By Arthur Becker-Weidman, Ph.D., Dyadic Developmental Psychotherapy Topic Expert Contributor

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In this first article here I will describe what Dyadic Developmental Psychotherapy is. Dyadic Developmental Psychotherapy began as a family-therapy approach, grounded in attachment theory, for the treatment of children with disorders of attachment. It has developed over the past decade into a broader approach for treatment and has been found to be an evidence-based, effective, and empirically validated treatment.

Dyadic Developmental Psychotherapy has as its central therapeutic mechanism the maintenance of a contingent, collaborative, sensitive, reflective and affectively attuned relationship between therapist and child, between caregiver and child, and between therapist and caregiver. Dyadic Developmental Psychotherapy focuses on and relies upon the intersubjective sharing and joint development and organization of emotional experience. Intersubjectivity refers to shared emotion (also called attunement), shared attention, and shared intention.

A few basic principles of Dyadic Developmental Psychotherapy:

1. Confidence that both the caregivers’ and therapists’ own attachment strategies are organized and resolved must be present before involving the child in the therapy. Previous research (Tyrell et al. 1999; Dozier et al. 2001) has shown the importance of the caregivers and therapists state of mind for the success of interventions.

2. The therapist and caregiver provide intersubjective experiences for the child that are positive, concordant, and healing. These intersubjective experiences are characterized by shared affect (attunement), joint focus of awareness and attention, and complementary intentions. Intrafamilial trauma will significantly disrupt the development of intersubjectivity and increase the risk that the child will be unable to create a coherent meaning for many events and especially traumatic ones.

3. Use of PACE and PLACE. These acronyms describe the ‘attitude’ of the therapist and caregiver. PACE refers to the therapist setting a healing pace to therapy by being playful, accepting, curious and generate and regulate through empathy (and playfulness when appropriate), the emerging affect that is associated with events being explored. The therapist is also able to facilitate an open, reflective attitude to reorganizing the experience of these events through her accepting and curious stance. PLACE refers to the parent creating a healing environment by being playful, loving, accepting, curious and empathic. These ideas are described more fully in Becker-Weidman & Shell (2005) and Hughes (2006, 2007).

4. The inevitable misattunements and conflicts that arise in interpersonal relationships are directly addressed and then repaired through the ongoing qualities of the relationship (PACE). The need for interactive repair is especially important as the themes often being explored are often characterized by shame and fear. Repair helps with both affect regulation and directly addresses the child’s convictions that he must face stressful events alone, or that any conflict will lead to abandonment. The attachment figures – parent and therapist – are responsible for the initiation of repair, rather than the child.

In my next article, I will describe some of the interventions and methods of this treatment. Your comments and questions are welcome.

References

Becker-Weidman, A., (2004) “Dyadic Developmental Psychotherapy,” in Attachment Disorder Resource Book, As Simple As That Foundation, August 2004.

Becker-Weidman, A., (2005) “Dyadic Developmental Psychotherapy: A multi-year follow-up…Preliminary Summary Findings,” Connections, June 2005.

Becker-Weidman, A., & Shell, D., (Eds.) (2005, Reprinted 2008) Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of Trauma-Attachment Disorders. Woods N Barnes publishing, Oklahoma City, OK, 2005.

Becker-Weidman, A., (2006) “Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23 #2, pp 147-171.

Becker-Weidman, A., (2006) Dyadic Developmental Psychotherapy: A multi-year Follow-up, in, New Developments In Child Abuse Research, Stanley M. Sturt, Ph.D. (Ed.) Nova Science Publishers, NY, pp. 43-60.

Becker-Weidman, A., (2006) Principles of Attachment Parenting, 3 DVD set.

Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf

Becker-Weidman, A., (2008) “Treatment for Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy” Child and Adolescent Mental Health Volume 13, No. 1, 2008, pp. 52-60.

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., & Shell, D., (in press), Attachment Parenting: Developing Connections and Healing Children.

Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287–304.

Hughes, D. (2004) An attachment-based treatment of maltreated children and young people. Attachment and Human Development,6, 263–278.

Hughes, D. (2005) The development of Dyadic Developmental Psychotherapy. In: Creating Capacity for Attachment (eds A.Becker-Weidman & D. Shell), pp. vii–xvii, Wood N Barnes, Oklahoma City, OK.

Hughes, D. (2006) Building the Bonds of Attachment, 2nd edn. Jason Aronson, Lanham, MD.

Hughes, D. (2007) Attachment-Focused Family Therapy. W.W. Norton, NewYork.

Hughes, D., (2008) Attachment-Focused Parenting. Norton, NY.

©Copyright 2009 by Arthur Becker-Weidman, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Arthur and/or see his GoodTherapy.org Profile