Showing posts with label effective treatment. Show all posts
Showing posts with label effective treatment. Show all posts
May 11, 2013
Early Neglect and Child Development
Early Neglect and Child Development:
Randomized trail compares children in institutions with those in foster care
Summarized by Arthur Becker-Weidman, PhD
Severe neglect and institutional care cause significant difficulties in attachment, biology, cognitive functioning including executive and neuropsychological functions, and behavioral and emotional regulation. Studies of children in Romanian orphanages and other settings have demonstrated the pervasive and negative impact of such neglect on various domains of child development. Those of us who work with such children know the complexities of helping families with these children. Their difficulties may include disturbed patterns of attachment, sensory-integration dysfunction, various neuropsychological impairments, mental health issues, and problems with emotional and behavioral regulation. These children are extremely challenging to work with and their families need comprehensive and supportive treatments.
The Bucharest study, led by Charles Nelson, III, Nathan Fox, and Charles Zeanah, Jr., is a randomized trial comparing the emotional and physical well being of institutionalized children with those place in foster homes. The study involved 136 children in orphanages in Romania. The average age was 22 month, ranging from 6 to 31 months of age. All children selected were free of neurological, genetic, and other birth defects based on a study-team pediatrician's examination. The children selected then has a series of baseline physical and psychological assessment. Half the children were randomly assigned to foster care while the other half remained in the institution. The children placed in foster care were placed in homes that had been recruited, trained, financed, and maintained by the study team. This would be considered high quality foster care. The study team also recruited a third group of typically developing children who lived with their birth families and who had never been institutionalized. The study went on for ten years.
One important finding that has significance not only for institutionalized children, but for all children who experience maltreatment is that there sensitive periods during which environmental influences are particularly powerful. The study found that the average IQ of the institutionalized children, measured at thirty, forty, and fifty-two months was in the low to middle 70's while it was ten points higher for the children in foster care. In other words, after only between eight and thirty months longer in an insitutional setting, there was about a 12.5% drop in IQ. The average IQ for the group of children never institutionalized was 100; or about 20% than the children in foster care. Or, to put it differently, about two years in an institution is associated with a 30% lower IQ. The sensitive period seems to be the first two years. The study found that a child placed in a home before two years of age had a significantly larger gain in IQ than a child placed in foster care after two years of age.
The study measured attachment and found that the institutionalized children displayed incompletely formed and aberrant relationships with care-givers. However children place in foster care, at 42 months of age (after an average of 20 months in foster care) displayed major improvements in making emotional attachments. About half the children in foster care demonstrated secure attachments while only eighteen percent of the child in institutions demonstrated secure attachments. Sixty-five percent of the children never placed in institutions displaced secure attachments. This seems to demonstrate the capacity of healing relationships to help remedy these significant early deficits. However, as with IQ, children placed in foster care before two years of age were more likely to form secure attachments when compared with children placed after two years of age.
Foster care had a major influence on levels of anxiety and depression; reducing their incidence by half. The more secure the attachment between the child and foster parent, the greater probability that the child's symptoms would be reduced.
The study examined brain activity using an EEG. They found that infants in institutions has significant reductions in alpha and heightened theta waves, which they stated reflect delayed brain maturation. When measured eight years later they found that children placed in foster care before two years of age showed no difference in EEG when compared with children never in an institution. Children who remained in the institution and those placed in foster care after two years of age showed EEG patterns reflecting delayed brain maturation. Institutionalized children had smaller brain volumes.
Finally they examined telomeres, regions at the ends of chromosomes that provide protection from the stresses of cell division and which are shorter in people who have experienced extreme psychological distress than in those who have not experienced such stresses. Children who spent any time in an institution had shorter telomeres than those who had not.
REFERENCES
Almas, A., et. al., (2012). Effects of Early Intervention and the Moderating Effects of Brain Activity on Institutionalized Children's Social Skills at Age 8. Proceeding of the National Academy of Sciences, 109 (2), 17,228-17,231.
Nelson, C., (2007). Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project. Science 318, 1937-1940.
Scientific American (2013). How Adversity Affects Young Children www.ScientificAmerican.com/apr2013/orphans, accessed May 11, 2013.
Oct 23, 2011
New Book on the Practice of Attachment-Focused Therapy
Dr. Becker-Weidman is one of the editors of a new book to be published early in 2012 on the professional practice of attachment-focused therapy. The two other editors are Lois Ehrmann and Denise LeBow. The book will serve as a practice manual defining standards of care. The book will be a valuable resource for social workers, psychologists, mental health practitioners, departments of social services, child welfare organizations, judges, and attorneys. The book's table of contents will be:
Chapter 1: Terminology and Diagnosis
Chapter 2: Purposes and Scope of Guide
Chapter 3: Overview of Attachment Theory: Synopsis of Key Concepts
CHAPTER 4: Overview of Attachment-Focused Therapy
CHAPTER 5: Core Concepts of Trauma and Trauma Focused Therapy
CHAPTER 6: Intake, Screening, & Referral
CHAPTER 7: Assessment of Children With Attachment Issues
CHAPTER 8: Treatment Planning
CHAPTER 9: Considerations in Behavior Management
CHAPTER 10: Training, Consultation, and Competency
CHAPTER 11: Ethical Considerations in Attachment Focused Therapy
CHAPTER 12: Vicarious Trauma and the Clinician’s Responsibility for Self Care
References
Glossary
Appendix A: Paper on Coercion in Treatment
Appendix B: Screening and Assessment Tools
Appendix C: Out-of Home Placements
Appendix D: Study Guide
Chapter 1: Terminology and Diagnosis
Chapter 2: Purposes and Scope of Guide
Chapter 3: Overview of Attachment Theory: Synopsis of Key Concepts
CHAPTER 4: Overview of Attachment-Focused Therapy
CHAPTER 5: Core Concepts of Trauma and Trauma Focused Therapy
CHAPTER 6: Intake, Screening, & Referral
CHAPTER 7: Assessment of Children With Attachment Issues
CHAPTER 8: Treatment Planning
CHAPTER 9: Considerations in Behavior Management
CHAPTER 10: Training, Consultation, and Competency
CHAPTER 11: Ethical Considerations in Attachment Focused Therapy
CHAPTER 12: Vicarious Trauma and the Clinician’s Responsibility for Self Care
References
Glossary
Appendix A: Paper on Coercion in Treatment
Appendix B: Screening and Assessment Tools
Appendix C: Out-of Home Placements
Appendix D: Study Guide
Oct 9, 2009
Teen maturity
Teenagers are as logical as adults but lack their social and emotional maturity. This might not be a surprise to too many parents but it comes as the result of a study of 935 10-30 year-olds by researchers at Temple University in Philadelphia. Participants in the study were tested on their psychosocial maturity, including tests of impulse control, sensation seeking, resistance to peer influence, future orientation (jam today vs jam tomorrow) and risk perception. They were also tested on their cognitive abilities such as logical thinking. There were no differences in psychosocial maturity throughout the 10-17 year-old age group but there were differences between those who were 16-17 and those 22 and over, and between those who were 18-21 and those above 26. People's cognitive capacities got better from 11-16 but their was no improvement thereafter.
You can find out more about this research at
http://www.sciencedaily.com/releases/2009/10/091007153745.htm
You can find out more about this research at
http://www.sciencedaily.com/releases/2009/10/091007153745.htm
Aug 19, 2009
Training Psycholgists from other counties: What I've learned
Recently a psychologist from the Czech Republic completed a month-long training program at The Center for Family Development. I’ve been reflecting on how training professionals from other countries here at the Center, and my travels training others overseas has affected my work I’ve trained professionals from any countries: Canada, Singapore, Australia, Bermuda, Finland, and the Czech Republic. Those of you who teach may have an experience similar to mine; that teaching keeps my thinking fresh, current, and in an ongoing process of development. Having to explain and demonstrate treatment principles causes me to think about my work and the work of others in a fresh and deep way. It also prods me to read and research. Training professionals from other nations who have a different culture, history, and language has enriched my work in a number of ways. It causes me to think about the differences in:
Child Welfare policies
Child Welfare practices
Effects of different experiences on child development
Universals
The meaning of symptoms
The meaning of words
Some examples of the differences I’ve noticed in child welfare policy and practice include the following. In the US many domestically adopted children receive a subsidy from the state. This is to encourage families to adopt since adoption is preferable to “permanent” foster care. Many other nations do not provide adoption subsidies and we find that their placement rates are much lower than in the US and the length of time children spend in care is much longer. The Czech Republic uses primarily institutional care for children and not foster care. In some countries the government places children only within their community (ethnic and religious).
