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.
The method has been used by groups such as Synanon, Straight, Inc., Élan School, and similar methods have been employed in Large Group Awareness Training, TROSA. . 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.
Attack therapy can be particularly problematic when the group members are captive, and not allowed to leave during the sessions. In Group Psychotherapy with Addicted Populations, Flores notes that attack therapy can take place when individuals are psychologically intimidated in a confrontational atmosphere. 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. 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." 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. According to Maran's book Dirty, attack therapy can take place in "all-night encounter groups and daily interactions." 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.
In Concise Encyclopedia of Psychology, Corsini and Auerbach note that attack therapy puts an emphasis on the expression of anger by each individual. 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. 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.
Groups that use attack therapy
In their textbook, Helping People Change, Kanfer and Goldstein note that controversial group Synanon used a form of attack therapy. A publication by the National Association for Mental Health wrote that the Synanon form of attack therapy was also called the "Synanon confrontation game". 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. Balgooyen compared "Synanon game verbal attack therapy" to standard group therapy, in a study published in the Journal of Community Psychology. In Dictionary of American Penology, Williams writes that attack therapy was actually first developed in the Synanon group. 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." The attack therapy techniques used in Synanon have been described in Therapeutic Community by a former participant as "brutal and bordering upon sadism." 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." In her book "Help at Any Cost: How the Troubled-teen Industry Cons Parents And Hurts Kids"  Mai Szalavitz describes the abusive attack therapy techniques by Straight, Inc. This method of therapy was also used at the now defunct Élan School. Part of the reason for Elan being closed was due to pressure from activists who saw the usage of this form of therapy as wrong and humiliating.
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.
William Miller and colleagues found that the more confrontational a counselor was, the more his or her clients with alcohol problems drank.
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.
- Struggle session; a similar method of using group-based personal attacks for the purposes of reinforcing political (as opposed to psychological) orthodoxy.
- Dr. John Juedes; William Barton (2002). "Fringe Psychology of the 1960s In Breakthrough/ Momentus Training". Archived from the original on 19 April 2007. Retrieved 2007-05-10.
- Institute of Medicine (U.S.) (1990). 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. National Academies. pp. 247–248.
- Scripts People Live: Transactional Analysis of Life Scripts, Claude M. Steiner, Page 256. ISBN 0-8021-3210-3, Grove Press, 1990
- Group Psychotherapy with Addicted Populations, Philip J. Flores, Page 355., 1997, ISBN 0-7890-6000-0, Haworth Press
- Help at Any Cost: How the Troubled-teen Industry Cons Parents And Hurts Kids, Maia Szalavitz , Page 7, Page 65., ISBN 1-59448-910-6, 2006, Riverhead Cite error: Invalid
<ref>tag; name "Szalavitz" defined multiple times with different content (see the help page).
- The Death of Psychotherapy, Donald A. Eisner, Page 45., 2000. ISBN 0-275-96413-2, Praeger/Greenwood
- Group Counselling, Keith Tudor, Page 16., ISBN 0-8039-7620-8, Sage Publications Inc, 1999.
- Dirty: A Search for Answers Inside America's Teenage Drug Epidemic , Meredith Maran, Page 93., 2004, ISBN 0-06-073061-7, HarperCollins
- Adolescents, Alcohol, and Substance Abuse, Peter M. Monti, Suzanne M. Colby, Tracy A. O'Leary , Page x., 2004, Guilford Press, ISBN 1-59385-090-5
- Concise Encyclopedia of Psychology, Raymond J. Corsini, Alan J. Auerbach, Page 114., 1998, John Wiley & Sons, ISBN 0-471-19282-1
- One Nation Under Therapy , Christina Hoff Sommers, Dr. Sally Satel, Page 75., 2006, ISBN 0-312-30444-7, St. Martin's Griffin
- Social Problems, James William Coleman, Donald Ray Cressey , 1984, Page 351. ISBN 0-06-041327-1
- Helping People Change: A Textbook of Methods, Page 508., Frederick H. Kanfer, Arnold P. Goldstein, ISBN 0-08-025097-1, 1980, Pergamon Press
- The magazine of the National Association for Mental Health, v.56 no.3-4 1972 + v.57 1973, Page 50.
- Balgooyen, T. J., (1974), Journal of Community Psychology., 2(1), 54-58., "A Comparison of the Synanon game verbal attack therapy and standard group therapy practice on hospitalized chronic alcoholics."
- Dictionary of American Penology , Vergil L. Williams , 1996, Page 28., ISBN 0-313-26689-1, Greenwood Press
- Therapeutic Communities for the Treatment of Drug Users, Rowdy Yates, Barbara Rawlings , Page 39., 2001., ISBN 1-85302-817-7, Jessica Kingsley Publishers
- Therapeutic Community: Social Systems Perspective , Fernando B. Perfas, Page 30., ISBN 0-595-32131-3, 2004.
- Motivational Interviewing: Preparing People for Change, William Ross Miller, Stephen Rollnick , 2002, Page 12., ISBN 1-57230-563-0, Guilford Press
- DeRogatis, Jim (March 2001). Spin Magazine. SPIN Media LLC. p. 124. Retrieved 1 September 2014.
- Meyer, June. "Controversial Elan School closing due to low numbers, negative Web campaign". http://bangordailynews.com/. Bangor Daily News. Retrieved 1 September 2014.
- Lieberman M., Yalom I., Miles M., Encounter Groups: First Facts, Basic Books, 1973, p. 170-174.
- Miller et al., 1993 W.R. Miller, R.G. Benefield and J.S. Tonigan, Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles, Journal of Consulting and Clinical Psychology 61 (1993), pp. 455–46
- Singer, Margaret Thaler; Janja Lalich (1996). Crazy Therapies : What Are They? Do They Work?. San Francisco: Jossey-Bass Publishers.
- Miller, William R., Ph.D., William White, M.A. (October 4, 2007). "Confrontation in Addiction Treatment". Counselor: The Magazine for Addiction Professionals. www.counselormagazine.com. Archived from the original on 30 April 2008. Retrieved 2008-04-16.