Dyadic Developmental Psychotherapy Research Articles

Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy.

Dyadic Developmental Psychotherapy (DDP) is a family-based therapy for adopted children aiming to achieve secure attachment between the child and parent. Due to restrictions under the COVID-19 pandemic, delivery of DDP transitioned from face-to-face to online methods. This study aimed to explore families experience of online DDP compared to face-to-face DDP, looking at the advantages and disadvantages of remote delivery methods and the implications this has on future service delivery for clinicians. Semi-structured interviews with 6 families were conducted online. Analysis of transcripts using Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes: environment and child engagement, non-verbal communication, travel and familiarity with remote interactions. Parents recognised the influence the physical and online environment had on their child's engagement levels, however, varied in their experience and hence preference of delivery method. All families emphasised the importance of non-verbal communication within DDP sessions and majority highlighted this may be lost online. For families who travelled to face-to-face DDP, car journeys provided a unique opportunity to decompress and reflect after sessions. For families where travel is unfeasible, online DDP was a lifeline, demonstrating the ability of remote therapy to widen access to specialist healthcare. Familiarity with online work emerged as a strong indicator of positive attitudes towards remote DDP, especially if the previous experience is positive and the child is confident using technology. Overall, families differed greatly in their experience of remote and face-to-face DDP indicating a new approach must be undertaken with each family beginning therapy, ensuring it is unique and individual to their needs.

Conversations of DDP: Experiences of blocked care within an Edge of Care team

Dyadic Developmental Psychotherapy (DDP) is an established approach used to support families and children to develop healthy relationships. The approach was originally used therapeutically with foster and adoptive families, but has been further developed for working with biological parents or caregivers and residential care staff. DDP informed interventions have been used in the Edge of Care service, and this article outlines some of the benefits they have had, particularly in relation to blocked care and supporting parents or caregivers to reconnect with their children. It has also been helpful in supporting professionals and parents/caregivers to reconnect, in turn promoting child welfare and safety.

Dyadic Developmental Psychotherapy for children living with adoptive parents or special guardians: a longitudinal assessment of the impact on child and caregiver wellbeing outcomes

Dyadic Developmental Psychotherapy (DDP) is a form of psychotherapy for families where children and young people have experienced early trauma or attachment disruption. This study used longitudinal survey data to understand the format of DDP as it is provided in England for children who are adopted or subject of a Special Guardianship Order (SGO), and to analyse the potential effects of DDP on standardised outcomes of child and caregiver wellbeing. Participants were 150 families who received DDP through funding from the Department for Education’s Adoption Support Fund in England between 2018 and 2021. Adoptive parents and special guardians (caregivers) answered surveys at three timepoints; before therapy was provided (baseline), when therapy had ended (wave 2), and 6 months later (wave 3). Linear mixed modelling demonstrated significant improvements in child/young person difficulties in multiple subscales of the SDQ, including emotional difficulties and conduct problems, between baseline and wave 2. In the same time frame, similar improvements in caregiver wellbeing were also observed, as measured by the SWEMBS. These findings suggest an association between the provision of DDP and an improvement in child/young person and caregiver wellbeing on standardised measures, with these improvements maintained 6 months later. Implications and recommendations for future research to substantiate the findings are discussed.

Increasing connection in intellectual disability services: A dyadic developmental psychotherapy perspective on behavioural distress

Increasing connection in intellectual disability services: A dyadic developmental psychotherapy perspective on behavioural distress

Advocating the need for neuro-informed working with intercountry adoptees

BackgroundIntercountry adoption is declining and many adoptees at any point of their life are in search of therapeutic services. Specialized care is scare and regular services seem to be missing the point. Regular therapeutic services do not cater to the specific needs of adoptees because they often forget to take the early adversity into account.Adoption specific therapeutic services are called for worldwide, this needs not be very difficult. Affective neurobiology, trauma and attachment research next to adoption studies have given practitioners many tools to design a sustainable therapeutical practice for both adoption aware assessment as well as adoption aware treatment. ObjectiveAdvocating a neuro-informed approach to treatment when intercountry adoptees present developmental or other mental health problems. This approach is based on a combination of professional reflection as well as on theory and the idea is that it can be used broadly by clinicians, even when not specifically trained or focused on intercountry adoptions. Participants and settingTheoretical insights are combined with clinical experience in De Adoptiepraktijk, a private, specialized mental health practice, making the argument for embracing a neuro informed approach in working with intercountry adoptees in the Netherlands. MethodsTheoretical evaluation, argumentation and personal reflection illustrated by a small case study.Results Overview of problems, models and methods to be used in clinical work with intercountry adoptees. ConclusionsProposition to use theoretical and practical insights from the neurosequential network, dyadic developmental psychotherapy, sensorimotor psychotherapy11The author trained both in Dyadic Developmental Psychotherapy as well as Sensorimotor Psychotherapy, in the latter she is a certified advanced practitioner and consultant intern. and the polyvagal theory to help clinicians assess the problems adopted clients encounter and plan interventions accordingly.