My travels and training at the Center have led me to think much more precisely about language. For example, some concepts and words in our language are very difficult to translate into the other language, For example, the concept “Dyadic” in Dyadic Developmental Psychotherapy cannot be translated into Finnish. I think much more precisely about language in my practice and I listen carefully to words and the many meanings of similar words. Words define and give meaning to experiences and define one’s reality. Different words lead to different meanings and different realities, even though the objective experiences may be the same in treatment now I focus a lot on the words families and children us and how that affects relationships for good and bad. For example, how often have you heard a child say, “I was bad,” instead of “I did something bad/wrong.” What a difference that represents. Or, “When I think about John and my kids,” versus “When I think about John and my other sons.” My work overseas as made me more open to ambiguity in language and to then explore that ambiguity (“What do you mean by xxxx,” or “Does that mean xxxx?”). I find that clarifying those ambiguities is helpful for development and healing. Discussing the meaning of events, experiences, and words with families and helping them discuss that among themselves seems to help increase their reflective function, empathy, and insightfulness.
Child Welfare policies
Child Welfare practices
Effects of different experiences on child development
Universals
The meaning of symptoms
The meaning of words
Some examples of the differences I’ve noticed in child welfare policy and practice include the following. In the US many domestically adopted children receive a subsidy from the state. This is to encourage families to adopt since adoption is preferable to “permanent” foster care. Many other nations do not provide adoption subsidies and we find that their placement rates are much lower than in the US and the length of time children spend in care is much longer. The Czech Republic uses primarily institutional care for children and not foster care. In some countries the government places children only within their community (ethnic and religious).
My travels and training at the Center have led me to think much more precisely about language. For example, some concepts and words in our language are very difficult to translate into the other language, For example, the concept “Dyadic” in Dyadic Developmental Psychotherapy cannot be translated into Finnish. I think much more precisely about language in my practice and I listen carefully to words and the many meanings of similar words. Words define and give meaning to experiences and define one’s reality. Different words lead to different meanings and different realities, even though the objective experiences may be the same in treatment now I focus a lot on the words families and children us and how that affects relationships for good and bad. For example, how often have you heard a child say, “I was bad,” instead of “I did something bad/wrong.” What a difference that represents. Or, “When I think about John and my kids,” versus “When I think about John and my other sons.” My work overseas as made me more open to ambiguity in language and to then explore that ambiguity (“What do you mean by xxxx,” or “Does that mean xxxx?”). I find that clarifying those ambiguities is helpful for development and healing. Discussing the meaning of events, experiences, and words with families and helping them discuss that among themselves seems to help increase their reflective function, empathy, and insightfulness.
Aug 9, 2009
Children with Sexual Behavior Problems
Children with Sexual Behavior Problems
Arthur Becker-Weidman, Ph.D.
Children with sexual behavior problems, a broad category including such diverse behaviors as public masturbation, touching others, and aggressive behaviors, are challenging for the adults in their lives. The most recent issue of Child Maltreatment, Vol. 13, #2, May 2008 is devoted to this topic. The issue describes important material regarding assessment, treatment, policy and stereotypes.
I found the material that countered “common knowledge,” most interesting. Do children who have been sexually abused develop sexual behavior problems? Yes, they do have increased rates of sexual behavior problems (SBP), as do other children with other types of trauma. In fact exposure to violence has a much stronger association with SPB’s than does prior sexual abuse. The material makes clear that SBP’s are complex behaviors with multidimensional elements.
The issue is encouraging and supportive of our work. Several articles make the point that including the family in treatment is an important element of efficacious treatment.
The article by Mark Chaffin on policy is very interesting. The perception that youthful sex-offenders are high risk, unique and require special treatment, are homogeneous, and impossible or very difficult to treat turns out to be false. Research shows that children with SBP’s pose a low long-term risk for future child sexual abuse perpetration and sex crimes. For example, for teenage sex offenders the long-term future sex offense rates are between 5% (for those who received treatment) 15% (for those without treatment). For pre-teen children the range is 2% to 10% at ten year follow-up. At ten year follow-up the rate of sex abuse perpetration among those with SBP’s who received treatment was no different than for those children with ADHD. This and other material supports the argument that the policy issue of putting such children on public lists is simply bad policy. Other material shows that children with SBP’s do not require specialized treatment and that generally effective treatment approaches are effective for these children.
There are several other excellent articles in this issue. One describes the impact of various maltreatment experiences on sexualized behaviors. Another describes predictors of SPB’s among children with complex histories of maltreatment. There are two outcome studies and a very well written meta-analysis of treatment for children with SBP’s. Finally, the issue ends with the Report of the ATSA Task Force on Children with Sexual Behavior Problems which describes best practices for the evaluation and treatment of children with SBP’s and various policy recommendations.
In summary, this is an outstanding journal issue and it should be in every clinician’s library.
Arthur Becker-Weidman, Ph.D.
Children with sexual behavior problems, a broad category including such diverse behaviors as public masturbation, touching others, and aggressive behaviors, are challenging for the adults in their lives. The most recent issue of Child Maltreatment, Vol. 13, #2, May 2008 is devoted to this topic. The issue describes important material regarding assessment, treatment, policy and stereotypes.
I found the material that countered “common knowledge,” most interesting. Do children who have been sexually abused develop sexual behavior problems? Yes, they do have increased rates of sexual behavior problems (SBP), as do other children with other types of trauma. In fact exposure to violence has a much stronger association with SPB’s than does prior sexual abuse. The material makes clear that SBP’s are complex behaviors with multidimensional elements.
The issue is encouraging and supportive of our work. Several articles make the point that including the family in treatment is an important element of efficacious treatment.
The article by Mark Chaffin on policy is very interesting. The perception that youthful sex-offenders are high risk, unique and require special treatment, are homogeneous, and impossible or very difficult to treat turns out to be false. Research shows that children with SBP’s pose a low long-term risk for future child sexual abuse perpetration and sex crimes. For example, for teenage sex offenders the long-term future sex offense rates are between 5% (for those who received treatment) 15% (for those without treatment). For pre-teen children the range is 2% to 10% at ten year follow-up. At ten year follow-up the rate of sex abuse perpetration among those with SBP’s who received treatment was no different than for those children with ADHD. This and other material supports the argument that the policy issue of putting such children on public lists is simply bad policy. Other material shows that children with SBP’s do not require specialized treatment and that generally effective treatment approaches are effective for these children.
There are several other excellent articles in this issue. One describes the impact of various maltreatment experiences on sexualized behaviors. Another describes predictors of SPB’s among children with complex histories of maltreatment. There are two outcome studies and a very well written meta-analysis of treatment for children with SBP’s. Finally, the issue ends with the Report of the ATSA Task Force on Children with Sexual Behavior Problems which describes best practices for the evaluation and treatment of children with SBP’s and various policy recommendations.
In summary, this is an outstanding journal issue and it should be in every clinician’s library.
Jun 3, 2009
Attachment and Autism
let me answer your last question first. "Attachment Disorder" is a loosely defined term with wide variation in meaning. The five categories of patterns of attachment used in the research with adults (Secure, Avoidant, Preoccupied, Disorganized, and Cannot Classify) are research categories not clinical diagnoses. Same for the corresponding patterns defined by the Strange Situation Procedure (Mary Ainsworth).
Autism and Reactive Attachment Disorder a distinct disorders with distinct diagnostic criteria (DSM IV) and that require different treatments and approaches. One is caused by chronic early maltreatment within a caregiving relationship; the other is more of a neuological disorder).
The books you've mentioned I'm not familiar with. If you do want a good orientation to Attachment Theory and Attachment Research, let me suggest any of the following book:
1. Becker-Weidman, A., & Shell, D., (Eds.) (2005), Creating Capacity for Attachment, Wood ‘N’ Barnes, Oklahoma City, OK.
2. Handbook of Attachment: Theory, Research, and Clinical Applications 2nd Edition. Edited by Jude Cassidy and Phillip Shaver. The Guilford Press, 2008.
