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Dyadic Developmental Psychotherapy (DDP)

Topic Areas
Scientific Rating
Child Welfare Relevance
Attachment Interventions (Child & Adolescent)
3  — Promising Research Evidence
High

About This Program

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: 5 – 17

For parents/caregivers of children ages: 5 – 17

Program Overview

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 and they often have 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, 329-337.

    Becker-Weidman, A. (2011-2012). Dyadic Developmental Psychotherapy: Effective treatment for complex trauma and disorders of attachment. Illinois Child Welfare, 6(1), 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.

The goals of Dyadic Developmental Psychotherapy for the child are:

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

The goals of Dyadic Developmental Psychotherapy for caregivers are:

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

Logic Model

The program representative did not provide information about a Logic Model for Dyadic Developmental Psychotherapy (DDP).

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

Program Delivery

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

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
  • Outpatient Clinic
  • Group or Residential Care

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)

Manuals and Training

Prerequisite/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

Manual Information

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

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Through The Attachment-Focused Treatment Institute:

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 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 Cisco WebEx.

Through The Dyadic Developmental Psychotherapy Institute (DDPI):

DDPI offers face-to-face certificated Dyadic Developmental Psychotherapy Training Programs, as well as supervision leading to a DDPI Practitioner Certificate

Education and Training Resources, including events and trainings, practitioners, consultants, and trainers for professionals and parents, can be found on this website: www.ddpnetwork.org

Number of days/hours:

48 to 60 hours, depending on trainee's goals.

The number days/hours for the DDP Level 1 and Level 2 (which are the prerequisites for Practitioner Certification) are 4 days and 28 hours each. The website may be consulted for other DDPI sponsored activities: www.ddpnetwork.org - resources - latest news, resource library and newsletters (UK, US/CA).

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Dyadic Developmental Psychotherapy (DDP) as listed below:

There is a robust process to access for both an individual practitioner's and an organization's readiness for DDP through the Dyadic Developmental Psychotherapy Institute (DDPI). For the individual practitioner, there are precertification and certification guidelines which will lead them to embody the philosophy, principles, values, culture, and skills of DDP. Please see https://ddpnetwork.org/ddpi/practitioner-certification-ddp/ for more information. The Organizational Certification Practicum is designed to lead an organization to transform its culture and philosophy of care to embody the principles, values, and skills of the DDP approach. For organization precertification and certification, please consult https://ddpnetwork.org/ddpi/organisation-certification-ddp/.

Formal Support for Implementation

There is formal support available for implementation of Dyadic Developmental Psychotherapy (DDP) as listed below:

Consultation is required as a part of the practitioner and organization certification process. A fee is required for consultation and these services may be provided onsite or virtually, either individually or in a group. Consultation frequency is dependent on the precertification practitioner or organization and the consultant. Please see https://ddpnetwork.org/ddpi/practitioner-certification-ddp/ and https://ddpnetwork.org/ddpi/organisation-certification-ddp/. DDPI requires practitioners and organizations to participate in a renewal process to ensure that DDP principles stay current and embedded into the practitioner's and organization's work. Please consult: https://ddpnetwork.org/ddpi/practitioner-certification-ddp/renewal-practitioner-certification/ and https://ddpnetwork.org/ddpi/organisation-certification-ddp/renewal-of-organisational-certification/.

Fidelity Measures

There are fidelity measures for Dyadic Developmental Psychotherapy (DDP) as listed below:

Recordings (in DVD form) of trainees are used to observe practitioners' implementation of DDP. The review of these DVDs is used to evaluate the trainees' level of fidelity to DDP. DVDs are reviewed by consultants certified by the Attachment-Focused Treatment Institute using a review/coding form. In addition, the text, The Dyadic Developmental Psychotherapy Casebook by Arthur Becker-Weidman, PhD, provides full transcripts of sessions with therapist and editor annotations. This text serves as a reference and model of ideal DDP practice. In addition, there is a Consultant Review form that is used to evaluate trainee fidelity to the differential use of DDP components in different phases of treatment. The Consultant Review form is available to consultants, DDP trainees, and anyone who requests a copy through the program contact (see bottom of the page). There is also a set of eight question packets that practitioners complete as part of the training program.

Implementation Guides or Manuals

There are no implementation guides or manuals for Dyadic Developmental Psychotherapy (DDP).

Research on How to Implement the Program

Research has not been conducted on how to implement Dyadic Developmental Psychotherapy (DDP).

Relevant Published, Peer-Reviewed Research

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)
Number of Participants: 64

Population:

  • Age — 5–17 years
  • 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, New York

Summary: (To include basic study design, measures, results, and notable limitations)
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.

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

Additional 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.

Hughes, D., Golding, K. S., & Hudson, J. (2018). Healing relational trauma with attachment-focused interventions: Dyadic Developmental Psychotherapy with children and families. New York: W. W. Norton.

Contact Information

Benjamin Hargrave
Title: Co-Chair
Agency/Affiliation: DDPI Worldwide Board of Directors
Email:

Date Research Evidence Last Reviewed by CEBC: June 2023

Date Program Content Last Reviewed by Program Staff: August 2023

Date Program Originally Loaded onto CEBC: June 2014