Understanding and helping children who have experienced maltreatment.

Children who experience maltreatment from within their families can suffer trauma that is devastating to their physical and psychological development. The label developmental trauma has developed to describe this trauma and to guide diagnosis. This has been expanded to describe seven domains of impairment. Together these help the clinician to provide a formulation of a child's difficulties which avoids multiple diagnoses and can guide treatment planning. Dyadic Developmental Psychotherapy and Practice (DDP) is an intervention model that can meet the therapeutic needs of the children alongside the support needs of parents and practitioners caring for them. The attitude of PACE (playfulness, acceptance, curiosity and empathy) is central within DDP interventions, used by therapists, parents and practitioners who together make up the network around the child. Tailoring DDP interventions can be guided by a pyramid of need developed by the author. This helps clinicians develop flexible intervention packages tailored to the needs of the child, family and practitioner. Within the paper these ideas are explored illustrated by the fictional example of Janice. She was maltreated in early childhood and now lives in foster care with Mary and Simeon.

Relationships in Good Hands - Clinical and Cost-effectiveness of Dyadic Developmental Psychotherapy

Relationships in Good Hands - Clinical and Cost-effectiveness of Dyadic Developmental Psychotherapy

The development of DDP-informed parenting groups for parents and carers of children looked after or adopted from care

This article describes the development of two parenting groups – Nurturing Attachments ( Golding, 2014 ) and Foundations for Attachment ( Golding, 2017 ). Both programmes are informed by the Dyadic Developmental Psychotherapy (DDP) model developed by Dan Hughes in the USA ( Hughes, 2011 ; Hughes, Golding and Hudson, 2019 ). The groups were devised to provide much needed support for foster, residential and kinship carers and adopters parenting children and young people of all ages. Participants express high satisfaction upon attending the groups and in the most recent evaluations, report positive and statistically significant changes to their self-efficacy, competence and reflective function. This is despite the continuing challenges presented by the children and the high levels of stress experienced by many parents. The groups are part of the package of support which these carers and parents require, and can supplement individual parenting support and therapeutic interventions as needed. As the development of the groups has been grounded in the experience of foster carers and adoptive parents, underpinned by theory and supported by robust outcome studies, it can be concluded that they provide a helpful intervention for the carers and parents.

Nurturing attachments parenting program: The relationship between adopters’ parental reflective functioning and perception of their children’s difficulties

This article draws on an evaluation of the effectiveness of the Nurturing Attachments group work program provided by AdoptionPlus for adoptive families in England. Twenty-nine adoptive families participated in a longitudinal quantitative study, completing questionnaires and validated measures before and after group attendance. The Nurturing Attachments program, informed by Dyadic Developmental Psychotherapy, was developed to help foster and adoptive parents strengthen their relationships with the child and support children who had experienced developmental traumas. Most parents were caring for children who were late placed and who had complex and overlapping difficulties. Post-training, parents reported increased confidence in their own parenting and statistically significant positive changes in self-efficacy and in their capacity for reflective functioning. However, unexpectedly, adoptive parents identified more children as having greater emotional and peer difficulties and fewer with symptoms of conduct disorders. This article focuses on the relationship between perceptions of adopted children’s behavior and parental reflective functioning (PRF) and self-efficacy. It explores whether improved reflective functioning, particularly curiosity, led to a better understanding of their child’s behaviors and thus an increased recognition of emotional distress. Recommendations for supporting adoptive parents, including the importance of supporting PRF, within a wraparound package of support during childhood and adolescence are made.

Adoptive parents' experiences of dyadic developmental psychotherapy.

Dyadic developmental psychotherapy (DDP) is an attachment-focused therapy frequently used with adoptive and foster families. While the evidence base for DDP is building, national guidance has called for further trials and qualitative evidence. This study aimed to understand the experience of adoptive parents who have completed DDP therapy. Semi-structured interviews with 12 adoptive parents were analysed using interpretative phenomenological analysis. Four superordinate themes were identified: (1) increased understanding, (2) 'It's a different method of parenting generally', (3) the DDP journey and (4) 'It's a shared kind of experience you go through and come out together'. Parents felt they had increased insight into their child's mind and how to better support their child. They felt DDP was a good fit to their unique situations and it appeared to promote acceptance. The DDP journey started with parents feeling uncertainty and questioning the effectiveness of DDP. However, generally parents became committed to the therapy once they saw change and expressed fear and sadness at ending. Parents acknowledged the dyadic nature of DDP, feeling it helped build trust and security and supported co-regulation. Parents also acknowledged the therapist's role in conveying the core DDP principles. Further implications for practice and research are highlighted.

