”. Intuitively, prior to seeing the show, I had already stripped the kids rooms and had them very close to me at all times and on video. I could not trust them and they were dangers. Now for the restraint.

    The restraint is in a prone position with the childrens head to the side and on a pillow. There are reasons for this position. Children that are violent will hit, kick, bite, pinch, spit, vomit, urinate, and defecate in order to get out of the restraint. Being alone, I held their arms with my hands and straddle their legs. Their chest is always open and not confined so as to not impede any breathing. You obviously have not encountered one of these children. My sons tantrums often would last in excess of 4-6 hours. The kids will manipulate in any way in order to avoid or get out of a hold. The hold is continued until the child is calm plus five minutes. These kids will fake being calm and then immediately tantrum again if the five minute time period is not maintained. Believe me, I experienced it. After the hold, the child is what is called, reintegrated. The child is held and calmly talked to as to what they did and how they can make better decisions.

    The holds are for safety and security only. These children often will get wild and have out of control behavior prior to a tantrum. Holds are used when the child fails to regulate their behavior for the safety and security of the child and family.

    My kids did well after the program, until that is when they encountered many people like you that have absolutely no experience with the severely traumatized child with reactive attachment disorder and cognitive defects. The kids manipulate others constantly and reach people that they think are, “soft” and people they can get attention from. My son would also play with chemicals, take apart plumbing, and pull his clothes apart stitch by stich at night instead of sleep. He was a danger to self and others. I was very desperate as most parents of these kids get. My son became so violent that I had to send him to a treatment center that specializes in children like this. Unfortunately, he was released early, manipulated his therapist and returned home as violent as he left. A very stressful time for me and I definitely was not at my best during last year and was well spent financially and psychologically. Another therapist later that thinks like you, doesn’t understand and we have problems again with the childrens manipulation. Long story, but I have been misquoted, misunderstood, chastised and misguided by people like you.

    Part of the program involves work from the children. Kids like this really don’t care if you strip their room or place them on restriction. You have to reach them by giving them some work when they disobey. A psychiatric facility in our area does the exact same thing with teens. The kids see people as vending machines where if they manipulate the machine and push the right buttons, they will get their prize. Kids perform physical work to get their emotions out among other reasons because they are very poor at expressing themselves adequately.

    Thanks to Dr. Federici’s methods and guidance, I have reinstituted his program on my own and my son is free from violence. I have been too lenient with both children and am now re-energized and running the program full force.

    Leave Dr. Federici alone, he has saved a multitude of children that would have been hopeless. My son was headed for the juvenile justice system and is now a calm child more willing to cooperate.

    Thank you, Valle Oberg

    • Valle,

      As always, the following is my opinion. You obviously have your mind made up and these comments should in no way be interpreted as my trying to pull you away from Dr. Federici. I am simply responding to issues you brought up in order to make my views known and provide some references that support my views. My intent is not to bother Dr. Federici although he and his supporters seem to feel that way. My intent is to express my serious concerns about the intervention he recommends in his book and media appearances. If you examine the history of mental health practices there have been a number that have produced strong, enthusiastic testimonials, but when tested in well-designed studies were shown to not be helpful or even harmful. That’s why there has been a focus in recent years on potentially harmful therapies. At least some people in the mental health profession are attempting to learn so that history does not keep repeating itself.

      I have examined current standards and guidelines for restraint and while the position he recommends in his book was acceptable and widely used in institutions years ago, there are several things about it that are at odds with current guidelines, including the pillow and not being on top of the person at all, not even straddling. You might want to have a look, for example, at this white paper by two people who currently are advisors for the states of Florida and Georgia on restraints. The links to it are in this article:

      https://phtherapies.wordpress.com/2010/10/21/prone-restraints-should-they-ever-be-used/

      I linked to the full transcript to the BBC documentary in the article you just commented on.

      When it comes to interventions, especially ones as radical and unconventional as his, as Peter Fonagy pointed out, it is very important that they be formally tested for safety and efficacy with randomized clinical trials. Anecdotes are not enough.

