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Why Therapeutic Parenting is the Last Thing You Should Do With a Child With Severe RAD

Updated: Sep 19, 2023



When my husband and I began our foster/adoption journey, we believed that therapeutic parenting—providing a safe, consistent, and nurturing environment—would heal any child who entered our home. Every clinician we spoke with confirmed this popular theory.


It never once occurred to us that therapeutic parenting could fail and make a child more ill.



Due to my professional interests, I knew how the nervous system formed and how trauma and chronic stress alter its development. Yet, I also knew that the nervous system is incredibly plastic, especially in young people. My husband and I were familiar with attachment theory—that children need to develop a relationship with at least one primary caregiver for healthy social and emotional development.


Our foster care training reinforced the belief that love, time, and consistency are all that kids who’ve endured trauma need. That was easy, we thought. We were ready to give him a ton of love and stability. But we didn’t realize that our son wasn’t ready to receive it.


The lovely notion of therapeutic parenting (for children without reactive attachment disorder)


Therapeutic parenting is a term that most foster or adoptive parents have heard at some point in their journey. There are countless books, seminars, and YouTube and Tik Tok videos on the subject. I read most of the books. My husband and I trained in several of the named techniques.


Mitchell (2008) defines therapeutic parenting as "characterized by routine and consistency, acceptance, and containment whilst also promoting a focus on the critical emotional aspects of the carer-child relationship, offering love, nurturance, security, and belonging."


Our foster care training reinforced the belief that love, time, and consistency are all that kids who’ve endured trauma need. That was easy, we thought. But we didn’t realize that our son wasn’t ready to receive it.

Through therapeutic parenting, parents ideally provide the traumatized child with a safe and nurturing environment that was denied early on, thus allowing the child to heal.


The end goal of therapeutic parenting is that the child feels safe enough to self-regulate emotions and trust themselves and others, leading to prosocial behaviors and healthy relationships.


For many traumatized kids, therapeutic parenting is effective. I will never claim that my husband and I are perfect therapeutic parenting parents, but it is working well for two out of three adopted children in our home. Yet, those two children didn’t fall toward the severe end of the spectrum for reactive attachment disorder. That is the difference.


The problem with therapeutic parenting for a child with reactive attachment disorder

It wasn’t until years into our foster/adoption journey that a therapist uttered the words reactive attachment disorder, simultaneously blowing apart my paradigm of parenting trauma, and making sense of my lived experience.


There are two fundamentals of therapeutic parenting that are flawed in relation to kids with reactive attachment disorder. That is:

  • Therapeutic parenting stems from the assumption that every child is willing to heal, wants to heal, and is able to heal. It assumes they can feel safe, can trust, and can self-regulate.

  • All of the responsibility for the child’s healing falls on the parent’s ability to therapeutically parent, assuming that the child is open to their parenting.

My husband and I believed these fundamentals at the start of our therapeutic parenting journey. But the key problem is in the child feeling safe.


“A child with reactive attachment disorder can’t reap the benefits of therapeutic parenting until they let their guards down to trust safe adults,” says RAD Advocates President Amy VanTine. “That requires professional help. Parents can’t do it alone. In fact, attempting to do so can make matters worse.”


The paradox of reactive attachment disorder is that safe, nurturing people feel triggering to a child with reactive attachment disorder. Whatever their circumstances, kids with the disorder did not feel safe early in their lives. Therefore, the child is left not wanting, not willing, or not able (or some combination of all three) to feel safe, trust, or be vulnerable around parental figures.


The safer, the more loving, the more patient, the more consistent, and the more therapeutically you parent a child with reactive attachment disorder, the less safe that child will feel if they're not ready for it.


Healing does not and cannot occur if the child sees the environment as threatening or hostile. Healing only occurs when the child feels safe. Safety leads to trust. Trust leads to vulnerability. Vulnerability leads to healing. It all starts with feeling safe, not actually being safe. Simply telling the child that they are safe does not mean they will feel that way.