A qualitative exploration of the experiences of adoptive parents attending 'Nurturing Attachments', a dyadic developmental psychotherapy informed group.

Children who are adopted have frequently experienced a range of aversive experience which impact on their ability to form secure attachments. Dyadic Developmental Psychotherapy (DDP) is an intervention designed to develop and promote secure attachments with children who have experienced developmental trauma. Eight adoptive parents participated in semi-structured interviews regarding their experiences of attending the 'Nurturing Attachment' group informed by DDP. The transcripts of their interviews were explored using Interpretative Phenomenological Analysis. The analysis revealed five inter-connected superordinate themes which were as follows: A supportive group, A shift in perspective, 'Turning trauma into secure attachment', 'Am I doing it right?' and Continuing the adoption journey. Themes are considered in relation to the theoretical underpinnings and practice of DDP. Some further implications for clinical and research practice are also discussed.

Dyadic Developmental Psychotherapy (DDP): An Attachment‐focused Family Treatment for Developmental Trauma

The impact of intrafamilial, relational trauma on the development of children is severe and pervasive, affecting all aspects of the child's functioning. The psychological treatment of children who have experienced such trauma may well have the greatest impact in facilitating their development when it adopts a relational approach incorporating central features of attachment theory while also including their caregivers when they are able to provide safety. Dyadic developmental psychotherapy (DDP), an attachment‐focused family therapy, has two phases. In the first, the therapist sees the caregivers alone to ensure that they have the motivation and ability to relate with the child in ways that facilitate attachment security. This stage includes a description of the process of the treatment and the caregivers’ central role in the co‐regulation of emotional states, reducing the impact of the trauma on the child, assisting the child in turning to them for comfort and safety, and assisting in the development of new meanings of the trauma itself and its effect on the child's future. During the joint sessions, the therapist, utilising an intersubjective stance, actively facilitates a dialogue between therapist, child, and caregiver that incorporates the goals mentioned above and, within an open‐and‐engaged conversational tone, helps the child to develop a coherent autobiographical narrative that is not fragmented by terror and shame.

Special Issue: Relational Trauma and Family Therapy

Special Issue: Relational Trauma and Family Therapy

Dyadic Developmental Psychotherapy (DDP): the development of the theory, practice and research base

Dyadic Developmental Psychotherapy (DDP) is a relationship-focused therapy characterised by a strong therapeutic alliance, empathy and unconditional positive regard. It seeks to treat the complex psychological problems of looked after and adopted children as they struggle to develop a greater measure of stable functioning in their homes. It was developed by Dan Hughes based on his extensive clinical experience of working with children and families together and is rooted in a close study of relevant theory. DDP can help children who have been hurt and/or neglected within their families in their early years by supporting them to recover from previous trauma and to experience attachment security and emotional connection within their current family. As with any developing therapy, questions have been raised about its clinical relevance and effects. One such critique recently appeared in an article by Mercer (2014) and this will be used to demonstrate how misunderstandings, misinterpretations and the selective use of case studies can lead to misguided views of this important innovation. This article particularly addresses inaccuracies in accounts of the development of DDP as an intervention for looked after and adoptive children and their families, how DDP is practised around the world and how theory underpins the model. Although a lack of evidence derived from robust evaluations is acknowledged, the authors discuss the evidence base that is currently available and plans that are in place to strengthen this.

Revisiting an Article About Dyadic Developmental Psychotherapy: The Life Cycle of a Woozle

This paper examines a 2006 Child and Adolescent Social Work Journal article (Becker-Weidman in Child Adolesc Soc Work J 23:147–171, 2006a) that purported to show the effectiveness of Dyadic Developmental Psychotherapy (DDP). It is suggested that this claim, based only on weak evidence, has been the foundation of a “woozle” (Nielsen in Psychol Public Policy Law 20:164–180, 2014), a belief system that persists simply because the original statements have been repeated so often. A history of repetition and republication is traced, and current statements by the UK National Health Service and other sources are presented as evidence that acceptance of DDP began with repetition of the 2006 claims. Suggestions are made for editors and reviewers, who are in a position to prevent the creation of new woozles by carefully examining the claims made in submissions to their journals.

Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom.

