Containment Therapy for early bonding disorders (including autisms and early psychoses / pervasive developmental disorders (PDDs), see below) was drawn up and published for the first time by Prof. Carlos G. Wernicke after Holding Times, a body bonding approach, was presented to him by the Czech psychologist Jirina Prekop in Germany; this technique was introduced by Welch (United States) in 1980 and spread to some European countries by Nobel Laureate Niko Tinbergen.
Holding Times originally received this name by Welch and was translated to German as “Festhalten.” Its first translation into Spanish was “abrazo forzado” (lit. “forced embrace”). Finally, Prof. Wernicke more accurately termed it “Abrazo de Contención” (lit. “containment (supporting) embrace”).
Thus, Prof. Wernicke attempted to give a scientific foundation to the results of Holding Times, including it in a comprehensive therapeutic framework (see below), in which Holding Times is only given under certain conditions previously arrived at by the parents.
It is important, then, not to confuse the Containment Therapy introduced and developed by Prof. Carlos G. Wernicke in 1987:
- With Holding Times (Containment Embrace), that is only one of the techniques included in the therapeutic framework, only one of the several approaches that make up the Containment Therapy with.
- The later translation of a book in Spain (Prekop, 1991), in which the publisher decided to translate it as “terapia de contención” (lit. “containment therapy”), employing these terms (Containment Therapy - Holding Times) as synonyms.
- The application of Holding Times for other conditions (for example, non-severe bonding disorders), even as a “lifestyle,” proposed by other authors and groups.
- The subsequent appearance of writings in the Spanish language about a “terapia de contención” (lit. “containment therapy”), independent from the work of Wernicke, also for other conditions and from theoretical and ideological points of view which are different from and not related to those of Prof. Carlos G. Wernicke, even though these writings have literally copied paragraphs from Wernicke without quoting the sources.
Containment therapy
The following updated text is based on extracts from various works presented and published by Prof. Carlos G. Wernicke on the subject.
Summary
Containment Therapy was introduced in 1987 by Carlos G. Wernicke on the basis of his experiences in treating children with brain dysfunctions and mental retardations, his study of human primary needs, and his concern about autisms and early psychoses in general.
It is founded on the holistic paradigm with a psychodynamic base, according to a systemic-dynamic-transdimensional approach.
Its indications are the severe human bonding pathologies, as autisms and early psychoses in general, the emotional accompanying disease in mental retardations, and severe behavior and/or learning disorders produced or aggravated by pathological bondings.
It operates simultaneously through five approaches:
• Treatment of basal clinical conditions • Psycho-educational counseling for parents • Containment Embrace • (Re)habilitative therapies • Medications and diets.
After a thorough diagnostic study, an individualized action program is developed that takes into account all the areas and knowledge that are available.
It abbreviates and precedes an on-going psychotherapy, or rather makes the psychotherapy superfluous when this is not the appropriate indication. It put a base on the new cognitive-behavioral approaches and in early intervention.
Regarding results -which begin to be reached in days or weeks, even in autistic children improvements in visual and body contact, in seeking and accepting parents, in imitative behavior, in dealing with fears, in hypersensitivity, interest, play, communication, language, and behavior are reached. Stereotipies and aggressiveness are reduced.
Predictors of success are: A detailed diagnostic process; a greater maturity level; a lesser chronology / maturation gap; the presence of speech (in children aged 5 years and older), and the collaboration of both parents.
Pervasive Developmental Disorders (PDD) (DSM-IV-TR) are syndromes in which development is not only partially blocked. On the contrary, the interruption in development includes all aspects of the individual. Step by step, this formulation replaces the previous denomination that was given to these clinical descriptions, namely “early psychoses”, as it is being understood that the psychotic features are only a part of the disorder. Only for the sake of convenience, then, we will speak of early psychoses as a synonym of PDD.
In 1991 Wernicke published for the first time the
definition we wish to use as a foundation of this conceptualization, which is based on descriptions by the German child psychiatrist R. Lempp and the Swiss adult psychiatrist L. Ciompi.
