Dyadic Developmental Psychotherapy (DDP)
Introduction
Dyadic Developmental Psychotherapy (DDP) is a controversial method of treating children with histories of maltreatment using the principles of attachment therapy[1]. The main premise of DDP is that the development of children is highly dependent and influenced by the nature of the relationship with their parents or caregivers. Therefore, the treatment sessions have a parenting component as well.
Goals of Dyadic Developmental Psychotherapy
Dyadic Developmental Psychotherapy seeks to help children who have experienced deep trauma establish secure patterns of attachment. Children suffering from severe trauma have internalized a negative working model of the world[2]. They have difficulties relating to adults and to themselves. These attachment issues make it hard for them to develop functional relationships. This form of therapy is most commonly performed on children residing in foster homes, adoptive homes or residential treatment centers.
When is Dyadic Developmental Psychotherapy Used
Children who have experienced neglect or abuse are at risk of developing trauma-attachment symptoms. Maltreatment in the early stages of growing-up can lead to various developmental issues such as depression, anxiety or acting-out. Many of these children are violent and aggressive and as adults they are at risk of developing psychological problems and personality disorders such as antisocial personality disorder, narcissistic personality disorder, borderline personality disorder and even psychopathic personality disorder.
Neglected children are at risk of social withdrawal, social rejection, and pervasive feelings of incompetence. Adopted children are especially vulnerable to such attachment disorder symptoms.
“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 he dyadic experiences provided by the new parent”, argues Dr. Daniel Hughes, the psychiatrist that laid the foundation for this type of therapy[3].
Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average)[4].
How Dyadic Developmental Psychotherapy Works
A session of Dynamic Developmental Psychotherapy consists in working with the child as well as the parent or the caregiver. The therapist meets in private with the caregiver and instructs him in attachment parenting methods. Effective methods require a degree of structure and consistency as well as a supportive environment that stimulates playfulness, love, acceptance, curiosity and empathy.
Working with the parents is important because their own issues may create difficulties in the treatment of the child. Due to this approach, caregivers often feel incompetent.
After establishing a relationship with the parent, the therapist meets the child, in the presence of the caregiver. Treatment consists in three broad categories of intervention: affective attunement, cognitive restructuring and psychological re-enactments.
Dynamic Developmental Psychotherapy puts great emphasis on non-verbal processes rather than on verbal content as a way of addressing past trauma in a safe medium. DDP techniques rely strongly on eye contact, tone of voice, touch and movement. Children with severe trauma create strong barriers to deal with past maltreatment and have a difficult time talking about their inner turmoil. Therefore, this form of therapy relies on empathy in order to help the child find a secondary mental interpretation of traumatic events in order to develop a coherent autobiographical narrative that can help him relate to others and form relationship based on attachment and trust[5].
The main steps of the therapeutic process consist in identifying and exploring the patient’s behavior. By using the child’s curiosity, the therapist helps him explore, find a meaning and accept the behavior. Empathy is important as is it reduces the sense of shame and helps the patient feel accepted and understood. After accomplishing these stages, the therapist proceeds to normalize the child’s behavior. The patient will then share the breakthrough with the caregiver. The entire treatment process requires ongoing, dyadic experiences between parent and child. The final step is integrating the trauma by finding new representations that help reinterpret past trauma.
Criticism of Dyadic Developmental Psychotherapy
Dyadic Developmental Psychotherapy has been criticized for the lack of case studies that can provide a detailed perspective of the methods used and their impact on traumatized children.
Critics argue there are evidence of interventions for foster children who were erroneously classified as supported by evidence of efficacy. Furthermore, it is shown that holding therapy and dyadic developmental psychotherapy are not appropriately categorized as supported and acceptable interventions[6].
Dyadic Developmental Psychotherapy was developed by Dr. Daniel Hughes, a member of the American Psychological Association who received hid PhD in clinical psychology from Ohio University. Hughes is also the director of the Dyadic Developmental Psychotherapy Institute whose purpose is to provide training, certification, and supervision.
References
[1] http://www.dyadicdevelopmentalpsychotherapy.org/
[2] http://books.google.ro/books?id=cbPCN-1FAgcC&pg=PA19&hl=ro&source=gbs_selected_pages&cad=3#v=onepage&q&f=false
[3] http://www.danielhughes.org/treatmentandparent.html
[4] MacMillian, H.L. (2001). Childhood abuse and lifetime psychopathology in a community sample. American Journal of Psychiatry, 158, 1878–1883.
[5] http://www.center4familydevelop.com/research.pdf
[6] http://rsw.sagepub.com/content/17/4/513.abstract
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