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Psychology NA‑class

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Copyright

This is my article and I am the holder of the copyright. When the article was previously printed I allowed printing of the article, but retained ownership of the copyright.

Arthur Becker-Weidman, Ph.D., Center For Family Development 716-810-0790 AWeidman@Concentric.net

The comment above relates to an earlier version of the article, which had been marked as a possible copyright infringement. It was published on another site, but the assertion seems genuine enough to me. During the review, User:AWeidman followed the procedure given for rewriting the article on a /Temp subpage. As that version seemed to me more in the style of a encyclopedia article, and was better referenced etc., I moved it in place over the original version, which remains available in the page history. --Michael Snow 22:49, 28 March 2006 (UTC)

The claim that DDP meets the criteria for the EBT designation is a very questionable one, as I recently pointed out in a letter to the editorial board of the Child and Adolescent Social Work journal, cc'd to Becker-Weidman. My comments on the nature of evidentiary bases, especially as they relate to Becker-Weidman's publication, will shortly be posted on www.childrenintherapy.org -- under the title "EBT or not EBT?" I would appreciate editing of this page to include any rebuttal to those remarks that Becker-Weidman may be able to provide. Proof by assertion is not acceptable evidence, and if Misplaced Pages permits simple assertions on controversial issues, it may as well declare itself a blog. Jean Mercer.

The material was published in a professional peer-reviewed journal. Child and Adolescent Social Work found the study valid, reliable, and as meeting criteria for evidence-based-treatment as described in the article. Your comments have not yet appeared in the journal. Will they be published or was you letter dismissed as irrelevant. The article demonstrates that Dyadic Developmental Psychotherapy is an evidence based treatment and subsequent resarch that has also been published confirms that.

Please note that my comments were not written for publication, but as a letter to the editorial board, as I felt it would be desirable to allow the journal to handle the matter in a private way. I do notice that the article did not appear in the issue referenced in this article. Child and Adolescent Social Work Journal accepted the article; this is not an indication that they considered the material valid or reliable (and indeed i don't see what those adjectives have to do with a CCT study), or that they consider DDP to meet criteria for an evidentiary basis-- for example, meeting the TREND guidelines. As i am sure you know, I have commented elsewhere on this peer review issue. Not all journals have well-organized review procedures,and even when they do, mistakes can be made. You cannot segue from a journal's statement that it is peer-reviewed to the conclusion that any material published there automatically meets criteria for an evidentiary basis-- this is apples and oranges, even pineapples or kiwi fruit. In fact, DDP does not have a satisfactory basis of evidence for a number of reasons: 1)participants were self-selected, introducing confounding variables; no explanation was given for the failure of the comparison group to enter treatment, and no demographic comparison of the groups was presented; 2)there has been no independent replication of these findings; 3)researchers were apparently not blind to the treatment status of participants; 4)human subjects protection guidelines were not observed; 5)no specific description of treatment seems to be available, and the description given in the Wiki piece under consideration is at variance with the description in the "Dr. Art" book currently available on Becker-Weidman's web site; 6) the statistical analysis is problematic, substituting the easy but dangerous multiple-t approach to the ANOVA which should have been done here; 7) although the Wiki piece stresses the CBCL findings, the journal article (as it was posted on the web site) refers also to the use of the egregiously faulty RADQ checklist. If anyone would like to provide substantive counter-arguments to these points, as opposed to simply deleting my comments or mounting personal attacks, I would be very pleased to read them and to see them included in the article.Jean Mercer 15:52, 11 July 2006 (UTC)

Well, they obvioulsy rejected your "letter" and chose not to publish it. The journal, as far as I can see is a professional peer-reviewed journal that found Dr. Becker-Weidman's article worthy of publication and as providing substantive and valuable material that would be of use to professionals. The article did describe that those in the control group came for evaluation only and the statistics clearly show that the two groups did not differ in a significant way on a broad range of demographic, clinical, and test score data. CBCL scores are valid and reliable. Overall, the claims you make are irrelevant as the journal's acceptance of the article suggests your "issues" with the article are minor and do not take away from the scientific validity and value of this study. RalphLender 17:54, 11 July 2006 (UTC)

No, what it suggests is that CASWJ is not particularly concerned with research design. Not all journals have the same concerns. But from the point of view of establishing an evidentiary basis, my questions need to be addressed. Volunteers are different from non-volunteers, that's well known. So, why did some people come for evaluation only, and others for evaluation plus treatment? What were the basic differences between the groups? Did they have to do with family needs-- did some of the parents not like the offered treatment-- were other treatments chosen instead? All of those questions are relevant to interpretation of the outcome, as are the points that always go unmentioned, the transparency issues, the use of the RADQ, and the choice of statistics... not to mention compliance with guidelines for protection of human subjects.Scott Lilienfeld has been telling us that clinicians are not educated to understand these issues, and I'm afraid he may be right. Look, a lot of people have thought and written a great deal about establishing evidence to support the efficacy and safety of treatments. It's quite difficult to do a good CCT study. I don't demand that you randomize-- that can be almost impossible, especially in private practice. I don't even demand that you have a better design. But I do demand transparency in reporting, including appropriate statistical handling. By the way, it's really unconscionable to leave the incorrect reference information on this page and elsewhere, making it impossible for many readers to examine the paper for themselves. If you believe that there is really clear-cut evidence to support DDP, put it out there where readers can get at it, and explain why you think the design and analysis are acceptable. Once again, the real issue is not who is King of the Attachment Therapists or Big Expert on Research Design. The question is about protection of children and families, especially highly vulnerable adoptive families. It is a blow against those people to claim that a treatment is effective without unimpeachable evidence.To convince them of what is not true is to persuade them to spend their scarce resources and get nothing in return. I don't know what your ethics code says about that, but mine disapproves. Jean Mercer 20:25, 11 July 2006 (UTC)

Someone with an IP address from the Buffalo, NY, area seems to so much lack a secure base that s/he can't tolerate any discussion. So s/he deletes things (like the paragraph before last) in an Orwellian attempt to rewrite history. So I've put back the paragraph and remind that s/he can't rewrite the Misplaced Pages history. For the sake of his/her rapidly declining reputation, s/he should try explaining or justifying his/her editing behavior. 206.81.65.234 21:50, 24 April 2006 (UTC) A friend (not an alter ego) of Jean Mercer and of the truth

Page is growing nicely

This page is growing well. The evidence base for this form of treatment is rapidly expanding. Forgot to sign in RalphLender 20:41, 5 July 2006 (UTC)

I've read some very interesting material about this treatment and find it very compelling RalphLender 20:41, 5 July 2006 (UTC)

I have done some editng that I think reflects reality a bit better than the previous version. However, I notice a great deal of disorganization and repetition in the article. Are the original study and the follow-up really as identical as is presented here? One does think of Sir Cyril Burtt. Jean Mercer 22:13, 11 July 2006 (UTC)

I added a citation and cleaned up some of the material to be more neutral and correct DPeterson 00:34, 12 July 2006 (UTC)

