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