Dyadic Developmental Psychotherapy (DDP) is an evidence-based, attachment-focused treatment specifically designed for children and adolescents who have experienced complex trauma, developmental trauma, and attachment disruptions. This family-based psychotherapeutic intervention helps children and young people with the psychological difficulties resulting from developmental trauma. Developed by clinical psychologists Dr. Daniel Hughes and Dr. Arthur Becker-Weidman, DDP integrates principles from attachment theory, interpersonal neurobiology, and trauma-informed care to help children develop secure relationships with their caregivers.
Over two-thirds of children report experiencing at least one traumatic event by age 16, and at least 1 in 7 children experience abuse or neglect annually in the U.S. For children in foster care, adoption, or those who have experienced early maltreatment, the impact can be particularly profound. DDP provides a specialized therapeutic approach that addresses both the child's trauma-related symptoms and the parent-child relationship dynamics essential for healing.
Table of Contents
- What is Dyadic Developmental Psychotherapy?
- Key Principles and Theoretical Foundation
- How DDP Works: The PACE Approach
- Treatment Structure and Process
- Research and Evidence Base
- Benefits and Outcomes
- Who Can Benefit from DDP?
- Finding a DDP Therapist
- Frequently Asked Questions
- How Therapy Can Help / Find a Therapist
What is Dyadic Developmental Psychotherapy?
DDP is based on a theoretical understanding of attachment and intersubjective relationships, and the impact of developmental trauma. Unlike traditional individual child therapy approaches, DDP actively involves caregivers in the therapeutic process, recognizing that healing happens within relationships.
The therapy was originally developed for children who experienced emotional trauma resulting from chronic early maltreatment within the caregiving relationship. 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, they have failed to experience the dyadic (reciprocal) interaction between a child and parent that is necessary for normal development.
Core Components of DDP
Relationship-Focused Treatment: DDP is primarily a family therapy that emphasizes the parent-child relationship as the vehicle for healing.
Trauma-Informed Approach: Parents, relatives, teachers, and caregivers provide comfort and stability, and play a vital role by maintaining normal routines or establishing new ones after a crisis. With proper caregiving and access to trauma-informed services, many children recover and thrive.
Integration of Multiple Theories: DDP draws from attachment theory, interpersonal neurobiology, developmental psychology, and trauma research to create a comprehensive treatment approach.
Key Principles and Theoretical Foundation
Attachment Theory
Attachment bonding with primary caregivers and a resultant sense of security are well documented as essential to the development of core biopsychosocial capacities for self-regulation and engagement in interpersonal relationships. Secure attachment provides children with a foundation for emotional regulation, social skills, and healthy development.
Developmental Trauma
Exposure to traumatic stressors constitutes a unique and clinically significant form of attachment trauma when it either intersects with and disrupts the initial development of secure attachment internal working models in early childhood or it subsequently occurs in a manner that leads to the loss or disorganization of a previously attained sense of attachment security.
Interpersonal Neurobiology
Early childhood experiences can affect the structure of neurons as well as the communication between them. If altered due to disease pathology, this can have astounding effects on the development of different regions of the brain, especially the connections between the emotional regions and the different cortices that aid in shaping one's personality and other higher functions.
Intersubjectivity
DDP seeks to increase relational safety through applying principles of playfulness, acceptance, curiosity and empathy, with the aim of supporting and integrating emotional regulation, cognitive development, and autobiographical narratives.
How DDP Works: The PACE Approach
Central to DDP is the PACE approach, which stands for:
Playfulness
Participants depicted relational, playful, fun and light aspects of the therapy, which appeared to be experienced as enjoyable and emotionally regulating. DDP is intentional in this approach to foster relational safety, helping children stay open and engaged.
Acceptance
Acceptance creates psychological safety. The therapist and parents practice unconditional acceptance of the child's inner experience, while maintaining appropriate boundaries around behavior.
Curiosity
Therapists' light and non-judgmental curiosity appeared to be experienced as tolerable, creating space for co-creating new meanings. The therapist's non-judgmental and curious stance may enhance the caregiver's curiosity in the child's internal world.
Empathy
Empathy communicates our curiosity and acceptance, as we recognize and respond to the other's emotional experience.
Treatment Structure and Process
Phase 1: Parent Preparation
In the first phase of treatment the therapist works with the caregivers to build a therapeutic alliance and invite them to incorporate ideas from the DDP model into their parenting approach. This alone may create shifts in understanding and promote increased connection with their child. Joint sessions with the child may be indicated once the caregiver-therapist alliance is established.
