Bonding psychotherapy

1. Introduction

Version followed: present-day Bonding Psychotherapy as published by the International and European Societies for Bonding Psychotherapy (ISBP/ESBP; EAP-recognised), i.e. Daniel Casriel's method as theoretically re-founded by Konrad Stauss (Stauss 2006, German; English ed. ISBP 2007), with the clinical (inpatient) adaptations described by von Wahlert & Mestel (2011) and the trauma adaptations of Feuerhak & Schreckenberg (2009/2013). Casriel's earlier "New Identity Process" (AREBA, New York, late 1960s–1970s) is described only where it explains the method's origins, and in the Harm account. Stauss's book and Casriel's books are not drawn on here; this guide rests on the societies' own published texts, a German clinical paper and lecture materials [source: ISBP; EAP intro; von Wahlert & Mestel 2011]. Verification pass (October 2026): the Synanon and Daytop history in the Harm account was re-checked against the New York Times (2014), a peer-reviewed history of therapeutic communities (Broekaert et al. 2006), a 1974 US federal treatment manual (SAODAP) and a review of O'Brien's own book on Daytop. The unsourced advocacy timeline used before was dropped, and a claim about a named Daytop alumnus was removed because no reliable source was reached. The classic bonding position (4.5) was checked against ISBP and a 2023 University of Padua thesis.

Bonding Psychotherapy is an experiential, mainly group-based psychotherapy developed by New York psychiatrist and psychoanalyst Daniel Casriel (1924–1983) from the 1960s, and named after the "bonding exercise" he introduced in his last decade. Casriel defined bonding as emotional openness combined with physical closeness to another person, and held it to be a biologically anchored basic need [source: ISBP; Wikipedia: Casriel]. Stauss widened the need model (attachment, autonomy, self-esteem, identity, physiological comfort and pleasure, meaning/spirituality) and linked it to attachment theory, Grawe's consistency theory, neuroscience and Greenberg/Elliott's process-experiential work [source: ISBP; EAP intro].

How change is thought to happen: people deprived of bonding learn that love "has a high price", form negative beliefs (e.g. "I am not lovable", "if I get close I will be hurt/controlled"), and protect themselves with withdrawal or hostility that invites further disappointment (a vicious circle). In a trusting group, physical closeness on the mat evokes the feelings, memories and beliefs tied to that history; these are expressed (often loudly), the underlying attitudes are identified and replaced by realistic positive ones, and new behaviour is practised. Learning is meant to happen on three levels at once: feeling, thinking, behaviour [source: ISBP; EAP intro].

2. Framework

There is no published session-by-session manual among the sources used; Bonding is organised by setting and by the structure of the group session rather than by numbered phases [source: ISBP; EAP intro]. ISBP's own conference material describes Stauss's contribution as relating Casriel's concepts to attachment theory [source: Kooyman, Olij, Storm & de Vaynes van Brakel Buys, ISBP Conference 2013]. [uncertain: Stauss 2006 may describe a fuller process model.]

Settings and dose [source: ISBP; EAP intro; therapie.de]

Ongoing weekly groups: sessions 2–3 hours; short-term groups run 3–6 months, long-term groups 1–3 years.
Growth-oriented weekend or longer workshops.
Clinical programmes: psychosomatic hospitals and residential addiction programmes, as main or adjunct treatment; in Germany often within a therapeutic community on the "Herrenalb model" (Walther Lechler, Bad Herrenalb) [source: von Wahlert & Mestel 2011; Wikipedia: Casriel].
Usually embedded in accompanying individual or group therapy, which may continue afterwards; without a supporting community, Bonding should be tied into individual or group therapy [source: therapie.de].
Larger groups are usually led by two (or more) therapists [source: EAP intro; therapie.de].

Entry and selection [source: Brocchini 2024; von Wahlert & Mestel 2011]

Casriel's practice: a pre-entry interview covering motivation, history and personality; access to the intensive "marathon" only after some months of evaluation, followed by at least 12 weeks of post-marathon groups.
Access criteria named in ISBP material: personality structure and timing.
Clinical exclusions (von Wahlert & Mestel; see section 5): dissociation without anti-dissociative skills, low structural integration (OPD ≥ 2.5), compulsive sexualising of contact, extreme avoidance, flat rejection of feelings without a model of their use. People with fragile or very rigid ego structure: only in a clinical setting and in modified form [source: ISBP].

Structure of a typical session [source: ISBP; EAP intro; therapie.de; Gordon et al.]

Opening round/introductions (in workshops) and the therapist's short talk on closeness, expressing feelings, and the links between thinking, feeling and behaviour; ground rules (no sexualising, no violence, confidentiality).
Open period: participants report on their week, relationship issues in the group, honest and supportive feedback.
Pause.
Bonding exercise and attitude group, often run in parallel in two rooms; both are open and optional, and people can move between them.
In pairs the roles swap about halfway through [source: therapie.de].