Perhaps, if for "neutral" one reads "positive." however, I see you left the apostrophes I inserted-- that's a step in the right direction. My questions from 11 july still need to be answered, and the article is not well organized. I would propose the following parts: definition; description of treatment; theoretical background; evidentiary basis. Every point currently in the article could be placed in one of these categories. In the description and the theoretical sections, the material needs to be more concisely descriptive; presently there are a lot of words, but the naive reader would not know much after wading through them. The descriptive section also needs to clarify the work done with parents-- the "Dr. Art" book on Becker-Weidman's web site does not suggest much about this except that parents are apparently advised to bottle-feed school-age children. In the section about theory, I would think a reference to Stern would be a propos. Also, because of Hughes' remarks in his 1997 (I think) book, it would seem that Foster Cline's contribution should be acknowledged-- Hughes has never given a clear statement about his current view on this and why it has altered, if it has. Although the concept of attachment is shared with Bowlby, much of the background lies elsewhere; Bowlby never suggested that early stages of attachment could be re-worked by imitating the normal events of those periods. This is an important point to deal with, because the APSAC task force report specifically rejected the use of age regression techniques (see the november issue of Child Maltreatment for a LTE proposing a definition of age regression.)To claim compliance with APSAC, proponents of DDP need to offer a rationale for their use of bottle-feeding and similar practices.Jean Mercer 12:52, 12 July 2006 (UTC)

As a reader of this, and other pages, it might be useful for you to read the book 'Creating Capacity For Attachment' edited by Dr. Becker-Weidman & Deborah Shell, Wood N Barnes, Oklahoma City:OK 2005 as that has an excellent description of the theory base for Dyadic Developmental Psychotherapy. I found nothing in that book that suggest the approach is coercive. I aldo found no references to Foster Cline. The book has an excellent chapter about work with parents too; this has nothing in it about "age regression," which, to my reading, is not a part of this treatment approach. The approach is consistent with APSAC and various other practice parameters. So, I think all your concerns have been addressed in that text. RalphLender 15:27, 12 July 2006 (UTC)

The reference to Foster Cline had to do with Hughes, whose work is said to be the foundation of DDP. I have no doubt that the B-W and Shell book does not index age regression or use this term, but there is some category of practices that APSAC termed "age regression" (and unfortunately, in the midst of their fine work, they neglected to define the term). I assume that no one is speaking seriously of hypnotic age regression, past-lives regression, or any of that stuff, so I see nothing else for age regression to mean except practices that treat the child in age-inappropriate ways such as bottle-feeding and prolonged gaze, with the intention of re-working emotional processes that are thought to have gone wrong long before. If I am wrong, perhaps you can tell me what APSAC meant by rejecting age regression, and what practices would be relevant here. Your explanation would need to include a rationale for Dr. Becker-Weidman's mentioning on his web site the practice of bottle-feeding a school-age child.12.75.151.203 16:12, 12 July 2006 (UTC) Sorry, i thought I'd signed in. Jean Mercer 21:52, 12 July 2006 (UTC)

Well, since the book does not referernce Foster Cline and does not include recommendations or treatment methods that meet 12.75.151.203's def. of age-regerssion, this is now a non-issue and not relevant to this discussion. So, this discussion can be closed at this time. RalphLender 17:07, 12 July 2006 (UTC)

Not quite so fast, perhaps. Examining the actual theoretical and historical background of an idea may take more time and work than the idea's proponents sometimes think. Often examination of earlier work from which a current author drew concepts will tell you a lot about a theme that's being elaborated. I'm suggesting that Hughes' past enthusiasm for holding therapy, in the Foster Cline pattern, is a foundation for DDP; this seems especially likely to be relevant because Becker-Weidman states that he received training in Evergreen. Of course, not too many people would want to cite Cline nowadays, so i don't expect this to be mentioned in the edited book. As for age regression, are you suggesting that the material on Dr. Becker-Weidman's web site is not congruent with his statements in his paper in that edited book? If that's the case, perhaps you'd better discuss the matter in this article. Treatment methods certainly evolve-- are you saying that's happened here? There is no question that the Dr. Art book refers to bottle-feeding, so perhaps there's more to be discussed about this treatment than has yet appeared. Jean Mercer 21:52, 12 July 2006 (UTC)

Incidentally, the report of the follow-up study has one quite remarkable characteristic, and other researchers would be most appreciative if Dr. Becker-Weidman would tell us how he managed this. It would appear that no participants from either the treatment or the comparison group were lost to follow-up after an interval of almost four years. Even in residential treatment this would be surprising.Jean Mercer 21:58, 12 July 2006 (UTC)

That is just silly. Must we discuss surgery pre-Anesthesia if discussing new developments in surgery? No, what you suggest is not relevant to articles here. The book speaks for itself. Dr. Becker-Weidman's credentials are extensive and impressive and his publications are compelling and well-respected in the professional community; at least as I read it. I am not going to answer every one of your questions as these are irrelvant and "red-herrings." In addition, you obviously did not read the two studies published by Dr. Becker-Weidman carefully as there is specific discussion of attrition. This now makes one wonder about the veracity of your other statements if you either did not read the material carefully ore are misrepresenting it. In any event you are incorrect. I'd say this line of discussion if completed...Next. DPeterson 22:25, 12 July 2006 (UTC)

This Wiki article, right here, says the two studies had the same numbers of people and appears to say that they were there both initially and at the later assessments. If this was not the case-- e.g. there were 100 initially in the treatment group, in the treatment goup, and this was reduced to 34 at the end of the treatment period with 34 still present a couple of years later-- this should be said, especially because there's so much detail being given. Why not just refer the reader to the published paper if a full discussion is not to be given? (Speaking of that-- got any page numbers for the CASWJ article? Without page numbers, you know, readers can't get it on interlibrary loan if that's what they need to do, and it is an obscure publication.)

As for the anesthesia analogy, no, of course, if you're talking about methods, there would be no reason to talk about history. But if you were talking about a theory of anesthesia and how it gave rise to current work in anesthesia, then you would need to talk about history. This article and other related pieces make a point of mentioning the theoretical background of DDP--- you needn't do this if you don't want to, but if you do it you need to discuss the historical development from one thing to another. Otherwise, you're just waving the name Bowlby around as a symbol of authority, not actually considering the development of ideas. In any case, it's an interesting question: how come Hughes was into holding ten years ago, now he's not? What is the explanation? Can Hughes or B-W explain this change of thinking? If they can, it's awfully important, because they are the people who might be able to turn around the group who still use coercive restraint. So the question about background is very meaningful at every level, including protections for children presently in treatment. Jean Mercer 23:45, 12 July 2006 (UTC)

Again, read the book and the articles so you have your 'facts' straight. An article about anesthesia would not include the material you describe...that would just be irrelevant. Dr. Hughes and Dr. Becker-Weidmaan do not need to describe changes in their practice. Do we ask the cancer surgeon to explain in excruiting detail, as you seem to want, why the surgeon no longer routinely does radical mastectomies when the surgeon did that routinely ten years ago? No, of course not!

The practice of Dyadic Developmental Psychotherapy appears to meet all professional standards, APA, NASW, APSAC, Amer Academy of Pediatrics, etc., etc., etc....

Again, raising "red-herrings," much as the ACT group and other fringe groups do is not productive here, so the discussion really ought to end...but if you insist on acting as a spokesperson for ACT, at least say so. A Neutral Point of View is much preferred....68.66.160.228 00:33, 13 July 2006 (UTC)

• • • When beliefs are diametrically opposed, the only neutrality involves two statements, each clarifying the stand of one group. Is that what you would like to do?12.75.168.251 17:55, 13 July 2006 (UTC)Jean Mercer (sorry , flubbed sign-in somehow)

I agree. The book and articles are clear. The approach is not coercive and does not use "age-regression" as part of the method. I see no point in continuing this "dialogue" and giving validity to views that are not relevant. The facts, as previously put, are quite clear. RalphLender 13:57, 13 July 2006 (UTC)

Saying the facts are clear doesn't make them so, and repeating a claim of effectiveness is just a quaint rhetorical device. This is an encyclopedia article and therefore should be accessible to the lay reader. If that person wanted to read all the original material, he or she would go and do so; whatever is stated in the article should provide the information in a concise but complete form that the average reader can deal with. That means 1)the whole article needs to be re-written for organization-- I suggested earlier a format that would work; 2)if details of research are mentioned at all (and they need not be), necessary information should be included, and unnecessary repetition should be omitted; 3)where any point is made, it needs to be a meaningful part of the whole communication, not just a signal commanding belief; this is why I say, either remove the allusion to theory completely, or if you think it's important do a proper job on it.