3. A Secure Base. John Bowlby, Basic Books, NY, 1988.
4. John Bowlby & Attachment Theory. Jeremy Holmes, Routledge, NY, 1993.
5. Parkes, C.M., Stevenson-Hinde, J., & Marris, P., (Eds.), (1991). Attachment Across the Life Cycle, Routledge, NY.
If you are interested in evidence-based, effective, and empirically validated treatments for Reactive Attachment Disorder and Complex Trauma, you could look at:
1. Becker-Weidman, A., & Shell, D., (Eds.) (2005, second printing 2008) Creating Capacity for Attachment.
2. Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
3. Becker-Weidman, A., (2008) "Treatment for Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy" Child and Adolescent Mental Health Volume 13, No. 1, 2008, pp. 52-60.
4. Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” manuscript submitted for publication.
5. 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.
6. Hughes, D., (2008). Attachment Focused Family Therapy.
Also the folloiwng links may help:
http://psychology.wikia.com/wiki/Main_Page
You can then look at articles about Attachment theory, Reactive Attachment Disorder, Dyadic Developmental Psychotherapy, Attachment disorder, etc.
I hope this helps.
regards. I look forward to hearing back from you.
Autism and Reactive Attachment Disorder a distinct disorders with distinct diagnostic criteria (DSM IV) and that require different treatments and approaches. One is caused by chronic early maltreatment within a caregiving relationship; the other is more of a neuological disorder).
The books you've mentioned I'm not familiar with. If you do want a good orientation to Attachment Theory and Attachment Research, let me suggest any of the following book:
1. Becker-Weidman, A., & Shell, D., (Eds.) (2005), Creating Capacity for Attachment, Wood ‘N’ Barnes, Oklahoma City, OK.
2. Handbook of Attachment: Theory, Research, and Clinical Applications 2nd Edition. Edited by Jude Cassidy and Phillip Shaver. The Guilford Press, 2008.
3. A Secure Base. John Bowlby, Basic Books, NY, 1988.
4. John Bowlby & Attachment Theory. Jeremy Holmes, Routledge, NY, 1993.
5. Parkes, C.M., Stevenson-Hinde, J., & Marris, P., (Eds.), (1991). Attachment Across the Life Cycle, Routledge, NY.
If you are interested in evidence-based, effective, and empirically validated treatments for Reactive Attachment Disorder and Complex Trauma, you could look at:
1. Becker-Weidman, A., & Shell, D., (Eds.) (2005, second printing 2008) Creating Capacity for Attachment.
2. Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
3. Becker-Weidman, A., (2008) "Treatment for Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy" Child and Adolescent Mental Health Volume 13, No. 1, 2008, pp. 52-60.
4. Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” manuscript submitted for publication.
5. 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.
6. Hughes, D., (2008). Attachment Focused Family Therapy.
Also the folloiwng links may help:
http://psychology.wikia.com/wiki/Main_Page
You can then look at articles about Attachment theory, Reactive Attachment Disorder, Dyadic Developmental Psychotherapy, Attachment disorder, etc.
I hope this helps.
regards. I look forward to hearing back from you.
May 20, 2009
Therapeuctic Crisis Intervention
I found this article quite interesting and valuable:
Josh Lechter, assistant director of child care for the Community-Based Acute Treatment program at Walker, has written a paper featured in the most recent issue of Refocus, the Residential Child Care Project newsletter published by Cornell University.tci
His paper, Using TCI’s Family Care Provider Training To Break Down Language Barriers Between Residential Treatment and Life at Home, discusses the success of a new initiative at Walker to share therapeutic crisis intervention training and techniques with the families of Walker students.
Therapeutic Crisis Intervention For Family Care Providers (TCIF) is a curriculum-based class adapted from the same crisis prevention and behavior management skills taught to The Walker School staff. Developed by the The Family Life Development Center at Cornell University, the 5-day course involves modeling and role playing to familiarize family members with strategies and techniques for deescalating problems and emotionally volatile situations with their children at home. According to the developers at Cornell, Walker is the first organization to offer TCIF training to the families of children with serious emotional and behavior issues.
Judging from the enthusiastic response of participating families, the availability of this specialized training for parents and caregivers will help to improve the likelihood of a child’s successful transition from residential treatment to home and community. In the paper, Lechter recounts the comments of several grateful parents, including one who said, “the course was a blessing. I now do not feel alone in helping my children with their mental health needs.”
See this article for more details
http://www.walkerschool.org/upload/REFOCUS_VOL_14.pdf
Josh Lechter, assistant director of child care for the Community-Based Acute Treatment program at Walker, has written a paper featured in the most recent issue of Refocus, the Residential Child Care Project newsletter published by Cornell University.tci
His paper, Using TCI’s Family Care Provider Training To Break Down Language Barriers Between Residential Treatment and Life at Home, discusses the success of a new initiative at Walker to share therapeutic crisis intervention training and techniques with the families of Walker students.
Therapeutic Crisis Intervention For Family Care Providers (TCIF) is a curriculum-based class adapted from the same crisis prevention and behavior management skills taught to The Walker School staff. Developed by the The Family Life Development Center at Cornell University, the 5-day course involves modeling and role playing to familiarize family members with strategies and techniques for deescalating problems and emotionally volatile situations with their children at home. According to the developers at Cornell, Walker is the first organization to offer TCIF training to the families of children with serious emotional and behavior issues.
Judging from the enthusiastic response of participating families, the availability of this specialized training for parents and caregivers will help to improve the likelihood of a child’s successful transition from residential treatment to home and community. In the paper, Lechter recounts the comments of several grateful parents, including one who said, “the course was a blessing. I now do not feel alone in helping my children with their mental health needs.”
See this article for more details
http://www.walkerschool.org/upload/REFOCUS_VOL_14.pdf
May 5, 2009
Bringing Your Child Home from the Orphanage: ideas
A FEW TIPS ON BRINGING YOUR BABY HOME FROM AN ORPHANAGE
Generally, infants adopted before the age of six months fare no differently than infants raised from birth. However, after six months, the effects of institutional care begin to emerge. It is important to realize that even the best orphanages are not good places to raise a child. In NY state the infant-care giver ratio required by regulation for infant day care is no more than two infants per care provider...so 5:1 is better than 10:1, but still it won't help the child develop a normal, healthy, and secure attachment to a specific figure, which is what the attachment system is supposed to do. Several visits during a year won't make much of any difference on your child's development or on this most important process.
That being said, it is also important to remember that children are rather "plastic" and that attachment develops during the first two to three years of life. So, you will need to do some work when you bring your child home to make up for the early deprivations that your child has experienced.
1. It is best to make the room as similar to the orphanage as possible to make for an easier transition.
2. Serve the same foods at first.
3. Keep ALL others at a distance for the first several weeks to months so your child develops a specific and unique bond with you.
4. It would be best for you to spend the first two to three months at home constantly with the child; carrying the child and physically being present to meet the child's needs and to develop a affectively attuned relationship that will allow you to anticipate your child's needs and meet those, as well.
1) YOU, AND ONLY YOU, WEAR YOUR BABY!! Carry them with you wherever you go, and whatever you do. (Unless dangerous) Attach them to your bodies. A great baby carrier is one that the baby can have skin to skin contact with you – Baby Trekker (1-800-665-3957) is a good one. Carry the baby on your hip; tie to your body under a sweatshirt, front carrier, or in your arms. The more contact the better. These babies were not held enough. Hold Them!!!! A LOT!!! ALL THE TIME!!!! For the rare times the baby is not in your arms, have them in the same room as you are in.
2) YOU ARE THE ONLY CAREGIVER!! You always bottle, feed, bath, dress, change and most of the play. If friends and family want to help let them walk the dog or clean your house, wash bottles or do laundry, bring food or make you tea. No baby-sitters and no sending the baby away for respite. Until your baby is firmly emotionally attached to you, NO ONE the baby doesn't see daily should hold or even touch him or her, and even those that the baby sees daily should hold him or her at a very minimum.