Within one piece of mat work [source: von Wahlert & Mestel 2011]

Introduction to the purpose of feelings → closeness in the chosen position → noticing inner processes → expression, coming in waves lasting moments to minutes (often anger → grief → relief) → a calmer holding phase in which a new attitude sentence is stated and confirmed. The expressive phase typically lasts about 20–30 minutes.

Course-level phases [uncertain] ISBP lecture material borrows a three-step model from group analysis/psychodrama (Gasca 2002: destructuring, transitional, re-aggregation with closing rituals); this is presented comparatively, not as an official Bonding phase model [source: Brocchini 2024].

Criteria for moving on (largely [synthesis] from the sources' descriptions): move from talk/observation to mat work once the person understands the rules and consents to touch; from gentle or distance positions to the classic position as tolerance of closeness grows; over many sessions, closeness is expected to shift from alienation and fear to acceptance and safety, which the societies treat as the core sign of progress [source: ISBP]; end or step down when new attitudes are being used in daily life and supported outside the group.

3. Guiding principles

Bonding is a basic need. Treat the client's hunger for closeness as legitimate, not regressive; frame problems as adaptations to bonding deprivation [source: ISBP].
Several basic needs, not one. Watch autonomy, self-esteem, identity, comfort/pleasure and meaning as well as closeness; don't push closeness at the cost of autonomy [source: ISBP; von Wahlert & Mestel 2011].
Work on three levels. Every piece of work should touch feeling (expression), thinking (attitude) and behaviour (practice) [source: EAP intro].
Casriel's three entitlements. "I exist", "I need", "I am entitled" (to meet needs, make mistakes, be happy) are the template for new attitudes [source: ISBP].
People are basically good. Address self-defeating behaviour without condemning the person [source: ISBP].
A block is a theme. When the person cannot feel or express, explore the block as meaningful material rather than pushing through it [source: ISBP].
Mentor, not director. The therapist accompanies and "does not push anyone anywhere" (ISBP lecture wording) [source: Brocchini 2024].
Participation is voluntary. Bonding exercise and attitude group are both optional; offer alternatives, never require mat work [source: EAP intro; von Wahlert & Mestel 2011].
Consent before touch. Get explicit agreement before any physical contact, including therapist touch [source: von Wahlert & Mestel 2011].
No sexualising, no violence. Any sexualised contact is prohibited; state this at the start of every group [source: ISBP; Gordon et al.].
Vary partners. Encourage a different partner each session so that fears and attitudes show up across relationships [source: ISBP].
Expression can be loud or quiet. Strong vocal expression is typical, but gentle expression and watching how a feeling changes are equally valid; mat work is not always needed [source: therapie.de; von Wahlert & Mestel 2011].
Don't skip anger. Bypassing anger can prolong grief; allow it in a contained form [source: von Wahlert & Mestel 2011].
Adapt the dose to structure. Choose position and intensity by severity, resilience and the client's wishes [source: therapie.de; Feuerhak & Schreckenberg].
Feedback is honest and supportive. Peers say what they see in a warm, accepting frame, not as attack [source: ISBP].
Contain afterwards. Provide community, follow-up groups or individual sessions so experiences can be digested and transferred to daily life; warn against chasing post-session "highs" [source: therapie.de; Brocchini 2024].

4. Intervention inventory

The published sources describe procedures at the level below; where they give no step detail, steps are marked [synthesis]. All example language is illustrative unless quoted and cited. Touch-based and high-arousal items carry risk flags; see also the Harm account.

4.1 Pre-entry interview and selection

Purpose / when: Before anyone joins a group or workshop; decides whether, where (outpatient vs clinical) and in what form the person can do Bonding [source: Brocchini 2024; von Wahlert & Mestel 2011; ISBP].
Steps: (1) Assess motivation, history (including trauma, abuse, sexual boundary violations) and personality structure. (2) Screen for the clinical contraindications in section 5 (dissociation, low structural integration, compulsive sexualisation of contact, extreme avoidance) [source: von Wahlert & Mestel 2011]. (3) Explain the method, including touch, loud expression and the right to decline. (4) Agree on setting and position (classic vs adapted). (5) Record consent to physical contact [synthesis on documentation].
Example language (illustrative): "In this group people lie on mats and hold each other while feelings come up, sometimes loudly. You decide how close you go, and you can say no at any point. Is there anything about being touched that I should know?"
Watch for: History of sexual abuse, current dissociation, eagerness that looks like a search for rescue or highs; a person who cannot imagine saying no is not yet ready for classic mat work [synthesis].

4.2 Introductory talk and ground rules

Purpose / when: At the start of every session or workshop, and always for new members [source: ISBP; therapie.de; Gordon et al.].
Steps: (1) Brief talk on emotional closeness, why feelings are expressed, and how thoughts, feelings and behaviour connect. (2) State the rules: no sexualising of any kind, no violence, confidentiality/anonymity. (3) Explain that both the bonding exercise and the attitude group are optional. (4) Invite questions.
Example language (illustrative): "The closeness here is for safety and feeling, never for sex. Nobody hurts anyone. What is said here stays here. You can sit out any exercise."
Watch for: New members nodding along without understanding; check individually [synthesis].