      Although you seem to feel that standard behavioral approaches do not work, there is evidence that they do work and the kinder, gentler approaches have worked very well in SAMHSA’s studies and they are dealing with children and adults who have very serious mental illnesses and behavior problems. Positive reinforcement, viewing the patients as human beings and finding out what comforts them is the key and they have been able to completely eliminate the need for restraints in some of their facilities and greatly reduce it in others. Restraints of any kind are viewed as trauma by the majority of patients and they are far from calming. When patients are guided to learn what does calm them, restraints are rarely necessary. But Federici warns in his book that his intervention is likely to upset the child, so it is not surprising that violent outbursts would occur. Who wouldn’t be upset if they had their room stripped bare and were isolated from everyone except their parents who they had to be three feet from at all times who take complete control over everything and are made to do repetitive, manual labor for hours on end? In contrast, SAMHSA’s approach helps the child find things that calm and soothe, rather than provoke. Note that these were written by people who have years of hands-on experience working with children with very serious behavior problems such as the ones you describe so you can’t say these are ivory tower people who never worked with such children.

      https://phtherapies.wordpress.com/2011/02/11/samhsa-video-on-alternatives-to-seclusion-and-restraint/

      SAMHSA is very representative of current, up to date guidelines which view the need to use restraints at all, as treatment failure, not a treatment.

      Under any current guidelines I have seen, if restraints are used at all they are only used when there is literally an immediate threat and the moment there is no longer a threat, restraints cannot be used. Someone at a Florida school recently got in trouble for using restraints after the immediate threat had passed with a child. The guidelines are very strict and in schools and institutions people who violate them get into trouble. That means if the child backs down and promises to be good, no restraints. If you look at the Saving Dane video, there is a part in that video where the boy is sitting on the bed with his mother. He is being defiant but the video shows that he is not at that moment presenting any immediate threat, yet she restrains him. The current guidelines also place a strict time limit on how long prone restraints can be used — most say no more than 10 or 15 minutes, certainly not hours at a time.

      Also, current guidelines are very strict about who can even use the “safer” versions of prone restraints (e.g. no pillows at all, no one straddling, etc. and there need to be two people, not one). In some states such as Ohio, prone restraints are entirely banned. Most importantly, the only people who can use these “safer” versions of prone restraints in the states that still allow them are people who have been formally trained and certified. What does this imply about parents using them who have only received informal training from a therapist and are using them, home alone with their child? This has me very concerned.

      What the longitudinal research (research that followed the children through time, up through age 15 thus far) has shown is that not all late international adoptees, even the ones from Romanian orphanages, had behavior problems and for many of the ones who did, they improved over time without any intervention, after they were adopted. Again, this is why we need to have controlled studies. Because some of these kids even with no intervention, get better on their own. The quasi-autistic symptoms are usually not ones that present a behavior problem. Jean Mercer gave a good summary of this research:

      http://childmyths.blogspot.com/2010/12/when-romanian-orphans-grow-up-recent.html

      For children who do have serious behavior problems there is no good evidence that this is related to “attachment” and there are positive behavioral therapies that have been shown to work, as the APSAC Task Force report mentions.

      What I don’t understand is that if Dr. Federici is so right about all this, why my criticisms are viewed as such a threat that he had to try to sue me (case was dismissed). Criticism is healthy for a truly scientific field to move forward and as you know, the recent court decision upheld my rights to criticize and express my opinions on Dr. Federici’s work. I am not forcing anyone to do anything. People can read my references and make their own decisions about what to do. He needs to accept that, by his own admission and according to statements made in reports such as the APSAC Task Force report, his work is controversial and people are free to express their criticisms on it. If he wants to be more accepted by mainstream bodies, then he needs to have randomized clinical trials of his interventions published in peer reviewed journals (preferably independently conducted by people with no vested interest), rather than making claims based on a self-published book and testimonials. In the age of evidence-based practice, claims based on testimonials, anecdotes and self-published books are going to be challenged. That’s my opinion.

