Attack therapy is a controversial type of psychotherapy evolved from ventilation therapy. It involves highly confrontational interaction between the patient and a therapist, or between the patient and fellow patients during group therapy, in which the patient may be verbally abused, denounced, or humiliated by the therapist or other members of the group.[1][2]
The method has been used by groups such as Synanon, and similar methods have been employed in Large Group Awareness Training.
A 1990 report by the Institute of Medicine on methods for treating alcohol problems suggested that the self-image of individuals should be assessed before they were assigned to undergo attack therapy; there was evidence that persons with a positive self-image may profit from the therapy, while people with a negative self-image would not profit, or might indeed be harmed.[2]
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Attack therapy can be particularly problematic when the group members are captive, and not allowed to leave during the sessions.[3] In Group Psychotherapy with Addicted Populations, Flores notes that attack therapy can take place when individuals are psychologically intimidated in a confrontational atmosphere.[4] In her book Help at Any Cost: How the Troubled-teen Industry Cons Parents And Hurts Kids, Maia Szalavitz writes that attack therapy can include the tactics of isolation, and rigid imposition of rules, which later leads to a restoration of limited permissive freedom, and an acknowledgement of those that did comply with the strict rules.[5] Psychologist Donald Eisner writes in The Death of Psychotherapy that attack therapy: "attempts to tear down the patient's defenses by extreme verbal or physical measures."[6] Tudor describes attack therapy in Group Counselling, writing that the individual is ridiculed in front of others, and cross-examined and questioned about their personal behavior patterns.[7] According to Maran's book Dirty, attack therapy can take place in "all-night encounter groups and daily interactions."[8] Monti, Colby, and O'Leary write in Adolescents, Alcohol, and Substance Abuse that in attack therapy, there was a movement to: "tear them down in order to build them up", referring to a methodology of tearing down the individual ego in order to then educate the individual in the inherent thought-patterns of the group and the group leader.[9]
In Concise Encyclopedia of Psychology, Corsini and Auerbach note that attack therapy puts an emphasis on the expression of anger by each individual.[10] One Nation Under Therapy by Satel and Sommers characterized attack therapy as among the "more bizarre expressive therapies", and put it in the same category as The Primal Scream, Nude Encounter, and Rolfing.[11] In Social Problems, Coleman and Cressey write that in attack therapy, one individual is criticized and "torn down" by the rest of the larger group. [12]
In their textbook, Helping People Change, Kanfer and Goldstein note that controversial group Synanon used a form of attack therapy.[13] A publication by the National Association for Mental Health wrote that the Synanon form of attack therapy was also called the "Synanon confrontation game".[14] The Concise Encyclopedia of Psychology also described the Synanon method of attack therapy, noting that it even differed from other models that could be seen as using a similar approach.[10] Balgooyen compared "Synanon game verbal attack therapy" to standard group therapy, in a study published in the Journal of Community Psychology.[15] In Dictionary of American Penology, Williams writes that attack therapy was actually first developed in the Synanon group.[16] In Therapeutic Communities for the Treatment of Drug Users , it is noted that in Synanon, attack therapy was referred to within the group by members simply as "The Game."[17] The attack therapy techniques used in Synanon have been described in Therapeutic Community by a former participant as "brutal and bordering upon sadism."[18] In addition to comparisons to Synanon, Miller and Rolnick also compare the methods of attack therapy to Scared Straight!, and "therapeutic" boot camps, in their book Motivational Interviewing: Preparing People for Change. They note that the supporters of attack therapy believe that: "..people don't change because they haven't suffered enough."[19]
In the book Mindstyles, Lifestyles, Lande wrote that the use of "humiliation, ridicule, and sarcasm" in Werner Erhard's Erhard Seminars Training was drawn from group encounter forms of attack therapy.[20] Lande also notes that Werner Erhard most likely learned this form of attack therapy from the groups Leadership Dynamics and Mind Dynamics.[20] The attack therapy group is compared to methodology used in Large Group Awareness Training, in Martin's We Know What You Want: How They Change Your Mind . Martin goes on to note case studies where individuals had severe negative emotional outcomes from these trainings and the techniques utilized therein.[21] Snyder wrote in Health & Human Nature that attack therapy was combined with encounter therapy by Werner Erhard in Erhard Seminars Training in such as way so as to "jar" the individual's perceptions.[22] In Encyclopedia of the American Religious Experience, it is theorized that the method of calling people "Assholes" in Erhard Seminars Training is a form of attack therapy.[23] Szalavitz notes in Help at Any Cost: How the Troubled-teen Industry Cons Parents And Hurts Kids that both Werner Erhard in Erhard Seminars Training and John Hanley in his group Lifespring were prior instructors in Mind Dynamics, a group that utilized attack therapy in its techniques.[5] More generally, attack therapy has been discussed in the framework of Sensitivity training and other parts of the Human Potential Movement.[24]
A study of group therapy in over 200 normal college students conducted by Yalom and Lieberman found that 9.1% of the students who completed over half of a series of "encounter groups" using attack therapy had psychological damage lasting at least six months. The most dangerous groups were the Synanon-style groups with a harsh, authoritarian leader.[25]
William Miller and colleagues found that the more confrontational a counselor was, the more his or her clients with alcohol problems drank.[26]
A 1979 study cited in Broadening the base of treatment for alcohol problems: report of a study by a committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine (1990) found that attack therapy applied to a "heterogeneous correctional population" did not result in a net benefit to the treatment group. The study noted that approximately half the individuals had benefited, while the other half had not been helped, or seemed in fact to have been harmed. The people who had been helped by the therapy were those who—according to the psychometric assessment carried out at the beginning of the study—had a positive self-image. The participants who had a negative self-image did not benefit from attack therapy. The report suggested that there should be a pre-treatment assessment of potential participants' self-image, and that treatment assignment should be guided by the results of such assessment.[2]