I wouldn't expect a description of anesthesia to refer to background unless the writer alluded to it to begin with-- then I'd want to know what the connection was. You (or somebody) have made the allusion to theory, so either complete it or remove it. And, as for explaining why a change has been made, I'd say that a professional who has advised others to follow practices that the practitioner later sees as inappropriate, has an obligation to correct the ill effects of their earlier advice. Anyone can make a mistake, but people with fiduciary responsibilities have a particular obligation to correct theirs in public. With respect to age regression, the Becker-Weidman web site does refer to relevant practices, but they aren't mentioned here in this article. Does that mean that there's more to DDP than is discussed here? Or does it mean that B-W's treatment is not DDP? The latter would be of interest, because the data reported here all came out of his office as far as I know. Well, guys, this has been real, but you can't be having fun all the time. I'm going out of town for a few days. See ya next week, no doubt.12.75.168.251 17:55, 13 July 2006 (UTC) Comments by unknown persons are suspect...It would be better to sign in. RalphLender 18:05, 13 July 2006 (UTC) It was me, Jean Mercer-- I thought I had signed in Jean Mercer 19:23, 13 July 2006 (UTC)

But the facts are clear...continuing to say they are not does not make that true. Your suggestions are not helpful in creating a useful article. The inclusion to theory is well written. I disagree with your assessment. The article is good as it is. While you may have a particular point to advocate for, based on memberhip, etc., this is probably not the place to do so. I see no references to "age-regression" on the site for the Center For Family Development, of which Dr. Becker-Weidman is a member. The book he co-edited and his articles "speak for themselves," on this subject and clearly preclude coercive interventions. RalphLender 21:05, 13 July 2006 (UTC)

I have to agree with RalphLender JonesRD 21:55, 13 July 2006 (UTC)

Yes, the article is very good: well written and with appropriate citations and support. I agree with the comments of RalphLender regarding Dr. Becker-Weidman. He is a licensed mental health professioal with many years experience and a number of publications to his credit. I disagree with mercer's comments and advocacy. DPeterson 02:34, 18 July 2006 (UTC)

Supporting References

I added a couple of references that show support for several of the principles of Dyadic Developmental Psychotherapy. If others have references or thoughts, let me know. DPeterson 02:39, 18 July 2006 (UTC)

I find it quite incredible that anyone thinks this article is well-written-- even those who are committed to the content. But, be that as it may, I repeat for the benefit of any newcomers that there is more than one point of view here. I am working on an additional section that will be a critical analysis of the existing material, including the Hughes work.I cannot believe that it would be congruent with Wiki principles for anyone to resist the inclusion of critical material of this type. I intend to include discussion of the age regression concept, by the way.Jean Mercer 14:15, 18 July 2006 (UTC)

I find the material on this page excellent. It is important that editors maintain a neutral point of view and not act as advocates or spokespersons for particular groups. Misplaced Pages articles should represent mainstream consensus views on topics and not be platforms for fringe groups or extreme points of view, which are not neutral points of view. RalphLender 16:11, 18 July 2006 (UTC)

Dyadic Developmental Psychotherapy Adherence to APSAC Task Force Report Recommendations

I ('MarkWood 20:32, 19 July 2006 (UTC)') thought it would be useful to put here material on how Dyadic Developmental Psychotherapy complies with the 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.

This important document presents several recommendations regarding the evaluation and treatment of children with disorders of attachment. While the report itself is based on old, and in some cases outdated and incorrect information, the recommendations are valid and should be followed by all clinicians who work with children.

The Report recommends the following regarding the diagnosis and assessment of attachment problems (pg. 86):

1. Assessment should include information about patterns of behavior over time, and assessors should be cognizant that current behaviors may simply reflect adjustment to new or stressful circumstances.

2. Cultural issues should always be considered when assessing the adjustment of any child, especially in cross-cultural or international placements or adoptions. Behavior appear­ing deviant in one cultural setting may be normative for children from different cultural settings, and children placed cross­ culturally may experience unique adaptive challenges.

3. Assessment should include samples of behav­ior across situations and contexts. It should not be limited to problems in relationships with parents or primary caretakers and instead should include information regarding the child's interactions with multiple caregivers, such as teachers, day care providers, and peers. Diagnosis of RAD or other attachment problems should not be made solely based on a power struggle between the parent and child.

4. Assessment of attachment problems should not rely on overly broad, nonspecific, or unproven checklists. Screening checklists are valuable only if they have acceptable measurement properties when applied to the target populations where they will be used.

5. Assessment for attachment problems requires considerable diagnostic knowledge and skill, to accurately recognize attachment problems and to rule out competing diagnoses. Consequently, attachment problems should be diagnosed only by a trained, licensed mental health professional with considerable expertise in child development and differential diagnosis.

6. Assessment should first consider more com­mon disorders, conditions, and explana­tions for behavior before considering rarer ones. Assessors and caseworkers should be vigilant about the allure of rare disorders in the child maltreatment field and should be alert to the possibility of misdiagnosis.

7. Assessment should include family and care­giver factors and should not focus solely on the child.

8. Care should be taken to rule out conditions such as autism spectrum disorders, pervasive developmental disorder, childhood schizophrenia, genetic syndromes, or other conditions before making a diagnosis of attachment disorder. If necessary, special­ized assessment by professionals familiar with these disorders or syndromes should be considered.

9. Diagnosis of attachment disorder should never be made simply based on a child's sta­tus as maltreated, as having experienced trauma, as growing up in an institution, as being a foster or adoptive child, or simply because the child has experienced pathogenic care. Assessment should respect the fact that resiliency is common, even in the face of great adversity.

The assessment and evaluation process recommended by Dyadic Developmental Psychotherapy, as described in the text, Creating Capacity for Attachment, edited by Becker-Weidman & Shell (2006)is a comprehensive evaluation of the child and family that considers strengths and weaknesses and that uses a variety of methodologies to gather information and evaluate the meaning of this data. Theassessment process is not limited exclusively to the assessment of attachment issues. Children who have chronic histories of maltreatment or institutional care may have a variety of issues that must be considered as part of a comprehensive assessment process. The evaluation inclues a screening for many issues including various mental health issues and diagnoses, sensory-integration issues, neuro-psychological issues, Fetal Alcohol Spectrum Disorder and the effects of prenatal exposure to alcohol and drugs, and various learning issues.

The assessment includes a comprehensive review of documents including adoption summaries, school records, health records, and previous evaluations and reports. Interviews the caregivers to get a full understanding of the child’s current functioning, history, and concerns are part of the process. As part of this interview there is an assessment of the caregiver’s capacity of provide an attuned and emotionally responsive environment.