  3. Just out of curiosity, Ms. Oberg– if they’re so disobedient, how do you get the kids to do the work you give them?

    • Dr. Mercer and Pignotti,

      I am under the opinion that you both are inexperienced in dealing with the post-institutionalized child, especially the severly traumatized ones. A bit of understanding is that I can only speak for myself. I am not speaking for Dr. Federici in any way, shape, or form. Another point is that of all the people I know, I know of none that adopted from an african nation that don’t have a huge problem.

      As Dr. Federici has written in the past, I have one of the most severe children he has evaluated. My particular case is compounded by having two of them. The mainline psychiatric community has failed my children over and over for seven years. Dr. Federici’s treatment was last ditch effort and it works. I have two and it worked on two.

      The idea of stripping the rooms and ridding their areas of, “things” is to start with a clean slate. The children from institutions don’t know how to act normally because of the extreme deprivation they endured. The three foot rule is so that the parent sees everything the child does and can intervene immediately. As a point, the three foot rule saved one of our animals because I was able to reach my daughter just as she was trying to squish it’s head. The animal suffered NO harm. Taking control of the out of control child is putting the child’s needs first, and in doing so, you are showing the child that you love them. But in the program, the children are slowly reintegrated with their friends and school.

      In reference to the type of hold. Being that I have endured holding a child for 4-6 hours at a time listening to the high pitched neurological screams, it is essential for safety and security. If the parent holds the child the way Dr. Federici prescribes, there is no chance of asphyxiation. If the child vomits, you simply move the child out of the vomit and they will not be in harm. Remember that the hold is used for the child that is out of control and it is for safety and security. After the hold is completed and the five minutes of calm, the child is held and discussion takes place to talk about why the rage and what is a better choice for the child to make.

      Another point is that even the residential treatment program that my son was in used restraint to control the out of control child. The children that I observed being restrained were restrained because they were yelling things like, “I hate you!” They were not observed to be violent. Restraining is a common event in the mainstream psychiatric community. The controversy is the method of restraint. As you know, there are no absolutes; studies change and outcomes change.

      The physical work statements are what I observe. I can tell you that, just as adults will physically exercise to increase endorphin release, it works with the kids also. These kids often also have depression. The child (with these problems and that have been properly evaluated) that repeatedly disobeys and is then put in a hold is put in the hold because as I stated in the prior comment, the disobedience often and most likely will result in an out of control tantrum. Again, if you have not lived it, you cannot imagine it.

      My kids can recite rules, but they don’t sink in unless some form of physical work is given. The physical work also seems to relax the child. This type of kid has many anxieties. After repetitions, it sinks in sooner or later.

      It is exhausting. And in my case, I cannot work outside the home as my son cannot be mainstreamed. If you would like to run my psychiatric hospital in my home with no respite, come on over. It is grueling and depressing that people that think they are doing good, do nothing but harm these families with their interference. This is one reason why I am redoing the program because my son has suffered significant trauma due to others actions.

      Another point, you can out-talk me psychologically because I am not a psychologist. I do however have experience with my post-institutionalized, severely traumatized child. I can tell you that my kids have been to the best in town and they have not helped my children at all. Dr. Federici is the one that helped. Watch the video again on Saving Dane, I believe several good points were missed.

      Thank you, Valle

      • Valle,

        First, I want to thank you for responding to the content of my criticism, a refreshing change from what certain others are doing.

        As always, I want to remind you that I am not attempting to give you advice about your particular child or situation. I would never presume to do that. I am simply responding to points you have made.

        First of all, the idea that the prone hold is being used for hours at a time has me very concerned. Just for the sake of clarification was your decision to restrain the child by yourself for up to four to six hours at a time Dr. Federici’s recommendation or something that you decided to do on your own? If the latter, did Dr. Federici approve of this? I ask because Dr. Federici’s diagrams show two people, so am not sure what his opinion is about only one person doing this procedure or what he would think about doing this for four to six hours. In any case, whether someone has experience with this population is not relevant. What is relevant is what current guidelines for restraints say and based on all of the ones I have examined, the ones that even allow prone holds/restraints put a very strict limit on them of 15 to 20 minutes, 30 minutes at the most, never hours and even that is highly controversial.