4.3 Open round and peer feedback

Purpose / when: First part of the session; brings in the week's events, tensions inside the group and honest, supportive feedback [source: EAP intro; ISBP].
Steps: (1) Invite reports on the week and on relationships in the group. (2) Encourage direct, kind feedback (in German clinics, peers use the informal "Du" form) [source: von Wahlert & Mestel 2011]. (3) Note themes to take into mat or attitude work.
Example language (illustrative): "What did you notice in yourself when she said that? Tell her directly."
Watch for: Feedback sliding into attack; stop it and reframe (see Harm account) [synthesis].

4.4 Partner choice

Purpose / when: Before the bonding exercise. Choosing (and being chosen) is itself material about closeness [source: ISBP; therapie.de].
Steps: (1) Participants choose partners freely; (2) encourage a different partner each session; (3) agree who works first; roles swap about halfway [source: ISBP; therapie.de]. (4) Make sure no one is left with a partner they refused [synthesis].
Example language (illustrative): "Look around: who would you like to work with today? Notice what makes you hesitate."
Watch for: Always choosing the same person; avoidance of certain genders or ages; feeling rejected when not chosen; these are themes for the attitude group [synthesis].

4.5 The bonding exercise (classic position)

Purpose / when: The core intervention: closeness on the mat evokes feelings, images and memories linked to attachment history; over many sessions it works as a "psychological microscope" for fears and beliefs about closeness [source: ISBP; EAP intro].
Steps: (1) Pair on mats. (2) Classic lying position: the working partner lies on their back, underneath, and holds on to (embraces) the supporting partner, who lies on top and gives containment and comfort [source: ISBP; Moccia 2023, citing Kooyman, Olij & Storm 2014 and a figure from Stauss & Ellis 2007; therapie.de; Gordon et al.]. Variants: the supporting partner may instead sit or stand (Kooyman et al. 2014, via Moccia 2023), and von Wahlert & Mestel describe the partner either holding or being held; graded and distance positions are in 4.6. (3) The working partner lets themself feel the closeness and notices what comes up. (4) Feelings are expressed verbally or nonverbally (see 4.7). (5) The supporting partner stays present as a holder/witness and does not intervene or interpret [source: therapie.de]. (6) The therapist moves between pairs, coaching. (7) After the expressive waves, a calmer holding phase follows in which a new attitude sentence may be said (4.10). (8) Swap roles.
Example language (illustrative): "Just notice being held. What happens in your chest? … Let the sound out if it wants to come."
Watch for: Freezing, going blank, spacing out (possible dissociation: stop and ground); breath-holding; partner discomfort. Working signs: emotions arrive in waves and resolve into relief, softness, trust; over weeks the person tolerates closeness with less fear [source: von Wahlert & Mestel 2011; ISBP]. Risk flag: prolonged full-body holding can re-evoke abuse or entrapment; always have an exit agreement and adapted positions available.

4.6 Adapted positions and graded closeness

Purpose / when: For severe illness, low resilience, trauma, or the client's wish; also as a step towards the classic position [source: therapie.de; Feuerhak & Schreckenberg].
Variants named in sources: embracing standing or sitting; "eye bonding" (holding hands with eye contact); sitting side by side or at a distance without touch [source: therapie.de]; trauma-adapted "holding mats", "mats of distance", laying on of hands, a slow approach, and a short five-minute hold [source: Feuerhak & Schreckenberg]. [uncertain: the lecture names these but gives little step detail.]
Steps ([synthesis] from these descriptions): (1) Let the client choose distance first. (2) Approach slowly, checking at each step. (3) Agree a time limit (e.g. the short hold). (4) Use a stop signal. (5) Debrief what the closeness evoked.
Example language (illustrative): "Where would you like your partner to sit? Closer, further? Tell us when it's right."
Watch for: Relief at being allowed distance is itself useful information; increase closeness only when the person asks [synthesis].

4.7 Coaching emotional expression on the mat

Purpose / when: To help emerging feelings reach full, authentic expression; the voice is treated as an activator [source: Brocchini 2024; von Wahlert & Mestel 2011].
Steps: (1) Encourage audible expression, at first quietly, then louder if the impulse grows. (2) Offer a short sentence that fits what is emerging (e.g. the participant report's "Ich brauche mehr!" / "I need more!") and let the person repeat it, increasing volume [source: Gordon et al.]. (3) The therapist may use wordless sounds to support [source: von Wahlert & Mestel 2011]. (4) Stay with the wave until the impulse fades; expect shifts such as anger → grief → relief. (5) Distinguish forced/performed expression ("gespielter Gefühlsausdruck") from authentic expression and slow down if it is performed [source: von Wahlert & Mestel 2011]. (6) Allow quiet, inward phases; newer practice also permits soft expression while observing how the feeling changes [source: therapie.de; Gordon et al.].
Example language (illustrative): "Try saying 'I need more' … again … now let it be as loud as it really is."
Watch for: Exhaustion, fear of losing control, hyperventilation, shame afterwards. Working: authentic feeling, then a spontaneous drop into calm, lightness and sense of being held [source: Gordon et al.]. Risk flag: pushing volume or repetition past the client's own impulse turns this into pressure (see Harm account).