BackgroundChildren with maltreatment associated psychiatric problems are at increased risk of developing behavioural or mental health disorders. Dyadic Developmental Psychotherapy (DDP) was proposed as treatment for children with maltreatment histories in the USA, however, being new to the UK little is known of its effectiveness or cost-effectiveness. As part of an exploratory study, this paper explores the feasibility of undertaking economic analysis of DDP in the UK.MethodsFeasibility for economic analysis was determined by ensuring such analysis could meet key criteria for economic evaluation. Phone interviews were conducted with professionals (therapists trained and accredited or in the process of becoming accredited DDP practitioners).Three models were developed to represent alternative methods of DDP service delivery. Once appropriate comparators were determined, economic scenarios were constructed. Cost analyses were undertaken from a societal perspective. Finally, appropriate outcome measurement was explored through clinical opinion, literature and further discussions with clinical experts.ResultsThree DDP models were constructed: DDP Full-Basic, DDP Home-Based and DDP Long-Term. Two potential comparator interventions were identified and defined as Consultation with Carers and Individual Psychotherapy. Costs of intervention completion per case were estimated to be: £6,700 (DDP Full-Basic), £7,100 (Consultations with Carers), £7,200 (DDP Home-Based), £11,400 (Individual Psychotherapy) and £14,500 (DDP Long-Term). None of the models of service delivery were found to currently measure effectiveness consistently. The Strengths and Difficulties Questionnaire (SDQ) was deemed an appropriate primary outcome measure, however, it does not cover all disorders DDP intends to treat and the SDQ is not a direct measure of health gain. Inclusion of quality of life measurement is required for comprehensive economic analysis.ConclusionsEconomic analysis of DDP in the UK is feasible if vital next steps are taken to measure intervention outcomes consistently, ideally with a quality of life measurement. An economic analysis using the models constructed could determine the potential cost-effectiveness of DDP in the UK and identify the most efficient mode of service delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0346-0) contains supplementary material, which is available to authorized users.

The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy.

BackgroundMaltreated children have significant and complex problems which clinicians find difficult to diagnose and treat. Previous US pilot work suggests that Dyadic Developmental Psychotherapy (DDP) may be effective; however, rigorous evidence from a randomised controlled trial (RCT) is lacking. The purpose of this study is to establish the feasibility of an RCT of DDP by exploring the ways that DDP is operating across different UK sites and the impacts of current practice on the potential set-up of an RCT.MethodsQualitative methods (interviews, focus groups and teleconferences) were used to explore trial feasibility with therapists and service managers from teams implementing both DDP and possible control interventions. Data were analysed thematically and related to various aspects of trial design.ResultsDDP was commonly regarded as having a particular congruence with the complexity of maltreatment-associated problems and a common operating model of DDP was evident across sites. A single control therapy was harder to establish, however, and it is likely to be a non-specific and context-dependent intervention/s offered within mainstream Child and Adolescent Mental Health Services (CAMHS). Because a ‘gold standard’ Treatment as Usual (TAU) does not currently exist, randomisation between DDP and TAU (CAMHS) therefore looks feasible and ethical.The nature of family change during DDP was regarded as multi-faceted, non-linear and relationship-based. Assessment tools need to be carefully considered in terms of their ability to capture change that covers both individual child and family-based functioning.ConclusionsAn RCT of DDP is feasible and timely. This study has demonstrated widespread interest, support and engagement regarding an RCT and permissions have been gained from sites that have shown readiness to participate. As maltreated children are among the most vulnerable in society, and as there are currently no treatments with RCT evidence, such a trial would be a major advance in the field.

Dyadic developmental psychotherapy: Toward a comprehensive, trauma-informed treatment for developmental trauma disorder

Dyadic developmental psychotherapy: Toward a comprehensive, trauma-informed treatment for developmental trauma disorder

Examining Dyadic Developmental Psychotherapy as a Treatment for Adopted and Foster Children

Dyadic developmental psychotherapy (DDP) is a mental health intervention intended primarily for children with problematic attachment histories. It has received increased attention in the United Kingdom and the United States in the last few years. DDP has been publicized as a research-supported treatment, but a review of research shows that it does not meet ordinary standards for this category. In addition, DDP appears to be based on a number of questionable metaphors that have been used in attempted explanations of personality development and mental illness. Some unanswered questions about the background assumptions of DDP are presented. Caution about this method of therapy is recommended.

Dialectical Behaviour Therapy and attachment: Vehicles for the development of resilience in young people leaving the care system

It is well recognised that Looked After Children (LAC) and Young People Leaving Care (YPLC) have complex mental health needs and often engage in self-destructive behaviours such as self-harm, drug and alcohol use and suicide attempts. They can experience a high level of instability in relationships and frequently live transient lifestyles. Traditional mental health services for children, young people and adults have been unable to meet the attachment needs of this particular group such that they rarely benefit from therapeutic interventions and remain in a constant state of emotional dysregulation. This article describes the way in which two distinct therapeutic models - Dyadic Developmental Psychotherapy and Dialectical Behaviour Therapy - have been interwoven in order to engage and captivate young people leaving care in a therapeutic relationship. This relationship can then be used to help build skills to increase their resilience as they enter adulthood.