        In the past, yes, psychiatric facilities did use prone holds for longer, but when they were found to be dangerous, the guidelines and standards changed. While there are undoubtedly such facilities that continue to violate these, all of the evidence shows that restraining someone in a prone hold, even by personnel who are trained and certified in doing them correctly, have this very strict time limit. The idea that a parent would use any prone hold for 4-6 hours at a time, at home alone with a child has me very concerned. It flies in the face of any current guidelines I have ever read, but in case I missed anything, I will provide you with the following challenge: Find me any current, official guidelines on restraint that state that it is okay to use a prone hold on a child for hours at a time. If you can find such a set of guidelines that are state-approved, I would be very interested in seeing them because I have done extensive searches of guidelines and all of the ones I have read, if they allow prone restraints, put a very strict time limit on them of less than a half an hour, some as short as five minutes. When someone is struggling with a child for that long, as Dr. Merrill Winston and his colleagues pointed out in their white paper, there is no way, even for a trained and certified person to guarantee that they will not become fatigued and inadvertently put pressure on the child. That is also why, even for short periods of time, many guidelines, such as the white paper I referred to, do not even allow straddling. Dr. Winston, I would add, is strongly against banning prone restraints, yet he is arguing against using them in the way described, is strongly in favor of doing everything possible to prevent their need in the first place by using behavioral interventions similar to those described by SAMHSA and only when there is an immediate physical threat. I strongly suggest a careful reading of Dr. Winston’s white paper.

        As for your statement that some psychiatric institutions restrain children for doing nothing more than yelling “I hate you” I am sure that is happened, but again, this is opposed to every set of current guidelines on restraint I have ever read and if this happened today, staff who did this would be in trouble. The person has to be posing an immediate physical threat.

        Dr. Federici has stated that he has been trained in the use of restraints and I have no doubt he has, but what I would be interested in knowing is what the date and location of his most recent training was and does he have some kind of certification, showing the date and place trained and with whom he trained that he can produce?

        I certainly don’t intend to argue with you about the severity of your child’s condition as I have not met him and am in no position to evaluate that. Again, I want to repeat I would never presume to do that. However, to generalize that all children adopted from a certain area in Africa have serious problems is not warranted. Even if all the ones you have met are that way, given your situation it is likely you have met the ones who are reaching out for help due to serious problems. There is no way to know how many parents who were not likely to encounter you because they are not having similar problems. Unless a systematic study has been done that followed children through time, there is no way to know that. People believed the same thing about Romanian adoptees, yet Michael Rutter’s and his ERA team showed that this was not correct and that there was a wide range of responses among late adoptees from Romania.

        The newer treatments described by SAMHSA are not so much about reciting rules as they are about catching situations early on, before they have a chance to escalate into an out of control, dangerous situation. Part of that involves identifying and eliminating what triggers the violence in the first place and identifying what will soothe these children. Such children can, SAMHSA’s research has shown, learn to recognize their own signs early on and find things that will calm them down and again, these are not inexperienced people who set these guidelines. These are people who work on a regular basis in the trenches, with seriously disturbed children. This is not psychobabble. This is solid, well-supported work that has been done. What I am very wary about is taking the word of a self-published book over the kind of systematic study that is being done at SAMHSA.

        Regarding it being exhausting, I’m sure it is and that I have no idea how much it is. SAMHSA found that doing it the old way, the professional staff in the facilities they studied were exhausted as well, doing things by the old model that involved forced obedience and restraint. Some of the staff even believed that they themselves had been traumatized by such an environment and most people subjected to restraint report that they consider it traumatic. When the staff learned this new way of dealing with the children, it greatly reduced their own job stress as well and everyone was happier. This is not pie in the sky idealism, but rather, well substantiated, systematic studies done by people who are in the trenches. The intention is not to in any way put blame on people who were doing it the old way, who were doing the best they knew to do at the time, but rather, the intent is to show a newer way that produces better results for all concerned.

