Dyadic Developmental Psychotherapy (DDP)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Dyadic Developmental Psychotherapy (DDP) has been rated by the CEBC in the area of: Attachment Interventions (Child & Adolescent).

Target Population: Families with children/teens with disorders of attachment and trauma. Typically adopted and foster children, those who meet the DSM-V criteria for Reactive Attachment Disorder, and trauma-related diagnoses, and those who meet the clinical criteria for Complex Trauma (aka Developmental Trauma Disorder)

For children/adolescents ages: 2 – 21

For parents/caregivers of children ages: 2 – 21

Brief Description

DDP is a model of treatment and parenting for children with problems secondary to abuse, neglect, and multiple placements. When a child's early attachment history consists of abuse, neglect, and/or multiple placements, he/she has failed to experience the dyadic (reciprocal) interaction between a child and parent that are necessary for normal development and he/she often has a reduced readiness and ability to participate in such experiences. Many children, when placed in a foster or adoptive home that provides appropriate parenting, are able to learn, day-by-day, how to engage in and benefit from the dyadic experiences provided by the new parent. Other children, who have been much more traumatized and compromised in those aspects of their development that require these dyadic experiences, have much greater difficulty responding to their new parents. For these children, specialized parenting and treatment is often required.

Within this model, the foundation of these interventions--both in home and in treatment--must incorporate attitude based on playfulness, acceptance, curiosity, and empathy. It must never involve coercion, threat, intimidation, and the use of power to force submission.

Note: There has been controversy regarding Dyadic Developmental Psychotherapy as an appropriate treatment. Based on the available literature, there is no evidence of harm from the use of DDP as described by the developers. For more information on this issue, please refer to the Attachment Interventions definition and to the following references:

Becker-Weidman, A., & Hughes, D., (2008) Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment. Child & Family social Work, 13, pp. 329-337.

Becker-Weidman, A., (2011-2012). Dyadic Developmental Psychotherapy: Effective Treatment for Complex Trauma and Disorders of Attachment. Illinois Child Welfare, 6(1), pp 119-129.

Becker‐Weidman, A., & Hughes, D. (2010). Dyadic Developmental Psychotherapy: an effective and evidence‐based treatment–comments in response to Mercer and Pignotti. Child & Family Social Work, 15(1), 6-11.

Chaffin, M., Hanson, R., & Saunders, B. E. (2006). Reply to Letters. Child Maltreatment, 11(4), 381-386.

Mercer, J., Pennington, R. S., Pignotti, M., & Rosa, L. (2010). Dyadic Developmental Psychotherapy is not ‘evidence‐based’: comments in response to Becker‐Weidman and Hughes. Child & Family Social Work, 15(1), 1-5.

Pignotti, M., & Mercer, J. (2007). Holding therapy and dyadic developmental psychotherapy are not supported and acceptable social work interventions: A systematic research synthesis revisited. Research on Social Work Practice, 17(4), 513-519.

Program Goals:

The goals of Dyadic Developmental Psychotherapy are different for the child and the caregiver as listed below.

Goals of Treatment for the Child:

  • Develop a more secure pattern of attachment
  • Resolve trauma symptoms
  • Secure a more permanent connection and relationship with the committed caregiver

Goals of Treatment for Caregivers:

  • Increase attunement with their child
  • Develop reflective function
  • Use attachment-facilitating parenting approaches
  • Increase sensitivity

Essential Components

The essential components of Dyadic Developmental Psychotherapy (DDP) include:

