Dyadic Developmental Psychotherapy: an Evidence-based and Effective Treatment for Children With Complex Trauma and Disorders of Attachment

in treatment facilitates the development of an affectively attuned relationship between the child and caregiver. An affectively attuned relationship may be described as a relationship in which the two persons are experiencing the same affect and that their affect co-varies. Within the safety of the attuned relationship the shame of past trauma and current misbehaviors are explored, experienced, and integrated. The caregiver-child interactions build on a dyadic affect regulation process that normally occurs during infancy and the toddler years. The child’s past traumatic history of abuse and neglect strongly suggests that such interaction, which facilitates a health attachment and a trusting and safe relationship, did not occur or occurred in an inadequate manner. Dyadic Developmental Psychotherapy facilitates the development of a healthy attachment between child and caregiver, enables the child to affectively trust the caregiver, and allows the child to secure comfort and safety from the caregiver.

 

This study examined the effects of Dyadic Developmental Psychotherapy on children with trauma-attachment disorders who meet the DSM IV criteria for Reactive Attachment Disorder, all of whom were either adopted or in foster care. A treatment group composed of thirty-four subjects and a usual care group composed of thirty subjects was compared. All children were between the ages of five and sixteen when the study began. Seven hypotheses were explored. It was hypothesized that Dyadic Developmental Psychotherapy would reduce the symptoms of attachment disorder, aggressive and delinquent behaviors, social problems and withdrawal, anxiety and depressive problems, thought problems, and attention problems among children who received Dyadic Developmental Psychotherapy. Significant reductions were achieved in all measures studied. The results were achieved in an average of twenty-three sessions over eleven months. These findings continued for an average of 1.1 years after treatment ended for children between the ages of six and fifteen years. There were no changes in the usual care-group subjects, who were re-tested an average of 1.3 years after the evaluation was completed. The results are particularly salient since 82% of the treatment-group subjects and 83% of the usual care-group subjects had previously received treatment with an average of 3.2 prior treatment episodes. This past history of unsuccessful treatment further underscores the importance of these results in demonstrating the effectiveness and efficacy of Dyadic Developmental Psychotherapy as a treatment for children with trauma-attachment problems. In addition, 53% of the usual care-group subjects received “usual care” but without any measurable change in the outcome variables measured. Children with trauma-attachment problems are at significant risk of developing severe disorders in adulthood such as Post Traumatic Stress Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, and other personality disorders.

A second study followed these children out to four years after treatment ended and found that the children in the treatment group continued to have scores in the normal range on the Child Behavior Checklist. (13).

The children in the usual care or control group continued to have scores on the Child Behavior Checklist that were unchanged prior to treatment and remained in the clinical range, and that actually got statistically significantly worse on several of the scales of the Child Behavior Checklist; despite the fact that all these children received treatment (but not Dyadic Developmental Psychotherapy) from other providers at other clinics.(14)

This study supports several of O’Connor & Zeanah’s (15) conclusions and recommendations concerning treatment. They state (p. 241), “treatments for children with attachment disorders should be promoted only when they are evidence-based.” The results of this study are a beginning toward that end. Dyadic Developmental Psychotherapy provides caregiver support as an integral part of its treatment methodologies. Finally, Dyadic Developmental Psychotherapy uses a multimodal approach built around the concordant intersubjective sharing of experience.

 

Arthur Becker-Weidman, Ph.D.

Director

Center For Family Development

5820 Main Street, suite 406

Williamsville, NY 14221

 

716-810-0790

REFERENCES

[1] Lyons-Ruth, K., & Jacobvitz, D., Attachment disorganization: unresolved loss, relational violence and lapses in behavioral and attentional strategies. In Cassidy, J. & Shaver, P., (Eds.) Handbook of Attachment. pp 520-554, NY: Guilford Press, 1999.

Solomon, J. & George, C. (Eds.). Attachment Disorganization. NY: Guilford Press,

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