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What does Treatment for RAD Look Like?

What is the difference between Traditional Therapy and Treatment for RAD?

A child with cancer should be taken to a doctor who specializes in cancer. A child with an abscessed tooth should not be taken to a proctologist for healing. With Reactive Attachment Disorder children need treatment for the condition they have. Children with this disorder exhibit extreme levels of behavior and manipulation. A therapist who is not trained to deal with these extremes can do more harm than good. According to Bessel VanderKolk MD of Harvard, “Traditional therapies are useless for people effected by trauma but especially for children because it does not reach the parts of the brain that were most impacted by the trauma.”

Therapy for attachment  uses the mother as the change agent to heal the broken bond between mother and child. Traditional therapy leaves the mother in the waiting room–not a part of the healing of the child. The focus in this treatment is on building trust in the child toward the mother, traditional therapies deal with building trust in the child toward the therapist.

Traditional therapies have consistently failed with children with Reactive Attachment Disorder. This is due to the fact that therapies such as: talk therapy, play therapy, and sand tray therapy, are based on establishing a relationship with the client – and then using that relationship as a trust base to help the child deal with their issues. In this situation they have a relationship disorder and struggle with trust issues.

What are the Treatment Goals?

The goals in treatment are to:

  • Put the mother and the child together in a healthy relationship
  • Give the child a safe place to release and resolve their past trauma
  • Build the child’s skills to use their words rather than actions to express themselves in a healthy way
  • Support and guide the parents with effective home interventions for behaviors

The Bad News

I have found lots of caring professionals that do not know that they do not know how to treat RAD. They have no training in this area and should refer the family to someone who. It is unethical and just plain WRONG when they don’t!

I worked with a family that had hired a therapist, calling himself an “Attachment Therapist”, that wasted fifteen months of a child’s life in weekly therapy sessions. He told the parents that he was working on establishing trust with this child with RAD so that he could begin to work on the child’s issues. He had decided that the child was not ready to deal with tough issues, while he continued to charge the parents the $100 a week for this quackery. If you had a toothache and three months later the dentist had not been able to resolve it or at least improve it, would you change dentists? Would you wait fifteen months? Unless I see visible improvement within six weeks I will look elsewhere for a new therapist.

Therapists trained in attachment work confront issues with the child in a timely manner. They realize that the painful issues of the child’s abuse/abandonment/neglect/pain are carried inside the child every minute and every day of their life. Surgeons don’t wait until a tumor is big enough to take it out. Attachment therapists don’t wait until the child’s childhood is over, family is destroyed – months and years of learning opportunities are wasted – before dealing with vital issues.

Children with RAD lie, manipulate and con. If they are taken behind closed doors with an adult who doesn’t live with the child, the child will use that opportunity to fine-tune their skills in manipulating, conning, and lying to the therapist. This causes tremendous regression in the child’s behavior. Trained treatment providers base the progress of the therapy on the child’s behavior at home, not the façade the child shows in the office. A mental health professional working with this population should be skilled at breaking through that façade and getting to the ‘real’ child, so that they can express their feelings and embrace honesty. As children are able to become emotionally honest about their feelings in therapy, they are more likely to volunteer the truth about other things. A therapist working with a child with Reactive Attachment Disorder must be trained to ‘listen’ to the child’s behavior, not their words – to actively listen to the child’s feelings, not their words. Loving acceptance by the mother of the child’s genuine feelings is a vital part of the bonding work. The rage that comes out continually with the child’s behavior must be released in a therapeutic environment in order for everyone to be safe.

The Good News

These children can heal! Eye contact, touch, movement, smiles, and the sharing of sugar between the mother and child are keys to bonding that the trained, skilled therapist works toward in each session. Dr. Foster Cline says, “It takes about one month for every year of age that the child is, to complete the majority of the healing.” So, a five-year-old would require about five months of therapy, a ten-year-old, about ten months. If the child has been placed out of the home in the previous two years the time doubles. If there is an organic problem such as Fetal Alcohol Syndrome, the time needed to heal is unpredictable.

Proper treatment is used to dissipate the rage in order that the heart-to-heart connection can begin. More traditional therapies such as talk therapy, play therapy, and sand tray therapies, can then be beneficial. A child with a broken heart needs a therapist who knows how to mend that heart. A  Therapist trained in treating attachment and trauma has the tools to do the job.

My non-profit is currently gearing up and planning a cutting edge training for mental health professionals who would like  more skills in this area. If you have a heart for these wounded children and their families please email us and we will send you the details as soon as we have them.  Nancy@attachment.org