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Reactive Attachment Disorder: The Evolution of Attachment Therapy

Talking to people about reactive attachment disorder or attachment therapy, even among those who are parenting children with RAD, I find that there is a certain amount of confusion as to what attachment therapy is.

People refer to the various well-known attachment therapists and authors, such as Nancy Thomas, Dan Hughes, Gregory Keck, Foster Cline, Martha Welch and others, as if each were doing something unrelated to the other.

There also appears to be some confusion about attachment therapy itself, in part due to some high profile scandals a few years back.

As in any other profession, attachment therapy has evolved over time.

Having been a paramedic and emergency medical technology instructor for many years, I can appreciate that. Techniques that were standard practice in the 1980s could result in a malpractice suit, or worse, if practiced today. Rather than implying that paramedics were negligent 25 years ago, the field of emergency medicine has evolved.

This is a good thing, and not something to be disparaged.

Another thing to consider is that evolution in the field of attachment therapy, as in any other field, requires the existence of pioneers - learned professionals who are willing to try new things in search of better results. Those that work can be expanded upon, while those that fail may be abandoned.

This too, is a good thing, and not something to be feared.

I was once warned that I could be sued for using duct tape to secure patients to a spineboard during a mass casualty situation, yet that is now a standard practice in many systems, with a modified form of duct tape marketed specifically for such a use.

As with paramedicine, attachment therapy has evolved over time. Therapeutic techniques that worked 25 years ago have evolved into new techniques that are even more successful today. Techniques that showed promise in the past have been abandoned for methods that show even greater promise today.

Dr. Daniel Hughes, who trained our nephew?s primary therapist, and whose books have been very helpful to us, has changed his methodology somewhat even during the time that we have been acquainted with him.

Does this mean that he was wrong before? Certainly not. Constant research, evaluation, and revision is necessary in order to find the best ways of reaching children with reactive attachment disorder.

There is a certain amount of confusion about some of the techniques used in attachment therapy, in part due to misinformation from well-meaning child rights activists and an opportunistic media.

For example, an attachment technique called ?holding therapy? has been given an undeserved bad name.

Martha Welch, one of the pioneers in attachment therapy, empathized the importance of holding in attachment therapy, developing a technique where a mother would hold her child in a comfortable, nurturing position, as a means of promoting bonding.

Others took this technique and added to it, some including a technique that involved intentionally inducing rage in the child. As far as I am aware, this has never been the standard in holding therapy, yet it is often used to typify the procedure.

When it is used today, holding therapy involves the child being cradles in his mother?s arms, in much the same way as you might hold a small infant. All of the key ingredients of bonding are present, including eye contact, smiles, touch, movement, and voice. This recreates the feeling of security that an infant would experience from a nurturing mother, taking the child back to a time when bonding should have taken place, in effect giving him another chance.

Often used synonymously with ?holding therapy? is another technique known as ?rebirthing,? which seeks to reenact the birth experience so that the child may emerge from a womb-like environment prepared to attach.

Unfortunately, ?rebirthing? has led to the deaths of at least two children, one in Colorado and another in Utah, from suffocation due to the confines of the blanket used to simulate the womb.

The death in Colorado involved an unlicensed therapist, and the one in Utah involved a parent who was trying the procedure at home, apparently without the knowledge of her child?s therapist. As far as I have been able to determine, no deaths have occurred due to rebirthing techniques conducted under the supervision of a licensed attachment therapist.

Because of these deaths and the ensuing controversy, rebirthing has been largely abandoned as a method of attachment therapy.

There have been other deaths of children due to frustrated and desperate parents trying things on their own at home. A parent in Utah experimented with a procedure that involved the forced consumption of large quantities of water, leading to the death of her child, for example, and a frustrated parent in Maine bound her attachment disordered child in a closet, covering her mouth with duct tape, leading to death by suffocation.

But I am unaware of even a single example of a child dying as a result of attachment therapy conducted by a licensed attachment therapist.

?Reparenting? is a technique that is often confused with ?rebirthing,? but in fact there is nothing threatening in reparenting.

There are things that every child has to go through in order to grow into a well adjusted adult. These are things that good parents instinctively do even without having read them in a book, but they include things that the attachment disordered child may have never experienced.

Even when not done in the right order, it seems that the child is helped by being able to have these experiences, which may include being held, rocked, and sung to by a parent, being fed through a bottle, playing tickling or hide-and-seek games, and being read to at night. If neglected in the early weeks, months, or years of a child?s life, the earliest experiences are essential for attachment.

There are a lot of attachment therapists and programs, each with its own philosophies and including some unique methods, and while there are significant differences between some of the therapeutic systems, the similarities between the better known programs are even greater.

We have had great success parenting our nephew. While our therapist was trained under Dan Hughes and we learned much from his books, as parents we borrowed parenting ideas from Nancy Thomas, Gregory Keck, and others, and did not often find them to be in opposition to one another.

I understand too well that parenting a child with reactive attachment disorder is not an easy task, and I can appreciate the urge to grasp at anything that promises to make your child?s life better, or your own easier.

Always consider the dangers in anything you are thinking of trying. Don?t believe everything you read on the Internet. Keep the lines of communication open between yourself and your child?s therapist, and always consult him or her before making significant changes in your parenting style or trying something new that someone has suggested to you. When in doubt, always clear it with an attachment specialist.





Last Modified on: Saturday, August 08, 2009



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