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'''Dyadic Developmental Psychotherapy''' is a treatment approach for families that have children with symptoms of emotional disorders, including [[Complex post-traumatic stress disorder|Complex Trauma]] and disorders of [[Attachment disorder|attachment]].<ref name="Becker-Weidman, A. 2008 pp.329-337">Becker-Weidman, A., & Hughes, D., (2008) "Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment," Child & Adolescent Social Work, 13, pp.329-337</ref><ref name="Becker-Weidman, A. 2008 pp.329-337"/><ref name="ReferenceA">Becker-Weidman, A., Dyadic Developmental Psychotherapy: Essential Practices & Methods, Lanham, MD: Jason Aronson, 2010</ref><ref name="ReferenceB">Becker-Weidman, A., The Dyadic Developmental Psychotherapy Casebook, Lanham, MD: Jason Aronson, 2011</ref> It was originally developed by psychologist Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers.<ref name="hughes2003">Hughes, D. (2003). Psychological intervention for the spectrum of attachment disorders and intrafamilial trauma. Attachment & Human Development, 5, 271–279</ref><ref name="hughes2004"/> Hughes cites [[attachment theory]] and particularly the work of [[John Bowlby]] as theoretical motivations for dyadic developmental psychotherapy.<ref name="hughes2004">{{cite journal|author=Hughes D|year=2004|title= An attachment-based treatment of maltreated children and young people|journal= Attachment & Human Development|volume= 3|pages= 263–278|url=http://www.attachmentcoalition.org/DDP.pdf}}</ref><ref name="Bretherton, I., 1992">Bretherton, I.,(1992) "The origins of attachment theory," Developmental Psychotherapy, 28:759-775.</ref><ref name="Holmes, J., (1993)">Holmes, J.(1993) John Bowlby and Attachment Theory, London:Routledge ISBN 0-415-07729-X</ref> However, other sources for this approach may include the work of [[Daniel Stern (psychologist)|Stern]],<ref name="Stern">Stern, D.,1985"> Stern, D. (1985) The Interpersonal World of the Infant. New York: Basic</ref> who referred to the attunement of parents to infants' communication of emotion and needs, and of Tronick,<ref name="Tronick">Tronick, E., & Gianino,A.,1986"> Tronick, E.,& Gianino, A. (1986). "Interactive mismatch and repair". Zero to Three, 6(3):1-6.</ref> who discussed the process of communicative mismatch and repair, in which parent and infant make repeated efforts until communication is successful.
Dyadic developmental therapy principally involves creating a "playful, accepting, curious, and empathic" environment in which the therapist attunes to the child's "subjective experiences" and reflects this back to the child by means of eye contact, facial expressions, gestures and movements, voice tone, timing and touch, "co-regulates" emotional affect and "co-constructs" an alternative autobiographical narrative with the child. Dyadic developmental psychotherapy also makes use of [[Cognitive therapy|cognitive-behavioral]] strategies. The "dyad" referred to must eventually be the parent-child dyad. The active presence of the primary caregiver is preferred but not required.<ref name="hughes2004"/>
Firstly the therapist becomes 'non-verbally attuned' with the child's affective state. The therapist then attempts to explore 'themes' with the child whilst remaining attuned. Whilst this is done, the therapist then 'co-regulates' (helps the child to manage) the child's emerging affective states with 'matched vitality affect', and develops secondary affective/mental representations of them which is co-constructed with the child for purposes of integration (the therapist tries to help the child gain a coherent narrative about their experiences and an awareness of the positive aspects of themselves). According to Hughes "The therapist allows the subjective experience of the child to impact the therapist. The therapist can then truly enter into that experience and from there express her/his own subjective experience. As the therapist holds both subjective experiences, the child experiences both. As the child senses both, the child begins to integrate them and re-experience the event in a way that will facilitate its integration and resolution." Hughes (2004)<ref name="hughes2004"/> In the anticipated frequent disruptions, due to the child's traumatic and shaming experiences, the therapist accepts and works with these and then 'repairs' the relationship.
The ultimate aim is for the child to be able to construct a new and coherent autobiography that enables the child to be in touch with their inner feelings. "As the therapist gives expression to the child's subjective narrative, s/he is continuously integrating the child's nonverbal responsiveness to the dialogue, modifying it spontaneously in a manner congruent with the child's expressions. The dialogue is likely to have more emotional meaning for the child if the therapist, periodically, speaks for the child in the first person with the child's own words." (Hughes 2004 p18)<ref name="hughes2004"/> ▼This 'nonverbal dance' should run through both positive and negative experiences. It is posited that maintaining/re-establishing attunement during negative affective experiences prevents the child from entering into a state of affective, behavioral, and cognitive disregulation (the child's feelings becoming out of control). The aim is for the therapist and child to develop a new common meaning for the traumatic experiences, shame-based behaviors, and the dyadic process itself (how you experience another, and how they experience you), and for the child to feel safe, understood and validated at a sensory-affective, pre-verbal level of experience.<ref name="hughes2004"/>
According to Hughes, the primary inter-subjective stance is one of acceptance and curiosity, empathy, (love) and/or playfulness, (later reduced to the acronym PACE or PLACE), all the while committed to remaining emotionally engaged and available to the child. It is an active, affectively varied, dyadic interaction that interweaves moments of experience and reflection. According to Hughes it is non-coercive and is intended to lead to the child feeling better understood and having a better understanding of themselves.