The parent’s reflective function and family of origin are important dimensions to be considered. The interview with the child includes a mental health assessment and the administration of several projective tests. The child is observed with the caregivers, and finally a variety of tests and measures are used to gather information from the child, caregivers, and teachers. The instruments commonly used include the following: Child Behavior Checklist (caregiver, child, and teacher versions), Vineland Adaptive Behavior Scales, House-Tree-Person Projective Test, Child Apperception Test, Behavior Rating Inventory of Executive Function (parent and teacher versions), Biography of parents, Day in the life of the Child narrative, Parent Stress Index, and, when indicated, we use a variety of structured observational methods and procedures such as the Ainsworth Strange Situation Protocol. Other tests and observational methods are used as indicated.

A more complete description of this assessment process and methodologies can be found in Becker-Weidman (2005) “The Logistics of Providing Dyadic Developmental Psychotherapy,” In Creating Capacity for Attachment (Eds.) Arthur Becker-Weidman, Ph.D., & Deborah Shell, MA, Wood ‘N’ Barnes, OK: 2005, pp 43-56.

The Report recommends the following regarding treatment and interventions (pg. 86 - 87):

a. Treatment techniques or attachment parenting techniques involving physical coercion, psychologically or physically enforced holding, physical restraint, physical domination, provoked catharsis, ventilation of rage, age regression, humiliation, withholding or forcing food or water intake, prolonged social isolation, or assuming exaggerated levels of control and domination over a child are contraindicated because of risk of harm and absence of proven benefit and should not be used.

(1) This recommendation should not be interpreted as pertaining to common and widely accepted treatment or behavior management approaches used within reason, such as time-out, reward and punishment contingencies, occasional seclusion or physical restraint as necessary for physical safety, restriction of privileges, "grounding," offering physical comfort to a child, and so on.

b. Prognostications that certain children are destined to become psychopaths or predators should never be made based on early childhood behavior. These beliefs create an atmosphere condu­cive to overreaction and harsh or abusive treatment. Professionals should speak out against these and similar unfounded conceptualizations of children who are maltreated.

c. Intervention models that portray young children in negative ways, including describing certain groups of young children as pervasively manipulative, cunning, or deceitful, are not conducive to good treatment and may promote abusive practices. In general, child maltreatment professionals should be skeptical of treatments that describe children in pejorative terms or that advocate aggressive techniques for breaking down children's defenses.

d. Children's expressions of distress during therapy always should be taken seriously. Some valid psychological treatments may involve transitory and controlled emotional distress. However, deliberately seeking to provoke intense emotional distress or dismissing children's protests of distress is contraindicated and should not be done.

e. State-of-the-art, goal-directed, evidence-based approaches that fit the main presenting problem should be considered when selecting a first-line treatment. Where no evidence-based option exists or where evidence-based treatment options have been exhausted, alternative treatments with sound theory foundations and broad clinical acceptance are appropriate. Before attempting novel or highly unconventional treatments with untested benefits, the potential for psychological or physical harm should be carefully weighed.

f. First-line services for children described as having attachment problems should be founded on the core principles suggested by attachment theory, including caregiver and environmental stability, child safety, patience, sensitivity, consistency, and nurturance. Shorter term, goal-directed, focused, behavioral interventions targeted at increasing parent sensitivity should be considered as a first line treatment.

g. Treatment should involve parents and caregivers, including biological parents if reunification is an option. Fathers, and mothers, should be included if possible. Parents of children described as having attachment problems may benefit from on­going support and education. Parents should not be instructed to engage in psychologically or physically coercive techniques for therapeutic purposes, including those associated with any of the known child deaths.

The Informed Consent Document addresses each of these recommendations. Dyadic Developmental Psychotherapy is an evidence-based treatment (See: Becker-Weidman, “Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” April 2006 issue of Child and Adolescent Social Work. Becker-Weidman, “The Effective Treatment of Abused Children with Dyadic Developmental Psychotherapy,” in, Child Abuse and Its Impact, Frank Columbus, Ph.D. (Ed.) Nova Science Publishers, NY, 2006.). It is grounded in Attachment Theory and relies of the creation and maintenance of a safe and secure base from which the family can explore issues. Attunement, the reflective function, and developing and maintaining an emotionally sensitive and response environment are core features of the treatment and the parenting principals (See, for example, Miranda Ring, Ph.D., (2005), “For Parents,” in Creating Capacity For Attachment.).

Caregivers are always involved directly in treatment and are trained in attachment facilitating parenting methods that use an attuned sensitive and reflective approach. In no instances are coercive methods used. Dysregulation is never sought and on those rare instances in which a child becomes dysregulated, the therapist works actively and sensitively to re-regulate the child.

Other sections of the APSAC recommendations address the child welfare system and ethical standards. Dyadic Developmental Psychotherapy complies with those recommendations. Specifically, the report recommended the following for the child welfare system:

Recommendations for child welfare

a. Treatment provided to children in the child welfare and foster care systems should be based on a careful assessment conducted by a qualified mental health professional with expertise in differential diagnosis and child development. Child welfare systems should guard against accepting treatment prescriptions based on word-of-mouth recruitment among foster caregivers or other lay individuals.

b. Child welfare systems should not tolerate any par­enting behaviors that normally would be considered emotionally abusive, physically abusive, or neglectful simply because they are, or are alleged to be, part of attachment treatment. For example, withholding food, water, or toilet access as punishment; exerting exaggerated levels of control over a child; restraining children as a treatment; or intentionally provoking out-of-control emotional distress should be evaluated as suspected abuse and handled accordingly.

The report recommended the following ethical standards.

Professionals should embrace high ethical standards concerning advertising treatment services to professional audiences and especially to lay audiences.

Claims of exclusive benefit (i.e., that no other treatments will work) should never be made. Claims of relative benefit (e.g., that one treatment works better than others) should only be made if there is adequate controlled trail scientific research to support the claim. Use of patient testimonials in marketing treatment services constitutes a dual relationship. Because of the potential for exploitation, the Task Force believes that patient testimonials should not be used to market treatment services. Unproven checklists or screening tools should not be posted on Web sites or disseminated to lay audiences. Screening checklists known to have adequate measurement properties and presented with qualifications may be appropriate. Information disseminated to the lay public should be carefully qualified. Advertising should not make claims of likely benefits that cannot be supported by scientific evidence and should fully disclose all known or reasonably foreseeable risks. the evaluation and treatment procedures and methodologies that are a part of Dyadic Developmental psychotherapy are all consistent with these recommendations. MarkWood 20:29, 19 July 2006 (UTC) MarkWood 20:32, 19 July 2006 (UTC)

I'll just comment on the informed consent issue for now. Becker-Weidman's i.c. document, as shown on his web site, does not meet guidelines for informed consent as given in the Federal Register and would not have been approved by an IRB. Of course, this work falls through a crack because there was no IRB consultation-- and because that is the case, the fiduciary obligations of the researcher become exceptionally serious, and all the more so because participants in this study were minors. However, I hope that more light will be shed on this when a member of the WikiProject Medicine group joins us.Jean Mercer 17:31, 20 July 2006 (UTC)

Again, mercer is wrong and 'misrepresenting the facts; raising red-herrings' again. The informed consent document on the website for The Center For Family Development is an 'informed consent to treat' document. It is typical of what licensed mental health professionals use and that many insurance companies require. This has nothing to do with research and so is a red-herring. The two studies published by Dr. Becker-Weidman were in prestigious professional peer-reviewed publications which determined that all relevant regulations, standards, and ethical considerations had been adequately and appropriately met. RalphLender 19:58, 20 July 2006 (UTC)

Excellent comparison of the APSAC recommendations and their concordance with the methods and approach of Dyadic Developmental Psychotherapy. SamDavidson 15:53, 21 July 2006 (UTC)

Adherence to American Academy of Child & Adolescent Psychiatry Practice Parameter

I thought the following would be of value in understanding this model of treatment. SamDavidson 15:52, 21 July 2006 (UTC)

The practice of Dyadic Developmental Psychotherpay is consistent with and in accord with the 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.

