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An Open Letter to Clinicians about "Unstable" Moms of Kids with Reactive Attachment Disorder

Updated: Jan 12, 2023

Dear Mental Health Colleague,

A mother called me in tears yesterday.

Her story was one of hundreds I’ve heard over nearly 40 years in the field of attachment. The woman’s 13-year-old adopted daughter told her therapist that her mom often hits and yells at her.

But here’s what happened from the mom’s point of view:

The 13-year-old had run away with an older boy and her mom grounded her. Out of anger, the girl threatened to get her mom "in trouble" for keeping her from the boy. And she followed through.

The girl’s therapist made a report to child protective services (CPS). A CPS social worker then placed the girl in emergency foster care while CPS agents investigated. The CPS agent quickly felt the girl’s report was credible. The woman is now worried she'll lose her biological children too, as threatened by CPS agents.

Here's something to consider:

The CPS investigator is likely unfamiliar with “the nurturing enemy”—a theory Nancy Verrier coined in her book The Primal Wound. If she knew the term, she may have taken far more time to investigate the case.

It’s a term you need to know too in your work with traumatized kiddos.

A nurturing enemy is a primary caregiver of a child with developmental trauma, often diagnosed as reactive attachment disorder or post-traumatic stress disorder. Although not gender-specific, the child most often identifies a mother figure—a stepmother, adoptive mom, biological grandmother, etc.—as his or her nurturing enemy.

A nurturing enemy attempts to love, guide, and parent the trauma out of a child. And he or she is often encouraged to do so by well-meaning clinicians, family, and friends. But no one can simply love away a child's trauma, unfortunately.

The closer a person tries to get to a child with developmental trauma, the further the child pushes away.


  • Early abuse and neglect actually change the brain, wiring it for survival. While most young children learn how to trust and accept nurturance and love, abused children learn how to survive—to rely only on themselves and get away from caretakers at all costs.

  • As traumatized children grow, they continue to refine their survival skills—even if they are no longer in harm’s way. They develop a keen ability to manipulate others in order to control their environments and feel safe.

  • Traumatized children’s maladaptive behaviors, once needed for survival, work against them. They push away the people who love and nurture them most. Thus, those people become the nurturing enemy.

It’s a rather simple concept to understand. Yet, it's still confusing as a clinician trying to decipher the needs of a child with developmental trauma. That's because a nurturing enemy can look like an unstable and irrational person.

It's helpful to know why:

A child with developmental trauma, well-versed at manipulation, appears charming and well-behaved with other adults. Meanwhile, he or she acts out in extremely concerning ways with the primary caregiver alone. The nurturing enemy is completely alone in managing and caring for the child.

She is, naturally, frustrated, angry, and often depressed.

Here are common dynamics that lead to a parent’s emotional breakdown:

  • Clinicians, the parent’s significant other, and extended family members view a likable and well-behaved child with an unfair, angry, and unreasonable parent. They give parenting advice that feels condescending. The parent feels even more angry and depressed.

  • Extended family members, caretakers, and other adults feel bad for the child. They give the child whatever he or she wants. The child acts out even more with the parent so as to increase time with caretakers. The parent begins to avoid child care opportunities since the child is more difficult and entitled afterward.

  • Friends make excuses to avoid getting together with the parent who is exhausted and complains about her life with the child often. Or the parent makes excuses not to visit friends since they don’t believe or understand her anyway.

  • The constant opposition by the child and lack of support wear the parent down. She begins to give in to the battle which feeds the child’s entitlement. The parent feels as though she is failing.

  • In her pursuit of a solution, the parent finds only expensive out-of-home options. She feels resentment toward the mental health system and professionals.

  • The parent must constantly supervise the child to protect the child, herself, and other children in the home. She is exhausted from the need for constant hypervigilance. She is hopeless, helpless, and struggles with sleep problems.

  • The parent feels resentful towards her child. Her temperament is challenged. She has become a mom she never wanted to be.

What You Can Do As a Clinician for Parents of Kids with Developmental Trauma (a.k.a. reactive attachment disorder)

As a clinician, join with the nurturing enemy to understand the dynamics of the struggle to love and parent a traumatized child.

Here are specific ways to get started:

1. Read Erik Erikson’s psychosocial stages of development.

This can help you to better understand the emotional developmental delays of a child suffering from developmental trauma (which can create reactive attachment disorder). The child’s lack of trust and the narcissistic wound of the toddler creates an internal working model of entitlement and survival. He or she cannot allow the nurturing enemy in for fear of giving up control. The child lacks empathy for self and others in a genuine way. To judge empathy as a clinician is incredibly difficult given the child’s ability to charm, manipulate, and appear empathic.

2. Meet with the child’s parents to hear their struggles first.

Listen and join with the parents before meeting with the child or having the child join the family session. A child with reactive attachment disorder is a poor reporter of his or her own symptoms.

3. As you move forward, always remember that the family might need a referral outside of what you can provide.

Outpatient therapy is only as successful as the child’s level of severity and the family’s ability to parent a child with emotional and behavioral challenges. Some children’s behaviors are too severe to stay in the home. And a family’s safety should never be compromised.

4. If you determine that you might help the family, join with the parents to sort out the various issues present and create a family plan.

Develop a treatment plan to help the child become a “family kid”. Your goal should be to lead the family to create a circle of security around the child. In doing so, you may need to work with the parent’s triggers on the front end before you can integrate the child. Also, you may need to address a parent’s own attachment history once you’ve gained his or her trust.

It is far from easy to work with families of traumatized children. Things aren't always what they seem.

And you have to work extra hard to get to the root of the problem. No matter what you do, take your time to consider the whole family’s needs—it is how you best serve the child as well.

And about the mom I mentioned earlier...we must take reports of child abuse seriously, of course. But we must also realize the grave dangers of false allegations. Innocent parents can go to jail. Their children, both biological and adopted, can be removed from their safe and stable homes and placed in the foster care system. The only winner in that scenario is the disorder. And, in that case, the child and family always lose.


Forrest Lien, LCSW

Over the last three decades of his career, Forrest Lien, LCSW, has worked with children with developmental trauma and their families. He avidly shared his expertise to advance the field of trauma. He has consulted with 20/20, HBO, and The Today Show and has presented at over 300 workshops internationally on the effects of early trauma including at the Mayo Clinic. As founder and owner of Lifespan Trauma Consulting, Forrest and his colleagues continue his legacy of support and advocacy for families of children with developmental trauma. They consult and guide parents and clinicians and provide appropriate assessments, medication, and treatment options for reactive attachment disorder. Learn more about Lifespan Trauma Consulting services here.


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