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Revision as of 09:52, 2 March 2006
DYADIC DEVELOPMENTAL PSYCHOTHERAPY
INTRODUCTION
There are many misconceptions and fictions about treatments for trauma-attachment disordered children. Is treatment dangerous and deadly? Is it a miracle cure? What, exactly, is attachment therapy? First, some truths. Dyadic Developmental Psychotherapy is the one of the only forms of treatment that is effective with trauma-attachment disordered children. It is the only “evidence-based” treatment, meaning that there has been research published in peer-reviewed journals . In an on-going follow-up study we found that 1.1 years after treatment ended, there were statistically and clinically significant reductions in aggressive, delinquent, avoidant, and other symptoms . It is important to note that over 80% of the children in the study had had over three prior episodes of treatment, but without any improvement in their symptoms and behavior. Dyadic Developmental Psychotherapy is primarily an experiential-based treatment, designed to facilitate experiences of safety and security so that a secure attachment may grow. Dyadic Developmental Psychotherapy, as with any specialized treatment, must be provided by a competent, well-trained, licensed professional. Dyadic Developmental Psychotherapy is a family-focused treatment.
Dyadic Developmental Psychotherapy is the name for an approach and a set of principals that have proven to be effective in helping trauma-attachment disordered children heal; that is, develop healthy, trusting, and secure relationships with caregivers. Treatment is based on five central principals. These principals are based on the causes and courses of disorders of attachment.
At the core of Reactive Attachment Disorder is trauma caused by significant and substantial experiences of neglect, abuse, or prolonged and unresolved pain in the first two years to three years of life. These experiences disrupt the normal attachment process so that the child’s capacity to form a secure attachment with a caregiver is distorted or absent. The child lacks trust, safety, and security. The child develops a negative working model of the world in which: Ø Adults are experienced as inconsistent or hurtful. Ø The world is viewed as chaotic. Ø The child experiences no effective influence on the world. Ø The child attempts to rely only on him/her self. Ø The child feels an overwhelming sense of shame, the child feels defective, bad, unlovable, and evil.
PRINCIPLES OF TREATMENT
FIRST PRINCIPLE
Therapy must be experiential. Since the roots of disorders of attachment occur pre-verbally, therapy must create experiences that are healing. Experiences, not words, are the “active ingredient” in the healing process. Traumatized children who are unable to trust do not respond to traditional forms of treatment such as play therapy, residential treatment, or talk therapies, since these therapies require and work through a relationship between the therapist and client.
Effective therapy uses experiences to help a child experience safety, security, acceptance, empathy, and emotional attunement. A number of techniques and methods are used including psychodrama, interventions congruent with Theraplay, and other exercises.
SECOND PRINCIPLE
Therapy must be family-focused. Therapy enables the child to address the underlying trauma so that what the parents have to offer by way of attunement and sensitivity can become effective and heal the child. It is the parents’ capacity to create a safe and nurturing home that provides a healing environment. Being able to have empathy for the child, accept the child, love the child, be curious about the child, and be playful are all part of the “attitude ” that heals. Parents are actively involved in treatment. They are either in the session with the child on the parent’s lap or watching the therapy through a one-way mirror or by closed circuit TV. This is essential. It ensures that the parents are actively and fully involved in treatment.
THIRD PRINCIPLE
The trauma must be directly addressed. Therapy helps healing by providing the safety and security so that the child can re-experience the painful and shameful emotions that surround the child’s trauma. Revisiting the trauma is essential if the child is to begin to revise the child’s personal narrative and world-view. It is by revisiting the trauma and sharing the anger and shame with an accepting, empathetic person that the child can integrate the trauma into a coherent self.
FOURTH PRINCIPLE
A comprehensive milieu of safety and security must be created. Traumatized children are often hyper-vigilant, insecure, and deeply distrusting. A consistent environment that is safe and secure is essential to creating the experiences necessary for the child to heal. This milieu must be present at home and in therapy. Good communication and coordination among home, school, and therapy is another important element of effective treatment. “Compression-wraps,” invasive and intrusive stimulation designed to evoke rage, “re-birthing,” and other provocative techniques are not part of Dyadic Developmental Psychotherapy. These intrusive and invasive techniques are not therapy, not therapeutic, and have no place in a reputable treatment program.
FIFTH PRINCIPLE
Therapy is consensual and not coercive. physical restraint is not treatment.
THERAPIST TRAINING
The therapist must be well trained, licensed, and have significant experience in treating trauma-attachment disordered children. A good resource to locate such therapists is the Association for the Treatment and Training in the Attachment of Children, ATTACh. In selecting a therapist you should look for the following: Ø Significant training from a recognized training program. I would recommend at least two-week of prior training followed by regular supervision of videotapes. Ask where the therapist was trained, how long ago, and for how long. Ø An office set-up so that sessions are videotaped and parents can watch sessions from another room if not actually in the room. Ø Ongoing training. Ask when was the last training event the therapist attended and how long was the event. Ø Licensure in the state in a recognized mental health discipline. Ø Membership in ATTACh. Ø A comprehensive informed consent document and appropriate releases. Ø An initial assessment to develop a differential diagnosis and treatment plan.
In summary, therapy for traumatized children who have disordered attachments must be experiential, consensual, and provide an environment of security, acceptance, safety, empathy, and playfulness. Only an experienced and trained therapist can provide attachment therapy.
REFERENCES
:“Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 12 #6, December 2005.
Creating Capacity For Attachment (Eds) Arthur Becker-Weidman, Ph.D., & Deborah Shell, MA, Wood 'N' Barnes, OK: 2005.