therapy

Therapy

Lynne Herbert, LPC utilizes Dyadic Developmental Psychotherapy in her practice. This is a
family-focused mode of care that works with children who may have experienced trauma,
neglect, abuse or loss as well as with other children with experiencing emotional and
behavioral problems. It is a psychotherapy that is based on principals derived from Attachment Theory and research and was developed by Lynne’s teacher, Dan Hughes, PhD.

The therapy is experiential. Attachment occurs during the first years of life. In this time period, the child does not have autobiographical memory. Experiences, therefore, and not words, are what create change. The child needs a different experience of themselves and others in relationship. They need to feel safe, loved, validated. They need to receive empathy, attunement, affection, and to be able to have a conflict or discuss challenging things without losing the person who this is with (the parent or therapist). This experiential work occurs with the child and family in the session, facilitated by Lynne, as well as in the home. The work needs to occur in both places, so much of Lynne’s work is also helping the parents to create a healing environment outside of the therapy office that will continue the therapeutic process.

Dyadic Developmental Psychotherapy emphasizes the feelings (or affect) that underlie behaviors of both the parents and the children. Each has developed their own means of attempting to keep themselves safe in a difficult relationship. Emotions cause behavior. And, if the emotions are addressed and change, then the behavior will follow suit. This is why behavioral modification programs often serve only as band-aids for creating change. Treatment is directive and client-centered.

Trauma is directly addressed. It is through the experience of this in a safe environment while receiving acceptance and empathy from a caregiver that a child can begin to revise their own narrative, their story. It is through this exploration in a safe environment that a child’s concept of the world and themselves in it can be fully illustrated and changed.

There have been many misconceptions about what constitutes effective treatment and care for children who have attachment difficulties or who have been diagnosed with Reactive Attachment Disorder. Some have used coercive techniques based on gaining power and control over children. This approach does not have the same goals, and techniques are based on creating a safe, accepting, and nurturing environment where the child can be challenged to explore emotions and feelings that have challenged his/her internal dialog. Therapy is consensual, not coercive. Physical restraint is not treatment, nor is “rage induction” or “rebirthing”.

The following has been quoted from:
http://www.answers.com/topic/dyadic-developmental-psychotherapy
regarding efficacy and evidence base of this mode of treatment.

(their reference sources also cited below)

This treatment has been found to produce measurable and sustained improvement in children diagnosed with Reactive Attachment Disorder (Becker-Weidman, 2006)(12). In that study it was found that other forms of treatment, such as individual therapy or play therapy did not produce any improvement; thus indicating that Dyadic Developmental Psychotherapy is effective while other forms of treatment are not effective for this disorder. Dyadic developmental psychotherapy involves creating a safe setting in which the client can begin to explore, resolve, and integrate a wide range of memories, emotions, and current experiences, that are frightening, stressful, avoided or denied. Safety is created by insuring that this exploration occurs with nonverbal attunement, reflective, non-judgmental dialog, along with empathy and reassurance. As the process unfolds, the client is creating a coherent life story or autobiographical narrative that is crucial for attachment security and is a strong protective factor against psychopathology. Therapeutic progress occurs within the joint activities of co-regulating affect and
co-constructing meaning.

Evidence Base

Dyadic Developmental Psychotherapy has been shown to be an effective treatment for children with Reactive Attachment Disorder. One study(1) found that children who received Dyadic Developmental Psychotherapy had clinically and statistically significant improvements in their functioning as measured by the Child Behavior Checklist(Achenback), while the children in the control group showed no change one year after treatment ended.

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. 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 DDP 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.

This study supports several of O’Connor & Zeanah’s 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. While there are a number of limitations to this study, given the severity of the disorders in question, the paucity of effective treatments, and the desperation of caregivers seeking help, it is a step in the right direction. DDP is not a coercive therapy, which can be dangerous. DDP provides caregiver support as an integral part of its treatment methodologies. Finally, DDP uses a multimodal approach built around affect attunement.

This study suggests that Dyadic Developmental Psychotherapy is an effective intervention for children with trauma-attachment problems.

A second study (Becker-Weidman, 2006b in Sturt, 2006) continued following these children for four years after treatment ended. This study examined the effects of Dyadic Developmental Psychotherapy four years after treatment ended on children with trauma-attachment disorders who meet the DSM IV criteria for Reactive Attachment Disorder. 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. 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 3.9 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 3.3 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, 100% 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.

