Reactive attachment disorder
The broad theoretical framework for current versions of RAD is attachment theory, based on work conducted from the 1940s to the 1980s by John Bowlby, Mary Ainsworth and René Spitz. Attachment theory is a framework that employs psychological, ethological and evolutionary concepts to explain social behaviors typical of young children. Attachment theory focuses on the tendency of infants or children to "seek proximity" to a "particular attachment figure" (familiar caregiver), in situations of alarm or distress, behavior which appears to have survival value. This is known as a discriminatory or selective attachment. Subsequently, the child begins to use the caregiver as a base of security from which to explore the environment, returning periodically to the familiar person. Attachment is not the same as love and/or affection although they are often associated. Attachment and attachment behaviors tend to develop between the ages of six months and three years. Infants become attached to adults who are sensitive and responsive in social interactions with the infant, and who remain as consistent caregivers for some time. Caregiver responses lead to the development of patterns of attachment, that in turn lead to internal working models which will guide the individual's feelings, thoughts, and expectations in later relationships. For a diagnosis of reactive attachment disorder, the child's history and atypical social behavior must suggest the absence of formation of a discriminatory or selective attachment.
Attachment-based psychotherapy
Therapists apply psychotherapy to patients with attachment disorders by applying a method of listening and reflecting on the experiences of the patient that caused their difficulty in making emotional connections. The therapist’s objective is to get the patient to open up to them so the patient can explore the experiences that are causing them to have dysfunctional relationships and to recreate the experience from the point of view of the therapist in order to resolve any emotional or social disruptions within the patient’s life. According to Dan Hughes this process is known as “attunement, disruption, and repair”. The first part of the treatment, the attunement, consists of the forging of a personal relationship between the therapist and the patient, it is the first step for the patient toward creating healthy attachments. Attachment patients live stressful lives with very little emotional attachments to people, thus it is the therapist's job to create a secure, accepting, caring, non-judgmental, and reliable environment where the patient can feel comfortable sharing their most traumatic experiences.