        The bottom line is, although you keep reiterating about a lack of experience, I am not asking you to take my word for it. I am referring you to sources that contain the work of people who do have extensive experience with this population and to current standards on restraints, so really, how much experience I have is not relevant.

  4. Another question: how does physical work “get their emotions out”? And what is the advantage of having emotions “out”, from your and Federici’s viewpoints?

    I’m asking for explanations because these statements don’t seem completely plausible in terms of conventionally-accepted psychological theories about development and personality.

    • Excellent questions, Dr. Mercer. I do hope we get a response.

      • I have some other comments on Ms. Oberg’s description of the rationales for the bare room and so on.

        1. “A fresh start” is an appealing metaphor for adoptive parents who (not surprisingly) would like to forget about the child’s past experiences. But a real fresh start is not possible. The child has a history, memories, even some cherished experiences from the past, and may well prefer “the evil he knows” to “the evil he doesn’t know”. Stripping the room and isolating a child who has rarely before been alone or with only one or two people are practices that involve drastic changes of the type used in brainwashing to break down the resistance of prisoners.

        Federici’s erstwhile colleague Dana Johnson makes a point of avoiding drastic changes when advising how to feed children adopted from foreign institutions. Generally, if we want to have genuine relationships with people rather than just control them, we work to build bridges between their needs and past experiences and our own. If a group of refugees were brought here, we’d make sure they had contact with people who spoke their language, and that their food, religion, sanitary customs, and so on were respected and provided for until they were ready to become more assimilated. That’s what we’d do for adults because we’d sympathize with their fear and grief. For children,however, Ms. Oberg is suggesting that all that past history and the present reaction to a strange life can and should be wiped out as quickly as possible. Rachel Stryker, in “The Road to Evergreen”, has written interestingly about the motivation for this.

        2. There are several issues concerned with the attitudes of foreign-adopted children toward pets. First, it’s very unwise to have pets near any child who is distressed and is not accustomed to being near small animals. Second, poor children from institutions in underdeveloped countries have not seen pet animals. People they know may have tolerated the presence of dogs to chase away strangers or to hunt, or of cats that could kill mice and rats. Those animals were not treated as pets and were not brought into the house. If they got in, they would probably be treated as vermin– even killed. To attack an animal that is in the house may be not only an acceptable thing in the child’s experience, it might even be an action for which praise is expected, like swatting a fly. Our cats and dogs in the house may be disgusting to the child, who tries to do what one is supposed to do by hurting an animal that comes near. Interpreting this behavior as evidence of the child’s mental illness, out of cultural context, can be a huge mistake.

        3. I still don’t understand how these disobedient children are successfully made to work. I am wondering whether their food supply is related to their cooperation.

        4. It is very striking to me that, except for the three-foot thing, these techniques are virtually identical to those advised for parental use by the attachment therapists with whom Federici is so disinclined to be classed.

        5.Ms. Oberg speaks of “high-pitched neurological screams”, by which I assume she means that the child’s screaming is like that of an infant with some forms of brain damage. But is the idea that the child is actually brain-damaged in some detectable way (other than what might be guessed to cause unwanted behavior)? If so, may I ask what other treatment he or she receives? Is this program of restraints and intense oversight expected to overcome neurological damage as well as wiping out the impact of a history of abuse and neglect?

        If this is expected from the use of Federici’s program, and if the child said to be brain-damaged is receiving no other treatment, I would suggest that there is medical neglect here. If he or she is receiving other treatment, Ms. Oberg needs to tell us what that treatment is rather than ascribing any improvement to Federici’s methods.