  • General Principles: Eye contact, voice tone, touch, movement, and gestures are actively employed to communicate safety, acceptance, curiosity, playfulness, and empathy, and never threat or coercion. These interactions are reciprocal, not coerced. The following guidelines demonstrate this:
    • Opportunities for enjoyment and laughter, play and fun, are provided unconditionally throughout every day with the child.
    • Decisions are made for the purpose of providing success, not failure.
    • Successes become the basis for the development of age-appropriate skills.
    • The child's symptoms or problems are accepted and contained. The child is shown how these simply reflect his/her history. They are often associated with shame which must be reduced by the adult's response to the behavior.
    • The child's resistance to parenting and treatment interventions is responded to with acceptance, curiosity, and empathy.
    • Skills are developed in a patient manner, accepting and celebrating "baby-steps" as well as developmental plateaus.
    • The adult's emotional self-regulation abilities must serve as a model for the child.
    • The child needs to be able to make sense of his/her history and current functioning. The understood reasons for the behavior are not excuses, but rather they are realities necessary to understand the developing self and current struggles.
    • The adults must constantly strive to have empathy for the child and to never forget that, given his/her history, he/she is doing the best he/she can.
    • The child's avoidance and controlling behaviors are survival skills developed under conditions of overwhelming trauma. They will decrease as a sense of safety increases, and while they may need to be addressed, this is not done with anger, withdrawal or love, or shame.
  • Treatment Logistics:
    • A comprehensive initial assessment must be conducted that touches on the seven domains that may be affected by Complex Trauma. This treatment program serves to develop a detailed treatment plan.
    • Treatment usually involves 1 session per week of 2 hours divided up as follows:
    • The initial several sessions are just with the caregivers to assist them in “discovering” the important elements of attachment-facilitating parenting and in reviewing the text, Attachment Parenting, edited by Arthur Becker-Weidman, PhD.
    • Once the caregivers are ready, then each 2-hour session begins with the therapist meeting with the parents, followed by the conjoint session with the child and caregivers, followed by time with the caregivers to “debrief” about the session.
  • Treatment Components: Treatment must be provided in a consistent manner to develop and maintain a therapeutic alliance. The components include:
    • Therapist use of self: (DDP involves the intersubjective sharing of self and therapist attunement with the client)
    • Focus on connections before compliance
    • PACE (Playful, Acceptance, Curious, Empathy) and PLACE (Playfulness, Love, Acceptance, Curiosity, and Empathy)
    • Intersubjective sharing of experience
    • Reflective capacity
    • Affective/Reflective dialogue
    • Commitment
    • Insightfulness
    • Development of a coherent autobiographical narrative
    • Co-regulation of affect
    • Co-creation of new therapeutic meanings
    • Follow-lead-follow
    • Interactive repair
    • Nonverbal-verbal dialogue
  • Treatment Phases: There should be differential use of the components in the five phases of treatment:
    • Creating the Alliance
    • Maintaining the Alliance
    • Exploration
    • Integration
    • Healing
  • Treatment Tools & Resources:
    • Role-plays
    • Use of media to engage family in collaborative and enjoyable activities to decrease tensions and improve affective connections

Child/Adolescent Services

Dyadic Developmental Psychotherapy (DDP) directly provides services to children/adolescents and addresses the following:

  • Trauma-related symptoms such as flashbacks, temper tantrums, difficulty trusting adults, disorganized attachment patterns, impaired affect regulation, impaired behavioral regulation, impaired peer-relationships, developmental delays in socialization, daily living skills, and communication

Parent/Caregiver Services

Dyadic Developmental Psychotherapy (DDP) directly provides services to parents/caregivers and addresses the following:

  • Difficulty attuning with their child “Buttons” triggered in parent by child’s behavior Past trauma that interferes with implementing attachment-facilitating parenting skills

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Foster/Kinship Care
  • Outpatient Clinic
  • Residential Care Facility

Homework

Dyadic Developmental Psychotherapy (DDP) includes a homework component:

The skills developed in session are asked to be practiced during the week. Drawings may be taken home and redone with the family. Parents may be asked to track certain behaviors and their response and to keep a journal. Children and caregivers may be asked to jointly prepare a time line of the child’s history.

Languages

Dyadic Developmental Psychotherapy (DDP) has materials available in a language other than English:

Finnish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Typical therapy office
  • Videotaping equipment
  • Texts for families (Attachment Parenting, edited by Arthur Becker-Weidman, PhD and/or Creating Capacity for Attachment, edited by Arthur Becker-Weidman, PhD)

Minimum Provider Qualifications

  • Be a licensed mental health practitioner with authority to practice in their jurisdiction
  • Certification in Dyadic Developmental Psychotherapy as an Attachment-Focused Therapist/Family Therapist by the Attachment-Focused Treatment Institute

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
  • Arthur Becker-Weidman, PhD
    Center for Family Development & Attachment-Focused Treatment Institute

    phone: (716) 810-0790
Training is obtained:

The Attachment-Focused Treatment Institute (http://www.attachment-focusedtreatmentinstitute.com) certifies practitioners of Dyadic Developmental Psychotherapy and Attachment-Focused Treatment. This is a University-based certification program, a part of the Graduate Counseling program of the Academy of Human Development. Practitioners required to show competency in the differential use of the components of treatment (14 specific components) in different phases of treatment (five phases). Training is available on site, at the host’s location, and via the internet using Cisco webEx.