When therapeutic parents turn into nurturing enemies


It is usually the primary caregiver, the person who spends the most time parenting and trying to connect with the child, who becomes the nurturing enemy, a term coined by Nancy Verrier in The Primal Wound. The phrase says it all and strikes at the heart of every parent who has loved a child with reactive attachment disorder.


As profoundly sad as it is, intimacy is the trigger for kids with reactive attachment disorder. They will do anything to get away from the threat—the therapeutic parent/nurturing enemy.



Before I understood the concept of the nurturing enemy, I had a mantra I would repeat to myself every time my child behaved poorly or raged; “I am an immovable mountain. I will not be swayed.” I was fully committed to being the loving, accepting, stable, steady, regulated, consistent, and safe person my son needed to heal. I saw the need behind my son’s behavior.


The safer, the more loving, the more patient, the more consistent, and the more therapeutically you parent a child with reactive attachment disorder, the less safe that child will feel if they're not ready yet.

I was patient and calm. I never lost my cool, even in the presence of hours-long rages or physical assaults. I demonstrated my trustworthiness so my son could feel safe and begin to heal. I put all the weight of his healing on my therapeutic parenting shoulders. Little did I know that, by doing this, I was causing more harm to both of us.


The closer I tried to get to him, the more exhausted I became and the more terrified he felt.


Living in a neverending cycle of behaviors


Early on, my child would mommy shop. Whenever he was upset with me, he would exclaim, “I want a new mommy!” Or, when we were out, he would approach other women and ask them to be his mommy. Initially, I passed it off as a phase that would subside the longer he was in our home. Because time, love, and consistency were supposed to heal him.


I didn’t know at the time that his mommy shopping was a red flag for reactive attachment disorder (or even that RAD existed). After all, I was mommy #3 or #4. Of course, he would believe that mommies are disposable. I would explain to him that I wasn’t going anywhere, no matter what. We read a book called No Matter What together every day.


Over time, I finally decided I had to accept and normalize his behavior. But that didn’t mean validating, mollifying, or even finding the “why” behind it. I accepted his fear that I would abandon him like mommies #1, #2, and #3 had, and his belief that mommies were interchangeable. I stopped reacting to it. And when I stopped trying to change it, the mommy shopping stopped.


I put all the weight of his healing on my therapeutic parenting shoulders. Little did I know that, by doing this, I was causing more harm to both of us. The closer I tried to get to him, the more exhausted I became and the more terrified he felt.

But then another behavior popped up. I would normalize and accept that behavior and it would stop. Then another would pop up. I would normalize and accept that behavior and it would stop. Behaviors popped up and I normalized and accepted them repeatedly. It was a never-ending cycle that I hoped would end one day when he saw that I was safe, stable, and trustworthy.


I held onto the belief that time, love, and consistency would cure my child eventually. People on our team, therapists, wraparound, school staff, etc., continued to encourage me to do more of the same. They told me I was doing everything exactly right.


Therapeutic parenting pushes a child with reactive attachment disorder past their limits


It was five years into our journey before a social worker minced no words. He said, “This isn’t going to get better. You need to start making plans.” At the time, I was utterly offended that anyone could believe, or for that matter say out loud, that a child wouldn’t get better in a therapeutically parented home.


I also had no idea what he meant by making plans. RAD Advocates, an organization that guides RAD parents through safe options for the family, didn’t exist yet. And it would be another six months before I heard of the term reactive attachment disorder.


After the encounter with the social worker and without any better ideas, we continued therapeutic parenting. I started to track behaviors and rages and realized they were somewhat predictable. It seemed my son was trying to find my limit of normalizing and accepting behaviors. I especially noticed how the slightest moments of vulnerability lead to rages.