4.8 Therapist touch to support release

Purpose / when: To help release a blockage during expression; described in a German inpatient programme [source: von Wahlert & Mestel 2011].
Steps: (1) Ask for and obtain explicit consent beforehand (the authors stress this is essential). (2) Touch is light and placed on the forehead, throat area or head [source: von Wahlert & Mestel 2011]. (3) Withdraw at once on any sign of distress or on request [synthesis].
Example language (illustrative): "May I put my hand on your forehead? You can say no."
Watch for: Risk flag: touch near the throat can be experienced as threatening, especially after strangulation or abuse; I recommend avoiding the throat entirely unless there is a clear, informed, individual agreement [synthesis]. Never apply pressure.

4.9 Working with blocks

Purpose / when: When the person cannot feel, cannot make a sound, or stops; the block is treated as a key theme [source: ISBP].
Steps ([synthesis] beyond the source line): (1) Name the block without judgment. (2) Ask what the block protects against ("If I let this out, then …"). (3) Turn the answer into an attitude (e.g. "I'll be too much") for 4.10/4.12. (4) Offer a lower-intensity way to continue, or stop.
Example language (illustrative): "Something stops you. What would happen if it came out?"
Watch for: Mistaking a protective dissociative shutdown for "resistance"; if the person is absent, ground, don't push.

4.10 Permission and new-attitude sentences on the mat

Purpose / when: To counter old prohibitions on feeling and to anchor new beliefs while the body is still open [source: von Wahlert & Mestel 2011; therapie.de].
Steps: (1) During expression, offer permission statements (in the clinical paper: "Das ist in Ordnung" – "That's OK"; "Trau deinen Gefühlen!" – "Trust your feelings!"). (2) Offer sentences that stress the positive side of a feeling, e.g. "Meine Angst ist meine Kraft" ("My fear is my strength") [source: therapie.de]. (3) In the calm holding phase, the person states a new attitude, e.g. "My feelings and needs are OK" [source: von Wahlert & Mestel 2011] or "I need and take your closeness" [source: therapie.de]. (4) Check that the sentence feels true.
Example language (illustrative): "Say it to her: 'I'm OK as I am.' How true is that, from 0 to 10?"
Watch for: Hollow repetition; adjust the sentence until it fits.

4.11 The screaming exercise (Casriel; historical)

Purpose / when: Casriel's original central technique in the New Identity Process: screaming to release pent-up feeling (especially anger) and open the person to new messages [source: Spektrum Lexikon; EAP intro].
Status: ISBP lecture material says the early Synanon-derived screaming exercise was gradually replaced by experiential emotion work [source: Brocchini 2024]. Its step detail is in Casriel (1972/1974) and is not reproduced here [uncertain].
Watch for: Risk flag: in the 1970s practice could be overly intense and even re-traumatising (von Wahlert & Mestel 2011). Use today only as client-led vocal expression (4.7), not as a required scream.

4.12 Attitude group: exploring self-defeating attitudes

Purpose / when: The cognitive-behavioural half of Bonding ("attitude work"), often in a second room parallel to the mats; Casriel designed it to change pathological thinking and behaviour [source: ISBP; Brocchini 2024; EAP intro].
Steps: (1) A participant brings a problem from the mats or daily life (partner, family, work). (2) The therapist questions specifically to uncover the irrational reaction behind the self-defeating behaviour. (3) Name the old attitude (sources' examples: "If I get close … I can't be me / I will be hurt / I will be controlled"; "I'm too much for others"; "I must spare the others"; "I'm not good enough", "I don't need anyone", "I have no right to exist") [source: ISBP; Gordon et al.; Kooyman et al. 2013]. (4) Link it, where useful, to family-of-origin patterns. (5) Formulate a realistic positive replacement. (6) Practise it (4.13) and reinforce it over following weeks [source: ISBP].
Example language (illustrative): "When he didn't answer, what did you tell yourself? … Where did you learn that?"
Watch for: Intellectualising instead of feeling; then send the person to the mats or slow down. Working: the person catches the old attitude in daily life and chooses the new one [source: Brocchini 2024 "mature sense of self" goal].