3) KEEP THE BOTTLE AS LONG AS POSSIBLE –EVEN LONGER! You, not the baby, hold the bottle. You can hold the bottle with your chin so you have two hands to snuggle your baby close to you. One handed it also fine. Hold the child the way a nursing mother does – chest to chest, close to you with as much skin-to-skin contact as possible. Look your baby in the eyes and when they do, instantly put the bottle in their mouth and tell them good job!! Keep looking at their eyes so when they are ready for eye contact, you don't miss it. Note: some babies with sensory-integration difficulties may find eye contact too stimulating and it may actually be disruptive to the child.
4) BATHE WITH YOUR BABY; this encourages skin-to-skin contact in a nice relaxing warm fun way.
5) A LOT OF FACE-TO-FACE baby games and funny faces and TONS of smiles and kisses!! Paint bright circles around your eyes. Close one eye, then the other, rapidly blink, and then change speeds, all the time with funny noises. Cover both eyes then one, and so on. Have the baby sit on your lap, and if this is too hard for them at first, lay them on a bed to do it. Then slowly trick them into letting you touch and hold them!! Keep it fun for them.
6) WHEN THERE IS A GREAT DEAL OF ANGER OR AVOIDANCE, the baby NEEDS to experience comfort, safety, and security. They feel so far away from you, and have to be brought closer to heal. Cradle the baby in your arms. Have their arm closest to you held close. Talk soothingly to them, and tell them to look in mommy's eyes. They have been ignored, hit, or yelled at in the orphanage. That is why it is SO IMPORTANT this ALL be done in an extremely loving way. Never squeeze the baby too close, speak harshly, lose your cool or forget why you are doing this. If you get to feel their anger, immediately put them down and call support. You have to remain supportive, yet expect their best. They may try to hit you, scratch, bite, scream and get to you any way they can. Their intense rage is there. Yes, even little babies. Eye contact, feeling safe, and being accepted no matter what in a loving way is the goal here. For whatever reason, they have shut off people. Now they need YOU to heal. Rub them, soothe them in singing, and soft speech, rock them and tell them you love them. Keep it up until they will calm down and look in your eyes and FEEL connected to you. At times they will fall asleep screaming. If so, and if possible, continue to hold them until they wake up, and then continue above. If you need to lay them down, have a monitor on so you can pick them up as soon as they wake up. For the very avoidant baby one unsolicited eye contact a week could be considered good! Keep it up; you have several good eye contacts a minute to look forward to! Remember, you did not create this anger in your baby.
7) NOW IS THE BEST AND EASIEST TIME TO WORK WITH YOUR BABY.
8) DO A LOT OF BABY MASSAGES. For the real avoidant baby, a half-hour. Each day you delay, the harder it is for them and you. Attachment issues do NOT just go away on their own. They only get worse. Twice a day would be minimum. All the time talk, sing and let that baby know how special they are!! Most of the babies seem to really enjoy this, and my daughter would even get out the lotion as soon as she could reach for it!!
9) ROCK THAT BABY!! They often can't stand you sitting in a rocking chair, but can often tolerate and enjoy you walking and dancing with them in your arms. (Remember face-to-face contact during this) Gentle motion, bouncing and rocking are a must!!
10) SLEEP WITH THE BABY. If you can, the best is to have the baby in your bed close to you. Second choice is to have the baby in their crib right next to your side of the bed with the side rail down. Have the crib touching snug to your bed, so if they climb out, they climb safely onto you!! They need t hear your breathing and know you are close. Yet for someone over one, you get special permission (in writing) to have him or her sleep in your room for mental health reasons. Should not be a big problem. Have the baby always fall asleep in your arms. Nap or night. They need to get used to feeling loved!!
11) SING, SING, SING!!! It lightens the load, and helps the baby feel the happy friendliness they missed out on. Joyful voices are so important!
12) ENCOURAGE EYE CONTACT WHEN FEEDING, BOTTLING, TALKING, CHANGING, AND ALL THE TIME!! Not coerced or forced, but loving eyes.
13) EXPECT A DIRTY HOUSE, soup out of the can and sandwiches for supper and piles of laundry. Know that you are not super mom, and that baby can't wait until all is in order to get on with their lives. Here is where all those well-meaning friends that want to hold that precious baby come in!! Let them work!!!
14) EXPECT TO BE CRITICIZED AND ACCUSED as over possessive, spoiling the baby, and making more than you should out of the baby's problems. You will be told all babies do that. This is by well meaning friends, neighbors, relatives, doctors, and social workers. Stick to what YOU KNOW the baby needs, and fight to get that for them. Remember YOU know that baby more than anyone else.
15) HAVE A GREAT SUPPORT SYSTEM. Have a trusted friend (hopefully someone who has had experience in attachment disorder) that you can call without being told you are making too much of it. Read books on attachment disorder. Know what dangers await that baby if they are not helped. Working with an infant or toddler has such a HUGE chance for success!! Not one act of kindness is wasted.
16) GET AN OFFICIAL EVALUATION BY AN ATTACHMENT EXPERT.
That way in court and with workers you do have leg to stand on in getting these babies what they need!!! It is a lot easier when you have a well-respected expert stick up for you.
17) KNOW YOU NEITHER CREATED YOUR BABY'S PROBLEMS, NOR CAN YOU CURE THEM. Your job is to give the baby the tools they need. The rest is up to them.
18) FOR THE BABY THAT HAS NOT YET ENTERED YOUR HOME – when you get that baby, get a piece of clothing or blanket unwashed and used recently by the primary caregiver. The smell will help the move. And don't you wash it!! Keep it close to the baby to help the baby adjust. No matter the baby's age or living conditions, the move to you is not easy. Never push this object, but make it available.
19) HELP YOUR BABY WITH A TRANSITIONAL OBJECT. This is a blanket or soft toy they can sleep with, use it in the car seat, and for the RARE time you cannot be with them. Helps in security.
21) IF YOU DO ALL OF THESE WITH LOVE AND KINDNESS AND THINGS GET WORSE OR REMAIN THE SAME, GET HELP.
Resources:
Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell
Nurturing Attachments by Kim Golding.
Generally, infants adopted before the age of six months fare no differently than infants raised from birth. However, after six months, the effects of institutional care begin to emerge. It is important to realize that even the best orphanages are not good places to raise a child. In NY state the infant-care giver ratio required by regulation for infant day care is no more than two infants per care provider...so 5:1 is better than 10:1, but still it won't help the child develop a normal, healthy, and secure attachment to a specific figure, which is what the attachment system is supposed to do. Several visits during a year won't make much of any difference on your child's development or on this most important process.
That being said, it is also important to remember that children are rather "plastic" and that attachment develops during the first two to three years of life. So, you will need to do some work when you bring your child home to make up for the early deprivations that your child has experienced.
1. It is best to make the room as similar to the orphanage as possible to make for an easier transition.
2. Serve the same foods at first.
3. Keep ALL others at a distance for the first several weeks to months so your child develops a specific and unique bond with you.
4. It would be best for you to spend the first two to three months at home constantly with the child; carrying the child and physically being present to meet the child's needs and to develop a affectively attuned relationship that will allow you to anticipate your child's needs and meet those, as well.
1) YOU, AND ONLY YOU, WEAR YOUR BABY!! Carry them with you wherever you go, and whatever you do. (Unless dangerous) Attach them to your bodies. A great baby carrier is one that the baby can have skin to skin contact with you – Baby Trekker (1-800-665-3957) is a good one. Carry the baby on your hip; tie to your body under a sweatshirt, front carrier, or in your arms. The more contact the better. These babies were not held enough. Hold Them!!!! A LOT!!! ALL THE TIME!!!! For the rare times the baby is not in your arms, have them in the same room as you are in.
2) YOU ARE THE ONLY CAREGIVER!! You always bottle, feed, bath, dress, change and most of the play. If friends and family want to help let them walk the dog or clean your house, wash bottles or do laundry, bring food or make you tea. No baby-sitters and no sending the baby away for respite. Until your baby is firmly emotionally attached to you, NO ONE the baby doesn't see daily should hold or even touch him or her, and even those that the baby sees daily should hold him or her at a very minimum.