During this phase:
- Parents learn about their child's trauma history and its impact
- The therapist explores parents' own attachment histories
- Parents practice PACE parenting techniques
- A strong therapeutic alliance is established
Phase 2: Child Involvement
Once parents are prepared, children join the therapy sessions. The child will then join the sessions when the therapist and parents are ready.
Key elements include:
- Building safety and trust with the child
- Using affective-reflective dialogue
- Exploring memories and experiences in a supportive environment
- Creating coherent narratives about the child's life experiences
Phase 3: Integration and Consolidation
The child gains relationship experience which helps her to grow and heal emotionally. Family members develop healthy patterns of relating and communicating. This in turn leads to fewer feelings of fear, shame or need to control within the family. Family members become open to each other's inner life as well as their outward behavior.
Research and Evidence Base
Recent Studies and Meta-Analyses
This is the first academic study focusing on the qualitative experiences of children undergoing DDP interventions. Consistent with preliminary and somewhat limited literature supporting DDP, and in alignment with DDP's core aims, findings infer that the attuned presence of the therapeutic adults may influence the degree of perceived change in attachment security.
This study used longitudinal survey data to understand the format of DDP as it is provided in England for children who are adopted or subject of a Special Guardianship Order (SGO), and to analyze the potential effects of DDP on standardized outcomes of child and caregiver wellbeing. Participants were 150 families who received DDP through funding from the Department for Education's Adoption Support Fund in England between 2018 and 2021. Linear mixed modeling demonstrated significant improvements in child/young person difficulties in multiple subscales of the SDQ, including emotional difficulties and conduct problems.
Evidence-Based Status
The California Evidence-Based Clearinghouse for Child Welfare reviewed DDP with research evidence last reviewed in February 2025. The program has been recognized as an evidence-based treatment for complex trauma and attachment disorders.
Meta-analyses have demonstrated robust effects for trauma-focused evidence-based treatments (TF-EBTs) on posttraumatic stress symptoms (PTSS) in trauma-exposed children and youth, irrespective of age, gender and trauma characteristics. These treatments have been shown to lead to large reductions in symptoms even under challenging circumstances and complex traumatic circumstances.
Benefits and Outcomes
For Children
Two master themes and eight subthemes were identified, describing a dynamic process where the qualities of the therapeutic interactions were salient, generating potential for increased caregiver closeness and connection. A cycle of interactive repair was important to maintain the process of developing trust. Five of the six participants were able to express benefits of the therapy, depicting increased connection and closeness with caregivers.
Research indicates children experience:
- Improved attachment security
- Better emotional regulation
- Reduced behavioral problems
- Enhanced ability to trust caregivers
- Decreased symptoms of PTSD and depression
- Improved social functioning
For Parents and Caregivers
In the same time frame, similar improvements in caregiver wellbeing were also observed, as measured by the SWEMBS. These findings suggest an association between the provision of DDP and an improvement in child/young person and caregiver wellbeing on standardized measures, with these improvements maintained 6 months later.
Benefits include:
- Increased parenting confidence
- Better understanding of their child's needs
- Improved emotional connection with their child
- Enhanced ability to manage challenging behaviors
- Reduced caregiver stress
Who Can Benefit from DDP?
DDP is particularly effective for:
Foster and Adoptive Families
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 are often required.
Children with Complex Trauma Histories
Adopted and fostered children who have experienced early trauma have higher rates of attachment disorders such as Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). Emotional dysregulation and behavioral difficulties are common in children with attachment disorders.
Families Dealing with Attachment Disruptions
Children who had experienced other types of victimization without any form of attachment trauma were less likely to meet criteria for DTD, highlighting the specific impact of attachment-related trauma.
Finding a DDP Therapist
Certification and Training
Practitioners offering Dyadic Developmental Psychotherapy will have trained as therapists and received additional training and supervision to develop skill in providing DDP as a therapy. All certified Practitioners, Trainers and Consultants in DDP can be found on the Find a Practitioner page.
What to Look For
When seeking a DDP therapist, consider:
- Certification through the DDP Network or DDPI
- Experience working with trauma and attachment
- Training in trauma-informed care
- Experience with your specific family situation (adoption, foster care, etc.)
Accessing DDP Services
There is a time-limited opportunity to take part in a national clinical trial of Dyadic Developmental Psychotherapy (DDP), which would give you the possibility of receiving a much higher number of sessions of DDP. The aim of the research study is to evaluate the effectiveness of DDP, compared to 'services as usual'.
Frequently Asked Questions
Is DDP only for adopted or foster children?
While DDP was initially developed for children in foster care and adoptive families, it can benefit any child who has experienced trauma or attachment disruptions, including children living with biological parents who have experienced early adversity.
How long does DDP treatment typically last?