The American Academy of Child and Adolescent Psychiatry’s practice parameter reviews the current state of assessment and treatment for Reactive Attachment disorder and provides specific recommendations.

Recommendation 1. “The assessment of reactive attachment disorder requires evidence directly obtained from serial observations of the child interacting with his or her primary caregivers and history (as available) of the child’s patterns of attachment behavior with these caregivers.”

In accordance with recommendations of Zeannah et. Al., 2000, typically, a full assessment takes place over a minimum of two or three sessions. Our assessment includes a review of a comprehensive history of the child’s early caregiving environment and information from a variety of sources. The assessment procedures recommended by Dyadic Developmental Psychotherapy (Becker-Weidman & Shell, 2005) include direct observations, clinical interviews, and a variety of psychometric instruments. The assessment of younger children involves direct observations in structured settings using formal methodologies, such as the Ainsworth Strange Situation Protocol (Ainsworth, et. al., 1978).

Recommendation 2. “A relatively structured observational paradigm should be conducted so that comparable behavioral observations can be established across relationships.”

Dyadic Developmental Psychotherapy relies on several structured and semi-structured observational methodologies to assess younger children. These include The Strange Situation Protocol (Ainsworth et. Al. 1978) and other methods. In addition, materials and observations from teachers and other caregivers are also used in the assessment process.

Recommendation 3. “After assessment, any suspicion of previously unreported or current maltreatment requires reporting to the appropriate law enforcement and protective service authorities.”

Dyadic Developmental Psychotherapy can only be provided by licensed mental health providers, who are mandated reporters.

Recommendation 4. “Referral for developmental, speech, and medical screening may be indicated.”

The assessment protocal suggested by Dyadic Developmental Psychotherapy includes screening for developmental issues, sensory-integration issues, neuro-psychological concerns, and a variety of mental health and related issues. When concerns in these areas are noted, referrals to the appropriate specialists are made and treatment is coordinated with those other providers.

Recommendation 5. “The most important intervention for young children diagnosed with reactive attachment disorder and who lack an attachment to a discriminated caregiver is for the clinician to advocate for providing the child with an emotionally available attachment figure.”

This may involve advocating for a child in residential or institutional care to be placed in an appropriate therapeutic foster home. The practice of Dyadic Developmental Psychotherapy advoctes working with the family to facilitate the development of such an emotionally available attachment figure by educating the parents in attachment-facilitating parenting methods and strategies. This is a vital component of treatment.

Recommendation 6. “Although the diagnosis of reactive attachment disorder is based on symptoms displayed by the child, assessing the caregiver’s attitudes toward and perceptions about the child is important for treatment.”

Reactive attachment disorder may be more accurately thought of as a disorder of the relationship. As such, interventions must address the child, parent, and relationship. We work extensively with the parents to provide specific parenting strategies and methods. Empowering the parents will often help parents who may be feeling disconnected, angry, or fearful to feel more competent; thus enabling them to act in a more healing manner. The model of parenting suggested by Dyadic Developmental Psychotherapy, creating a healing PLACE (Playful, Loving, Accepting, Curious, Empathic) and our model of treatment, maintaining a healing PACE (Playful, Accepting, Curious, Empathic), is designed to provide parents with the support and guidance necessary to facilitate a healing parent-child relationship. We build on the parents’ strengths.

Assessments may also include such formal methods as the Insightful Assessment or the Adult Attachment Interview.

Recommendation 7. “After ensuring that the child is in a safe and stable placement, effective attachment treatment must focus on creating positive interactions with caregivers.”

The model of creating a healing PLACE and maintaining a healing PACE re focused on creating a safe and secure base from which the child can begin to explore the world and develop appropriate and growth enhancing relationships. The parent training is focused on positive interactions. The approach does not use or condone the use of shaming or coercive parenting methods. The model provides training for the parents using modeling, coaching, and by providing reading material for their use. The recommendation goes on to state that, “Dyadic work, therapy with the child and primary caregiver together, is the second basic modality for working though address symptoms of RAD.” The approach, Dyadic Developmental Psychotherapy is consistent with this model (Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of Trauma-Attachment Disorders, edited by Arthur Becker-Weidman, Ph.D., & Deborah Shell, MA, LCMHC, Wood ‘N’ Barnes Publishing, 2005.)

Recommendation 8. “Children who meet the criteria for reactive attachment disorder and who display aggressive and oppositional behavior require adjunctive treatments.”

Specifically, the parenting approach enables parents to address these issues. Furthermore, the assessment screens for such co-morbid conditions as Bipolar I disorder that may be causing aggressive behaviors. A variety of adjunctive approaches may also be used, as indicated.

Recommendation 9. “Interventions designed to enhance attachment that involve non-contingent physical restraint or coercion…are not endorsed.

The sample Informed Consent document (Creating Capacity For Attachment, 2005) clearly states that intrusive, coercive, and other non-contingent interventions are not used or endorsed. Dyadic Developmental Psychotherapy is based on Attachment Theory and uses a model of treatment that relies on contingent collaborative communication, reflective abilities, reciprocal interactions, and contingent interactions. SamDavidson 15:51, 21 July 2006 (UTC)

This is very interesting and helpful. Thank you. MarkWood 16:20, 22 July 2006 (UTC)

Good Material

The two sections above are good material and certainly provide excellent background information. Thank you both for taking the time to research and post that material. JonesRD 16:57, 22 July 2006 (UTC)

I agree...excellent material that clearly makes the point and address several of the "accusations" in preceeding discussion. DPeterson 01:05, 22 August 2006 (UTC)

Lacks Sources

This article lacks references. It starts out giving references and then just stops. shotwell 08:14, 8 October 2006 (UTC)

Please do not remove the verify tag. I will place it in the specific places that need references so that my suggestion is more clear. shotwell 17:03, 8 October 2006 (UTC)

Verify tags put in as you did constitute Vandalism. You are being 'WARNED'for the third time to stop. There are abundent sources and references and much of the material is clearly a summary of material from professional peer-reviewed journals. I have added those in appropriate places. DPeterson 17:48, 8 October 2006 (UTC)

It was not vandalism, it was a request for citations. There are currently very few citations. There is no need for hostility or accusations of vandalism. shotwell 18:57, 8 October 2006 (UTC)

PLEASE. Let's Template:Assume Good Faith here and that Shotwell was only trying to improve this article with additional citations. I do agree that too many can be disruptive and can actually make an article too disjointed to read well. However, in this instance, what DPeterson has added should suffice. I would encourage DPeterson to just assume Good Faith as that makes editing and working with others go more smoothly. JonesRD_talk 22:24, 8 October 2006 (UTC)

Thank-you. Let me ask, does one paper constitute a source for the claim "Dyadic Developmental Psychotherapy has been shown to be an effective treatment for children with Reactive Attachment Disorder"? Academic Search Premier and LexisNexis Academic seem to only bring up one article with the phase "dyadic developmental psychotherapy". Pubmed journal search does not bring up any results at all. Can you please point me to some more peer-reviewed sources that back this up (other then Dr. Becker-Weidman's paper)? I don't think that wikipedia should claim any particular therapy is "effective" unless it is widely accepted by the psychological community.

Now, I'm not particularly wise in the ways of psych research, so perhaps I am searching the wrong places? If so, could you please point me in the right direction?

