Attachment  Treatment:

 Most traditional therapy involves talk therapy, and is based upon the development of a therapeutic relationship between client and therapist. This relationship requires mutual trust, respect, reciprocity, emotional honesty and ability to formulate thoughts and feelings into words.

Children with attachment disorder are unable to make use of such methods because:
• They do not trust
• They are not emotionally honest, and in fact are frequently not able to
• Identify their feelings or what is behind those feelings
• They do not respect anyone, including themselves
• They are not capable of reciprocal give and take relationships
• Their backgrounds of abuse, neglect, unresolved trauma or pain, loss and
• Abandonment frequently occurred during the first year or two of life, prior to
• Conscious memory of events.
• They do not know why they feel and act as they do.
• They are operating in the only way they know how to survive.

Successful therapy with these children will depend upon the therapist's willingness to use strategies to find and to face the depth of feelings that these children keep hidden, to revisit the trauma with the child-and to communicate that by doing this together, the trauma is not bigger than the child, and the child can overcome it. Therapists need to be prepared to face the horrors that these children have experienced if we ever hope to heal them.

Traditional 'talk' or 'play' therapies do not work with these children because such therapies depend upon the child's ability to develop a trusting relationship with the therapist. Children with Reactive Attachment Disorder are unable to form any genuine relationships. Therefore parenting must be very structured and very nurturing. Natural consequences, not lectures work best. Such children are very good at externalizing their feelings and getting everyone else to feel as miserable as the child does.

Counseling and Psychotherapy:

Many therapeutic methods are employed: role-playing, modeling of behaviors, behavioral shaping, cognitive restructuring, Gestalt Therapy, family therapy and general psychotherapy. Effective therapy requires a team approach which must always include the child's parents.

Therapy Includes:
• Visits to therapist with child and parents, or parents alone
• Therapist and child, without parents breeds triangulation and hurts the child
•  Teaches parents the functions of “therapeutic parenting”
•  This does not always look/feel like traditional parenting but is needed to heal
• May include resolution of feelings towards prior caregivers, causes of hurts
•  This may cause issues to surface that were buried
•  These issues may surface months/years later, appearing unconnected to current events
•  Helping the child let go of the birth parent fantasy and process their grief and loss relating to the moving beyond that fantasy

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

• ADD
• Anti-Social Personality Disorder
• Conduct Disorder
• Oppositional Defiant Disorder
• Fetal Alcohol Syndrome
• Developmental Disorder of Receptive Language
• Socio-Emotional Problems
• Mental Retardation
• Schizophrenia
• Rett's syndrome.

Counseling Goals:

• Resolution of early losses
• Development of trust
• Modulation of affect
• Development of reciprocal relationships
• Learning appropriate responses to external structure and societal rules
• Correcting distorted thinking patterns
• Developing self respect