Father and Son Playing

DYADIC DEVELOPMETAL PSYCHOTHERAPY

Dan Hughes, a Clinical Psychologist,  created Dyadic Developmental Psychotherapy (DDP) as a treatment for families with adopted or fostered children who had experienced neglect and abuse in their birth families and suffered from significant developmental trauma.

DDP is based on and brings together attachment theory, what we understand about developmental trauma, the neurobiology of trauma, attachment and caregiving, intersubjectivity theory and child development.

Troubled children may have had many changes in the people who look after them and find it hard to trust adults. They may believe that parents aren’t safe and can’t always be turned to for comfort and help. They may develop insecure attachments and try to stop their new parents from becoming emotionally close to them.

Dyadic Developmental Psychotherapy is aimed at helping the relationship between the child and their parent or caregiver. The conversations and interactions (verbal and non-verbal) within the therapy room are all based upon PACE. This means that the therapist will be playful, accepting, curious and empathic. The therapist will talk in a way that is like telling a story rather than giving a lecture. The child gains relationship experience which helps them to grow and heal emotionally. Family members develop healthy patterns of relating and communicating. Family members are helped to become open to each other's inner life as well as their outward behaviour. This in turn leads to less feelings of fear, shame or need to control within the family. The child is helped to respond to current experience and memories of past experience flexibly instead of through ridgid and repetitive responses. 

What is PACE?

Playfulness, Acceptance, Curiosity and Empathy

Central within DDP is PACE, a way of thinking which deepens the emotional connections in our relationship with others.

Playfulness brings enjoyment to the relationship. Acceptance creates psychological safety.  When we curiously explore within a relationship we express a desire to know the other more deeply. Empathy communicates our curiosity and acceptance, as we recognize and respond to the other’s emotional experience.

 

What is the process of Dyadic Developmental Psychotherapy?

  1. The therapist will begin by working with the parents.

    He will want to ensure that the parents are comfortable with the DDP parenting approach and to provide them with help to develop this further if necessary.

  2. The therapist will then actively prepare the parents for their role in the therapeutic process.

    An important part of this is getting to know the parents, building trust and respect on both sides.

  3. The therapist helps the parents to explore the impact on themselves of parenting this child.

    A part of this exploration will involve thinking about the parents’ attachment histories. Therapist and parents gain a better understanding of how the child might be triggering this history. This in turn can help parents to remain empathic to the child even when this relationship is challenging.

  4. The therapist will then help the parents to understand the therapeutic process and what their role will be in the sessions when the child joins them.
  5. When the therapist judges the parents are ready the child will join the sessions.

    There will continue to be opportunities for the parents and therapist to talk about the work, both before or at the beginning of sessions and through scheduled parent sessions.

  6. When the child is present the therapist will interact with the child in a way that helps him to understand her better.

    He will let the child know what he has learnt about her. The therapist helps the child to remain emotionally regulated. This is called co-regulation. The therapist and child understand the child’s present and past experience. This is called co-construction. The therapist will sometimes provide a structure for this communication, for example using puppets or drawing. Communication isn’t always through words.

  7. The therapist will help the child to talk to her parents.

    This supports the child to manage her emotions and to understand her experience. Sometimes the therapist will talk to the parents about the child. Sometimes the therapist will help the child talk to her parents. Sometimes the therapist will talk for the child; this means he tells the parents what he thinks the child would like to tell them.

  8. The therapist decides what to talk about because the child will suggest something.

    This is called a theme. For example the child might say: ‘Nobody loves me.’ The therapist will explore what it is like to think that nobody loves you. The therapist is following something the child has said. The therapist then leads the child to emotionally connect with this experience at a deeper level. This is called ‘follow-lead-follow’. Sometimes parents or therapist will introduce a theme. The therapist will talk about this in the same way.

  9. The sessions are about exploring experience.

    They are not about discipline, lecturing or trying to change behaviour. Behaviour will often change during the process of therapy but this is not the main focus of the work. There will be opportunities in the parent only sessions to get ideas about how to use appropriate discipline and boundaries.

  10. Therapy will end when:
    • The therapist and parents think that the child is developing some attachment security within the family

    • Family members can continue the process of being emotionally available and intersubjectively connected without the help of the therapist

This can be a long process because of the level of fear that the child has about being parented

Some therapists will offer breaks in therapy when it is felt that this will be helpful for the child.

Sometimes breaks are because the parents need more intensive support because of the challenges that they are experiencing.

What changes might be expected following DDP?

  • The child will feel safer and more secure with their parents. The child has a more secure attachment

  • Controlling behaviours will reduce

  • When stressed the child might return to old ways of relating and behaving. For example they might become more controlling again. However it will be easier to help the child feel less stressed. The child will then feel secure again

  • The child will find relationships easier

  • The child will regulate emotions more easily

  • The child will manage stress better

  • The child will understand their emotional experience better

  • As the child is helped to heal from the past trauma they will become more emotionally healthy