According to Hughes, what he describes as the 'attachment sequence of attunement, disruption, and repair' occurs frequently in an attachment-based model of therapy, just as it does in the parent-child relationship. 'Resistance' is described as a disruption in the relationship that is then co-regulated by the therapist. This involves the therapist guessing how the child feels in order to be able to empathize and express the feeling. Curiosity and acceptance are considered crucial to this process. The therapist 'co-regulates' the child's dysregulated responses to 'co-construct' a new meaning.
▲The ultimate aim is for the child to be able to construct a new and coherent autobiography that enables the child to be in touch with their inner feelings. "As the therapist gives expression to the child's subjective narrative, s/he is continuously integrating the child's nonverbal responsiveness to the dialogue, modifying it spontaneously in a manner congruent with the child's expressions. The dialogue is likely to have more emotional meaning for the child if the therapist, periodically, speaks for the child in the first person with the child's own words." (Hughes 2004 p18)<ref name="hughes2004"/>
===Role of caregiver===
The active presence of one of the child's primary caregivers is considered to greatly enhance psychological treatment that involves establishing dyadic interactions of nonverbal attunement, affective/reflective dialogue and frequent repair as such participation by the caregiver makes it easier for children to incorporate these transforming experiences into their daily lives.<ref name="Becker-Weidman, A. 2008 pp.329-337"/><ref name="ReferenceA"/><ref name="ReferenceB"/> It follows therefore that the affective/reflective capacities of the foster/adoptive caregiver—along with those of the therapist—must be adequately developed if children are to develop similar abilities within themselves. Hughes points out that the therapy presupposes that the therapist and parent are able to remain engaged with the children when their attachment schema are activated by the stress of the dyadic interaction and the therapeutic theme. The therapist must explore relevant past experiences of the caregivers to determine if they have the ability to remain present with the child whenever the child is at risk for affective, behavioral, and/or cognitive dysregulation. If the primary caregiver is the past abuser, it is crucial that full responsibility has been accepted otherwise the caregiver cannot be appropriately empathic. However Hughes considers that attachment based treatment can be undertaken with just the therapist.(Hughes 2004 p25)<ref name="hughes2004"/>
==Controversy==
DDP has been criticised for the lack of a comprehensive manual or full case studies to provide details of the process. In addition, although non-verbal communication, communicative mismatch and repair, playful interactions and the relationship between the parents attachment status and that of a toddler are all well documented and important for early healthy emotional development, Hughes and Becker-Weidman are described as making "a real logical jump" in assuming that the same events can be deliberately recapitulated in order to correct the emotional condition of an older child.<ref name="Pignotti & Mercer">Pignotti, M., & Mercer, J. (2007). Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions: A systematic research synthesis revisited. Research on Social Work Practice, 17 (4), pp. 513-519.</ref> It is also suggested that the therapy appears to use age regression techniques to bring about such recapitulation - a feature of [[attachment therapy]] not congruent with [[attachment theory]].<ref name="Pignotti & Mercer"/> Dr Becker Weidman cites Daniel Hughes 1997 book "Facilitating Developmental Attachment", which contains a section on the use of age regression, as a source document for dyadic developmental psychotherapy.<ref name="bw1"/>
Opinion is divided as to whether Dyadic Developmental Psychotherapy is in fact an [[attachment therapy]]. The APSAC Taskforce report on Attachment disorder, Reactive attachment disorder and Attachment therapy, published in 2006, places Hughes and Becker-Weidman within the attachment therapy paradigm and indeed specifically cites Becker-Weidman for, amongst other things, the use of age regression, though not for coercive or restraining practices (p. 79). They also describe DDP as an attachment therapy in their November 2006 Reply to Letters.<ref name="Chaffin et al."/><ref name="Chaffin Reply">Mark Chaffin, Rochelle Hanson and Benjamin E. Saunders | Reply to Letters | Child Maltreat 2006; 11; 381 | {{doi|10.1177/1077559506292636}} "Dr. Becker-Weidman is cited three times in the body of the report, none of which refer to coercive techniques. The first citation references his Web site's assertion that traditional therapies are either ineffective or harmful (p. 78). The second citation references his recommendation that children be encouraged to regress to an earlier age as part of treatment (p. 79). The third citation references his assertions, which we believe are unsupported, about practicing an evidence-based treatment (p. 85)."</ref>
Becker-Weidman had stated in his letter to the Taskforce that it was essential to treat a child at its developmental rather than chronological level, but the Taskforce in its November 2006 Reply to Letters disagreed (p. 382).<ref name="Chaffin Reply">Mark Chaffin, Rochelle Hanson and Benjamin E. Saunders | Reply to Letters | Child Maltreat 2006; 11; 381 | {{doi|10.1177/1077559506292636}}</ref><ref name="Becker-Weidman Letter">Arthur Becker-Weidman, Letter to the Editor, Child Maltreat 2006; 11; 379, {{doi|10.1177/1077559506292632}}.</ref>
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