Dear Therapist: 7 things to know about reactive attachment disorder (from another therapist/RAD mom)
Updated: Mar 2
I remember the moment well.
My 4-year-old son was dumping tray sand onto the carpet of his therapist’s office. He stared right into my eyes while doing so, even as I asked him to stop.
“I feel as though you’re anxious and concerned that your son is making a mess,” the therapist said to me.
The therapist then looked at my son, smiled sweetly, and turned back to me. “Are you worried about how to parent him?” she said.
She clearly did not understand what was happening. At all.
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I began to cry as I explained my son’s long rages and violence toward me. I described his odd behaviors with food and how he smeared his feces around the house.
My son was too young to understand what he was doing, she said, again with a smile. She advised that I was likely too controlling and, as a result, my son was merely trying to assert his independence.
In other words, my son’s outlandish and confusing behaviors were my fault.
This was when my husband and I placed our newly adopted son on private insurance rather than the subsidy Medicaid coverage that followed him from foster care into adoption.
We quickly learned, however, that resources for reactive attachment disorder were still incredibly scarce even with good insurance and private pay. I learned that most therapists, no matter their years of experience, don’t understand the realities of reactive attachment disorder.
And the lack of resources presented another form of trauma in our family. We continued to follow the advice and feel shame from clinicians who didn’t understand the disorder. All the while, we continued to fall apart as a family. And our son was not getting better.
Our journey was so turbulent, in fact, that it led me to a career path as a trauma and attachment counselor. While it seemed no one else understood how trauma manifests in the parent-child relationship, I did.
Although I learned many things through my education and clinical training, my experiences as a mom gave me the clearest insight as a therapist. Actually, everything I know about therapy is credited to parenting several children who came to us through birth, foster care, and adoption.
From therapist (and mom) to therapist, here are 7 things to know as you work with children with reactive attachment disorder:
1. It is unfair and ineffective to blame those raising the child.
Trauma turns lives upside down for everyone in the home, not just for the survivor. Practicality develops with trust. We are doing more harm as therapists if parents cannot be honest about the treacherous and scary reactions in the home due to their child’s trauma history. I tell my clients that if they can’t lay their cards down in my office, I’m only working with half a deck. Nobody wins—not the parents, not the child.
2. You cannot simply psycho-educate post-traumatic stress away.
Trauma affects the brain. If you work with clients impacted by trauma, you must take it upon yourself to learn more about this relation.
3. You need to do your own personal work.
Without boundaries of your own, you can’t help a person who needs to heal from trauma. It is impossible to help a client if you feel entangled in his or her feelings. It is our responsibility as providers to shift and move in order to provide practical treatment.
4. Oftentimes, parents simply need the equivalent of a hot cup of tea.
I cannot tell you how many times a well-meaning caseworker or therapist offered me a book as hope for my child. That is not what I needed. I longed for a listening ear and a verbal reminder that the marathon is long but that the finish exists.
5. Labels don’t help.
Too often, clinicians stamp families as “high conflict” or “resistant to treatment”. Doing so leads to dead-end roads and hopelessness. Your clients have given you the courage to show up in your office for help. Even if you don’t have any answers, you can be their creative beacon of hope.
6. You can learn from them.
My children and clients teach me a bit more about how to remain present, creative, innovative, and humble every day. Even when I fail as a provider, my clients show up again. And there I find my humility and gratitude with the human experience.
7. We need support along the painful road too.
Many professionals do not even realize when they do a poor job due to their own barriers. It is vital to care for yourself. Arrogant, burned-out and unconcerned professionals—whether therapists, caseworkers, physicians, judges, lawyers, or politicians—do more harm than good. Some even lack the ability to address their own history of unresolved trauma. Thus, the cycle continues into their work. When we don’t address our own responsibilities, we contribute to the failure of trauma treatment.
I truly love what I do each day. That doesn’t make it easy though—I get it. But when I finally crash into bed, I am exhausted and thankful to have seen healing come full circle. Just like trauma survivors and their parents, we need to keep track of the end of the tunnel when we’re in the dark. We are each human and vulnerable. And we all need the light.
Andrea Shindle has parented several children with reactive attachment disorder through her journey as a foster and adoptive mother. Those experiences led her to a career as a clinician in trauma, attachment and family and parenting issues. Andrea is a licensed professional and national board-certified counselor with a master of arts degree in couples and family counseling. She is a member of the American Counseling Association. Andrea has presented on trauma-informed care, vicarious trauma, self-care and principles of attachment and trauma in the classroom to professionals in various organizations. Andrea has a private practice in Greely, Colorado and is a court-expert witness on developmental trauma, complex trauma and bonding and attachment.