4.13 Attitude statement round

Purpose / when: To practise a new attitude bodily and socially [source: ISBP; EAP intro].
Steps: (1) The participant stands in the middle of the group. (2) They say the new belief (e.g. "I am good enough!") to each member in turn, with eye contact. (3) Delivery is either assertive self-assertion or soft, "as if nurturing a fragile new attitude" (paraphrase of ISBP). (4) Members respond honestly. (5) Notice what feelings rise as volume or conviction grows [source: ISBP].
Case (from ISBP/therapie.de): Peter, 34, afraid of criticism, repeats "I exist too!" to each member; his voice grows from tentative to a powerful scream, revealing stored anger and supporting self-assertion without over-compliance.
Example language (illustrative): "Go round and tell each person: 'I'm here too.' Look at them. Let your voice decide how loud."
Watch for: Collapse or shame mid-round; offer the soft version or a partner standing beside them [synthesis].

4.14 Enactment and imagery

Purpose / when: To address a significant person directly; listed among the levels of emotional expression [source: Brocchini 2024; Feuerhak & Schreckenberg].
Steps ([synthesis] for detail): (1) Invite the client to imagine the person present (Casriel group example quoted in ISBP slides: "Imagine that she is sitting in the middle of the room"). (2) Let the client speak to them. (3) Support expression, then return to the present and the group. Feuerhak & Schreckenberg describe an imagery intervention with a former psychiatric patient [details not given].
Example language (illustrative): "Put your mother on that cushion. What do you want to tell her?"
Watch for: Flooding with traumatic memories; use distance ("see her on a screen far away") or stop [synthesis].

4.15 Interpreting relational agreements and transference

Purpose / when: In attitude work, to make conscious the unspoken pacts behind symptoms (Casriel's example: an agreement with parents "never to get angry") and to work with projection and transference in the group [source: Brocchini 2024].
Steps ([synthesis]): (1) Notice the repeated pattern. (2) Offer a tentative hypothesis about the old agreement. (3) Test it against the client's experience. (4) Formulate the release from the agreement as a new attitude.
Example language (illustrative): "It looks as if you once promised never to be angry at home. Does that fit?"

4.16 Integration with other methods

Attitude-group therapists may use psychodynamic, Gestalt, systemic and transactional-analysis techniques; in Germany Bonding is often combined with Gestalt, psychodrama, TA or analytic therapy [source: ISBP; therapie.de]. Use only methods you are trained in.

4.17 Therapist co-regulation

Purpose / when: The therapist intervenes "with voice and body" (hugging, synchronised breathing, co-regulation of emotion) as a warm, responsive presence [source: Brocchini 2024].
Steps ([synthesis]): (1) Ask consent. (2) Match then slow the client's breathing. (3) Offer a hand or brief hug only if wanted. (4) Withdraw as the client settles.
Watch for: Risk flag: therapist hugging carries boundary and transference risks; keep it brief, visible to co-therapist, non-sexual, and document [synthesis].

4.18 Marathon and post-marathon groups (Casriel)

Purpose / when: Intensive extended sessions in Casriel's practice; admission only after months of evaluation, followed by at least 12 weeks of post-marathon groups [source: Brocchini 2024]. Length and timetable are not given in the sources used [uncertain].
Watch for: Risk flag: ISBP material notes documented breakdowns in encounter/marathon formats, post-session low mood and expectations of lasting "highs"; follow-up is mandatory [source: Brocchini 2024].

4.19 Therapeutic community and aftercare

Purpose / when: The group or ward community supports members between sessions and helps transfer experiences to daily life (inpatient Herrenalb-model communities; outpatient groups) [source: therapie.de; von Wahlert & Mestel 2011].
Steps ([synthesis]): Debrief at session end; agree a contact person or buddy; schedule the next individual or group session; give a plan for strong feelings at home.

4.20 Trauma-adapted Bonding

Purpose / when: For traumatised clients, where interactive pressure, diffuse boundaries, fragile self-perception and difficulty trusting raise the risk of re-traumatisation [source: Feuerhak & Schreckenberg].
Elements named: trauma-therapy methods drawing on Luise Reddemann's PITT (psychodynamic imaginative trauma therapy), smaller groups, resilience-building, more explanation and psychoeducation, the adapted mats and short holds in 4.6, and a modified form of confrontation called the "Revolver hand principle" with three securing questions [source: Feuerhak & Schreckenberg]. [uncertain: the content of the three questions is not given in the sources used; do not improvise it as if it were theirs.]
Steps ([synthesis]): stabilise first; establish safe-place/resource imagery; agree stop signals; keep expression within the window of tolerance; end each piece with orientation to the here and now.

5. Handling problems

Contraindications and when not to do mat work [source: von Wahlert & Mestel 2011; ISBP]

Do not offer classic mat work to: people prone to dissociation who lack anti-dissociative skills; people with structural integration at OPD level 2.5 or worse (most borderline and severe personality disorders); people who compulsively sexualise contact; people with extreme avoidance (possibly also ambivalent attachment); people who reject feelings and have no model of their usefulness. Fragile or very rigid ego structure: clinical setting and modified form only. Mat work is not always indicated; less expressive moments can be enough.

