top of page

Why Traditional Therapy Doesn't Usually Work (and Can Even Make Things Worse) for Kids with Reactive Attachment Disorder

Updated: Jan 31


Why Traditional Therapy Doesn't Usually Work (and Can Even Make Things Worse) for Kids with Reactive Attachment Disorder


If you’re parenting a child with reactive attachment disorder (RAD), you likely knew early on that the child is different from other children. We knew the first time we met our son Joe* through foster care. We assumed he was just a traumatized toddler in a new environment with strangers, which he was. But we hadn’t learned anything about reactive attachment disorder at that point.


Joe spent most of the first weekend with us vacuuming with his toy vacuum. He was not interested in interacting with us. He had food aversions. He didn’t sleep. 



We listened to everyone who told us that Joe just needed stability. We adopted him and expected that it’d take time for him to settle into our family. But, as time went on, the behaviors only escalated. 


As any concerned parent who didn’t know what was going on with their child would do, we sought out therapy. I asked family and friends for recommendations. We ended up at a child psychologist’s office who told me to read the book 1-2-3 Magic! to parent better. 


That therapy visit, when Joe was 4 years old, began a years-long journey of searching for answers and professionals to help us. I followed all of the parenting advice, trauma-related or not, I could find. But Joe’s reactive attachment disorder, for which we still did not have a diagnosis (and still hadn’t heard of), was impacting the entire family. 


We listened to everyone who told us that Joe just needed stability. We adopted him and expected that it’d take time for him to settle into our family. But, as time went on, the behaviors only escalated. 

More often than not, professionals offered solutions we had already tried or simply validated our efforts. Some therapists, usually those associated with hospitals or county agencies, actually did more harm than good. When I did find the rare gem of a therapist who understood what was happening with Joe and in our family, it was too little too late.


Over the therapy journey, I learned that an inexperienced therapist or one that doesn’t specialize in reactive attachment disorder is often worse than no therapy at all. Here’s why:


1. A child with reactive attachment disorder can’t talk out their preverbal trauma.


Because their trauma happened during critical neurological development before a child can verbalize and process life events, a child with reactive attachment disorder doesn’t have conscious memories of the early trauma. Reactive attachment disorder is caused by a disruption in the attachment cycle during the first few years of life. The disruption, whether due to abuse, neglect, frequent caregiver changes, or other reasons, causes the child to feel unsafe and mistrusting of adults. 


Children with reactive attachment disorder don’t know how to put words to how that subconscious trauma makes them feel. This leads to a baseline angry or fearful and hypervigilant disposition without them consciously knowing why.


As any concerned parent who didn’t know what was going on with their child would do, we sought out therapy. I asked family and friends for recommendations. More often than not, professionals offered solutions we had already tried or simply validated our efforts. Some therapists, usually those associated with hospitals or county agencies, actually did more harm than good.

The book The Body Keeps the Score by Bessel Van de Kolk puts forth the thesis that traumas, especially preverbal traumas, are stored on the unconscious level of the brain and within our body tissues. Our bodies respond to triggers from traumas that we do not consciously remember. This explains the development of many chronic mental health issues with which people struggle. Even though children with RAD do not have a conscious memory of their early life trauma, their bodies, and nervous systems still react to it. 

Because children with RAD don’t understand why they’re angry, fearful, and hypervigilant, they are prone to making up reasons to justify their feelings. Once that happens, they can blame their behaviors and various other things on these false reasons. It is a vicious, self-reinforcing cycle.


An example of this is the time my son Joe ended a family visit in a fit of rage. He was in an out-of-home placement and our entire family had gone to visit him. We were playing cards. My two other sons and I had both lost and were quietly coloring, waiting for Joe and my husband to finish the game. When my husband made a seemingly innocent comment about how Joe was shuffling the cards, Joe immediately started yelling and flipped the table. We ended the visit.


Our bodies respond to triggers from traumas that we do not consciously remember. This explains the development of many chronic mental health issues with which people struggle. Even though children with RAD do not have a conscious memory of their early life trauma, their bodies and nervous systems still react to it. 

The next day, Joe called to apologize. When we asked him why he got so upset, he responded, “Because she [meaning me, his adoptive mom] was being mean and telling me how to shuffle the cards.” I wasn’t involved at all. I was sitting at an entirely different table silently coloring. 


Because Joe’s baseline disposition is anger, especially at me as his nurturing enemy (read more on that here), his brain recoded the event to match his feelings and beliefs. I  had done something to anger him in his mind, not my husband. When we corrected Joe and said my husband was the one who commented on his shuffling, he accused me of lying to him. Joe needed me as his reason to justify his feelings of anger, lack of safety, and mistrust that were created years before we met.


