Dyadic Developmental Psychotherapy

Dyadic Developmental Psychotherapy, developed by Daniel A. Hughes over the last two decades, differs from traditional non-directive approaches to child therapy in its involvement of the child’s carer throughout the therapy sessions.

It is a treatment approach to trauma, neglect, loss and/or other dysregulating experiences that is based on principles derived from attachment theory and research, and also incorporates aspects of treatment principles for Post Traumatic Stress Disorder (PTSD).

Dyadic Developmental Psychotherapy 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 or avoided. Safety is created by ensuring that this exploration occurs with nonverbal attunement, reflective (non-judgemental) dialogue, along with empathy and reassurance. As the process unfolds, the child is creating a coherent life-story (or autobiographical narrative) which is crucial for attachment security and is a strong protective factor against psychopathology. Therapeutic progress occurs within the joint activities of co-regulating affect and co-constructing meaning.

Nonverbal attunement refers to the frequent interactions between a parent and infant, in which both are sharing affect and focused attention on each other in a way such that the child’s enjoyable experiences are amplified and their stressful experiences are reduced and contained. This is done through eye contact, facial expressions, gestures and movements, voice tone, timing and touch.

These same early attachment experiences, which are fundamental for healthy emotional and social development, are utilized in therapy to enable the child to rely on the therapist to regulate emotional experiences and to begin to understand these experiences more fully. Such understanding develops further thought engaging in a conversation about these experiences, without judgement or criticism. The therapist will maintain a curious attitude about the memories and behaviours, encouraging the child to explore them to better understand the deeper meanings in their life and gradually develop a more coherent life-story.

The primary therapeutic attitude demonstrated throughout the sessions is one of playfulness, acceptance, curiosity and empathy (PACE). For the purpose of increasing the child’s safety, their readiness to rely on significant attachment figures in their life, and their ability to resolve and integrate the dysregulating experiences that are being explored, a person who is an important attachment figure to the child, their parent/carer, will be actively present.

The role of the parent/carer in the child’s psychotherapy is the following:

  • Help the child to feel safe
  • Communicate PACE, both non-verbally and verbally
  • Help the child to regulate any negative affect such as fear, shame, anger or sadness
  • Validate the child’s worth in the fact of trauma and shame-based behaviours
  • Reassure the child that their relationship remains strong regardless of the issues
  • Help the child to make sense of their life so that it is organised and congruent

More information about DDP can be found at www.danielhughes.org.

Further details about the evidence base for DDP can be found in the following articles:

Becker-Weidman, A. (2006) Treatment for children with trauma-attachment disorders: Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, March, 2006.

Becker-Weidman, A. (2006) Dyadic Developmental Psychotherapy: a multi-year follow-up. In New Developments in Child Abuse Research. S.M. Sturt, Ed. Nova Science Publishers.

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