DDP sessions are tailored to each family and their needs, lasting between one to two hours per session, with the total number of sessions ranging depending on the family. Treatment duration varies based on the child's needs and family circumstances, typically ranging from several months to over a year.
What's the difference between DDP and traditional play therapy?
Unlike traditional play therapy, DDP actively involves parents in sessions and focuses on building the parent-child relationship. Dyadic Developmental Psychotherapy therefore involves the child and parents working together with the therapist.
Can DDP help with behavioral problems?
Yes. Linear mixed modeling demonstrated significant improvements in child/young person difficulties in multiple subscales of the SDQ, including emotional difficulties and conduct problems. The therapy addresses the underlying attachment and trauma issues that often drive problematic behaviors.
Is there evidence that DDP works?
The study findings support the hypothesis that DDP should continue to be evaluated as a potentially effective therapeutic intervention for care experienced children and families in the future. Multiple studies have shown positive outcomes, though researchers continue to build the evidence base.
How do I know if my child needs DDP specifically?
A mental health professional trained in evidence-based trauma treatment can help children and families heal. Treatments like trauma-focused cognitive behavioral therapy are proven effective, and there are many promising approaches to address child trauma. The best treatment depends on the type, timing, and severity of the trauma.
How Therapy Can Help / Find a Therapist
If your child has experienced trauma, neglect, or attachment disruptions, professional help can make a significant difference. DDP offers a unique approach that recognizes healing happens within relationships and provides structured support for both children and their caregivers.
Not all children experience child traumatic stress after experiencing a traumatic event, but those who do can recover. With proper support, many children are able to adapt to and overcome such experiences. As a family member or other caring adult, you can play an important role.
To find a qualified DDP therapist:
1. Visit the DDP Network to search for certified practitioners
2. Contact your local adoption or foster care agency for referrals
3. Ask your pediatrician or family doctor for recommendations
4. Search the GoodTherapy directory for trauma-informed therapists in your area
Remember, seeking help is a sign of strength, not weakness. With the right therapeutic support, children and families can heal from trauma and build secure, loving relationships.
References:
- Burch, K., Coombes, L., Macey, E., & Backinsell, A. (2023). Dyadic Developmental Psychotherapy for children living with adoptive parents or special guardians: A longitudinal assessment of the impact on child and caregiver wellbeing outcomes. Developmental Child Welfare, 5(2), 89-106. https://doi.org/10.1177/25161032231165757
- California Evidence-Based Clearinghouse for Child Welfare. (2025, February). Dyadic Developmental Psychotherapy: Detailed program information. Retrieved from https://www.cebc4cw.org/program/dyadic-developmental-psychotherapy/detailed
- Christopher, J., Cresswell, C., & Davies, J. (2025). Dyadic developmental psychotherapy for children with developmental trauma histories: An exploration of children's therapeutic experiences. Clinical Child Psychology and Psychiatry, 30(4), 874-892. https://doi.org/10.1177/13591045251348709
- Chrysalis Associates. (2025). Clinical trial of Dyadic Developmental Psychotherapy (DDP). Retrieved from https://www.chrysalisassociates.org/clinical-trial-of-dyadic-developmental-psychotherapy-ddp/
- DDP Network. (2024). About DDP: Dyadic Developmental Practice framework. Retrieved from https://ddpnetwork.org/about-ddp/
- Guo, S., Chen, Q., & Chan, K. L. (2025). Effectiveness of trauma-informed care programs: A meta-analysis. Trauma, Violence & Abuse, 26(1), 112-128. https://doi.org/10.1177/15248380251366271
- International Society for Traumatic Stress Studies. (2025). Improving access to evidence-based treatment for trauma. Retrieved from https://istss.org/wp-content/uploads/2025/09/2025-ISTSS-Briefing-Paper.pdf
- National Center for Biotechnology Information. (2025). Dyadic developmental psychotherapy for children with developmental trauma histories: An exploration of children's therapeutic experiences. PMC12436982. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC12436982/
- National Institute of Mental Health. (2025). Science updates about post-traumatic stress disorder (PTSD). Retrieved from https://www.nimh.nih.gov/news/science-updates/post-traumatic-stress-disorder-ptsd
- Substance Abuse and Mental Health Services Administration. (2024). Understanding child trauma. Retrieved from https://www.samhsa.gov/mental-health/trauma-violence/child-trauma
- Zimmermann, J., Kliewer-Neumann, J., Bovenschen, I., Lang, K., Gabler, S., Nowacki, K., & Spangler, G. (2024). Predictors of the rate and course of reactive attachment disorder and disinhibited social engagement disorder symptoms in foster children during the first year of placement. Child Abuse & Neglect, 154, 106872. https://doi.org/10.1016/j.chiabu.2024.106872