Updating the wording:
In all PDD there always is • An abnormally small channel capacity, resulting in • An inability in the processing of information, which in turn leads to • An —usually partial— disorder of the relation with the shared reality, which then leads to • A difficulty in the passage between the shared reality and the individually significant reality
The lesser amount of stimulants / satisfiers / information implies a deficient processing of this information, as its elaboration will need to be based on the limited information of the external reality, replacing them with abnormal interpretations, of such reality. Over time, this bad processing increases geometrically, with which the understanding of the contextual reality becomes very difficult.
The reality experienced by all people (a shared reality) is apprehended by the healthy child along his or her first years. Finally, the child embeds him or herself in the shared reality with all his or her ability to symbolize and making creative use of language. By no means does he or she abandon for this his individually significant reality, as represented in games, dreams, and fantasies, as in expressions accepted within social limits, as is the case with artistic creations; however, he or she learns that the individually significant reality has only a meaning for him or herself.
Each person with PDD presents cognitive, emotional and social clinical symptoms, corresponding to a developmental blocking at a given time. Beginning with this interruption, the natural evolution can lead to a regression on the road to development or even to an abnormal development using abnormal paths. Thus, it can be explained that a severe basal brain pathology resulting for example in a mental disability can be the cause of an early psychosis, and that an early psychosis, in turn, can naturally result —when there is no therapeutical intervention— in a mental retardation.
Although the psychological dynamics depend on the individual situation and should be thoroughly evaluated in each family, it is possible to extract common aspects that seek to explain the continuance of the child in a delayed maturational stage where personality is not yet integrated (that is, a phase of incomplete integration of all the functional systems into only one) when compared to the chronological age, or even his or her regression to earlier stages.
The chronic avoidance on the part of a subject who is strongly frightened by the deficient and/or abnormal grasping or understanding of the external reality cancels the learning through approximation and exploration that only will take place in the case of an extreme feeling of safety and confidence.
Generally, the environment tries in turn to get the child increasing his or her learning through teaching / training, which to the best increases the instrumental performances but does not reach a cure, as
a deep feeling has arisen related to his or her life experience: the panic fear.
In 1987, Wernicke began to practice a series of simultaneous approaches in the treatment of families with children with PDD, which he named Containment Therapy.
This simultaneous approaches are:
1. Treatment of causal symptoms (dys-systematization, dysfunction,
mental disability, brain injury)
2. Psycho-educational counseling for parents
3. EmbrHolding Times (Containment Embrace)
4. Habilitatory / rehabilitatory treatments / (instrumental treatments: special learning, speech therapy, occupational therapy, etc.)
5. When necessary, chemical interventions.
and follow-up.
As a result of the mind-body dichotomy in which all practitioners were trained and according to which we continue trying to help, diagnostic tests, even invading ones, are done that have as a consequence therapeutical dead ends or result in treatments intended to modify a certain aspect of the child: as an example, his or her biology or emotions or cognitions. The practitioner installs this fragmentation in his or her consciousness, since he or she has been trained for the diagnose and therapy of such fragments but not those of the child as a whole person.
When speaking about PDD, this approach is absurdly iatrogenic, increases anxiety even more and generates even more panic.
The psycho-educational counseling for parents is a turning point, and has to be done in every situation. Parents may and should actively participate in their child´s therapy.
Also by means of the technique called Holding Times, which is only one ingredient of the Containment Therapy, the psycho-educationally counseled parents actively participate in their child´s therapy. This is the best guarantee of succeeding.
The results of the combination of these two pillars of the Containment Therapy, i.e. psycho-educational counseling for parents and Holding Times are observed after a short time.
After a few days or weeks objective improvements can be seen.
Only when the familiar system has been (re)equilibrated and the child receives sufficient satisfaction for his or her basic needs from his or her parents, who are indeed his or her natural satisfactors, the habilitatory / rehabilitatory treatment of the functional systems delayed as a consequence of the generalized developmental blocking can be added -done by those practitioners that the individual condition requires.