3) KEEP THE BOTTLE AS LONG AS POSSIBLE –EVEN LONGER! You, not the baby, hold the bottle. You can hold the bottle with your chin so you have two hands to snuggle your baby close to you. One handed it also fine. Hold the child the way a nursing mother does – chest to chest, close to you with as much skin-to-skin contact as possible. Look your baby in the eyes and when they do, instantly put the bottle in their mouth and tell them good job!! Keep looking at their eyes so when they are ready for eye contact, you don't miss it. Note: some babies with sensory-integration difficulties may find eye contact too stimulating and it may actually be disruptive to the child.
4) BATHE WITH YOUR BABY; this encourages skin-to-skin contact in a nice relaxing warm fun way.
5) A LOT OF FACE-TO-FACE baby games and funny faces and TONS of smiles and kisses!! Paint bright circles around your eyes. Close one eye, then the other, rapidly blink, and then change speeds, all the time with funny noises. Cover both eyes then one, and so on. Have the baby sit on your lap, and if this is too hard for them at first, lay them on a bed to do it. Then slowly trick them into letting you touch and hold them!! Keep it fun for them.
6) WHEN THERE IS A GREAT DEAL OF ANGER OR AVOIDANCE, the baby NEEDS to experience comfort, safety, and security. They feel so far away from you, and have to be brought closer to heal. Cradle the baby in your arms. Have their arm closest to you held close. Talk soothingly to them, and tell them to look in mommy's eyes. They have been ignored, hit, or yelled at in the orphanage. That is why it is SO IMPORTANT this ALL be done in an extremely loving way. Never squeeze the baby too close, speak harshly, lose your cool or forget why you are doing this. If you get to feel their anger, immediately put them down and call support. You have to remain supportive, yet expect their best. They may try to hit you, scratch, bite, scream and get to you any way they can. Their intense rage is there. Yes, even little babies. Eye contact, feeling safe, and being accepted no matter what in a loving way is the goal here. For whatever reason, they have shut off people. Now they need YOU to heal. Rub them, soothe them in singing, and soft speech, rock them and tell them you love them. Keep it up until they will calm down and look in your eyes and FEEL connected to you. At times they will fall asleep screaming. If so, and if possible, continue to hold them until they wake up, and then continue above. If you need to lay them down, have a monitor on so you can pick them up as soon as they wake up. For the very avoidant baby one unsolicited eye contact a week could be considered good! Keep it up; you have several good eye contacts a minute to look forward to! Remember, you did not create this anger in your baby.
7) NOW IS THE BEST AND EASIEST TIME TO WORK WITH YOUR BABY.
8) DO A LOT OF BABY MASSAGES. For the real avoidant baby, a half-hour. Each day you delay, the harder it is for them and you. Attachment issues do NOT just go away on their own. They only get worse. Twice a day would be minimum. All the time talk, sing and let that baby know how special they are!! Most of the babies seem to really enjoy this, and my daughter would even get out the lotion as soon as she could reach for it!!
9) ROCK THAT BABY!! They often can't stand you sitting in a rocking chair, but can often tolerate and enjoy you walking and dancing with them in your arms. (Remember face-to-face contact during this) Gentle motion, bouncing and rocking are a must!!
10) SLEEP WITH THE BABY. If you can, the best is to have the baby in your bed close to you. Second choice is to have the baby in their crib right next to your side of the bed with the side rail down. Have the crib touching snug to your bed, so if they climb out, they climb safely onto you!! They need t hear your breathing and know you are close. Yet for someone over one, you get special permission (in writing) to have him or her sleep in your room for mental health reasons. Should not be a big problem. Have the baby always fall asleep in your arms. Nap or night. They need to get used to feeling loved!!
11) SING, SING, SING!!! It lightens the load, and helps the baby feel the happy friendliness they missed out on. Joyful voices are so important!
12) ENCOURAGE EYE CONTACT WHEN FEEDING, BOTTLING, TALKING, CHANGING, AND ALL THE TIME!! Not coerced or forced, but loving eyes.
13) EXPECT A DIRTY HOUSE, soup out of the can and sandwiches for supper and piles of laundry. Know that you are not super mom, and that baby can't wait until all is in order to get on with their lives. Here is where all those well-meaning friends that want to hold that precious baby come in!! Let them work!!!
14) EXPECT TO BE CRITICIZED AND ACCUSED as over possessive, spoiling the baby, and making more than you should out of the baby's problems. You will be told all babies do that. This is by well meaning friends, neighbors, relatives, doctors, and social workers. Stick to what YOU KNOW the baby needs, and fight to get that for them. Remember YOU know that baby more than anyone else.
15) HAVE A GREAT SUPPORT SYSTEM. Have a trusted friend (hopefully someone who has had experience in attachment disorder) that you can call without being told you are making too much of it. Read books on attachment disorder. Know what dangers await that baby if they are not helped. Working with an infant or toddler has such a HUGE chance for success!! Not one act of kindness is wasted.
16) GET AN OFFICIAL EVALUATION BY AN ATTACHMENT EXPERT.
That way in court and with workers you do have leg to stand on in getting these babies what they need!!! It is a lot easier when you have a well-respected expert stick up for you.
17) KNOW YOU NEITHER CREATED YOUR BABY'S PROBLEMS, NOR CAN YOU CURE THEM. Your job is to give the baby the tools they need. The rest is up to them.
18) FOR THE BABY THAT HAS NOT YET ENTERED YOUR HOME – when you get that baby, get a piece of clothing or blanket unwashed and used recently by the primary caregiver. The smell will help the move. And don't you wash it!! Keep it close to the baby to help the baby adjust. No matter the baby's age or living conditions, the move to you is not easy. Never push this object, but make it available.
19) HELP YOUR BABY WITH A TRANSITIONAL OBJECT. This is a blanket or soft toy they can sleep with, use it in the car seat, and for the RARE time you cannot be with them. Helps in security.
21) IF YOU DO ALL OF THESE WITH LOVE AND KINDNESS AND THINGS GET WORSE OR REMAIN THE SAME, GET HELP.
Resources:
Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell
Nurturing Attachments by Kim Golding.
Apr 5, 2009
Dyadic Developmetal Psychotherapy receives support
The new book, Treating Complex Traumatic Stress Disorder, edited by Christine Courtois and Julian Ford, The Guilford Press, NY, 2009, supports the various elements, principles, and techniques of Dyadic Developmental Psychotherapy. The chapter on family therapy approaches states, "Meta-analytic studies have found family based treatments to be more effective than treatment as usual (TAU)...The strongest evidence for the efficacy of family therapy for traumatic stress disorders is provided by studies with families of traumatized toddlers and preschool- or early elementary school-aged children." pp394-395.
The book describes the importance of affect regulation, focusing on attachment relationships in treatment, attention to developmental level and processes, emotional regulation, titrated exposure to traumatic memories, therapeutic alliance, intersubjectivity, and other topics that are core principles and methods of Dyadic Developmental Psychotherapy. It is heartening to find additional support for the use of DDP in the treatment of attachment and trauma disorders.
The book describes practice principles for treating children with complex traumatic stress disorder which are quite consistent with previous material published about DDP over the last several years:
1. Safety First
2. A relational bridge must be developed to engage, retain, and maximally benefit the child and caregiver(s).
3. Diagnosis, treatment planning, and outcome monitoring are always relational.
4. Diagnosis, treatment planning, and outcome monitoring are always strengths-based.
5. All phases of treatment should aim to enhance self-regulation competencies.
5a. Emotional regulation.
5b. Attention, memory, decision making (information processing).
5c. Self-regulation of consciousness and motivation.
5d. Bodily self-regulation.
5e. Relational self-regulation.
6. Determining with whom, when, and how to address traumatic memories.
7. Preventing and managing relational discontinuities and psychosocial crises.
from pages 67-78.
As described and elaborated in the book, these principles have also been previously described and elaborated on in various publications about DDP (several books and journal articles).
The book describes the importance of affect regulation, focusing on attachment relationships in treatment, attention to developmental level and processes, emotional regulation, titrated exposure to traumatic memories, therapeutic alliance, intersubjectivity, and other topics that are core principles and methods of Dyadic Developmental Psychotherapy. It is heartening to find additional support for the use of DDP in the treatment of attachment and trauma disorders.
