Elements of Dyadic Developmental Psychotherapy

Dyadic developmental psychotherapy, which is an evidence-based, effective, and empirically validated treatment is composed of a variety of elements and based on a number of principles that have strong empirical support. Dyadic developmental psychotherapy is, in some respects, an amalgam of effective principles of treatment. This article will describe the elements of dyadic developmental psychotherapy and a few of its underlying principles.

It is helpful to remember that everything begins with building an alliance. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.

Safety is the first principle of treatment. Without safety (physical, psychological, relational, and emotional) nothing else can happen. So creating and ensuring safety comes first. Safety is provided for a child by a caregiver who is:

1. Available
2. Sensitive
3. Responsive to the child’s needs
4. Able to provide interactive repair
5. Insightful
6. Reflective

Intersubjectivity is a central concept in dyadic developmental psychotherapy. Once safety is provided and maintained and the safe base created, the child can begin to explore, learning primarily from the child’s parents’ experience of the child and of the world. Intersubjectivity is a reciprocal process. It can be concordant or discordant. Intersubjectivity is composed of the following three elements:

1. Shared emotion (attunement)
2. Shared attention and joint awareness
3. Share intention; cooperation and collaboration

Shared Emotion: Children who have difficulty regulating their emotions cannot do this on their own. They need a sensitive and responsive parent who can do this for them—and then with them—so that the child can internalize this capacity. This co-regulation of affect is necessary if the child is to be able to explore past traumas that may generate anxiety or shame.

Shared Attention: This is a reciprocal taking turns. There is an interest in the other’s experiences and a common attention to what is occurring now.

Shared Intentions: This refers to the enjoyment of shared experiences and being together. It involves getting to know each other and the other’s experiences, feelings, and perceptions.

Another central element of dyadic developmental psychotherapy is the affective-reflective dialogue. This refers to a “conversation” that includes emotions and reflection on the self, other, and the relationship. Self-aware reflection is a cornerstone of healing.

The practice of dyadic developmental psychotherapy involves and recognizes the importance of the co-creation of meaning. Often what makes trauma traumatic is not the objective facts, but the meaning we ascribe to those events. What experiences mean creates the emotions we experience and then lead to the behaviors we exhibit. In treatment, we join our experience of an event with the child’s experience of that event and reflect on the similarities and differences of our experiences. This reflection of the implications of other ways to experience events, past and present, can lead to new affect and new modes of behavior.

Self-aware reflection, the reflective function, is another key element of dyadic developmental psychotherapy. It involves “the thinking mind” with regard to the inner world of self and other. This leads to greater understanding and greater flexibility in responses available. When parents have a well-developed reflective function, this leads to the child experiencing that they exist in a positive way in the heart and mind of the parent. New meanings lead to new options for action that leads to healthier functioning.

Interactive repair happens in treatment and at home. It is the reestablishment of the relationship and the reestablishment of concordant intersubjectivity following some conflict, separation, mistake, or other breach in the relationship. This highlights the importance of the relationship and that mistakes can be repaired. It is primarily the adult’s responsibility to make this happen.

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