Sometimes it is useful to reduce the great anxiety using specific psychiatric medicines, which could help to interrupt interactive vicious circles allowing a better living together. However, these medicines never should be the only approach, as neither a “first try“ to “see what happens.” In each individual situation, diets, vitamins or other medicines could be selected.
Results are considered notably better when younger the child, given the shorter chronologic - maturational gap.
To be a containment therapist, then, requires an holistic conception about the pathology and specialized technical knowledge. The usual experience with child and adult therapies showing less severe difficulties is not enough. The professional training according to a holistic paradigm is considered essential.
Holding Times (Containment Embrace)
This technique was introduced and applied as “holding times,” by Martha Welch, a child psychiatrist in the United States. It spread throughout Europe thanks to the efforts of English Nobel laureate N. Tinbergen, and from these efforts thanks to the Czech psychologist J. Prekop in Germany.
The Spanish translation of the book by N. and E. Tinbergen (Niños Autistas, Alianza, Madrid 1985) presented this concept as “abrazo forzado” (forced embrace), and by Wernicke in his first writings in Spanish as “holding” (for example: Una nueva técnica: el Holding, Tiempo de Integración, año IV no. 19, Buenos Aires 1991]) and soon as “abrazo de contención” (lit. “containment (supporting) embrace”). (La Terapia de Contención en autismos y psicosis tempranas, in Cuadernos de Psicomotricidad y Educación Especial, I - 2:32-45, Buenos Aires 1991).
The Containment Embrace is what its name indicates: The child is embraced within reassuring limits, within which he will be able to express what he needs to express, positively and negatively, even in relation to the one who is embracing him or her.
Embracement means also -and principally- consolation and tenderness.
The embracing person tries to reduce the panic fear, to give belonging (a framework, a context), to give both emotionally and physically experiencial stimuli (information), to enable, to support, and to stimulate the expression of feelings, and to accompany the child allowing exploration.
Therefore, the attitude of the embracing person must always be very comforting, calming, consoling, organizing limits that the child is unable to establish alone.
It is within these close physical and emotional limits that the child can slowly (re)commence his personal (re)organization.
Thus, the Containment Embrace is a flooding of safety.
This is a primal process, a profound and real satisfier of basic needs at the developmental level the child is showing, aimed to help the processing of the conflict among these basic needs.
The child has not to go into his or her shell to find security in him or herself, nor to return to an indiscriminate fusion in order to feel quiet.
Related approaches to this technique are M. Sechehaye´s symbolic realization, D. Casriel´s bonding, R. Zaslow´s Z- process, J. Rosen´s direct psychoanalysis, etc.
The Containment Therapy should be a known technique among them used in Early Intervention.
Holding Times, as an expression of comfort, consolation, deep satisfaction and tenderness, only makes sense within the framework of a comprehensive Containment Therapy that takes into account the family system, the family dynamics, and the individual psychological dynamics of the child. The underlying concept is that we have to consider all dimensions defining the human being (the physical, biological, emotional, cognitive, and spiritual dimensions)-, as each individual is indeed transdimensional, acting on the world y re-acting to the world with every dimension at once.
When a thorough diagnostic work has been performed, a therapeutic project has been established, and psycho-educational counseling for the parents has begun, the physical approach of mother and father to the child can begin as re-balancers of their child´s life.
Given that Holding Times is though a technical approach and not simply an affectionate hug, it is necessary to introduce it under professional supervision. Only then can it be carried out at home.
Every day, the person in the maternal role maintains the child embraced of through a sequence that could go to a resolution in a few minutes or last hours; though, there are always three moments: the confrontation (when the mother takes the child in her arms, in close physical contact, face to face); the apparent rejection (of the child towards the person who embraces him or her , principally at the beginning of the Containment Therapy), and the reconciliation (when both physically enjoy each other and the child no longer tries to move away, many times already during the first embraces).
