Dyadic developmental psychotherapy (DDP) can be described as an attachment-based therapy and an evidence-based treatment for attachment issues such as reactive attachment issues and complex trauma. Developed by Drs. Arthur Becker-Weidman and Daniel Hughes, DDP is commonly used to treat kids in adoptive families and foster care ( Hughes, 2017) . Specifically, it is used to treat children who have suffered abuse, trauma, or neglect. As a family-focused method of therapy, DDP incorporates properly-researched principles, including an emphasis on sensitive responsiveness, relationships, intersubjectivity, and attunement. In the view of Dr. Becker-Weidman, DDP was first developed as an intervention for kids who had suffered emotional trauma caused by chronic early mistreatment in the caregiving setting ( Apeiranthitou, 2021). As a consequence, the key goal of this therapy is to support children to develop the capability to uphold attachment-based relationships with caregivers and parents. The treatment is based on numerous theories such as the attachment theory. The parent-child relationship is at the core of d yadic developmental psychotherapy as it uses this relationship as the healing platform. Consequently, during the therapy, parents are shown a specialized trauma-oriented parenting style while children are taught interpersonal relationship skills and emotional regulation. To promote a secure and trusting relationship between the child and the parent, DDP addresses both of the lessons or processes simultaneously.
Theory and Practice Technique for DDP
Contributing Theories
DDP is grounded on numerous theoretical frameworks such as intersubjectivity, interpersonal neurobiology, attachment theory, and development theory. Generally, the theoretical foundation of the therapy is that when children are subjected to trauma at a tender age, the situation interferes with the physical and emotional development of their brains ( Hewitt et al., 2018) . As a result, such kids struggle to develop safe and secure attachments with their caretakers since they view them as the source of both security and fear. The complicated relationship development usually affect how such children make sense of their environment and their own self, translating into a jumbled and incoherent chronicle of who they are and how best they can explore and navigate their world ( Wingfield & Gurney-Smith, 2019) . Later in life, when such kids are placed in homes under the custody of devoted and loving caregivers, they may be unsure of how to handle this form of nurturing. In some cases, maladaptive behavior patterns and conflict tend to emerge and inhibit healing from taking place in the children’s new home environments. However, DDP therapists endeavor to repair and rebuild this relationship by teaching children emotional regulation while teaching parents an approach to parenting that effectively responds to the unique situations of the children ( Hughes, 2017) . Children are also taught new ways of appreciating their life experiences and how to trust their parents.
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Practice technique
In DDP, the role of the therapist is to improve the relationship between the parent and the child. The focus of the therapist, therefore, is on helping the caretakers to give sensitive and responsive care to the kid. To achieve this, the therapist ensures that an environment of safety is created to allow the child in therapy to explore current experiences, emotions, and memories that can be stressful, frightening, and avoided. In the view of Hewitt et al. (2018) , providing safety in DDP entails ensuring that emotions, memories, and experiences are discovered and explored with empathy, nonverbal attunement, reassurance, and non-judgmental and reflective dialogue. Consequently, child therapy can establish an autobiographical account that is critical to healthy attachment and security. An effective DDP process can help kids establish robust protective defenses to prevent future mental health issues.
Many families and children experience numerous benefits from DDP. These benefits include decrease in controlling behaviors, improved bond and quality of the relationship, increased sense of security and safety with caregivers, improved relationship and interpersonal skills, improved insight into emotional experiences, improved emotion regulation, and enhanced ability to manage and cope with stress ( Hughes, 2017) . Besides these benefits, study findings have revealed that responsive, attuned, and nurturing parenting promotes healthy brain development as well as strong emotional relationships between children and parents.
According to Hewitt et al. (2018) , DDP therapists commence treatment by training parents playful, accepting, curiosity, and empathy ( PACE) treatment. In this program, they are trained on how to interact with the kids and understand their behavior while maintaining their cool even amid challenging situations. Overall, DDP treatment follows a seven-step structure. First, the therapist gets to know the child's parents, evaluates their parenting approaches, and then teaches the parents the PACE approach. Secondly, the therapist assists the parents in practicing and preparing for their critical role in the treatment process of engaging the children in the therapy session. The preparation entails exploring the parent’s attachment experiences and how their children’s behavior may trigger them ( Hughes, 2017) . Thirdly, the child gets invited into the therapy session after the therapist ascertains that their parents are ready. Fourthly, the therapist takes some time to model how to communicate with the child, establishing the child’s understanding of his own history, and training the kid on emotion regulation. Next, the therapist instructs the child to talk to the parents to identify a theme ( Hughes, 2017) . For instance, the issue of abandonment may arise during this conversation. During the interaction between the child and the parents, the therapists help them discuss the identified theme safely. Parents will then be trained on how to make the child make sense out of the neglect he or she experienced ( Hughes, 2017) . The next step entails conducting numerous sessions in the same manner to ensure consistency. Lastly, when the therapist is satisfied that the child is safely attached and the intersubjective link takes place without the help of the therapist, treatment is terminated.
Effectiveness of DDP
Research findings have revealed that DDP is more effective compared to the usual treatment interventions, particularly for complex trauma and reactive attachment disorder. The findings suggest that effective therapy necessitates an appropriately attuned relationship. According to Apeiranthitou (2021) , as parents ponder with their safely attached children on the emotional states that create their mutual subjective experience, they connect with them in a vital co-constructive intervention of understanding how their mind operates. Moreover, it has been established that the inherent aspect of secure attachment, that is, collaborative and reliable communication, is a critical aspect of how internal integration of children is facilitated by interpersonal relationships ( Apeiranthitou, 2021) . This presents serious implications for the effectiveness of the therapy. For instance, when in a therapeutic relationship, the kid can reflect upon the traumatic experiences and the affect linked with such experiences without being affected. In so doing, the child develops an increased capacity to ensure increasing amounts of affect. Finally, the child becomes able to self-regulate.
