RAD: What Therapy Bombs?

I actually had a therapist call me indignantly and demand I stop saying that children must have a parent with them in the treatment room. I was shocked! She had long touted herself as an expert in the field of attachment. She told me, “I can get children to open up and talk to me better with the parents out of the room!”. Of course she can! THAT is the problem. They would rather talk to a stranger (and LIE) than the parents that love them! Clearly, she did not know what she was doing AND she did not know that she didn’t know. I find this all too often.

There are thousands of kind, dedicated treatment professionals that are totally unaware they do not know how to help children with RAD (Reactive Attachment Disorder). They spend many months (or years) trying hard and failing. The wise ones search for answers to different, effective treatment. The clueless blame it on the parents. As long as I breath I will fight for the children to get effective treatment. I will continue saying parents are an essential part of a child’s healing and must be included.

What Does the Leading Researcher on Trauma Say?

Bessel van der Kolk, MD. One of the world’s leading researchers on trauma and Reactive Attachment Disorder (RAD) has long spoken out on the ineffectiveness of traditional therapies for our children suffering with RAD. He says, “Traditional therapy is useless for severely traumatized people, but especially children because it does not reach the parts of the brain that were most impacted by the trauma.” Traditional therapies are; Non-directed Play Therapy, Sand Tray Therapy, and talk therapy including CBT and DBT. In 2011, in The Polyvagal Theory, Dr van der Kolk, writes “…Being able to manage emotional arousal interferes with being able to benefit from treatments such as cognitive behavioral therapy (CBT) (Jaycox, Foa & Morral, 1998”

What Do Leading Trauma and Attachment Therapists Say?

I interviewed some of the most outstanding therapists in the fields of trauma and attachment to be able to share with you what works!  Deborah Hage is an author and public speaker with over 40 years of success working with adopted and attachment disordered children. Deborah was the therapist for some of my children. They are now healthy, happy and loving adults thanks to her outstanding skills.  I asked her about CBT and DBT (Dialectical Behavior Therapy). She shared her wisdom: They are both “insight therapies”. They can be very helpful for stressed-out parents who benefit from talking about the change. Our children with trauma or RAD do not benefit from talking about the change. They must experience the change. Consequently CBT and DBT cannot be effective in treating our children.

Another outstanding therapist I spoke with who is well trained and successful in treating Reactive Attachment Disorder, James Dumesnil, LPCC said; “Techniques don’t work, relationships do.” He says; “This work is even more complicated because there is a need for prioritizing relationships with parent(s), and their child(ren), and with the dyadic relationship they have between them.” He continues on with more insight; “There are the times, when the mom and dad or moms or dads can be right on, and provide the scaffolding for the child to link their past to their current.”

Mr Dumesnil continues; “All children’s behavior is a form of commu

nication. CBT often does not work, but that is why behavioral interventions don’t work either. Because we cannot simply try to change the behavior, without coming to some understanding of what the behavior is communicating. Nothing will ever work with these kids or really with anyone, unless we understand their struggles. And then they will understand their struggles. And if we are able to truly comprehend the communication of the behavior of the traumatized child, AND be able to convey that to the child while they are open to that information— often after a bit of a crisis— then the child can become receptive, can begin to believe or at least start to look to see if there might be an ally in the neighborhood. And then maybe they can start to develop trust, and be open to good and helpful people and information.”

What Does Research Say?

The Journal of Child Psychology and Psychiatry (28 September 2016) published research by  Sachser, Keller and Goldbeck on children and adolescents diagnosed with Complex Posttraumatic Stress Disorder (CPTSD or another name for RAD) and their response to Cognitive Behavioral Therapy. While they found some improvement in other children and adolescents in the study they reported “those with CPTSD ended treatment with clinically and statistically greater symptoms than those with PTSD”. It documented the CBT made our children worse! 

 Why Does Traditional Therapy Fail with Children with RAD?

As Dr van der Kolk stated clearly; It does not reach the parts of the brain most impacted by trauma. If it doesn’t reach them, it can’t heal them.

1. RAD is a relationship disorder. They cannot establish a relationship with their own mother. Traditional treatments start with the treatment provider establishing a relationship with the client to use as a “trust base” for treatment. They are not capable of step one in the treatment process of these therapies so they clearly can’t get to step two and beyond.
2. Further research, by Dr. Bessel van der Kolk, shows physical proof that when someone with PTSD has an emotion their brain’s logic and language cores literally shut down. This substantiates that they are not capable of learning from words while the emotional centers are active. Those feeling areas are extremely active in any kind of effective therapy. Any parent of a child with RAD can tell you their child does not learn from words! Lectures, warning, reminders, explanations are all useless with this population. They don’t work.
3. Traditional therapy has the child alone in a room with the therapist. Children with RAD con, lie, and manipulate. It is part of their diagnosis. Alone in a room, with an adult who does not know the truth, they will test the adult by lying, conning or manipulating to see if they can trust that adult. An adult who believes their fables fails the trust test and no help from them will ever be accepted by the child with RAD. With the parent not present there is no one accessible to do a fact check. When an adult is fooled they flunk the child’s test for trust-ability and thus become completely ineffective. Game over!
4. Providers are taught to take the child in another room and leave the parent in the waiting area. The blatant messages to the child are; “Your parent is not important. Your parent can’t help you. You don’t need them.” That is the opposite message for healing to begin. Parents are essential!
5. Putting the deeply emotionally disturbed child in control of the treatment is common practice with non-directed play therapy, sand tray therapy and others. These children at any age are too disturbed to make those life changing choices. A trained professional should set up the treatment protocols and guide the therapy, not the disturbed child. Being in control of an adult actually causes a backlash. They do not feel safe when the adults “in charge” can be controlled by a child.
6. When a trauma-based child does not feel safe they unleash their pent-up fear on their mother after therapy when they get home. These untrained professionals tell parents it is “normal” for that to happen and that those feelings have been stirred up from their past trauma. If that is true why would any caring adult stir up overwhelming feelings in a child and then leave them to deal with it without professional help?

Is There a Pill for RAD?

No! If there was a medication that would open a heart to love and trust it would sell by the barrel full on Valentine’s day! No such drug exists. I have seen children on eleven different medications as the docs try to get the child to be safe enough to go home. It was not working at all! Find a good Psychiatrist to diagnose and treat your child. If they recommend Prozac or Zoloft grab your child and run! Check out the side effects to those meds! They are exactly what we do NOT want! Many of the school shooters were on one or the other of those. Bad idea! There are medications that can be helpful but most of the healing effort must be put toward creating a home healing environment that provides a strong feeling of safety with connecting and correcting in a healthy balance.

Find a skilled treatment provider to be successful in finding healing and peace for your child. My non-profit is working hard to organize a cutting edge training for Master’s level and above to give them the skills necessary. We need more skilled help! Have them email me at [email protected] to be added to the list of those professionals around the world waiting for more effective tools to treat their clients and we will keep them informed! 

We can make a difference, Nancy Thomas

Photo by Gerd Altmann