In the first article I discussed some of the causes of Reactive Attachment Disorder (RAD). In the second, I talked about the symptoms of RAD in infants and children. In this article, I want to discuss treatment or intervention. These are my opinions, of course, based upon working with RAD children and their parents over the past ten years.
If you suspect your child may have RAD, pursue an evaluation. Seek out a clinician that has both training and experience in working with RAD. You may need to leave your area to attend a clinic that specializes in helping RAD children. There are new centers and clinicians being trained regularly. Increasingly, more clinicians can diagnosis RAD, but effective treatment certainly is still hard to find. It does not exist in every community.
Most RAD children can be helped through outpatient therapy. In the most severe situations your child may need placement in a residential treatment center. If you have not tried outpatient attachment therapy, I would recommend this intervention be tried first. I have seen dramatic results with severely troubled children using outpatient help.
When therapy is conducted, several modalities can be used: individual, parent, family and group therapies. In my experience, doing individual or group therapy with the RAD child is largely ineffective. This is because most RAD children lie, minimize, and deny their problems. Without the parent’s input, the RAD child can effectively fool or manipulate almost all clinicians. In a group setting, RAD children are not likely to be open or honest. Parents have not reported success when their children were in individual or group therapy. I use family therapy exclusively. The parents are always present when I work with their child. This gives me access to the truth. Without real facts, help is impossible.
Family therapy is the most effective modality for other reasons. Parents are the most powerful, responsible and influential people in their child’s life. They are the therapist’s greatest ally in helping a RAD child. Consequently, teaching and educating parents how to bond with their children becomes a major part of family-based attachment therapy.
The therapy needs to be confrontive. The RAD child cannot be given the choice of facing or talking about his problems. If the decision is left up to the child, he will generally meet for months or years and not discuss his present problems or past trauma. When the parents are present, he can be more accurately confronted with his issues. This makes the therapy unpleasant and difficult for the child. Until he has made significant progress in bonding to his parents, the child will usually detest the therapy. One rule of thumb for me has been, “If your child likes his therapy, it probably is not being helpful.” In all likelihood, therapy is fun because your child is allowed to avoid his problems and be in control of the process.
The most helpful attachment therapy also provides extensive help to the parents. Nothing in normal growing up years or adulthood prepares us to parent RAD children well. Parents of RAD children need information and training on how to therapeutically parent their children. The therapy should give parents ideas and skills that accomplish the following goals:
1. The therapy should educate parents about RAD. It should help you understand why your child thinks, feels, and acts the way he does. Understanding of your child often leads to increased feelings of compassion for him.
2. Therapy should teach you how to protect yourself from your child’s pathology. Most parents, particularly mothers, feel very frustrated, beat-up, and victimized by their child. In order for you to have more loving feelings for him, you will need to stop being assaulted or victimized by your child. Parents need help learning to secure their own safety in spite of their child continuing to be hurtful.
3. Attachment therapy should teach you consequential parenting skills. These skills will help you regain control of your child as well as create a bond with him.
4. The therapy should teach you bonding or attachment activities. Your child will not get over RAD through talking. Both in the clinician’s office and at home, the therapy should be experiential. These experiences should be designed to impact the whole person, his body, mind, heart and soul. Your child will never become bonded through a verbal, logical, thoughtful, insightful, analytical series of conversations whether conducted by a therapist or yourself. You will not bond your child by saying the most profound statement at just the right time.
5. Attachment therapy should teach you how to use holding for nurturing as well as for control. Holding is controversial both inside and outside the professional community. Your therapist should discuss the use of holding openly with you. As a result, you should be able to make an informed decision about what treatment is best for your child. Ultimately, it is your decision whether or not to use therapeutic holding in an attempt to help your child.
When Foster W. Cline, M.D. began working with RAD in the early 1970’s, little was known about RAD. Even less was known about how to help these very troubled children. It was apparent that they did not respond to conventional therapy. An innovative therapy called Holding Therapy (also labeled Rage Reduction Therapy) showed promise. Over the years, the therapy has been used by an increasing number of professionals. As more clinicians have used holding with RAD children, the therapy has been refined and redefined. As a result, a diversity of interventions exists among professionals using this modality. They all have the same label, namely Holding Therapy. While there are common threads, a wide variety of therapeutic activities now take place within the definition of Attachment or Holding Therapy.
Some attachment therapists do not believe in using the holding modality but many do. Some do not believe the parents should hold their child delegating that task only to therapists. Others teach parents to do most, if not all, the holding. Some use only nurturing holding while others also use holding for control (restraining or containing holding). Without talking to each specific therapist, a parent should not presume to know what a therapy involves just by knowing that the therapist does Attachment or Holding Therapy.
RAD children are almost always intensely angry children. If therapy is effective it will constructively address the child’s anger. One therapeutic goal is to reduce the child’s anger. When it works, this is a sign of success. Hence, the label Rage Reduction Therapy was fitting. Present attachment therapies, however, address a broader range of emotions, including intense fear and sadness. All attachment therapy of which I am aware has an emphasis on addressing the child’s troubling emotions versus being only a cognitive or behavioral approach.
The goal of therapy for a RAD child is not to reduce his anger or to change his behaviors. The ultimate goal is to attach or bond the child to his parents. The goal is not to develop a good relationship between the child and therapist, but between the child and his parents. As such the therapy is most accurately called Attachment Therapy. When your child becomes bonded, changes will take place spontaneously. Changes in emotions, behaviors, attitudes, and thinking will happen automatically.
RAD is a condition with a wide range of severity. Do not approach it lightly, hoping you can heal it yourself by reading several articles or books. While educating yourself is helpful, it is rarely by itself the solution. Seek help, for both diagnosis and treatment, as both are becoming more available. Many families settle for months or years of therapy with no appreciable improvement. Continue to search for a clinician who can help you and your child.
© Walter D. Buenning, Ph.D.
Credits: Walter D. Buenning, Ph.D.
1773 S. 8th Street, Ste. 202
Colorado Springs, CO 80906
Dr. Buenning has a private practice in Colorado Springs. Prior to working with adoptive families, he worked for twenty years in mental health centers in several Western states.