Also, the tag is an accepted way of requesting a reference. shotwell 22:31, 8 October 2006 (UTC)

I appologize if I've over reacted, JonesRD. There are two papers regarding the outcome of Dyadic Developmental Psychotherapy cited in the reference section and in the article. One or two sources are adequate and acceptable. The peer reviewed articles in professional publications meet the standard of "effectiveness." The papers state that and those statements were accepted by professional peer reviewers. Too many tags have been found to be abusive in various situations. DPeterson 23:25, 8 October 2006 (UTC)

Which two are you referring to? I'm looking for evidence that this statement (and others like it) is widely accepted by the psychological community. shotwell 23:36, 8 October 2006 (UTC)

"Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy" Child and Adolescent Social Work Journal. 13(2), April 2006. Becker-Weidman, A., & Shell, D., (Eds.) (2005) Creating Capacity For Attachment, Wood 'N' Barnes, OK. ISBN 1-885473-72-9 This ia a peer reviewed publisher. Sturt, SM (Ed) (2006) New Developments in Child Abuse Research Nova Science Publishers, NY. ISBN 1-59454-980-X pp. 43-61, "Dyadic Developmental Psychotherapy: A multi-year follow-up study," This is a peer reviewed publication. One peer-reviewed publication is sufficient to support the statement that something is accepted. There is no statement in the article that the statement is "widely accepted by the psychological community. No evidence is such support is necessary either. The article is well sourced and referenced and meets the stqandard of Template:Verifiable. DPeterson 00:59, 9 October 2006 (UTC)

Thanks, I'll check them all out. Could you possible provide references for all of the unsourced claims? It appears that you have the literature on hand. I don't know why this is so difficult. shotwell 02:21, 9 October 2006 (UTC)

Yes, I think the addition of those references improves the article. I think that the unsourced claims are all largely found in the references cited above, in the article, and in the refernce list. It is a bit distracting as a reader to have a source put next to each sentance. I think what is now there provides a good basis and provides verifiability. Just my opinion as a reader. JonesRD_talk 20:10, 9 October 2006 (UTC)

Yes, more references are better. As a reader I think there are sufficient sources to meet the Misplaced Pages standard as being verifiable and find the the material helpful now. MarkWood 17:49, 10 October 2006 (UTC)

This article makes extraordinary claims. Really, the only thing supporting the majority of these claims are a few shoddy research articles and a single book. If wikipedia is going to make any claim about a the effectiveness of a therapy then we need references which show it is a widely held belief in the psychological community. A handful of small, questionable, and non-influential papers (judging by the number of times these papers have been cited) does not fit the bill. Most of this article is just cruft to advertise this form of therapy. It needs to be trimmed down to eliminate this cruft.

Here is an example: "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...". This claim is referenced by Becker-Weidman's paper! He is a proponent of the therapy. In fact, the truth of the matter is that the APSAC paper says things like this: "Some proponents have claimed that research exists that supports their methods, or that their methods are evidence based, or are even the sole evidence-based approach in existence, yet these proponents provide no citations to credible scientific research sufficient to support these claims".

Argument by repetition is not going to work with me. Please address my concerns. shotwell 19:34, 10 October 2006 (UTC)

I really think the article reads well. It is very thoroughly documented with references and sources. While we may disagree on the "status" of the references, all the journal articles are in peer-reviewed prof. pubs and so are many of the texts. Having passed peer review, the material meets the Wiki standard of verifiability. RalphLender 13:53, 11 October 2006 (UTC)

Adequate Sources, References, and Citations in accord with verifiable

The articles cited and the book were from professional peer reviewed publications, which are not "shoddy." Several books are cited as are several articles by Dr. Daniel Hughes. The APSAC task force published it's report before the articles cited above were published and the Task Force did not make the quote you cite in reference to this particular form of treatment. So, with several professional peer-reviewed publications and several books from peer-reviewed publishers cited, this is a well sourced article that meets the verifiable standard of Misplaced Pages. Furthermore, there are a significant number of other references cited in the Reference section. On the whole, I find that this article is as well or more adequately referenced than a number of others. The vast majority of editors seem to agree. DPeterson 19:47, 10 October 2006 (UTC)

That quote from the APSAC task force is in direct reference to Becker-Weidman, Hughes, and others like them. While we're on the topic, the same report says that AT should be investigated as possible child abuse and it makes no mention of "Dyadic Developmental Psychotherapy" as meeting their guidelines.

The books by Hughes were published before the APSAC task force paper. As such, the claims in this article are being made on Becker-Weidman's authority alone. The fact that a single report was published in a peer-reviewed journal does not make it correct or even suggest that it is correct. The fact that there is exactly one peer-reviewed study on this therapy does not mean the therapy is sound, has a valid evidential basis, or is widely accepted in the psychological community. As for the other references, they are only supporting very small claims. The largest claims in this article are being supported by about two papers (from the same researcher) that appear to have had very little influence.

I have no problem with describing the therapy and saying that one study showed it may be effective. I have no problem with explaining how and why this treatment is grounded in the theories of about two other people. I do have a problem with just asserting that it is effective and that it follows certain guidelines. Let me balance this by saying that I'd be equally resistant and skeptical about broadly asserting this therapy is ineffective.

Let me ask, is this therapy taught in any accredited universities? shotwell 20:36, 10 October 2006 (UTC)

No, the quote was not "in direct reference to Becker-Weidman, Hughes and others like them." Your bias is showing clearly now. It is vital that you maintain a 'NPOV' and not distort facts.

The facts and statements in this article are supported by professional peer reviewed research and publications...take a minute to read the reference list. Two studies showed the effectiveness of the treatment and many many others support various components of the treatment. Resarch demonstrates that it is effective, that is a verifiable fact.

DPeterson 21:37, 10 October 2006 (UTC)

By "others like them", I mean "proponents of attachment-based therapies that do not make use of physically coercive methods". It was not intended as an insult or slur (even if it was rather curt). There is a large part of the APSAC paper dedicated to such therapies and the weak evidential basis.

That said, I don't have to maintain a npov; that would be nearly impossible. We are not required to be neutral about everything -- we're required to write neutral articles.

And rather than just assert that they are supported by "professional peer-reviewed publications", can you please address my specific concerns? Namely, I am concerned about the extraordinary claims being supported by two papers from a single researcher.

Let me ask again: is this therapy taught in any accredited universities? This would help me see how widely accepted it is. shotwell 21:58, 10 October 2006 (UTC)

Please make your 'specific suggestions below'. You really should just 'make a proposal rather than harping endlessly'. As I read all this I do not find the claims "extraordinary." The statements are appropriately sourced and clearly verifiable. Several articles from professional peer-reviewed publications and several texts are cited and referenced. Let's move along here. Make your proposal below as various others have requested and let interested editors comment on your suggestions and we'll see what develops. JonesRD_talk 22:15, 10 October 2006 (UTC)

My specific proposals? Remove or reword extraordinary claims if they cannot be better sourced. Extraordinary claims include any claims about the proven efficacy of this therapy, the evidential basis for the therapy, and whether or not this meets the APSAC's guidelines. I'd do this, but one of the accounts would revert it.