Overwhelm / flooding [source: von Wahlert & Mestel 2011; Feuerhak & Schreckenberg]

Sources warn that unprepared patients can be flooded. Response ([synthesis] for steps): stop intensifying; switch from loud to quiet; eyes open, orient to the room, name five things you see; partner loosens or releases hold; move to sitting; therapist stays beside the person; debrief and plan support for the evening. Next time: more psychoeducation, a distance position (4.6), shorter hold.

Dissociation on the mat [synthesis, built on the contraindication above]

Signs: glazed eyes, no response, limpness, sudden flatness after intense expression. Release the hold, sit up, use name, ask simple orienting questions, feet on the floor. Do not interpret this as a "block" to push through. Reassess suitability.

Stuck / cannot feel / cannot get loud [source: ISBP; Gordon et al.; therapie.de]

Many people are inhibited at first despite wanting to express. Treat the block as theme (4.9); offer a short sentence to repeat quietly; allow soft expression; accept quiet inward phases as valid. Don't escalate volume for its own sake.

Performed or forced expression [source: von Wahlert & Mestel 2011]

Early on, expression may be "played". Slow down, ask what is actually felt, return to breath and body; authentic feeling often follows. [synthesis: never praise volume itself, or the group learns to perform.]

Resistance to closeness or touch [source: therapie.de; Feuerhak & Schreckenberg]

Offer graded positions (eye bonding, sitting apart, short hold); explore the fear in the attitude group ("If I get close, …"). Respect refusal fully; participation is optional [source: EAP intro].

Sexualisation or boundary crossing between partners [source: ISBP; von Wahlert & Mestel 2011]

Sexualising is prohibited. Stop the exercise discreetly, separate the pair, speak with each privately, restate the rule. [synthesis: if it recurs, exclude from mat work; compulsive sexualisation is a contraindication; check whether the other partner felt violated and offer support.]

Rejection / not being chosen / jealousy [synthesis]

Bring it to the open round or attitude group as attachment material; ensure therapists partner with anyone left alone, or offer a distance exercise.

Non-attendance and dropping out after an intense session [source: Brocchini 2024; therapie.de]

Low mood after sessions and disappointment when the "high" fades are named risks. Prepare people for this at the start, provide follow-up contact, and tie the work into individual therapy.

Ruptures with the therapist [synthesis]

Typical triggers: feeling pushed, feeling touched without real consent, or feeling abandoned when the therapist moves to another pair (as in the participant report, where the coach switched pairs mid-work) [source: Gordon et al.]. Acknowledge, take responsibility for your part, ask what the client needs, and adjust consent and coaching agreements.

Group drifting toward attack [synthesis, informed by the method's history]

If feedback becomes ridicule, cross-examination or pressure to "break" someone, stop it at once, restate the supportive-feedback rule, and repair with the person targeted. See Harm account.

Addiction settings [synthesis]

Bonding is used in residential addiction programmes [source: ISBP]; coordinate with the treatment team about craving after intense sessions and never use confrontational methods as a substitute for evidence-based addiction care.

Touch, consent and documentation [synthesis, building on von Wahlert & Mestel 2011]

Get explicit consent for each kind of touch, renew it each session, agree a stop word, keep two therapists present for mat work, and record consent and any incident. Check your national body's rules on touch in psychotherapy.

Harm account

None of the sources cited reports deaths or physical injuries from ISBP-style Bonding Psychotherapy. The documented and acknowledged risks are psychological (flooding, re-traumatisation, post-session crashes), plus the broader record of the confrontational communities from which Casriel's methods partly came. The history below separates what is documented about Casriel from what is documented about Synanon and later programmes, which he did not run.