The book describes practice principles for treating children with complex traumatic stress disorder which are quite consistent with previous material published about DDP over the last several years:
1. Safety First
2. A relational bridge must be developed to engage, retain, and maximally benefit the child and caregiver(s).
3. Diagnosis, treatment planning, and outcome monitoring are always relational.
4. Diagnosis, treatment planning, and outcome monitoring are always strengths-based.
5. All phases of treatment should aim to enhance self-regulation competencies.
5a. Emotional regulation.
5b. Attention, memory, decision making (information processing).
5c. Self-regulation of consciousness and motivation.
5d. Bodily self-regulation.
5e. Relational self-regulation.
6. Determining with whom, when, and how to address traumatic memories.
7. Preventing and managing relational discontinuities and psychosocial crises.
from pages 67-78.
As described and elaborated in the book, these principles have also been previously described and elaborated on in various publications about DDP (several books and journal articles).
Mar 12, 2009
Article about Dyadic Developmental Psychotherapy
A very nice summary about Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for trauma and attachment disorders can be found at
http://psychology.wikia.com/wiki/Dyadic_Developmental_Psychotherapy
While most Wiki's, especially Wikipedia, are not reliable sources of information since articles and subjects can be taken over by zealots with one or another bias or ax to grind, the Psychology wiki encourages people to register and use their real professional identity and the articles are pretty well vetted.
http://psychology.wikia.com/wiki/Dyadic_Developmental_Psychotherapy
While most Wiki's, especially Wikipedia, are not reliable sources of information since articles and subjects can be taken over by zealots with one or another bias or ax to grind, the Psychology wiki encourages people to register and use their real professional identity and the articles are pretty well vetted.
Mar 4, 2009
Training
The new Dyadic Developmental Psychotherapy Institute is off to a great start. The Institute will certify therapist, consultants, and trainers in Dyadic Developmental Psychotherapy. The use of the term Dyadic Developmental Psychotherapy and related terms, such as stating that one is a Dyadic Developmental Psychotherapy therapist are now protected. This will help ensure integrity to the model, which now has a firm evidence and empirical basis demonstrating its effectiveness.
Feb 27, 2009
Evidence-Based and Emprically Supported Treatment: DDP
A recent article, 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, described the evidence-based and empirically supported treatment, Dyadic Developmental Psychotherapy. This article presents the empirical support for this treatment and the strong empirical support for the various elements of DDP. Anyone interested can contact me to get a PDF reprint.
Jan 2, 2009
Attachment Facilitating Parenting
Attachment Facilitating Parenting
Arthur Becker-Weidman, Ph.D.
Center For Family Development
Many adopted and foster children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiving relationship. Such a history can lead to the development of Complex Trauma (Cook et. al., 2003; Cook et. al., 2005), disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems (Gauthier, Stollak, Messe, & Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These children are likely to develop Reactive Attachment Disorder (Greenberg, 1999; Lyons-Ruth & Jacobvitz, 1999). Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990). Many of these children are violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and as adults are at risk of developing a variety of psychological problems (Schreiber & Lyddon, 1998) and personality disorders, including antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman, 2000), narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder (Dozier, Stovall, & Albus, 1999). Therapeutic Parenting is often necessary to help these children heal (Becker-Weidman, A., & Shell, D., 2005/2008). This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation. Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:
• Sensitivity
• Responsiveness
• Following the child’s lead
• The sharing of congruent intersubjective experiences
• Creating a sense of safety and security
The effective implementation of these principles requires parents who:
• Are strongly committed to the child.
• Have well developed reflective abilities
• Have good insightfulness
• Have a relatively secure state of mind with respect to attachment
This type of parenting is consistent with Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for children with trauma and attachment disorders (Becker-Weidman & Hughes, 2008). Many foster and adoptive parents find their children’s behaviors strange, frightening, disturbing, and upsetting. They often don’t understand why their child behaves as the child does; “after all, my child is now safe, doesn’t he get it?” It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.
Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child’s behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to “anyone” for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive. By understanding what is driving the behavior and appreciating the child’s fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stop…they may change into other problems, but if the underlying cause remains, then the problems will surface again and again.
Let’s discuss the principles required. These principles are more fully elaborated elsewhere (Becker-Weidman & Shell, 2005; Becker-Weidman, 2007)
SENSITIVITY. Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child’s level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.
RESPONSIVENESS. Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child’s need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.
FOLLOWING THE CHILD’S LEAD. By this I mean that the parent will need to respond to the child and follow the child’s lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child’s pace. It is very important to move at the child’s pace to create the necessary sense of safety and security that these children need.
THE SHARING OF CONGRUENT INTERSUBJECTIVE EXPERIENCES. Intersubjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.). Or another example, when talking about the death of the child’s loved grandparent, you both may share the same emotions (grief), both are recalling memories of the grandparent (shared intention and attention). It is the sharing of congruent intersubjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.
CREATING A SENSE OF SAFETY AND SECURITY. Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.
Unless the child feels safe, exploration is not possible.
So, what sort of parent is needed? We know form extensive research, that one of the best predictors of placement stability is the parent’s commitment to the child (Dozier, Grasso, Lindhiem, & Lewis, 2007). Therefore, building or rebuilding parental commitment is an important first step. Unless there is strong commitment, the child cannot feel safe and, as discussed above, safety is the most important first step in helping a hurt child heal.
Reflective capacity is also vital to placement stability and to the healing of adopted and foster children. The parent must be able to reflect on the child’s underlying emotions, how the past may be re-enacted in the present, and what in the parent’s own past is being triggered by the child. A well developed reflective function is necessary if the parent is to respond to the child in a healthy and healing manner. We all have buttons. The job of the therapeutic parent is to understand one’s buttons so that these can be disconnected so that when pushed, nothing happens.
Insightfulness (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001; Oppenheim, & Koren-Karie, 2002; Oppenheim, Goldsmith, & Koren-Karie, 2005) is related to reflective capacity.
A parent’s state of mind with respect to attachment is the best predictor of the child’s. (Main, & Cassidy, 1988; Main, & Hesse, 1990). If the parent has a Secure state of mind with respect to attachment, then the adopted or foster child is more likely to develop a healthy and secure pattern of attachment and heal (Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008). We know that when young children are placed in a foster home, the child will begin to develop a pattern of attachment that is the same as the foster parent’s state of mind with respect to attachment (Dozier, Stovall, Albus, & Bates, 2001). Obviously, in older children, this is a more difficult task. In the general population, about 60% of the adults have a secure state of mind with respect to attachment. For parents who have an insecure state of mind with respect to attachment, they can still learn to parent effectively with help (Becker-Weidman, A., & Shell, D., 2005/2008; Bick & Dozier, 2008).
USEFUL RESOURCES FOR PARENTS
1. Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
2. Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.
3. Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.
4. Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .
5. Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.
REFERENCES
Becker-Weidman, A., & Shell, D., (Eds.) (2005, 2008). Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes & Williamsville, NY: Center for Family Development.
Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
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.
Bick, J., & Dozier, M., (2008). Helping Foster Parents Change. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 452-471). NY: Guilford.
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants’ attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135–157). NY: Cambridge University Press.
Cicchetti, D., Cummings, E. M., Greenberg, M. T., & Marvin, R. S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti & M. Cummings (Eds.), Attachment in the preschool years (pp. 3–50). Chicago: University of Chicago Press.
Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.
Dozier, M., Stovall, K., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477.
Dozier, M., Grasso, D., Lindhiem, O., & Lewis, E., (2007) “The role of caregiver commitment in foster care,” in D. Oppenheim & D. Goldsmith, (Eds.) Attachment Theory in Clinical Work with Children. NY: Guilford.
Dozier, M., Stovall, K. C., & Albus, K. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 497–519). NY: Guilford Press.
Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment styles in maltreated children: A comparative study. Child Development and Human Development, 31, 113–128.
Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20, 549–559.
Greenberg, M. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 469–496). NY: Guilford Press.
Koren-Karie, N., Oppenheim, D., Dolev S., Sher, E., & Etzion-Carasso, E. (2002). Mothers’ insightfulness regarding their infants’ internal experience: Relations with maternal sensitivity and infant attachment. Developmental Psychology, 38, 534-542.
Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 520–554). NY: Guilford Press.
Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age six: Predictable from infant attachment classifications and stable over a one-month period. Developmental Psychology, 24, 415–426.
Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status. In M. T. Greenberg, D. Ciccehetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–184). Chicago: University of Chicago Press.
Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68–69.
Oppenheim, D., Koren-Karie, N., & Sagi, A. (2001). Mothers’ empathic understanding of their preschoolers’ internal experience: Relations with early attachment. International Journal of Behavioral Development., 25, 16-26.
Oppenheim, D. & Koren-Karie, N. (2002). Mothers’ Insightfulness Regarding their Children’s Internal Worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23(6), 593-605.
Oppenheim, D., Goldsmith, D., & Koren-Karie, N. (2005). Maternal Insightfulness and preschoolers’ emotion and behavior problems: Reciprocal influences in a day-treatment program. Infant Mental Health Journal.
Prino, C. T., & Peyrot, M. (1994). The effect of child physical abuse and neglect on aggressive withdrawn, and prosocial behavior. Child Abuse and Neglect, 18, 871–884.
Robins, L. N. (1978). Longitudinal studies: Sturdy childhood predictors of adult antisocial behavior. Psychological Medicine, 8, 611–622.
Schreiber, R., & Lyddon, W. J. (1998). Parental bonding and current psychological functioning among childhood sexual abuse survivors. Journal of Counseling Psychology, 45, 358–362.
Steele, M., Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K., (2008). Forcasting Outcomes in Previously Maltreated Children. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 427-452). NY: Guilford.
Arthur Becker-Weidman, Ph.D.
Center For Family Development
Many adopted and foster children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiving relationship. Such a history can lead to the development of Complex Trauma (Cook et. al., 2003; Cook et. al., 2005), disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems (Gauthier, Stollak, Messe, & Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These children are likely to develop Reactive Attachment Disorder (Greenberg, 1999; Lyons-Ruth & Jacobvitz, 1999). Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990). Many of these children are violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and as adults are at risk of developing a variety of psychological problems (Schreiber & Lyddon, 1998) and personality disorders, including antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman, 2000), narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder (Dozier, Stovall, & Albus, 1999). Therapeutic Parenting is often necessary to help these children heal (Becker-Weidman, A., & Shell, D., 2005/2008). This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation. Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:
• Sensitivity
• Responsiveness
• Following the child’s lead
• The sharing of congruent intersubjective experiences
• Creating a sense of safety and security
The effective implementation of these principles requires parents who:
• Are strongly committed to the child.
• Have well developed reflective abilities
• Have good insightfulness
• Have a relatively secure state of mind with respect to attachment
This type of parenting is consistent with Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for children with trauma and attachment disorders (Becker-Weidman & Hughes, 2008). Many foster and adoptive parents find their children’s behaviors strange, frightening, disturbing, and upsetting. They often don’t understand why their child behaves as the child does; “after all, my child is now safe, doesn’t he get it?” It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.
Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child’s behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to “anyone” for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive. By understanding what is driving the behavior and appreciating the child’s fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stop…they may change into other problems, but if the underlying cause remains, then the problems will surface again and again.
Let’s discuss the principles required. These principles are more fully elaborated elsewhere (Becker-Weidman & Shell, 2005; Becker-Weidman, 2007)
SENSITIVITY. Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child’s level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.
RESPONSIVENESS. Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child’s need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.
FOLLOWING THE CHILD’S LEAD. By this I mean that the parent will need to respond to the child and follow the child’s lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child’s pace. It is very important to move at the child’s pace to create the necessary sense of safety and security that these children need.
THE SHARING OF CONGRUENT INTERSUBJECTIVE EXPERIENCES. Intersubjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.). Or another example, when talking about the death of the child’s loved grandparent, you both may share the same emotions (grief), both are recalling memories of the grandparent (shared intention and attention). It is the sharing of congruent intersubjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.
CREATING A SENSE OF SAFETY AND SECURITY. Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.
Unless the child feels safe, exploration is not possible.
So, what sort of parent is needed? We know form extensive research, that one of the best predictors of placement stability is the parent’s commitment to the child (Dozier, Grasso, Lindhiem, & Lewis, 2007). Therefore, building or rebuilding parental commitment is an important first step. Unless there is strong commitment, the child cannot feel safe and, as discussed above, safety is the most important first step in helping a hurt child heal.
Reflective capacity is also vital to placement stability and to the healing of adopted and foster children. The parent must be able to reflect on the child’s underlying emotions, how the past may be re-enacted in the present, and what in the parent’s own past is being triggered by the child. A well developed reflective function is necessary if the parent is to respond to the child in a healthy and healing manner. We all have buttons. The job of the therapeutic parent is to understand one’s buttons so that these can be disconnected so that when pushed, nothing happens.
Insightfulness (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001; Oppenheim, & Koren-Karie, 2002; Oppenheim, Goldsmith, & Koren-Karie, 2005) is related to reflective capacity.
A parent’s state of mind with respect to attachment is the best predictor of the child’s. (Main, & Cassidy, 1988; Main, & Hesse, 1990). If the parent has a Secure state of mind with respect to attachment, then the adopted or foster child is more likely to develop a healthy and secure pattern of attachment and heal (Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008). We know that when young children are placed in a foster home, the child will begin to develop a pattern of attachment that is the same as the foster parent’s state of mind with respect to attachment (Dozier, Stovall, Albus, & Bates, 2001). Obviously, in older children, this is a more difficult task. In the general population, about 60% of the adults have a secure state of mind with respect to attachment. For parents who have an insecure state of mind with respect to attachment, they can still learn to parent effectively with help (Becker-Weidman, A., & Shell, D., 2005/2008; Bick & Dozier, 2008).
USEFUL RESOURCES FOR PARENTS
1. Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
2. Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.
3. Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.
4. Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .
5. Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.
REFERENCES
Becker-Weidman, A., & Shell, D., (Eds.) (2005, 2008). Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes & Williamsville, NY: Center for Family Development.
Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
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.
Bick, J., & Dozier, M., (2008). Helping Foster Parents Change. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 452-471). NY: Guilford.
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants’ attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135–157). NY: Cambridge University Press.
Cicchetti, D., Cummings, E. M., Greenberg, M. T., & Marvin, R. S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti & M. Cummings (Eds.), Attachment in the preschool years (pp. 3–50). Chicago: University of Chicago Press.
Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.
Dozier, M., Stovall, K., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477.
Dozier, M., Grasso, D., Lindhiem, O., & Lewis, E., (2007) “The role of caregiver commitment in foster care,” in D. Oppenheim & D. Goldsmith, (Eds.) Attachment Theory in Clinical Work with Children. NY: Guilford.
Dozier, M., Stovall, K. C., & Albus, K. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 497–519). NY: Guilford Press.
Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment styles in maltreated children: A comparative study. Child Development and Human Development, 31, 113–128.
Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20, 549–559.
Greenberg, M. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 469–496). NY: Guilford Press.
Koren-Karie, N., Oppenheim, D., Dolev S., Sher, E., & Etzion-Carasso, E. (2002). Mothers’ insightfulness regarding their infants’ internal experience: Relations with maternal sensitivity and infant attachment. Developmental Psychology, 38, 534-542.
Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 520–554). NY: Guilford Press.
Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age six: Predictable from infant attachment classifications and stable over a one-month period. Developmental Psychology, 24, 415–426.
Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status. In M. T. Greenberg, D. Ciccehetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–184). Chicago: University of Chicago Press.
Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68–69.
Oppenheim, D., Koren-Karie, N., & Sagi, A. (2001). Mothers’ empathic understanding of their preschoolers’ internal experience: Relations with early attachment. International Journal of Behavioral Development., 25, 16-26.
Oppenheim, D. & Koren-Karie, N. (2002). Mothers’ Insightfulness Regarding their Children’s Internal Worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23(6), 593-605.
Oppenheim, D., Goldsmith, D., & Koren-Karie, N. (2005). Maternal Insightfulness and preschoolers’ emotion and behavior problems: Reciprocal influences in a day-treatment program. Infant Mental Health Journal.
