Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version  (DDP-AFTI )

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 - 17

For parents/caregivers of children ages: 2 - 17

Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version (DDP-AFTI) is a family–focused approach to addressing attachment difficulties and the effects of complex trauma on child development, family relationships, and related areas. The approach is grounded in Attachment Theory. Components include a comprehensive assessment, relationship focused treatment, parenting advice and support, and referrals for other services as needed. 

Arthur Becker-Weidman, PhD

• Agency/Affiliation: Attachment-focused Treatment Institute
• Website: https://www.attachment-focusedtreatmentinstitute.com/dyadicdevelopmentalpsychotherapy.html
• Email: AWeidman@gmail.com

The goals of Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version (DDP-AFTI)  are:

For the child:

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

For caregivers:

• Resolve caregiver’s attachment trauma that may interfere with developing more attachment security with their child
• Increase attunement with their child
• Develop reflective function
• Use attachment-facilitating parenting approaches
• Increase sensitivity

The essential components of Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version (DDP-AFTI) 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 their 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 their history, they are doing the best they 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.
  • 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 – Attachment-focused Treatment Institute Version  (DDP-AFTI ) directly provides services to children 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 – Attachment-focused Treatment Institute Version  (DDP-AFTI ) 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 

Recommended Intensity

After comprehensive initial assessment is conducted, the therapy is a weekly 2-hour session.

Recommended Duration

Approximately 1 month for per year of child’s age; for adolescents, approximately ten to fifteen months. 

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Foster / Kinship Care
• Group or Residential Care
• Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
• Outpatient Clinic
• Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

This program does include 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 timeline of the child’s history. The parents are provided with a text about attachment, attachment-facilitating parenting and complex trauma. 

Languages

Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version  (DDP-AFTI ) has materials available in the following languages other than English:

• Czech
• Finnish
• French
• German
• Italian
• Polish
• Portuguese
• Spanish

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 in 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) 

Prerequisite/Minimum Provider Qualifications

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

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details: 

• Becker-Weidman, A. (2016). Dyadic Developmental Psychotherapy: The definitive manual. LAP LAMBERT Academic Publishing.  

The manual can be secured from the program contact or on Amazon. 

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Through The Attachment-Focused Treatment Institute: Training can be provided onsite or virtually. The Attachment-Focused Treatment Institute (http://www.attachment-focusedtreatmentinstitute.com) certifies practitioners of Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version (DDP-AFTI) 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 are 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 Zoom.

Number of days/hours:

48 to 60 hours, depending on trainee’s goals

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version .

Formal Support for Implementation

There is formal support available for implementation of Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version  as listed below:

On going consultation, review of video tapes. Formal support is optional.  Usually training participants are contacted within a month of completing the training to review any obstacles. 

Fidelity Measures

There are fidelity measures for Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version  as listed below:

Recordings of sessions are reviewed. 

Implementation Guides or Manuals

There are no implementation guides or manuals for Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version .

Implementation Cost

There are no studies of the costs of Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version .

Research on How to Implement the Program

Research has not been conducted on how to implement Dyadic Developmental Psychotherapy – Attachment-focused Treatment Institute Version .

Child Welfare Outcome: Child/Family Well-Being

• Becker-Weidman, A. (2006) Treatment for children with trauma-attachment disorders: Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, 23(2), 147–171. https://doi.org/10.1007/s10560-005-0039-0

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Sample:

  Age — 5–17 years

  Participants: 64

  Race/Ethnicity — 56 Caucasian, 5 Asian, and 3 African American

  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, N

  Summary:

  The purpose of the study was to examine the effectiveness of Dyadic Developmental Psychotherapy (DDP). Participants in the treatment group received DDP, while participants in the usual care group received an evaluation only. Measures utilized include the Randolph Attachment Disorder Questionnaire (RADQ) and the Child Behavior Checklist (CBCL). Results indicate that 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.

• 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), 119–129.