After a particularly intimate and vulnerable moment one day, I braced myself for an inevitable rage. Sure enough, I heard a crash from his room followed by crying the next day. I rushed to help him. He had a welt on his forehead. I gently washed his forehead, applied ice, and asked him what happened. He looked me dead in the eyes and said, “It doesn’t matter what happened, I’m going to tell my teacher you did it and you will go to jail.”


My son was so terrified of trusting me that he caused himself injury to try to get rid of me. I had pushed past what he could handle.


Therapeutic parenting pushes a family past their limits


After following through on his plans, my son eventually confessed to the investigator that he intentionally hit his head on a metal bed frame to get me in trouble.


The investigator suggested I take his confession as a sign of remorse. Maybe it was, maybe it wasn’t. But, we were now forced to focus solely on safety for both of our sakes. I realized that the patience, consistency, nurturing, and love I’d demonstrated over the course of years had gone too far. Therapeutic parenting had not honored his limits or mine.


After that incident, I stepped back and allowed my husband and the wraparound team to take over the day-to-day management of our son. I kept searching for answers, but no one seemed to have any new ideas other than it was past time to look for out-of-home placements.


We applied to dozens of placements, such as therapeutic boarding schools and residential treatment centers, only to be rejected time and time again. It was too late. His behaviors were too much for them to handle.


I realized that the patience, consistency, nurturing, and love I’d demonstrated over the course of years had gone too far. Therapeutic parenting had not honored his limits or mine.

For both of our safety, I could no longer be alone with our son. We tried a variety of schedules and living arrangements to limit the amount of time we had together. None of it was sustainable.


Over the course of the year that followed that incident, on rare occasions when he and I were alone, he would become enraged and violent. In the end, our family was so broken that we made the choice only desperate parents make. We relinquished custody of our son to the state and ultimately relinquished our parental rights.


Therapeutic parenting as the end goal, not the beginning


In retrospect, I wish I would have listened to the rare voices that warned us about the path we were on. I wish I had known, before adopting, about reactive attachment disorder. I wish I had probed the social worker about what “making plans” meant. I wish I had known about therapeutic boarding schools and residential treatment centers sooner.


I wish I had known about RAD Advocates. I wish I had known the financial, emotional, social, professional, and spiritual costs that awaited my family for not heeding those warnings. Maybe we wouldn’t have stayed so long on the therapeutic parenting path that made him more ill. Maybe we could’ve found the right help while he was still young.


While our family learned these lessons too late, maybe they come just in time for you or a family you know. Recognize the signs of reactive attachment disorder. Find good help. Understand that you can’t do this alone.


There’s hope, but it doesn’t come as easy as love and a stable home. If only. For kids with reactive attachment disorder, love and therapeutic parenting must come after some healing. Not the other way around.



References


Mitchell, J. (2008). A case study in attempted reform in out of home care: A preliminary

examination of the introduction of the circle therapeutic foster care program in

Victoria. [Masters thesis, Monash University[.

Verrier, N. (2003). The primal wound: Understanding the adopted child. Louisville: Gateway

Press.


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4 Comments


I am sorry. Your description of normalizing one escalated behavior after another is a perfect example of the "frog in a kettle" syndrome. Cindy, I am not sure Allison used a specific intervention model. In reality, I think all foster and adoptive parents are (or should be) therapeutic foster parents. She describes her approach above. Would you suggest if she had followed one of the specific models you list below she would have been successful?

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Thanks! I know some of these, but not all. We've had great luck with an OT who does the same thing with our son. I feel like our kids attachment with us is pretty good, but one thing we have struggled with is setting boundaries, because of the extreme reactions from our daughter. Our son will get angry, swear, slam doors but after a while will usually accept the limit, which is annoying , but a normative resonse from teens, I think. I am interested to see see what I can learn about the interventions that I'm not familiar with. Many programs have at least some good online, I know.

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Allison, thank you for sharing such a difficult journey. My heart cries for this child and for you. What therapeutic parenting program did you use, e.g. PACE, TBRI, Integrative Parenting, Unplowed Ground, Imago? Thank you, Cindy

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