  5. Interesting parallel from Dr. Mercer to prisoners and breaking them down. I recently watched a documentary by the person who was assigned to interrogate Saddam Hussein in all the months he was a prisoner, to extract information from him prior to his execution. He was not physically tortured. The techniques were much more sophisticated than that and the key technique that was described by his interrogator was to make Saddam dependent upon the interrogator in such a way that he would have to literally ask him for everything, even the time of day. The result was that Saddam formed a bond with the interrogator to the point where he considered him the most meaningful person in his current life (in the prison) and ultimately told him everything he needed to know before he was ultimately executed. This is a very effective interrogation technique for a prisoner, but is that really how we want to form bonds with our children, by stripping them of their past and everything they are familiar with and making them dependent on the parents for everything? Aren’t the goals here quite different?

  6. Dear Valle Oberg,

    My son has autism and he was prone restrained in the school system for 2 years until he had a breakdown and became so out of control he had to be hospitalized. We didn’t know they were doing this to him and would never have allowed it. When I look back now there were signs that something was going on with him but I just didn’t see it at the time. What he went through in the school system explains why he became so aggressive with us at home.

    He had to go into the hospital and while he went through treatment there were times when he was restrained in a standing position, but only as a last resort but never prone. They didn’t even use prone restraint in their program because they felt it was too dangerous. If they had allowed it we would not have taken him there. We worked very closely with the staff to make sure they were using positive behavior and calming techniques to help him heal. He could get very aggressive at times but the staff were very kind and worked very hard to help him reduce his aggressions.

    I think that prone restraint is a very dangerous restraint and it has too much room for human error which could lead to the death of a child or a child being seriously injured. It can also traumatize a child to the point that they fear everything and everyone. We are still working on the emotional healing but he has come a long way and he has not been restrained at school or at home in over 3 years now.

    A good BCBA, ABA Therapy, sensory diet and positive behavior techniques are areas you should be looking at to help your children. You may also want to do some reading on Post Traumatic Stress Disorder in children. Believe me when I say I know it’s not easy. I know how hard it can be and I know how aggressive my son use to be (not to mention the property destruction!!) but prone restraint is not something I would ever consider.

  7. Dr. Mercer and Dr. Pignotti,

    You don’t understand and that is clearly evident.

    By the way, I may not be a psychologist in training; however, I am highly intelligent.

    I have no additional statements due to the fact that the level of understanding necessary for the severly traumatized post-institutionalized is not present on your end, nor are you willing to see other points of view. I only hope that you leave Dr. Federici alone. He is the most genuine, caring, and knowledgeable person when it comes to these children.

    I hope that someday your minds and hearts open up.

    Take care, Valle Oberg

    • Valle, I never intended to call your intelligence into question. When I Googled your name, I actually found that if you are the same Valle Oberg listed on a certain website, you and I might have a distant past affiliation with a certain group in common. I would be the last person in the world to judge anyone’s intelligence or anything else for making such mistakes.

      Actually I am very open-minded, but to evidence, not unsubstantiated assertions based on nothing more than success stories. I am always open to well-supported new information and always willing to listen to any that you or anyone else has to offer. However, I have not found any evidence other than testimonials that backs up your assertions and notice that you have not supplied any current restraint official guidelines that supports the manner in which you have reported using them with your children. I remain very concerned and remain open to any further discussion you may have to offer in the future and you may contact me either via this blog or via e-mail. It is your right to close your door if you wish and I respect that right. However, mine remains open, to further discussion for the sake of better understanding.

      I do see your point of view and I am extensively well read on the subject of trauma and post-institutionalized children and actually do have some experience working with children who were severely traumatized and/or have serious behavior problems as I worked in a practice that specialized in such children for five years. However, seeing a point of view does not mean that I have to agree with it and I am not convinced that you actually see my point of view. Unfortunately, many self-proclaimed experts in this area are not engaging in practice that is based on evidence. Believe it or not, your comments have helped me to gain a better understanding of where at least some of Dr. Federici’s supporters are coming from. In any case, thanks for addressing the actual issues, a refreshing change from the responses of certain others.

      • Dr. Pignotti,

        Be careful. There are more than one person with my exact name. My name is common in Sweden and I met a man in Florida many years ago that had my exact name. I am very careful on my legal documents. The fact that you had time to google my name lets me know how much free time you may have.