Prino, C. T., & Peyrot, M. (1994). The effect of child physical abuse and neglect on aggressive withdrawn, and prosocial behavior. Child Abuse and Neglect, 18, 871–884.
Robins, L. N. (1978). Longitudinal studies: Sturdy childhood predictors of adult antisocial behavior. Psychological Medicine, 8, 611–622.
Schreiber, R., & Lyddon, W. J. (1998). Parental bonding and current psychological functioning among childhood sexual abuse survivors. Journal of Counseling Psychology, 45, 358–362.
Steele, M., Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K., (2008). Forcasting Outcomes in Previously Maltreated Children. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 427-452). NY: Guilford.
Dec 7, 2008
Dyadic Developmental Psychotherapy Institute
The Dyadic Developmental Psychotherapy Institute (DDPI) has been formed to allow therapist to become appropriately trained and certified as practitioners and/or consultants of Dyadic Developmental Psychotherapy(DDP). The DDPI has a certification process to become a certified practitioner of DDP and to become a certified consultant of DDP.
Dyadic Developmental Psychotherapy, which is an effective and evidence-based treatment (Becker-Weidman & Hughes, 2008) has been developing for over a decade now. The purpose of the Institute and its certification program is to ensure that practitioners of the model adhere to its basic principles and to maintain integrity of the model. Dyadic Developmental Psychotherpay, Dyadic Developmental Psychotherapy Institute, Certified Dyadic Developmental Psychotherapy Psychotherapist, Certified Dyadic Developmenal Psychotherapy Consultant, Certified Dyadic Developmental Psychotherapy Trainers, DDP, DDPI, CDDPP, CDDPC, and CDDPT are all registered service marks/trademarks of the DDPI and may only be used with its permission.
DDPI will provide a certification process for those clinicians who are utilizing the DDP model of treatment and who wish to become certified in having demonstrated their knowledge of its core principles and their competence in its implementation in their practice. To be certified clinicians will have completed a minimum number of hours both in DDP course participation as well as in receiving consultation of their utilization of DDP in their treatment (through video review). Clinicians will also be certified to be DDP consultants, who are responsible for the providing consultation to those applying to become DDP certified therapists.
REFERENCES
Becker-Weidman, A. (2006a). Treatment for children with trauma-attachment disorders: Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, March, 2006.
Becker-Weidman, A. (2006b). Dyadic Developmental Psychotherapy: a multi-year follow-up. In New Developments in Child Abuse Research S.M. Sturt, Ed. Nova Science Publishers.
Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,”
http://www.center4familydevelop.com/research.pdf
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.
Becker-Weidman, A. & Shell, D. Eds. (2005, 2nd Printing 2008). Creating Capacity for . Oklahoma City OK: Wood ‘N’ Barnes, Williamsville, NY: Center For Family Development
Bowlby, J., (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. NY: Basic.
Holmes, J., (1993). John Bowlby Attachment Theory. London: Routledge.
Hughes, D. (1997). Facilitating Developmental Attachment: The Road to Emotional
Dyadic Developmental Psychotherapy, which is an effective and evidence-based treatment (Becker-Weidman & Hughes, 2008) has been developing for over a decade now. The purpose of the Institute and its certification program is to ensure that practitioners of the model adhere to its basic principles and to maintain integrity of the model. Dyadic Developmental Psychotherpay, Dyadic Developmental Psychotherapy Institute, Certified Dyadic Developmental Psychotherapy Psychotherapist, Certified Dyadic Developmenal Psychotherapy Consultant, Certified Dyadic Developmental Psychotherapy Trainers, DDP, DDPI, CDDPP, CDDPC, and CDDPT are all registered service marks/trademarks of the DDPI and may only be used with its permission.
DDPI will provide a certification process for those clinicians who are utilizing the DDP model of treatment and who wish to become certified in having demonstrated their knowledge of its core principles and their competence in its implementation in their practice. To be certified clinicians will have completed a minimum number of hours both in DDP course participation as well as in receiving consultation of their utilization of DDP in their treatment (through video review). Clinicians will also be certified to be DDP consultants, who are responsible for the providing consultation to those applying to become DDP certified therapists.
REFERENCES
Becker-Weidman, A. (2006a). Treatment for children with trauma-attachment disorders: Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, March, 2006.
Becker-Weidman, A. (2006b). Dyadic Developmental Psychotherapy: a multi-year follow-up. In New Developments in Child Abuse Research S.M. Sturt, Ed. Nova Science Publishers.
Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,”
http://www.center4familydevelop.com/research.pdf
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.
Becker-Weidman, A. & Shell, D. Eds. (2005, 2nd Printing 2008). Creating Capacity for . Oklahoma City OK: Wood ‘N’ Barnes, Williamsville, NY: Center For Family Development
Bowlby, J., (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. NY: Basic.
Holmes, J., (1993). John Bowlby Attachment Theory. London: Routledge.
Hughes, D. (1997). Facilitating Developmental Attachment: The Road to Emotional
Recovery and Behavioral Change in Foster and Adopted Children (1997).
Hughes, D. (1998). Building the Bonds of Attachment: Awakening Love in Deeply
Troubled Children.
Hughes, D. (2003). Psychological Interventions for the Spectrum of Attachment
Disorders and Intrafamilial Trauma. Attachment and Human Development, 5,
271-277.
Hughes, D. (2004). An Attachment-Based Treatment for Maltreated Children and Youth.
Attachment and Human Development, 6, 263-278.
Hughes, D. (2006). Building the Bonds of Attachment: Awakening Love in Deeply
Troubled Children.2nd Edition.
Hughes, D. (2007). Attachment-focused family therapy.
Oct 26, 2008
Dyadic Developmental Psychotherapy: An evidence based and effective treatment
Dyadic Developmental Psychotherapy is an effective and evidence-based treatment for trauma and attachment disorders. There have been a few empirical follow-up studies published in professional peer-reviewed publications following a group of families that received DDP and a group who received other forms of treatment. These studies demonstrated that the children treated with DDP had clinically and statistically significant reductions in various scales of the Child Behavior Checklist (Achenbach) while those who received other treatments (play therapy, residential treatment, group therapy, family therapy, etc) from other providers showed no changes and, after four years, actually showed clinically and statistically significant deteriorations in their behavior.
Craven & Lee (2006) determined that DDP is a supported and acceptable treatment (category 3 in a sixlevel system). However, their review only included results from a partial preliminary presentation of an ongoing follow-up study, which was subsequently completed and published in 2006. This initial study compared the results DDP with other forms of treatment, ‘usual care’, 1 year after treatment ended. A second study extended these results out to 4 years after treatment ended. Based on the Craven & Lee classifications (Saunders et al. 2004), inclusion of
those studies would have resulted in DDP being classified as an evidence-based category 2, ‘Supported and probably efficacious’. Other than lacking two randomized controlled studies, DDP would have be classified as a category 1, "Well supported efficacious treatment," the highest level.
The interested reader may want to look at the following references for further details:
Becker-Weidman, A., (2006)“Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23 #2, April 2006, pp 147-171.
Oklahoma City , OK
Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287–304.
Saunders, B., Berliner, L. & Hanson, R. (2004) Child physical and sexual abuse: guidelines for treatment. Available at: http://academicdepartments.musc.edu/ncvc/resources_prof/
Craven & Lee (2006) determined that DDP is a supported and acceptable treatment (category 3 in a sixlevel system). However, their review only included results from a partial preliminary presentation of an ongoing follow-up study, which was subsequently completed and published in 2006. This initial study compared the results DDP with other forms of treatment, ‘usual care’, 1 year after treatment ended. A second study extended these results out to 4 years after treatment ended. Based on the Craven & Lee classifications (Saunders et al. 2004), inclusion of
those studies would have resulted in DDP being classified as an evidence-based category 2, ‘Supported and probably efficacious’. Other than lacking two randomized controlled studies, DDP would have be classified as a category 1, "Well supported efficacious treatment," the highest level.
The interested reader may want to look at the following references for further details:
Becker-Weidman, A., (2006)“Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23 #2, April 2006, pp 147-171.
Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
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.
Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287–304.
Saunders, B., Berliner, L. & Hanson, R. (2004) Child physical and sexual abuse: guidelines for treatment. Available at: http://academicdepartments.musc.edu/ncvc/resources_prof/
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