What was actually done

Synanon (from 1958, Santa Monica, California): founded by Charles "Chuck" Dederich as a residential drug-rehabilitation community (a 1974 federal manual gives 1959 and says it began as a programme for alcoholics modelled on AA). Its core group method, "the Game", had one member talk about themselves while peers gave harsh, often profane criticism (described in the literature as attack therapy). Later a 72-hour version was introduced, which Dederich himself called brainwashing; it was used to pressure members to submit, including to abortions, vasectomies and violence [source: Wikipedia: Synanon, citing Simon 1978; Kanfer & Goldstein 1980; Longform 2014]. A peer-reviewed history describes the Game as the "circle" that alternated with Synanon's hierarchy, "an uninhibited conversation" about feelings, community issues and relationships [source: Broekaert et al. 2006, p. 2]; the 1974 US federal manual says Synanon's discussion groups grew into "intense group confrontations and verbal attack sessions" and that Synanon shaved the heads of residents who broke its rules [source: SAODAP 1974, pp. 2, 18].
Casriel and Synanon (1962–1963): Casriel visited Synanon in July 1962, moved in for a closer look, wrote So Fair a House: The Story of Synanon (1963), and in February 1963 gave $2,000 to seven Synanon members to start an East Coast community in Westport, Connecticut [source: Wikipedia: Casriel, citing NYT obituary 1983 and others]. A 2023 thesis summarising Casriel (1972) says he saw Synanon meetings with frequent verbal attacks, shouting and insults, while physical violence was not allowed [source: Moccia 2023]. ISBP's own texts say he took from Synanon the deep emotional release and confrontation of self-destructive behaviour [source: ISBP; EAP intro].
Daytop (from 1963/64, Staten Island, New York): Daytop began as Daytop Lodge, a pilot halfway house for addicts on probation run under the New York State Probation Department [source: SAODAP 1974, p. 2; Wikipedia: Casriel]. The New York Times obituary of Monsignor William B. O'Brien says he opened the first Daytop residence in 1963 with three partners, the psychiatrist Daniel Casriel, Joseph Shelly and Alexander Bassin, after meeting Casriel at the Synanon community in Westport, and that the model was inspired by Synanon [source: Vitello, NYT 2014]. Wikipedia: Casriel describes him as psychiatric consultant to Daytop Lodge from summer 1963 and later psychiatric director and medical superintendent of Daytop Village; a peer-reviewed history instead dates Daytop Village to 1964 and names O'Brien and Charles Devlin as founders, without mentioning Casriel [source: Wikipedia: Casriel; Broekaert et al. 2006, p. 4] [uncertain: founding date and list of founders differ between sources]. ISBP says Synanon inspired the Daytop model, which Casriel went on to develop [source: ISBP]. Methods: the "concept" therapeutic communities, Daytop among them, adopted many Synanon procedures and hired Synanon graduates [source: Broekaert et al. 2006, p. 2]; residents obeyed strict rules and attended daily group therapy that often became confrontational, with penalties such as wearing a sign describing the transgression and cleaning bathrooms [source: Vitello, NYT 2014]; a review of O'Brien's own book says residents "talk their rage out in encounter groups" [source: Kirkus review of O'Brien & Henican 1993]. By 1974 a federal manual noted that Daytop made more use of individual therapy than other therapeutic communities, judging group processes limited [source: SAODAP 1974, p. 3]. None of the reliable sources cited calls Daytop's groups "the Game" or gives their exact format, so that label is not applied to Daytop here. Later residential programmes built on the therapeutic-community methods popularised at Synanon and Daytop include Élan School in Maine (opened 1970) [source: Wikipedia: Élan School, citing DeRogatis, Spin 2001].
AREBA and the New Identity Process (late 1960s–1970s, Manhattan): a small therapeutic community (about a dozen beds for young addicts) on the upper floors of Casriel's office building; residents lived and "worked" there and took part in group therapy using screaming, hugging and affirmations of basic needs [source: Wikipedia: Casriel]. A German psychology lexicon describes screaming as the central element, aimed especially at anger, alongside confrontation groups in which members mirrored the client's behaviour back to them [source: Spektrum Lexikon der Psychologie, 2000]. Exact session formats, durations and how participation was secured are not documented in the sources cited [uncertain].
Marathons: Casriel's practice included marathon sessions after months of evaluation, followed by post-marathon groups [source: Brocchini 2024].
1970s European practice: German clinicians state that earlier (1970s) Bonding practice could be overly intense and even re-traumatising [source: von Wahlert & Mestel 2011]. No cited source gives named cases.

How it caused harm

Confrontation/attack: In Lieberman, Yalom and Miles' study of over 200 students in encounter groups, 9.1% of those completing more than half the sessions had psychological damage lasting at least six months; the most harmful groups were Synanon-style with harsh, authoritarian leaders [source: Wikipedia: Attack therapy, citing Lieberman, Yalom & Miles 1973]. A 1979 correctional study cited by the Institute of Medicine found no net benefit: people with a positive self-image gained, those with a negative self-image did not or seemed harmed; more confrontational alcohol counsellors' clients drank more (Miller et al.) [source: same]. Mechanism: shame and humiliation of people whose self-esteem is already low, plus group pressure to comply.
Synanon escalation: documented violence (over 80 violent acts attributed to members, a skull fracture of an ex-member, the 1978 rattlesnake attack on an attorney, a 1978 Marin County grand jury report on child abuse) [source: Wikipedia: Synanon]. This shows where closed confrontational communities can go; it is not attributed to Casriel.
Within Bonding work itself: re-traumatisation through interactive pressure, diffuse boundaries and fragile self-perception in traumatised clients [source: Feuerhak & Schreckenberg]; flooding of unprepared patients [source: von Wahlert & Mestel 2011]; breakdowns in encounter/marathon formats, post-session low mood, and chasing "highs" [source: Brocchini 2024]. Casriel himself worried that attack-style encounter damaged self-esteem and that patients could not be watched over after sessions [source: Brocchini 2024].
Prolonged physical holding: none of the sources cited reports an injury from Bonding holding. [synthesis] Plausible mechanisms: re-enactment of abuse or entrapment when a person is held lying down, consent compromised by group expectation, and touch that is or feels sexualised.
Most at risk: trauma survivors (especially sexual or physical abuse), people prone to dissociation, people with low structural integration or borderline organisation, people with low self-esteem, adolescents and people in residential or coerced treatment where they cannot easily leave [source: von Wahlert & Mestel 2011; Feuerhak & Schreckenberg; Wikipedia: Attack therapy; last item synthesis].