        I found that you posted inferences on a different blog of yours. A correction of your misinterpretation of Saving Dane and hold positioning. The correct hold position is with the child’s arms out to the sides and not held behind their back. Holding the arms behind their back can cause shoulder subluxation and too much pressure on the thorax. The parent is not to lean on the child so as to ensure freedom of respiration. The arms, as in the Saving Dane video are held out to the side.

        The experience you have on your credentials is hardly enough in my opinion to warrant such an assault on other viewpoints. We have no affiliation and when you are citing references to cease restraints, the references are mainly for hospitals, psychiatric facilities, detox programs and residential treatment programs. If you had that much experience with the adopted Post-institutionalized child, you would know that you cannot. “de-escalate” these kids.

        I would have ignored your last post except for the fact that a few facts needed clarification.

        Thank you, Valle

  8. Go back and reread that I wrote, Valle. I didn’t say you were that same person. Of course you may not be. There are even other people on the internet with my name, which is also very unusual and there are those who have falsely impersonated me. I said “IF” you were the same person. Are you saying you are not that Valle Oberg as the one I found on the Google search? It only took me about two minutes to find that on the Google search and most people can spare a few minutes from their busy schedules. I was curious about your background after the all the time and effort you took to respond to me. I see you haven’t explicitly denied it, so I’ll ask you directly. Are you that same Valle Oberg? You can choose to answer or not, but I’m asking. Given all the fuss Ronald Federici has made over my 35-year-ago and long dead involvement in Scientology and the anonymous supporters of Federici have done so as well, along with the fact when you first approached me and responded on my TFT blog, you brought up Scientology yourself when it has nothing to do with the topic of that blog, I have every right to ask you about what I found. You, of course, also have the right to choose not to answer me, although I don’t understand why, if you’re not that Valle Oberg, you don’t just say so directly. I’m not saying you are or you aren’t…just sayin.

    I also take exception to the statement on your blog that Scientology is in any way, shape or form, “my” cult. I don’t have a cult. I am, in fact an outspoken critic of Scientology and have been for decades. I left and completely repudiated Scientology 35 years ago. What this means is that I currently hold none of their beliefs and completely reject the writings and proclamations of L. Ron Hubbard including his famous quote that “there are no absolutes”.

    By the way, I tried to post a response on your blog and was not able to. I find it interesting that I am allowing you to freely post here on my blog, but I haven’t been able to post anything on your blog. I don’t know if that’s intentional on your part or if it’s some kind of glitch in your system, but thought I’d let you know.

    Now it is my turn to ask you to be very careful about misquoting me. I never said the child’s arms were behind their back in Federici’s model and I was not “quoting the position used in Saving Dane”. I was quoting from an excerpt that was commenting on a number of different ways the prone hold could be dangerous. I never said Federici did everything described in the quote. The main thing I was commenting on from that quote was the straddling part which is not part of the recommended guidelines and also about the pillow under the person’s head, which is not recommended in a number of policy statements. And I was referring to the diagram in his book, not Saving Dane.

    I find it interesting you would single out something that I was not identifying as part of Federici’s recommendation, yet did not address what I was identifying that clearly was part of what he recommended in his book, such as the use of the pillow, the straddling and the time. If you read my comments on the quote, this is made very clear what part of the quote I am commenting on. Also, there is a time limit and I challenged you to find any guidelines that say it is safe to use any kind of prone restraint for hours at a time. If it’s dangerous in an institutional setting to do that where there is heavy supervision, how much more dangerous would it be for someone who is at home alone with a child? I suggest a more careful reading of what I wrote and that you not attempt to put words in my mouth.

    What I am citing here are widely-recognized policies and procedures that do involve hospitalized children with very serious behavior problems and your implication that the post-institutionalized child would somehow be exempt from those is simply not credible. The children that were studied were children who had to be hospitalized because they could not be managed at home so if anything, they may even be worse off than the children you describe. I never said you were legally bound to follow them and I realize that the regulation does not extend to private individuals who are unaffiliated and using them and in my opinion, that’s a big problem because I think what unaffiliated individuals do on their own, when it involves vulnerable children, should be regulated. That’s my opinion. My point was not to say that what you are doing is illegal because unfortunately it’s not currently illegal. My point is to show evidence that there are serious dangers involved with the use of prone restraints in the way that was recommended..

