Holding Time, Martha G. Welch, M.D., Simon and Shuster, New York, $17.95 246 pp.

Reviewed by John A. Speyrer

While this book acknowledges the contributions of Bowlby, Winnicott, Klaus and others, no mention is made of Janov's primal therapy. That's unfortunate, since holding therapy and primal therapy bear more than a casual similarity. Written by a child psychiatrist, the book is subtitled, ``How to Eliminate Conflict, Temper Tantrums, and Sibling Rivalry and Raise Happy, Loving, Successful Children.'' I don't know if the techniques espoused by the author will solve all of these child rearing problems, but after reading Dr. Welch's book, I feel that holding therapy bears closer investigation. The therapy has been used with autistic children, and while a cure for autism is not claimed, the results are deemed to be impressive. Holding Time is all about how parents, especially mothers, should use Welch's techniques with normal and slightly disturbed children.

The therapy consists of holding the child. But there is much more to it than mere holding. Various response stages during the therapy, in both the parent and the child, are recognized. The first stage reached during holding is one of confrontation as the child protests being held. Sometimes this initial phase results in a happy exchange between the two. Stage two is rejection as the child struggles to get away. As this happens, the mother expresses her feelings and concerns to the child. At this point the mother uses her strength and tenacity to prevent the child from breaking away from her embrace. As the struggle intensifies, there is eventually and invariably a dissolving of the struggle as the relationship becomes tender and intimate, with intense eye contact, touch and conversation relating to feelings. This is the final stage of resolution and is marked by feelings of closeness and contentment.

Dr. Welch recommends that a mother should begin holding therapy when the child is a baby. She claims that you will not be making your baby angry. Instead you will be allowing your baby to express anger. She recommends that if your baby struggles for you to release him, hold him even tighter. The infant will become frustrated and wail, but it is very important for the mother to not stop holding until the stage of resolution is reached.

The author particularly recommends holding during temper tantrums of the ``terrible twos.'' She recommends that the mother tell the toddler to ``get those feelings out.'' Eye contact with the child should be maintained during each session.


Why and how does holding therapy work? I'll attempt to answer this question with another: Are these infants and toddlers perhaps having connected primal feelings of anger, sadness, hurt and fear? The author does not really answer the first question directly, but she does mention in one case study why holding was therapeutic for that child. She prefaces her explanation by writing that it is not only in infants and children that cuddling and holding can result in a paradoxical reaction. Achieving the contact that they were missing can reactivate the memory of the upset and anger of not having had the cuddling and love when it was needed.

I feel that, perhaps, this fully explains why holding therapy works. It would, of course, have to be doing more than simply ``reactivating the memory'' of the child. The forced holding would have to connect the infant or child to an even earlier repressed anger and hurt. The ensuing struggle to escape is an avoidance reaction as the child defends against rising feelings of rejection and anger. The constrained holding triggers a connection by the child to his primal feelings with the resultant resolution. The happiness and closeness between the mother and child, which ensues after the feeling is resolved has its counterpart in the feelings of calm, contentedness and elation characteristic of the immediate post-primal state of adults (This hypothesis could easily be confirmed with vital sign measurements).

However, this is not why Dr. Welch believes the therapy works. Other than that one case, her overall position is that it is present-day upsets which are being dealt with in holding time therapy and she does not emphasize that those frustrations may have an earlier origin.

There have been a number of attacks of holding therapy. The fact that the child is being forced into therapy and physically restrained against his will is a prominent criticism. I was surprised to read criticisms of the therapy in two of Alice Miller's books. She writes that holding therapy condones the use of force in the present and therefore implies that force in the past was also acceptable. She says that in the long run, the manipulation and exploitation of holding therapy cannot help the child. I don't believe Alice Miller understands the therapy. I am happy my mother forced me to begin attending school -- even if I did not want to go! The use of force is not always detrimental. Holding Time concerns the therapy as practiced by the child's mother. However, there are therapists who do holdings with others, usually parents, present.

For infants and toddlers, I can think of no other therapy, other than primal, which might be helpful to children with behavioral, psychosomatic or emotional problems. For a number of reasons, many therapists do not believe that primal therapy techniques should be used with children unless the therapist is their parent. Holding therapy bears closer examination by the psycho-therapeutic community.

See the author's website at The Martha G. Welch Center For Family Treatment