The claims are verifiable, not extraordinary. They are referenced and sourced with many citations...just make your specific suggestions below...you keep avoiding doing that, whay is that?DPeterson 23:07, 10 October 2006 (UTC)

I'm not really harping, I'm asking questions. Isn't the talk page for discussion about the article? shotwell 22:23, 10 October 2006 (UTC)

SPECIFIC PROPOSALS FOR ADDITIONS AND CHANGES

Here is the place to put your specific suggestions for what you want added, edited, or changed...it would be best to write out here what you propose so that others can comment and we can build consensus; which will make for a better article. DPeterson 23:07, 10 October 2006 (UTC)

How about this? I'll take a short break from this article while I research the topic some more. This way I'll be able to list specific proposals. shotwell 00:40, 11 October 2006 (UTC)

All you need to to is put a specific suggestion here...what you want to add, change, or edit. Pretty siimple. That allows all who wish to comment to do so and that is how consensus is built, which is a cornerstone of Misplaced Pages philosophy. DPeterson 01:13, 11 October 2006 (UTC)

I agree. I'd like to know more about this though so I'm still going to take a short break. I encourage you to add more references in the meantime and to reword much of the POV language. shotwell 01:51, 11 October 2006 (UTC)

As primarily a reader and somtime editor, I agree that I'd prefer to see specific suggestions spelled out...what, exactly, is proposed. That allows me to comment in a more helpful way. RalphLender 13:51, 11 October 2006 (UTC)

Here are some suggestions I can make at this point:

• Becker-Weidman's paper only studied DDP as a treatment for RAD and not AD. The claim "this is an evidence based treatment for AD and RAD" is not supported by credible research. I still dispute the use of a single paper to say that this treatment effectively treats RAD. Nonetheless, there are no peer-reviewed papers that support the use of DDP in treating AD. Hence, we cannot make the claim. I'm not interested in a semantic discussion of the term "Attachment Disorder" because there are many clinics that claim to treat AD and AD is often referred to as a supposedly clinical diagnosis.

• None of the peer-reviewed references support the claim that DDP fits the guidelines set forth in the task-force report and I cannot find any other credible reference that supports this claim. We can't say that the therapy satisfies those guidelines if there is no credible (per WP:RS) source to back it up. Although I don't think the claim is needed at all, it needs to be changed to something like "Practitioners of this therapy say.....".

• I think we need to remove or reword extraordinary claims about the evidential basis and efficacy of this therapy for the following reasons: This technique appears to be used exclusively or mainly at two particular clinics, it does not (seem to) appear in any major treatise, and DDP does not seem to appear in the literature except for Hughes' and Becker-Weidman's research. Furthermore, Becker-Weidman's second study appears to have used the same sample group from the first study. The sample group in the first study was chosen retrospectively and this is a well-known mechanism to inadvertently introduce researcher bias into a study. (I understand that this is a common research method, but I object to such methods being used as the sole reference in an encyclopedia article). WP:RS clearly states:

The fact that a statement is published in a refereed journal does not make it true. Even a well-designed experiment or study can produce flawed results or fall victim to deliberate fraud. (See the Retracted article on neurotoxicity of ecstasy and the Schön affair.)

Honesty and the policies of neutrality and No original research demand that we present the prevailing "scientific consensus". Polling a group of experts in the field wouldn't be practical for many editors but fortunately there is an easier way. The scientific consensus can be found in recent, authoritative review articles or textbooks and some forms of monographs.

There is sometimes no single prevailing view because the available evidence does not yet point to a single answer. Because Misplaced Pages not only aims to be accurate, but also useful, it tries to explain the theories and empirical justification for each school of thought, with reference to published sources. Editors must not, however, create arguments themselves in favor of, or against, any particular theory or position. See Misplaced Pages:No original research, which is policy. Although significant-minority views are welcome in Misplaced Pages, the views of tiny minorities need not be reported. (See Misplaced Pages:Neutral Point of View.)

Make readers aware of any uncertainty or controversy. A well-referenced article will point to specific journal articles or specific theories proposed by specific researchers.

I am led to conclude that we need to reword claims of efficacy and evidential basis to reflect that these opinions are not widely held by the psychological community.

• My final proposals are probably non-controversial. I think the article should be re-ordered as follows 1.)All descriptions of therapy 2.) Theoretical Basis 3.) Evidential Basis. This is a more logical order for an encyclopedia entry. Also, there is a diagram which summarizes DDP; it appears in several places (particularly in Becker-Weidman's paper). I'm not sure who holds the copyright to this diagram, but it'd be neat to include if we're allowed. This article is describing a fairly complex psycho-therapeutic method and any diagrams would be helpful to the reader. Finally, the in-line citations should follow a single method. If we're going to use footnotes, we should should use the ref tag (rather than cite like this (1)). If we're going to use the Harvard method, then footnote citations need to be changed.

I'm not going to make any of these changes because anything I do seems to result in an instant revert. If we can all promise not to instantly revert changes to this article, then I'll make them myself. I'm not interested in debating if the debate will simply involve "You're wrong".

I am in the midst of reading Hughes' work and will come back later to provide more feedback after I'm through. My primary concern (or question) is that Hughes appears to advocate the use of physically coercive methods, while The Center for Family Development states rather strongly that such methods are inherently flawed and not a part of DDP. Are there two DDP's? shotwell 14:50, 12 October 2006 (UTC)

COMMENTS

There are two peer reviewed studies by Dr. Becker-Weidman, one in the J of C&A SW and one in New Developments in Child Abuse Research. I think the second one may discuss AD and RAD...Hughes work discusses both. However, replacing A.D. with RAD would be fine, I suppose...where would you specifically suggest that occur?

If you have other specific proposals, put the 'wording' in a new section for comment and review. I don't find the claims "extraordinary," just credible and based in Template:Verifiable sources.

Your final proposal is interesting, so, put it into a spcific section below so editors can review it and comment on it and build agreement...by put it into a section, I mean write precisely what you want the article to read...the words, so editors can comment.

Hughes makes clear he does not use physically coercive methods...read the articles. In those articles it is also clear how the approach is congruent with various professional standards.

Right, make the changes/proposals here...write exactly what you want in the article here first...good idea. RalphLender 16:03, 12 October 2006 (UTC)

This article is excellent. I like the layout. It has a broad range of sources and references. Makes for good and credible reading. SamDavidson 20:34, 12 October 2006 (UTC)

Claims needing verification

Because nobody has addressed my specific concerns without simply refuting them, I am going to place a {{verify}} tag on top of this article. Placing {{fact}} tags everywhere makes the article look ridiculous (as we all seem to agree). To reinforce why I'm putting the tag here, I'll list a sample of claims that I believe need a reference, or that I believe need a better reference. I'm listing the claims one by one, rather than list entire paragraphs. I'm doing this to point out the contentious claims made in this article. By contentious, I mean claims that a non-trivial number of experts/therapists/psychologists may disagree with. (Note that I'm not asking that we footnote every one of these sentences. As we have seemed to previously agree, a ridiculous number of footnotes looks silly.)

• "Children who have experienced pervasive and extensive trauma, neglect, loss, and/or other dysregulating experiences can benefit from this treatment."

'Conclusion of article in professional peer reviewed journal cited in article and reference list.'

• "The treatment meets the standards of the American Professional Society on Child Abuse, The American Academy of Child Psychiatry, American Psychological Association, American Psychiatric Association, National Association of Social Workers, and various other groups' standards for the evaluation and treatment of children and adolescents."
• "This is a non-coercive treatment."

'Conclusion of article in professional peer reviewed journal cited in article and reference list.'

• "The principles and methodology of Dyadic Developmental Psychotherapy are based on long-standing treatment principles with very strong empirical evidence and a long history of proven efficacy."

'Conclusion of article in professional peer reviewed journal cited in article and reference list. Identified in articles and books on the subject.'

