There are typically two types of therapies used for children suffering from attachment disorders:
- Parent-child interaction therapy
This is typically utilized when a child still resides in their natural home and it’s assumed the disorder arises from deficiencies in the way parents interact with their children. A therapist will observe the caregiver and child interact in natural settings and then offer guidance on how to respond in more therapeutic ways. Essentially, they function like a parenting coach.
- Cognitive therapies
Whether cognitive behavioral therapy, dialectical behavior therapy, or any of the other varieties of cognitive therapy out there, all work directly with the child to help them better understand the behavior of others while also recognizing how their own thought patterns trigger them into unhealthy responses.
Harmful interventions that SHOULDN’T be used
Because children with RAD and other attachment disorders can be so difficult to work with, caregivers are often willing to try just about anything in their desperation to change things. But this can lead to unwise decisions that make things worse. Here are some interventions you should definitely avoid:
Out-of-home facility treatment or institutional placement
Children with attachment disorders can act in violent or even psychotic ways, which means many parents or caregivers consider an in-patient psychiatric facility to help them. This is a mistake. As Lyons Hardy explains, “A short-term residential treatment facility would be an undesirable location for treatment because it involves frequent changes in both caregivers and peers and would discourage the formation of long-term bonds. …The most effective treatment would include remaining in a stable location with the same caregivers for a minimum of several years, and preferably until adulthood.” (Hardy, 2007, p. 38)
My personal belief is that in-patient facilities for children shouldn’t exist at all, but they especially shouldn’t be used for kids whose disturbances stem from an attachment disorder. Such a placement will only serve as another disruption to attachment that reinforces the underlying condition, throwing more fuel into the furnace that is creating these behaviors. You’re going to get a child back in worse shape than they left, because you’ll have only aggravated their wound. Keep them in your home unless you plan to abandon them permanently.
Rage reduction therapy, restraint, and forced affection
Candace Newmaker was 10-years-old when love killed her. As an adoptee from North Carolina, Candace was exhibiting signs of reactive attachment disorder. So her adoptive mother took her to Colorado for a 2-week intensive course in “attachment therapy.”
This facility practiced a dangerous and controversial method promoted by Rage Reduction theorists, in which children are held tightly against their will for extended periods of time. The belief is that this might force the rage out of them by forcing the type of close, intimate comfort they apparently lacked earlier in life. So Candace was wrapped in a blanket and held tightly for 50 minutes while she struggled to break free. During this session, which was being videotaped, Candace was smothered to death in a misguided attempt to show her love.
This wasn’t an isolated tragedy: At least 5 other children have died in recent years from similar types of attachment therapies. (Potter et al., 2009, p. 23) It amazes me that smart people who are so attuned about the source of a child’s rage could be so insanely stupid when it comes to the methods they promote for treating it.
For those of you who might ever consider such an intervention, here’s why this approach is wrong: Love can’t be forced, and forced physical affection isn’t love at all, it’s a form of violence. Trapping a child, holding them down, smothering them in a blanket and restricting their movement – such an invasion of their body autonomy – is only going to reinforce the idea that adults are dangerous, hurtful, overbearing, intrusive, and not to be trusted.
It’s going to make their condition worse rather than make them better. As the American Academy of Child and Adolescent Psychiatry states, “interventions designed to enhance attachment that involve non-contingent physical restraint or coercion…have no empirical support and have been associated with serious harm, including death.” (AACAP, 2005, p. 1216)
Those promoting this type of therapy may offer moving before and after videos in which defiant children suddenly become placid after an hour of forced contact and allow themselves to be picked up or held. The kids haven’t been cured, they’re in a state of shock, and such results will be short-lived. These type of intrusive techniques are not going to help you any in your long-term goals.