I am writing this post tonight because I've had it. I'm exhausted and saddened by the stories of parents who have been "helped" by "attachment therapists." This "help" has basically consisted of indoctrination into methods that are at best, misguided and only anecdotally effective, and at worst, abusive.
These parents are coping with a child's behaviors as they spiral out of control. This might include aggression, lying, stealing, hoarding food, and controlling behavior. Parents are desperate, willing to do anything for relief, willing to follow anyone who offers hope. I don't blame parents for falling prey to some of these dangerous methods. But I am sad for them, and with them, for their child's lost years of potential healing when this happens.
If you've been exposed to the concept of "attachment therapy" for children, chances are you've heard of some of the wild interventions out there- the most newsworthy of which was "rebirthing" which actually resulted in a child's death. Because historically there was a lack of focus around helping children with histories of profound trauma and neglect, many controversial models of treatment sprung up and continue to prosper without any real evidence to support them. Some of these models further reinforce family dysfunction and isolation rather than promote true healing for children.
It is so difficult for parents to sort through the self-proclaimed "attachment experts" and know which interventions, models, and therapists could be potentially harmful, particularly when a child's behaviors have escalated to the point that parents are so desperate and hopeless. Today I will list some "red flags" for families to watch for in a potential or current therapist. I hope that this can help even just one family to find an intervention that supports, heals and empowers their child, rather than one that hurts.
Red Flags for Parents:
The therapist acts as if she knows everything about your child based solely on a diagnosis of Reactive Attachment Disorder or "RAD."
If a therapist spends more time talking about "RAD kids" or "these types of kids" than about YOUR particular child and YOUR particular situation, that is a big problem. It creates an "self and other" mentality that alienates you from your child. Therapists like this often mysteriously have full caseloads of children with "Reactive Attachment Disorder"- an extremely, extremely rare condition. As a point of reference, in my work with troubled children over the past 8 years, I have not met a single child who would be classified as having a true Reactive Attachment Disorder, as described in the DSM-V. (However, many children come to me having been diagnosed with Reactive Attachment Disorder by those unfamiliar with the condition).
The therapist places all the blame for the dysfunction in the family on your child, never asking parents to consider their role.
Attachment problems are RELATIONSHIP problems, not child problems. If your therapist never encourages you to understand your half of the equation, she is doing your entire family a great disservice. Healing a child with an attachment problem requires healing that child's most important relationships.
The therapist urges parents to see any attempts by the child to connect, show empathy or remorse, or act in an otherwise functional manner as "manipulation" or "charming."
Children who have survived trauma often relied on manipulating and controlling the adults around them to survive. They may continue to use manipulation and control in order to feel safe. However, when a child's efforts to connect (genuine or not) are discounted, that child will feel hopeless about change. How can a child ever truly grow and heal if each small positive step they take is disbelieved by those most important to them?
The therapist encourages parents to limit the child and family's contact with the outside world.
Some therapists will encourage parents to only socialize or seek support from other "RAD parents;" others will point out that your child must "attach" to you before developing any other relationships.
Creating isolation is a method that abusive people use to psychologically weaken and control their victims. Never trust someone who actively encourages you to stop trusting the trustworthy people in your life.
The truth is that all of us have unique and painful experiences at times. Others can understand and will care about your predicament if given the chance. A great therapist will encourage you to connect with others for support!
The therapist cautions that other professionals won't understand her methods, but "this treatment is the only thing that will work."
Nowadays, there are many fantastic and evidence-based models of treatment for attachment-related problems. Anyone who disagrees with this either egotistical or ignorant. And anyone who asks you to hide their methods from other professionals is not trustworthy!
The therapist encourages placing your child outside of the family home, such as in a homeless shelter, relative's home or therapeutic foster care, to help them "long for how good they had it with their parents."
This sort of intervention generally increases attachment insecurity as your child learns that you won't be there to support them in their darkest moments and that they can't count on you. This doesn't generally improve behavior in the long term, but instead creates emotional abandonment: Something that can and does traumatize children.
(A caveat here is that placing your child outside your home may be important if you feel you cannot protect or nurture your child.)
The therapist advocates withholding food, water, touch, affection, or social experiences with others as punishment.
Using your child's basic needs as a method of coercion and control is a recipe for disaster. The Department of Social Services will view many of these "interventions" as abuse or neglect and could even remove a child from your care for following these "treatment methods." This certainly won't heal your child.
The therapist encourages parents to override their instincts. She shames parents who question her methods.
Therapy should be a dialogue in which your therapist partners with you and teaches you, but also learns from you. In good therapy, you should feel even more strongly connected to your deepest instincts and values as a parent. You should feel more empowered to live in a way that honors your unique belief system. A healthy therapist will never tell you to do something that feels morally wrong to you. A healthy therapist will encourage questions about her methods and celebrate skepticism and curiosity.
When asked for the scientific research behind her methods, the therapist cannot deliver.
Psychology is a soft science, but it's still science. If a therapist is practicing within a model that is not supported by substantial, well-grounded research, she should disclose this at the start of treatment and ask you to sign off. You should be made aware of the risks and benefits of any treatment, as well as any controversy surrounding a particular model. You can ask your therapist if the California Evidence-Based Clearinghouse recognizes her model as "evidence-based." Any defensiveness on this point is a huge red flag.
The therapist warns that children will become murderous, abusive, or psychopathic, or sociopathic without treatment.
Some therapists will create fear and dependency in parents by insisting that their child is so deeply disturbed that only her controversial methods can save the family. This sort of fear mongering creates huge problems in relationships as it separates parents from their better instincts, alienates parents from their children, and creates deep mistrust and emotional distance in parent-child relationships.
Therapists who describe a child's actions as evil or vindictive are also clearly not understanding the meaning of the child's behavior. All behavior has meaning. In the case of a severely abused and neglected child, "antisocial" type behaviors are often driven by feelings of terror, emptiness, helplessness, or worthlessness. Good therapists will look for the meaning behind the child's behavior, work to meet the child's underlying emotional needs, and help parents take the behavior less personally.
The therapist insists on demeaning punishments for the child.
Common examples here include repetitive manual labor, time-outs that last more than a handful of minutes, not allowing children to sit on the furniture, or giving only bland food ("prison food" or "soup kitchen meals").
Therapists who are well-versed in the research know that punishment is actually one of the LEAST effective ways to change behavior, and punishment increases shame. Traumatized children are already full of shame, and feel bad inside. Any model that exacerbates their shame by demeaning them will further compound their traumatization. Any model that encourages parents to dwell on their child's wrongdoings will create shame in the child and distance in the parent-child relationship.
The therapist believes that the child's healing occurs through his submission to, or complete dependence on, the parent.
Children need to learn how to have healthy, developmentally appropriate levels of control. They do not need to be 100% dependent on a parent in order to be attached to that parent. They do not need to completely relinquish control in order to be healthy. Any model that actively works to strip away all of a child's power and make them helpless and overly dependent will traumatize the child and create resentment toward their parent.
These are just a few of many "red flags" I've noticed in helping families recover from controversial attachment therapies. If you are curious in exploring for yourself which models of treatment are evidence-based, please visit the California Evidence-Based Clearinghouse for Child Welfare.
Danielle Maxon is a child therapist and Licensed Clinical Social Worker in the State of North Carolina. She has been strengthening families in North Carolina since 2011. In August of 2015 she created her private practice, Under Wing Therapeutic Services, PLLC, which offers parent-child play therapy, parenting support and individual counseling for children under 12. Danielle specializes in the treatment of complex trauma, including profound neglect, orphanage experiences and adoption She especially loves helping defiant, aggressive little ones and exasperated parents.