Recognising it today

Confrontational lineage: programmes that publicly ridicule or cross-examine a member, keep people in a session against their will, run all-night groups, or claim the ego must be "torn down" to be rebuilt; this pattern is documented across Synanon-derived communities and troubled-teen programmes (e.g. Straight, Inc., Elan, CEDU, WWASP schools) [source: Wikipedia: Attack therapy; Wikipedia: Synanon]. Rationales to watch for: "people don't change until they've suffered enough" (attributed by Miller & Rollnick to supporters of the approach), "honesty means brutality", "breaking through denial".
Red flags in a Bonding or holding group ([synthesis], informed by the risks above): no pre-entry interview or screening; mat work presented as compulsory or as proof of commitment; a leader who pushes volume, repetition or holding beyond the client's impulse; touch (including throat or head) without asking each time; no stop signal; partners pressured into closeness or sexualised contact tolerated; no follow-up after workshops or marathons; promise of lasting euphoria or a cure from one weekend; people with trauma, dissociation or personality disorder admitted to intense workshops without a clinical setting; leaders without recognised psychotherapy training or society certification; group isolated from outside therapists.
How legitimate current Bonding differs: voluntary, optional exercises; screening and contraindications; consent before touch; explicit ban on sexualising and violence; graded and distance positions; soft as well as loud expression; supportive, not attacking, feedback; embedding in individual therapy or a community with aftercare; certified trainers [source: ISBP; EAP intro; von Wahlert & Mestel 2011; therapie.de; Feuerhak & Schreckenberg].
Not to be confused: coercive "holding therapy" or "attachment therapy" for children (restraint of a resisting child) is a different practice and not part of ISBP Bonding [uncertain: no source on it is cited here].

What to do instead and how to help those harmed

Safer alternatives ([synthesis]): for attachment and emotion-regulation problems, emotion-focused/process-experiential therapy (which Stauss draws on), mentalisation-based or schema therapy, and trauma-focused treatments with a stabilisation phase (e.g. Reddemann's PITT, cited by Feuerhak & Schreckenberg); for addiction, motivational interviewing and other non-confrontational approaches, in line with the finding that confrontational counselling worsened drinking [source: Wikipedia: Attack therapy]. If Bonding is used, use the adapted, consent-based form in section 4.
Assessing affected clients ([synthesis]): ask specifically about the group format, what was done physically, whether they could refuse, any touch they did not want, sexual contact, being shamed in front of others, and how they felt in the days after; screen for PTSD/complex PTSD, dissociation, depression and suicidality using standard risk assessment; note shame, self-blame ("I wasn't open enough") and loyalty to the group or leader.
Treatment ([synthesis]): validate that pressure and touch without real consent can harm even in a therapy setting; restore control (client sets distance, pace, touch: usually none); stabilise before any trauma processing; work with shame and with ambivalence about a community that may also have helped; avoid any re-enactment of confrontation.
Ethical, reporting and legal duties ([synthesis]): sexual contact in therapy, or touch without consent, is a professional-conduct matter: support the client to complain to the practitioner's licensing or professional body (and the national Bonding society if a member), and follow your jurisdiction's mandatory-reporting rules for minors and vulnerable adults; physical or sexual assault may be a criminal matter for the police. Document what the client tells you in their words. Within your own practice: written informed consent for touch, two therapists for mat work, incident records, and supervision.

Sources

Web pages:

Books cited:

Casriel, D. (1963). So Fair a House: The Story of Synanon. Prentice-Hall.
Casriel, D. (1972). A Scream Away From Happiness. New York: Grosset & Dunlap (date per the New York Public Library catalogue record; ISBP lists 1974, possibly a later printing).
O'Brien, W. B. & Henican, E. (1993). You Can't Do It Alone (known via the Kirkus review only).
Casriel, D. M. (1983). New Identity Prozess. In R. J. Corsini (Ed.), Handbuch der Psychotherapie. Beltz.
Lair, J. & Lechler, W. (1980). I Exist, I Need, I'm Entitled. Doubleday.
Stauss, K. (2006). Bonding Psychotherapie: Grundlagen und Methoden. Kösel; English ed. Bonding Psychotherapy, ISBP 2007.
Corsini, R. (Ed.) (2001). Handbook of Innovative Psychotherapies. Wiley.
Lieberman, M. A., Yalom, I. D. & Miles, M. B. (1973). Encounter Groups: First Facts. Basic Books (cited via Wikipedia).

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