Jun 9, 2011

Dyadic Developmental Psychotherapy Identified as an Effective Treatment by UK Institute

IN an exciting development, the Institute for Research and Innovation in Social Services, recognizes Dyadic Developmental Psychotherapy as an evidence-based, effective, and empirically validated treatment. The Institute is a large, internationally regarded institute whose function is to promote positive outcomes in the social service field by identifying evidence informed practice and disseminating research, innovations, and improvements in social services policy, practice, and programming.

The Institutes most recent report, "Insights: Attachment-Informed practice with looked after children and young people, had the following key points:

Attachment behaviour ensures the survival of infants and young children by keeping their caregivers close and available to provide protection and comfort. The attachment relationship provides the context for the main developmental tasks of infancy and early childhood, particularly emotional regulation and the development of the capacity to ‘mentalise’.

The characteristics of caregivers affect the organisation and security of children’s attachment relationships with them. Sensitive, responsive parenting and parental ability to reflect on the infant’s own thoughts and feelings are associated with secure attachments in children.

Children who have experienced maltreatment are significantly more likely to develop disorganised
attachments and these can have lifelong physical, emotional and social consequences.

Recent evidence from neuroscience confirms the importance of the early emotional and social experience of
infants for the healthy development of their brains. Maltreatment can disturb the patterns of cortisol
(stress hormone) secretion which can affect immediate and long term mental and physical health.

Looked after children benefit from developing secure attachments with their caregivers and interventions
should support the development of these, whether children remain at home or are cared for outside their family.

Successful placements are more likely when carers are able to respond to children at their emotional age
rather than their chronological one. Interventions with children should aim to address developmental brain
impairment by providing care that can build fundamental brain capacities. For looked after children this will mean less use of verbal techniques and a greater concentration on physical, sensory and emotional ways of working.

Caregivers should be assessed on their capacity to tolerate difficult behaviour and remain sensitive and
responsive to the needs of children.

Support and training should be provided to caregivers on a frequent and regular basis to ensure that they are able to maintain their capacity to be reflective about children rather than reactive to their behaviour.

Attachment-informed practice may require a policy and culture shift to ensure that children’s needs
are appropriately met when they are cared for away from home.

As you can see their key point that carers should respond to children based on their emotional age rather than their chronological age is supported by our study revealing that children with Complex Trauma and disorders of attachment are substantially younger developmentally than their chronological age:
Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” Child Welfare, 88 (2)137-161.

The Institue's paper goes on to state it's support for Dyadic Developmental Psychotherapy as an evidence-informed and validated treatment approach:
Dyadic Developmental Psychotherapy is an attachment-focused approach in which a therapist supports the caregiver and child’s relationship and the development of secure attachment by encouraging the reflective function of the caregiver, enabling attunement, regulating emotion and co creating meaning. The therapist
interactions are characterised by PACE (playfulness, acceptance, curiosity and empathy) and similar qualities are supported in the caregiver with the addition of love (PLACE). This approach has been well evaluated with foster carers and adoptive parents and recently elements of this model have been successfully introduced within residential child care (Becker-Weidman and Hughes, 2008).

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


Ilana said...

As a teacher, how can I see the difference between "triangulation", manipulation from a child with attachment disorders and true abuse in foster care, which is not too rare either? I have an obligation to report abuse if I see it!

How can I "follow through with all and any consequences" without appearing to be an almighty adult reigning on a child without rights?

Should I follow through even if my "consequences" provoke very bad fits of rage in the child, which could otherwise be avoided?

Arthur Becker-Weidman, PhD said...

Thanks so much for your comment and question. They raise a number of very important points.
I generally don't think of children who have experienced chronic early maltreatment within a caregiving relationship as manipulative. People learn adaptive ways of related that are grounded in their past experiences. So, I view a child's behavior as being grounded in what may have "made sense" in a prior world, so to speak.
As a mandated reporter your role is not to evaluate a claim of abuse but to report what is, in your professional opinion and in accordance with your jurisdictions statutes, abuse.
Rather than thinking of consequences, which is often a polite way of saying punishment, I'd focus on the relationship and on what needs to happen to repair the damage that may have been done to the relationship by the other person's actions. I'd first try to understand the child's view, the underlying affect that drove the behavior. By being accepting of the child's emotions and then being curious you will ultimately discover the meaning of the actions for the child. Once that is know and understood by all, repairing the relationship (by, for example, helping you sort papers or something else that will help you feel better) will be easy and the child will participate because what you are doing is not punishment, retribution, shaming, etc. Generally when a child becomes dysregulated that probably means that the adult has not understood the child and not been attuned to the child's view and the child's emotional experience and has missed something of vital importance. It is your job to keep the relationship and child regulated...to keep a healing PACE.