Number of days/hours:

48 to 60 hours, depending on trainee’s goals

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Becker-Weidman, A. (2006). Treatment for children with trauma-attachment disorders: Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, 23(2), 147-171.

Type of Study: Retrospective non-equivalent control groups design
Number of Participants: 64

Population:

  • Age — 5-17 years
  • Race/Ethnicity — 56 Caucasian, 3 African American, and 5 Asian
  • Gender — 38 Male and 26 Female
  • Status — Participants were children with a DSM-IV diagnosis of Reactive Attachment Disorder whose case closed in 2000 or 2001 with a significant history of physical abuse, physical or psychological neglect, sexual abuse, or institutional care.

Location/Institution: The Center For Family Development, Williamsville, New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study examines the effectiveness of Dyadic Developmental Psychotherapy (DDP). Children in the treatment group received DDP, while children in the usual care group received an evaluation only. Measures included the Randolph Attachment Disorder Questionnaire (RADQ) and the Child Behavior Checklist (CBCL). Results indicated children in the DDP group showed significant decreases in symptoms of attachment disorder, withdrawn behaviors, anxiety and depression, social problems, thought problems, attention problems, rule breaking behaviors, and aggressive behaviors, compared to the usual care group. Limitations include the lack of randomization and small sample size.

Length of postintervention follow-up: 1.1 to 1.3 years.

Becker-Weidman, A. (2008). Treatment for children with reactive attachment disorder: Dyadic Developmental Psychotherapy. Child and Adolescent Mental Health, 13(1), 52.

Type of Study: Retrospective non-equivalent control groups design
Number of Participants: 44 of 64 original study participants located at the time of the 4-year follow-up

Population:

  • Age — Not specified (see original study for full sample information)
  • Race/Ethnicity — Not specified (see original study for full sample information)
  • Gender — Not specified (see original study for full sample information)
  • Status — Participants were children with a DSM-IV diagnosis of Reactive Attachment Disorder whose case closed in 2000 or 2001 with a significant history of physical abuse, physical or psychological neglect, sexual abuse, or institutional care.

Location/Institution: The Center For Family Development, Williamsville, New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study examines outcomes from a previous study [Becker-Weidman, A. (2006)] that utilized Dyadic Developmental Psychotherapy (DDP), and extends those results out to 4 years. Children in the treatment group received DDP, while children in the usual care group received an evaluation only. Measures included the Randolph Attachment Disorder Questionnaire (RADQ) and the Child Behavior Checklist (CBCL). Results indicated statistically significant reductions in outcome variables that continued 4 years after treatment ended. Furthermore, while the DDP group continued to exhibit behavior within the normal range, the control group’s behavior worsened. Limitations include the lack of randomization, small sample size, and high attrition rate, lack of direct reliable and valid measure of attachment between child and caregiver, and reliance on caregiver reported measures.

Length of postintervention follow-up: Approximately 4 years.

References

Becker-Weidman, A. (2010). Dyadic Developmental Psychotherapy: Essential practices & methods. Lanham, MD: Jason Aronson.

Becker-Weidman, A. (2011). The Dyadic Developmental Psychotherapy casebook. Lanham, MD: Jason Aronson.

Becker-Weidman, A., (2011-2012). Dyadic Developmental Psychotherapy: Effective Treatment for Complex Trauma and Disorders of Attachment. Illinois Child Welfare, 6(1), pp 119-129.

Contact Information

Name: Arthur Becker-Weidman, PhD
Agency/Affiliation: Center for Family Development & Attachment-Focused Treatment Institute
Website: www.center4familydevelop.com
Email:
Phone: (716) 810-0790
Fax: (719) 636-6243

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: June 2014