The basic principles of Dyadic Developmental Psychotherapy are grounded in well established treatment principles for the treatment of complex trauma:

Safety
Self-regulation
Self-reflective information processing
Traumatic experiences integration
Relational engagement
Positive affect enhancement

(See Cook et. al., "Complex Trauma in Children and Adolescents" Psychiatric
Annals 35:5 May 2005 and Principles of Trauma Therapy by John Briere & Catherine
Scott, Sage, NY 2006 for further details).

In addition, many of the components of Dyadic Developmental Psychotherapy are
based on sound clinical principles from Child Development research and treatment
(Zeanah, 1993). Respect for the client, attunement, developing reflective abilities, and
related components (Lambert, 2004).

Dyadic Developmental Psychotherapy meets the standards and is in
compliance with the American Association for the Abuse of Children's
(APSAC) Task Force's recommendations (APSAC Task Force Report and
Recommendations: Report of the APSAC Task Force on Attachment
Therapy, Reactive Attachment Disorder, and Attachment Problems.
Child Maltreatment, 11 (1), 2006, pp 76-89.) and the American Academy
of Child and Adolescent Psychiatry practice parameters (AmericanAcademy
of Child and Adolescent Psychiatry’s “Practice Parameter for the
Assessment and Treatment of Children and Adolescents with Reactive
Attachment Disorder of Infancy and Early Childhood,” 2005.) .

References:
1. "Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental
Psychotherapy" Child and Adolescent Social Work Journal. 13(2), April 2006.
2. Becker-Weidman, A., & Shell, D., (Eds.) (2005) Creating Capacity For Attachment, Wood 'N'
Barnes, OK. ISBN 1-885473-72-9
3. O'Connor and Zeanah (2003) "Attachment disorders and assessment approaches Attachment
and Human Development 5(3)223-244:Taylor and Francis
4. Hughes, Daniel, (2006) Building the Bonds of Attachment, 2nd edition, NY: Guilford Press.
5. Hughes, D. (2004). An attachment-based treatment of maltreated children and young people.
Attachment & Human Development, 3, 263–278.
6. Hughes, D. (2003). Psychological intervention for the spectrum of attachment disorders and
intrafamilial trauma. Attachment & Human Development, 5, 271–279.
7. Sturt, SM (Ed) (2006) New Developments in Child Abuse Research Nova Science Publishers,
NY. ISBN 1-59454-980-X
8. Bowlby, J. (1969,1982) Attachment [Vol. 1 of Attachment and Loss]. London: Hogarth Press;
New York, Basic Books; Harmondsworth, UK: Penguin (1971). ISBN 0-465-00543-8.
9. Bowlby, J. (1973) Separation: Anxiety & Anger [Vol. 2 of Attachment and Loss]. London: Hogarth
Press; New York: Basic Books; Harmondsworth: Penguin (1975). ISBN 0-465-09716-2.
10. Bowlby, J. (1980) Loss: Sadness & Depression [Vol. 3 of Attachment and Loss]. London:
Hogarth Press; New York: Basic Books; Harmondsworth: Penguin (1981). ISBN 0-465-04237-6.
11. Bowlby, J. (1988) A Secure Base: Parent-Child Attachment and Healthy Human Development.
London: Routledge; New York: Basic Books. ISBN 0-415-00640-6.
12. Bretherton, I. (1992) "The origins of attachment theory". Developmental Psychology,
28:759-775.
13. Holmes, J. (1993) John Bowlby and Attachment Theory. London: Routledge.
ISBN 0-415-07729-X.
14. Becker-Weidman, A., (2006) Dyadic Developmental Psychotherapy: a multi year follow-up.
in Sturt, S., (ed) New Developments in Child Abuse Research. NY: Nova.
15. Cook et. al., "Complex Trauma in Children and Adolescents" Psychiatric Annals 35:5 May
2005
16. Briere, J., & Scott, C., (2006) Principles of Trauma Therapy NY: Sage.
17. Zeanah, C., (ed) (1993). Infant Mental Health. NY: Guilford.
18. Lambert, M., (ed) (2004). Bergin and Garfield's Handbook of Psychotherapy and Behavior
Change (5th ed)., NY: Wiley.
19. APSAC Task Force Report and Recommendations: Report of the APSAC Task Force on
Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems. Child
Maltreatment, 11 (1), 2006, pp 76-89
20. American Academy of Child and Adolescent Psychiatry’s “Practice Parameter for the
Assessment and Treatment of Children and Adolescents with Reactive Attachment Disorder
of Infancy and Early Childhood,” 2005.