Dyadic Developmental Psychotherapy

What is Dyadic Developmental Psychotherapy?

Dyadic Developmental Psychotherapy (DDP) is a treatment approach to trauma, loss, and other stressful experiences that a child may experience. DDP is based on the premise that the parent-child attachment relationship will be the central factor in the child’s subsequent healthy development.

DDP involves creating a safe setting in which the child can begin to explore, resolve, and integrate a wide range of memories, emotions, and current experiences, that are frightening, shameful, avoided or denied. Safety is created through the process of creating “attachment security”, which means that the child learns to feel safe with and trust the adults who are responsible for their care.

DDP focuses on assisting the child to feel safe, which is necessary for the child to begin to explore, resolve and integrate trauma. Since the primary purpose of attachment is to generate safety, DDP focuses on facilitating the development of attachment security between the child and his or her caregiver, to provide the safety they need to heal from the trauma. While resolving the trauma, the therapist is helping the child to turn toward the attachment figure under times of stress, which deepens the attachment.

How Does DDP Work?

The therapist will first carry out a brief assessment. This will involves meeting with the caregiver to obtain an understanding of the child and his or her presenting problem.

The goals of DDP include increasing the child’s psychological safety, his readiness to rely on significant attachment figures in his life, and his ability to resolve and integrate the traumatic or dysregulating experiences that are being explored. For this reason, DDP sessions involve the child and his or her primary attachment figure. This may be a parent, foster parent, or some other adult who is taking care of the child and important in his or her life.

The goals of DDP include:

  • Emotional development: learning to identify, regulate and communicate emotions.
  • Relationship repair: learning to identify and resolve conflicts with other people.
  • Accepting comfort: learn to seek and accept comfort from those who are responsible for their care.
  • Inner-life awareness: learn to speak about one’s own emotions, thoughts, wishes, and intentions so that they are deeply understood by others.
  • Awareness of inner-life of other: learn to more accurately perceive and understand the motives underlying the behaviour of others
  • Imitation: learn to value the process of learning through imitation (mentoring) the basic skills and interests of the parents or caregivers.
  • Self-discovery: learn to discover positive qualities of self through the experience of the positive impact on those who are responsible for one’s care, and learn to discover the vulnerable and “unwanted” parts of self and explore without shame.

What is PACE?

PACE represents the characteristics of a parental attitude that create safety and emotional intimacy, openness and delight within the parent-child relationship. It provides a context in which any conflicts or behavioral problems can find an easier resolution. PACE enables the relationship to truly transform both parent and child.

The therapist strives to facilitate a safe environment for the child to develop attachment security by maintaining the attitude of PACE. The attributes of PACE are:

  • Playfulness: reflects the positive, unconditional, deep interest in each other and in the act of being together.  Playfulness may involve laughing, gentle teasing, and telling funny stories, or it may be just sharing in an activity and being with each other with lightness and openness.
  • Acceptance: is where the experience of the child is completely accepted and not evaluated as being wrong or bad. Acceptance, when felt completely and taken for granted, becomes a secure base upon which a child is much more likely to learn from his mistakes. Acceptance is unconditional, and does not undermine the child’s self-worth, nor threaten his or her relationship with his caregiver. This gives him the freedom to explore his mistakes and to learn from them.
  • Curiosity: causes parents to be continuously involved in acts of discovery of their child, noticing all their special qualities and abilities. The child notices the impact of their actions and expressions on his parents, and is more likely to engage in actions that have a positive impact on his parents. His parents’ continuing curiosity about him and discovery of the meaning of his actions and expressions affects the child’s experience of himself.
  • Empathy: is a natural response to being with another person. Our brains are wired to experience empathy for others. Children who experience empathy from their attachment figure are more likely to be able to manage very difficult situations without becoming dysregulated through the experience of intense anger, fear, discouragement or shame. When parents experience their child’s negative emotional states with him, these states get smaller. When parents experience their child’s positive emotional states with him, these states get larger.

Who Would Benefit from DDP? 

DDP is a helpful intervention for children who are experiencing a wide range of emotional, behavioral and relational difficulties. It is useful for children who live with their birth parents, adoptive parents, foster parents, or extended family members.

DDP has been used extensively with children who have experienced complex or developmental trauma. (Complex trauma is when children have been exposed to multiple traumatic events that have an immediate or long-term impact Developmental trauma occurs when complex trauma occurs within the context of the family, is chronic and prolonged, and impacts on development.)

Many children and youth with attachment difficulties and a history of trauma experience significant difficulty forming relationships with both adults as well as peers. If the child or youth is living with a caregiver who has the ability and commitment to facilitate the development of attachment security, then a central goal of their therapy is to enable them to to achieve such security with their caregiver.

At times children and youth who experience trauma may be living with caregivers who might not be seen as attachment figures, such as children in group homes or short-term foster placements. While the goal of therapy may not be attachment, these children still need to learn how to relate well with their caregivers, even if attachment is not the primary goal.

For More Information: 

  • Daniel A. Hughes (2006) Building the bonds of attachment. Awakening love in deeply troubled children. N.Y.: Jason Aronson.
  • Daniel A. Hughes (2009) Attachment-focused parenting. Effective strategies to care for children. N.Y.: W. W. Norton & Company