If your leg is broken, you see a doctor and likely come out with a cast. If your child skins her knee, you apply a Band-Aid. We crave answers and solutions to our problems. We like things to be black and white, cut and dried—if this, then that. But there's not a straightforward reactive attachment disorder treatment to heal the impact of early trauma on a child.
When my husband and I adopted from foster care, we knew the children would need therapy. Who wouldn’t with their traumatic pasts? I logged on to the Psychology Today listings and looked for local therapists who listed “adoption” and “trauma,” “child” and “adolescent” as specialties. I interviewed to find who I thought was a good fit. I thought I was on top of things. The kids’ social workers—the “experts”—had no more advice than this. The recipe was: permanency + therapy = success.
Our children didn’t want any more therapy, but we insisted. They saw their therapist once a week, sometimes twice. We were not invited to be a part of their therapy, but we met with their therapist occasionally for updates. Neither of the children were particularly engaged or forthcoming with her. Our daughter decided to make friends with the therapist and talk to her about surface-level stuff like dance team and homework. Our son—who many years later would be diagnosed with reactive attachment disorder—seized the opportunity to triangulate. The therapist fell for it and started seeing our parenting as the problem. She called us in so she and our son could say we were too strict. Of course, all our rules and structure had been built up by necessity, since he saw us at the nurturing enemy and fought us at every step.
Kids with reactive attachment disorder experienced abuse, neglect or inconsistent caregiving in their first three years of life. They learned caregivers are not to be trusted. They want to be in charge and rail against anyone trying to tell them what to do or trying to get emotionally close. The therapy we thought would help our son was actually making him worse. It was validating his belief that we were the problem. It’s a common problem parents dealing with reactive attachment disorder face.
What helps one child with reactive attachment disorder and their family may not help another. And, of course, the practitioner is just as important as the method. RAD Advocates asked parents what they’ve tried and what helped or didn’t help their family.
Among the approaches that some families felt helped were (in no particular order): neurofeedback, trust-based relational intervention (TBRI), eye movement desensitization and reprocessing (EMDR), equine therapy, wilderness therapy, residential treatment, supplements/diet changes, informed respite, correct co-morbid diagnosis and correct medications, attachment therapy or RAD-aware therapists who never see the child without the parents present (see guidelines below).
Just as often, survey respondents felt nothing they had tried helped.
“Talk therapy, play therapy, equine therapy, attachment therapy, in-home services, school-based services, biofeedback, acupuncture, chiropractic, diet modifications, eye tracking exercises, martial arts, brain balance, medications ... I'm sure I'm leaving something out. Never a candidate for EMDR due to lack of compliance. Nothing worked,” wrote one mother, echoing the sentiment of many survey respondents.
Asked what the biggest obstacles were to finding appropriate help, parents listed too narrow a definition of reactive attachment disorder, little understanding of reactive attachment disorder, misdiagnosis, lack of skilled/trained clinicians, services not covered by insurance, a lack of family support and blaming parents. Another huge obstacle is the child’s willingness to participate in treatment.
"My child is or seems to be unwilling to get better. He refuses to participate in most therapies, or learns what to say but isn't genuine. He is the biggest obstacle to his healing. Secondarily, so few people are familiar with reactive attachment disorder or have any experience. It's impossible to find a therapist who understands RAD," wrote another mother, again echoing the sentiments of many.
The therapy we thought would help our son was actually making him worse. It was validating his belief that we were the problem. It’s a common problem parents dealing with reactive attachment disorder face.
Another mother wrote: “Nothing was effective for the long term. I see improvement at times, and there are periods that are ‘better’ instead of ‘worse,’ but this is a lifelong issue. The best therapy would have been that which helped me to improve my skills of how to help her without enabling, how to keep engaged while setting boundaries. In other words, how to help her while not tanking my own life or those of my family.”
This brings up something that many parents did find helpful: Personal therapy to work on our own triggers, reactions and stress. This is something my husband and I did and found helpful to keeping our sanity.
Guidelines for Finding a Therapist
Finding an appropriate therapist is key for any chance at success. At the first Navigating RAD conference RAD Advocates put on in 2021, they provided guidance to parents for finding a therapist, which I’ll share here. You can also view and share the infographic here.
Eight ways to identify a qualified therapist for your child with reactive attachment disorder:
You feel understood. You’re comfortable that the clinician grasps your family situation and the disorder. You shouldn’t need to explain reactive attachment disorder and how it plays out in a family to a qualified clinician.
You’ve found a licensed professional. Some states allow people to practice without professional training. An affective clinician, however, has the necessary credentials.
The clinician specializes in reactive attachment disorder. While a variety of therapeutic techniques exist, no one person can master them all. It’s a red flag when clinicians say they do. Seek those who have had a RAD-specific training or first-hand experience with the disorder. University education typically includes minimal information about reactive attachment disorder, so a degree isn’t enough.
You’re never blamed for your child’s behaviors. A good therapist supports you as a parent. They should not advise you on how to parent in front of you child. Your child should understand that you are in charge, not the therapist.
You play an active part in your child’s healing process. While traditional therapists often establish and build trust individually with clients, such an approach isn’t effective for reactive attachment disorder. Your child’s therapist should consider you a part of the “therapy team” (rather than leaving you to sit in the lobby). This prevents parent-child-therapist triangulation (which is common with reactive attachment disorder and inhibits the relationship a parent tries to establish with the child).
The therapist (not the child) leads the therapy sessions. Some traditional therapists allow children to guide therapy. For children with reactive attachment disorder, however, this approach can make matters worse given the controlling and manipulative nature of the disorder. It is fine for the clinician to ask your child to check-in about how they are doing, etc. However, the clinician should have a plan for and direct every session with your child.
The clinician focuses on your child’s traumatic experiences rather than the fine details of past events. Your child needs to process, not recount, their trauma history. The therapist should lead your child through how they experienced and felt during past events, not the specifics of what occurred. Their memories may include inaccuracies and distract from the true work of healing.
The therapist meets where your child is developmentally, not chronologically. Your therapist should understand that trauma impacts the brain and tailor therapy accordingly. The ways in which a 16-year-old brain can articulate and process trauma, for example, is far different from that of a 5-year-old brain in a 16-year-old body.
If your current therapist is not a good fit, do not be afraid to switch. Ask around for recommendations, and try and find a therapist who meets as many of the above criteria as possible.
"Family therapy with an attachment specialist has helped the most,” one mom wrote in response to the survey. “While the sessions often are directed at what the ‘target kiddo’ needs, the therapist does an EXCELLENT job of staying neutral, building trust with everyone, re-framing my daughter’s behaviors so that my husband and I can have more empathy and helping to remind us adults to get the support we need (respite, individual therapy, etc.). It took a long time to find a therapist who really does respect and understand my daughter, while also holding us all accountable in a gentle but effective way. Meds also help.” (See this article for more information on medications and reactive attachment disorder.)
The road is different for all RAD families, but there is hope for everyone. With the right reactive attachment disorder treatment and the child's eventual willingness to change, some children can heal. With the right support and guidance, families can find solace and a path toward emotional and physical health and safety. Whatever your situation, keep your head up and continue to seek your own way forward.
About the Author:
Micaela Myers and her husband adopted a pair of siblings from foster care in 2015, when the children were 9 and 13. Since then, she has become an advocate for foster care reform and the support and education of adoptive parents. She was a member and is a supporter of RAD Advocates. Micaela earned her MFA in writing from Vermont College of Fine Arts and works as a professional writer and editor in Wyoming.