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DYADIC DEVELOPMENTAL PSYCHOTHERAPY (DDP)… what it is and why it is effective

Dyadic Developmental Psychotherapy (DDP) was originally developed by American clinical psychologist, Dr Daniel Hughes, as an intervention for children whose emotional distress resulted from earlier traumatic experiences, such as separation from familiar caregivers or abuse. It is a treatment approach for families that have children with significant emotional difficulties, including complex trauma and disorders of attachment. These ‘disorders’ are often demonstrated in extremely challenging behaviours, usually the result of a ‘fight, flight or freeze’ reaction to overwhelming levels of anxiety and stress.

 

DDP primarily involves creating a ‘playful, accepting, curious, and empathic (PACE)’ environment in which the therapist ‘tunes in’ to the child’s inner world of thoughts, feelings and experiences. The therapist then reflects this back to the child by means of eye contact, facial expressions, gestures and movements, voice tone, careful timing and touch. By doing this the therapist helps the child to manage the difficult feelings resulting from distressing early experiences and together they make sense of those early experiences. In most cases, the child’s current caregiver is also involved directly in the therapy, being available as a safe and secure base from which the child can explore very difficult experiences and feelings.

 

To achieve its goals DDP also makes use of strategies from other therapy approaches, such as cognitive behavioural therapy and narrative approaches; however, the key benefit of DDP over these more traditional approaches alone is the therapist’s direct involvement in helping the child to manage difficult feelings alongside making sense of difficult experiences. The challenging behaviours often exhibited as a result of traumatic early experiences are usually experienced by the child at an emotional rather than ‘thinking’ level. As such, the child is unlikely to be able to manage overwhelming emotions and behaviours in a rational or thoughtful way; hence the benefit and effectiveness of an approach such as DDP.

 

DDP is effective because of its reliance on and development of a shared understanding, emotion and experience between the therapist and child, caregiver and child, and therapist and caregiver. As the therapist helps the child to feel increasingly in control of his or her emotions more generally – DDP calls this process ‘co-regulation’- the child begins to feel increasingly safe and secure. Only then can the child safely experience and explore distressing and often shameful feelings and memories associated with the past.

 

Furthermore, DDP’s preferred involvement of caregivers in treatment helps to develop a ‘tuned in’ relationship between the child and caregiver. A ‘tuned in’ relationship is happening when two people experience the same feelings during a shared event or occurrence; it is as if they are reflections of each other in a mirror. Within the safety of the ‘tuned in’ relationship, the distress and shame of past trauma and current challenging behaviours can be explored. A child who has experienced ongoing abuse and neglect in early childhood is unlikely to have experienced sufficient ‘tuned in’ interaction with a key caregiver. As a result, the child will not have had the opportunity to develop a healthy bond or attachment with a safe and trustworthy adult. DDP helps to develop a healthy attachment between child and caregiver, enabling the child to learn to trust the caregiver, and obtain a sense of safety and comfort from the caregiver.

 

The number of DDP treatment sessions will depend upon the individual needs of the child or young person. Between sixteen and twenty-four sessions is typical, but in some instances fewer or more may be appropriate. Sessions would typically occur weekly, but this can be negotiated according to the needs and practicalities of individual situations. Sessions would ideally occur at a neutral venue where there are few distractions to the child and carer. For this reason, sessions within the home environment are not encouraged.

 

Overall, DDP is becoming increasingly accepted in the United Kingdom as an effective therapy intervention for children who have experienced early trauma and loss. The emphasis placed upon the child’s deepening relationship with a trustworthy caregiver allows the child to safely explore distressing memories and feelings from the past, and move towards a future that is more hopeful and secure.

 

(Author: Dr Meryl Forse)

Sources/further reading:

Golding, K. and Hughes, D (2012). Creating Loving Attachments: Parenting With PACE to Nurture Confidence and Security in the Troubled Child. Jessica Kingsley Publishers.

Hughes, D. (2007). Attachment-focused family therapy. W.W. Norton & Company.

Hughes, D. (2009). Attachment-focused Parenting – effective strategies to care for children. W.W. Norton & Company.