DDP is also effective for complex trauma and reactive attachment disorder because the attuned relationship between the child and the caretaker as well as that of the child and the therapist allows the child to make sense from the affect and memories. DDP shares numerous fundamental elements with clinical practice and optimal social casework ( Apeiranthitou, 2021) . For instance, respect for the child’s experiences and consideration of the client’s dignity are the fundamental principles that underpin social work practice, which are also critical aspects of DDP. Nonetheless, what distinguishes DDP from the conventional, optimal sound clinical practice is the strong weight attached to maintaining a properly attuned relationship with the kid and a robust acceptance of the kid’s affect and memories. Moreover, DDP emphasizes process and experience rather than content and verbalization. DDP procedure necessitates greater use of self, in comparison to behavioral approaches and structural or strategic family therapy interventions.
According to Apeiranthitou (2021) , understanding and accepting the child’s affect and the motivation behind the affect brings more affective meaning to the client, which is grounded on the prior experiences and memories of trauma. This is critical to effective therapy and offers solutions to numerous attachment challenges. Importantly, research findings have indicated that the use of acceptance and curiosity to reveal a deeper meaning is a vital aspect of DDP as it creates a new understanding and meaning of the present condition of the child. DDP addresses these dimensions through the use of touch, cognitive restructuring, eye contact, tone of voice, repeated implementations of the needs and shame attachment cycles ( Hewitt et al., 2018) . Due to DDP, clients can affectively internalize the love, nurturing, and structuring of their caregivers, leading to increased ability to endure affect without being dissociated. This, ultimately, leads to increased trust and improved self-esteem. Consequently, the effectiveness of DDP lies in the fact that children can use their caretakers as a safe and secure agents of comfort, from which they can understand the world ( Apeiranthitou, 2021) . Socially, such kids exhibit reduced levels of thought disorders, anxiety, aggression, delinquent behaviors, depression, as well as lower levels of withdrawal behaviors. Notably, it is through the effective internalization of the caretaker that traumatic children trust the caretakers and feel the drive to attach themselves to such individuals, translating into conscience and morality.
Despite its effectiveness, DDP has been criticized due to some of its underlying limitations. To begin with, critics of the treatment argue that it is basically inclined towards adoptive and foster families, despite the fact that there are several children who suffer childhood trauma but remain under the care of neglectful or abusive parents. While some of the parents may be able to consult therapists to help them address the source of the abusive behavior, such parents may be ill equipped to mend the damage done ( Hewitt et al., 2018) . Moreover, DDP has been criticized for lack of randomized clinical trials to back its efficacy. Nonetheless, it adheres to laid down research practices that consider the therapeutic affiliation as a strong pointer of outcomes. Finally, DDP has been criticized that it fails to meet the criteria for consideration as evidence-based, given that it does not offer a basis for conclusions regarding usual treatment methods ( Hewitt et al., 2018) . In other words, DDP has been found to have no support for the claims about effectiveness at any degree of evidence, despite having a debatable theoretical basis.
Conclusion
Overall, DDP offers an effective treatment of attachment issues such as reactive attachment issues and complex trauma. The intervention relies on the creation of affective attunement between the client and the therapist, the therapist and the caretaker, and between the caregiver and the client. The process of ensuring affective attunement enables the parties involved to achieve dyadic regulation of affect, particularly between the therapist and the child. This enables the client to feel a sense of security and safety, besides experiencing the affect related to past traumas. Doing so allows for assimilation of the past experiences instead of dissociating the memory and the affect. Additionally, DDP’s significant involvement of caretakers in the therapeutic process facilitates the establishment of an affectively attuned bond between the caretaker and the child. In an affectively attuned association, two parties experience similar affect, which co-varies. Within the comfort and safety of the attuned association, the disgrace of the current misbehavior and past trauma are explored, felt, and integrated. The interaction between the child and the interaction is often grounded on the dyadic regulation process that is experienced during early childhood. The past traumatic experiences of neglect and abuse of the child implies that such interaction that promotes a healthy attachment as well as a trusting and safe association, occurred inadequately or failed to occur completely. Notably, DDP promotes the development of a safe attachment between children and caregivers, allowing children to actively trust their caretakers while also enabling them to secure safety and comfort from the caretakers.
References
Apeiranthitou, V. (2021). The effectiveness of Dyadic Developmental Psychotherapy (DDP) and Attachment Biobehavioural Catch up (ABC) for children experiencing early maltreatment or disruptions in care: Literature Review of RCT studies. Dialogues in Clinical Neuroscience & Mental Health , 4 (1), 41-49.
Hewitt, O., Gurney-Smith, B., & Golding, K. (2018). A qualitative exploration of the experiences of adoptive parents attending ‘Nurturing Attachments’, a dyadic developmental psychotherapy informed group. Clinical child psychology and psychiatry , 23 (3), 471-482.
Hughes, D. (2017). Dyadic developmental psychotherapy (DDP): an attachment‐focused family treatment for developmental trauma. Australian and New Zealand Journal of Family Therapy , 38 (4), 595-605.
Wingfield, M., & Gurney-Smith, B. (2019). Adoptive parents’ experiences of dyadic developmental psychotherapy. Clinical child psychology and psychiatry , 24 (4), 661-679.