For a therapist to chat with Joe about my alleged card-shuffling offense wouldn’t help because it never happened. They’d be spending a lot of time on a fictitious event based on made-up reasons and feelings. And it’d only lead to a further divide from our family members who had their own feelings about what actually happened and the lies he was perpetuating. 


2. Effective therapy requires voluntary and honest participation that children with reactive attachment disorder avoid.


Children have control over what they do or say in therapy. And because children with reactive attachment disorder crave a sense of control, they exploit whatever control they do have. They do so to feel safe and avoid vulnerability. That said, they’ll often take control of therapy sessions.


In talk therapy, children with reactive attachment disorder often either refuse to talk, lie, or manipulate the therapist. I sat through countless therapy sessions where Joe climbed on furniture, tried to pick fights with the therapist, answered in nonsense noises, or sat silently glaring simply to avoid participating.


Therapy modalities that require as little voluntary participation as possible often work better for children with reactive attachment disorder. One example is neurofeedback which utillizes technology for the brain rather than interaction primarily with the therapist. 


3. Children with reactive attachment disorder often manipulate talk therapy sessions. 


Talk therapy is great for people who have the willingness and capacity to assess their own behaviors and motivations honestly and critically. As already mentioned, however, children with reactive attachment disorder often are not honest and crave control. Because children with reactive attachment disorder often start therapy early in their lives, they become therapized. Therapized usually refers to the positive effects of receiving therapy. Children with reactive attachment disorder, on the other hand, become so well-versed in the language of therapy that they can easily manipulate an unknowledgeable therapist. The therapist might believe the child is improving because they’re saying all the right things or that they have issues they don’t actually have.


Joe could easily list off inappropriate behaviors and his coping skills for a therapist. He could craft an excellent apology, even admitting responsibility for his behavior. But outside the therapist’s office, he continued the same maladaptive behaviors and refused to employ his coping skills. And the older he got, the more he justified his behaviors. 



Inexperienced therapists can also inadvertently create more opportunities for children with reactive attachment disorder to manipulate, whether in their office or elsewhere. 


Once during an intake, the therapist asked Joe if he’d ever had thoughts of harming or unaliving himself. He was young and had been shielded from this up to this point.  He earnestly asked, “Why would anyone be stupid enough to do that?” As his parent, I knew this was his genuine feeling towards the idea of suicide.   


The therapist, however, took the topic and the question quite seriously. She explained how people become so depressed that they simply can’t go on. Over the course of the appointment, Joe intermittently asked probing questions about depression and suicide.  The therapist was grave and serious in all her responses. He learned it’s a big deal that gets attention. 


For months after that appointment, Joe claimed depression and suicidal ideation every time he didn’t want to do something. I got multiple phone calls every week about how Joe had to go to the nurse’s office, suspiciously around the time the class was working on math, due to his crippling distress. This finally ended when he claimed suicidal ideation at his pediatrician’s office. The doctor, knowledgeable about reactive attachment disorder and familiar with Joe’s tactics, knew he was testing to see what would happen. Thankfully, the doctor handled it in a way that ended all talk of depression and suicide going forward.


Children have control over what they do or say in therapy. And because children with reactive attachment disorder crave a sense of control, they exploit whatever control they do have. They do so to feel safe and avoid vulnerability.

For Joe, therapy became a game of how to beat the system rather than an earnest attempt to learn how to regulate himself and how to trust others. Sometimes, no therapy is better than the wrong therapy when it comes to working with children with reactive attachment disorder.


4. Many professionals do not understand reactive attachment disorder and how to work with families who are dealing with it.


One misunderstanding about reactive attachment disorder is that only the child is struggling. Yet, reactive attachment disorder affects every member of the family. The nature of the disorder leads to family instablity. And the child cannot begin to heal in an unstable and chaotic environment – which, ironically, is what they create.


Unfortunately, many people don’t understand reactive attachment disorder. This includes professionals. Universities offer little education on the diagnosis for those likely to work with clients, patients, or students with reactive attachment disorder. The lack of professional education puts therapists at a particular disadvantage in effectively working with families with reactive attachment disorder.


For Joe, therapy became a game of how to beat the system rather than an earnest attempt to learn how to regulate himself and how to trust others. Sometimes, no therapy is better than the wrong therapy when it comes to working with children with reactive attachment disorder.