    The methods you have recommended have never been tested in randomized clinical trials for safety and efficacy. It has nothing to do with whether or not there are “absolutes”. Just because the findings of research are not the last, final word is not reason to use that as an excuse to disregard the latest research and use prone restraints with features that are currently recommended against in policies and procedures that are based on current evidence. Prone restraint and heavy handed interventions are part of the past and by all indications I have seen, they are being used less and less. That’s the bottom line and just because there are people who have taken it upon themselves to call themselves “experts” and promote these methods, is not evidence that they are safe and effective. That’s called an argument from authority. The “experts” have to play by the same rules as everyone else to have credibility among evidence-based mental health professionals. They need to have their work and their claims subjected to randomized clinical trials that show, at the very least, that the methods do no harm. With untested methods that have not been tested against a control group, we simply cannot know if they are safe, much less effective. Again, I’m not saying this is against the law because unfortunately, there is no law against mental health professionals using untested procedures although in my opinion, there ought to be one where children and people who cannot make choices for themselves are concerned.

    The point you seem to completely be missing is that if there is so much concern about how prone restraints are used by highly trained professionals in institutional settings who are heavily supervised and even then strict policies and procedures are needed to ensure safety, what does that say about a parent who was trained by a therapist, who is at home alone with her child, using prone restraints? Where is the supervision and accountability? Currently, there is none, legally and in my opinion there should be a law against doing this to any child in any setting. Note that the word “should” is indicative of an opinion, not a fact. If a child is in that bad a condition, how is it that the parent is trying to manage alone, without any help, in the first place? Usually, parents of seriously mentally ill children need to have some kind of help with them, rather than trying to manage them on their own.

    My pointing this out is an exercise of a legitimate right to criticize and question, not an assault and I will continue to point that out.

    The deescalation techniques have been used successfully on children with very severe behavior problems. For you to portray post institutionalized children as the very worst of the worst as some kind of special case that needs to have hours and hours of prone restraint and radical interventions, simply is not supported by the evidence found in longitudinal studies of internationally adopted children. Even if they are the worst of the worst, there is no evidence that such interventions are helpful and no, testimonials are not evidence. You seem to be implying that all experts agree that his intervention is the way to go. Not so. Are you aware that in a sworn affidavit in Federici v Pignotti, et al. he declared that he considered Marolyn Morford a direct competitor? While I don’t agree she is a competitor because she is in a different state, she does have decades of experience with this population and she disagrees with the type of intervention you support. So no, these self proclaimed “experts” do not have a monopoly on the field.

  9. Emelia Martelli permalink

    Wow, just….wow.
    I’ve seen teenaged children respond to debate with more maturity than Valle Oberg.

Trackbacks & Pingbacks

  1. Invitation to Dr. Ronald Federici « Potentially Harmful and Other Questionable Therapies
  2. Prone Restraints: Should they ever be used? « Potentially Harmful and Other Questionable Therapies
  3. Clarification Regarding the So-Called History Making Lawsuit Blog « Monica Pignotti: The Truth
  4. Federici v Pignotti et al: Case Dismissed « Potentially Harmful and Other Questionable Therapies
  5. New Website on Ronald Federici’s Critics « Potentially Harmful and Other Questionable Therapies
  6. Scientology and Other Unusual Belief Systems: Dispelling the Myths about Who Gets Involved « Potentially Harmful and Other Questionable Therapies
  7. If you Google Monica Pignotti, Read This First « Monica Pignotti: The Truth
  8. Adoption issues
  9. Question and Challenge to Dr. Ronald Federici and his Supporters « Potentially Harmful and Other Questionable Therapies
  10. Questions Regarding Ronald Federici and Heather Forbes Aggression Training « Potentially Harmful and Other Questionable Therapies

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