Traditional therapists are taught to meet individually with their clients to build trust. But this is a dangerous practice for children with reactive attachment disorder. As mentioned in the previous bullet, children with reactive attachment disorder often lie and manipulate therapy sessions. A private audience with someone eager to build rapport with them gives them ample opportunity to do so. Many children with reactive attachment disorder make false allegations against their family members, including in therapy. 


Because children with reactive attachment disorder have a keen survival-based skill in manipulating relationships, they can convince a therapist that rapport has been established. Inexperienced therapists will not understand that the child is, in fact, manipulating them and the child continues to distrust them. 


 

When given the chance to triangulate their parents and other adults against each other, the child with reactive attachment disorder maintains the sense of control that they desire. While this makes them feel safe, it only works against them in having a stable and healthy home


5. Felt safety, not past trauma, is the primary issue for kids with reactive attachment disorder to work on.


After they believe trust has been established, traditional therapists often work to dive into their client’s past trauma. They attempt to get down to the event, or events, that have caused their client to become anxious, distrustful, depressed, angry, and fearful. As previously stated, however, children with reactive attachment disorder often do not remember the trauma that created their anger and fear.  


Rather than focusing primarily on the trauma events, effective RAD therapists first work on establishing trust between the child and their healthy parents, not themselves.

The primary issue for children with reactive attachment disorder isn’t their trauma. It’s their lack of felt safety that is at the heart of the disorder and the subsequent behaviors that manifest. Rather than focusing primarily on the trauma events, effective RAD therapists first work on establishing trust between the child and their healthy parents, not themselves.

The traditional method of therapy is opposite from what a child with reactive attachment disorder and their family needs. 


6. Many therapists push attachment too soon with children with reactive attachment disorder and their "nurturing enemy".


Some therapists, including ones who consider themselves trauma-informed and in-home therapists, do not understand the concept of the nurturing enemy, a term coined by author Nancy Newton Verrier's book "The Primal Wound". The term refers to an adult, often the primary caregiver, who attempts to get the closest to the child. Because the child fears attachment, they fear that adult. Many of their behaviors are attempts to reject or create distance from that person. In return, that adult experiences trauma from their living situation with the child.


Both the child and parent needs to feel safe with one another before they can work on attachment. If attachment is pushed too soon, the child feels more afraid and will act out all the more to escape the primary caregiver. This only leads to further division between the parent and child, fueling the fire for everything from false allegations to adoption disruption. Of course, such a result is not what the clinician intents.


We had a reactive attachment disorder specialist design a therapy program for our family. It started with sessions with me – as the nurturing enemy that Joe most feared – and Joe. Once Joe and I established a baseline of trust, my husband joined as my support. We demonstrated a unified parental front for Joe. Once that was established, our other children would join in for full family therapy. This is the sort of arrangement a therapist trained specifically to work with reactive attachment disorder can provide.


Find a Different Path for Your Child with Reactive Attachment Disorder


While there’s nothing easy about parenting a child with reactive attachment disorder, hope is not lost. It is a matter of forging a path that isn’t traditional or typical. After all, you’re not parenting a neurotypical child. It is a matter of trusting ones intuition — that something’s-not-right feeling — early enough to step off the traditional path that everyone will tell you to follow. 


Since many professionals haven’t attained the experience or education necessary to work with your child, you’ll need to rely on yourself as the expert on your child. As uneasy as that may feel, start to respectfully expect professionals to treat you as such. If they do, you’ve probably found the right people to support you. If not, keep looking until you do (here's a guide to get started on finding a good therapist and you could also attend NavRAD).



*name changed to protect identity


About the Author:


After parenting a child with reactive attachment disorder (RAD), the author is passionate about furthering advocacy and education for RAD families. She hopes that, one day, other families will receive more support, understanding, and empathy than hers did. For now, she chooses to remain anonymous until that time comes. But she continues to volunteer for RAD Advocates in their mission to educate and advocate to equip families, communities, and professionals to effectively support children with reactive attachment disorder.


1,564 views1 comment

1 Comment


I felt every word of this very deeply. The years of incorrect therapy damaged the relationship with my RAD son beyond repair. The disdain and disgust I received from therapists when I tried to educate them on what I had meticulously researched about RAD really angered me. I could not convince anyone that time alone with my son would only lead to false allegations, manipulation and triangulation. The lies amazed me. I spent so much energy trying to prove to therapists that my son was lying. About everything. I can completely relate to being the said cause of a problematic situation when it was not me. Often when I wasn't even around. And I had no support or ba…

Like
bottom of page