• "Dyadic Developmental Psychotherapy is an effective and evidence-based treatment..."
• "It relies on sound treatment principles based on empirical evidence..."
• "Dyadic Developmental Psychotherapy has been shown to be an effective treatment for children with Reactive Attachment Disorder."

'Conclusion of article in professional peer reviewed journal cited in article and reference list.'

• "This study supports several of O’Connor & Zeanah’s conclusions and recommendations concerning treatment."

'Conclusion of article in professional peer reviewed journal cited in article and reference list.'

• "This study suggests that Dyadic Developmental Psychotherapy is an effective intervention for children with trauma-attachment problems." (It may suggest that, but we claim the inference in an article without a secondary source)

'Conclusion of article in professional peer reviewed journal cited in article and reference list.'

• "All children were between the ages of five and sixteen when the study began." (This isn't true, the study was done retrospectively)

'Conclusion of article in professional peer reviewed journal cited in article and reference list.' The two studies were based on all cases seen at the clinic during one twelve month period.

• "The role of the parent in his/her child's psychotherapy is the following..." (All psychotherapy, or just DDP)
• "Frequently a person's symptoms are his/her unsuccessful ways of regulating frightening or shame-based memories, emotions, and current experiences. Angrily telling a person to stop engaging in these symptoms may actually increase their underlying causes...."
• "When we help to carry and contain the pain with him/her, and when we co-regulate it with him/her, we are providing him/her with the safety needed to explore, resolve, and integrate the experience. We do not facilitate safety when we support a client's avoidance of the pain, but rather when we remain emotionally present when he is addressing the pain."

'Conclusion of article in professional peer reviewed journal cited in article and reference list.' 'Also see texts by Dr. Hughes and books in list.'

• "Dyadic Developmental Psychotherapy meets the standards and is incompliance 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 (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.) In addition, the practice of Dyadic Developmental Psychotherapy is consistent with the practice standards of the American Psychological Association and the National Association of Social Workers." (the one reference in this statement does not support the claim) 'Conclusion of article in professional peer reviewed journal cited in article and reference list.'

This list is not exhaustive and I'll have more to add once these claims are removed, reworded, or better sourced. Each one of the above claims has to do with the efficiay of DDP, its acceptance by the psychological community, and so on. Claims such as these need to be very well sourced and they need to be indicative of widely held beliefs in the psychological community. We are writing an encyclopedia here and it is not the place to make a case for or against this therapy. I have a strong appreciation of minority views, so I'm not trying to eradicate those views from the article (nor do I want them eradicated). For example, rather than remove broad claims like "this treatment is effective and evidence based...", I would like to see "Two studies have asserted this therapy is effective" (or something along those lines).

I kindly ask that nobody remove the {{verify}} tag until these issues are settled. When providing references, please recall WP:RS, WP:V, WP:OR, and WP:CITE shotwell 20:25, 14 October 2006 (UTC)

The two articles by Dr. Becker-Weidman, the book he co-edited, and the articles by Dr. Hughes all are verifiable sources for those comments. Would it work to put the appropriate citation at the end of each relevant paragraph? DPeterson 01:01, 15 October 2006 (UTC) If you want citations at the end of each section, that is fine....but it may get a little redundant. I will add those now and later remove the tag.DPeterson 01:22, 15 October 2006 (UTC)

I do not believe that Hughes' work can be used to source claims about the evidential basis or efficacy of this therapy. His work was around before the APSAC task-force report and that report said that there was no evidential basis for such therapies. Moreover, any assertion about the efficacy of a particular therapy should be referenced by a statement from an organization such as the APA. I really don't agree with flatly stating the therapy is effective because Misplaced Pages articles shouldn't endorse specific treatment methods. However, in the interest of reaching a compromose I'm happy with the claims if someone can dig up references that indicate this treatment is endorsed by a major organization (e.g. APA) or major work (something like what I'm told Bergin and Garfield's Handbook of Psychotherapy and Behavior Change is). If no such references can be found, then we need to change those assertions to reflect the fact that a very limited number of professionals believe this therapy is effective.

As for Dr. Becker-Weidman's two research papers on this topic, I have no problem with using them so long as they are backing up properly phrased claims. The issue can be easily dealt with by changing a proposition like "This therapy is effective" to "Two studies concluded that this therapy is effective. In those studies....".

Thus, I appreciate that we are working together here but I do not think the {{verify}} tag is ready to come off. shotwell 07:48, 15 October 2006 (UTC)

Dr. Hughes work does provide a verifiable source for some, but not all, of the items you want sources for. Clarims regarding efficacy do not require APA approval. Misplaced Pages only requires sources and references be verifiable. There is evidence in this case, since three peer reviewed publications state that the treatment is effective. This is sufficient. Now, if you can produce evidence of an empirical study demonstrating that the treatment was not effective, than that should be cited.

Your proposed language is 'acceptable'to me...it is factual and specific and represents a NPOV. May I suggest that we let other editors comment on that and if there is largely a consensus, we follow that? I will put your proposal in a new section for comment below.

DPeterson 13:15, 15 October 2006 (UTC)

Proposal on change in language

How do other's feel about changing the words "'This therapy is effective'" to '"Two studies concluded that this therapy is effective. In those studies..."' This proposal was made by Shotwell, see above section. DPeterson 13:15, 15 October 2006 (UTC)

1. I agree with this suggestion.DPeterson 13:15, 15 October 2006 (UTC)
2. Seems reasonable to me. SamDavidson 17:20, 15 October 2006 (UTC)
3. I think my opinion is clear, but I just wanted to say that I am very happy about our ability to come together on this point. shotwell 17:33, 15 October 2006 (UTC)
4. I think the proposal is a good one and went ahead and made what I think everyone wanted...if I've goofed, please let me know and edit to what was intended. JohnsonRon 00:51, 17 October 2006 (UTC)

I've removed the tag to the page because of the change made by JohnsonRon. DPeterson 03:01, 18 October 2006 (UTC)

I appreciate that we're working together, but my other points have not been addressed. Please address the points listed above before removing the verify tag again. shotwell 14:57, 20 October 2006 (UTC)

What other points? My reading of both sections and the article leads me to the conclusion that all points have been addressed by the inclusion of the citations in the reference section and at the end of various paragraphs. RalphLender 15:45, 20 October 2006 (UTC)

Poll on "verify" Tag

Do other editors think the tag should remain or be deleted at this point? PLEASE BE SURE TO SIGN YOUR COMMENTS.

'RETAIN TAG'

1. _

'REMOVE TAG'

1. I 'support' removing the tag at this point since all the important and relevant areas have been sourced and provided with verifiable references. It is not appropriate to have a citation for every sentance. The articles and books cited are the sources of the verifiable data here. RalphLender 15:50, 20 October 2006 (UTC)
2. 'YES'. All the major points have been addressed. JonesRD_talk 21:01, 20 October 2006 (UTC)
3. 'Agree' DPeterson 01:40, 22 October 2006 (UTC)
4. Yes, get rid of it. The article is sourced properly and meets the Misplaced Pages standard for verifiability.

I'm sorry, a straw poll cannot justify the removal of the tag. Misplaced Pages is not a democracy. We should discuss, not vote. Please clearly address the concerns I listed above. shotwell 16:02, 20 October 2006 (UTC)

Polls are an accepted dispute resolution procedure. All the concerns have been addressed. If you feel they have not, then please create a new section listing those you feel are still pending. As I read the sections, everything is addressed by the citations provided and also by the references to the professional peer reviewed journals articles and books cited. RalphLender 17:39, 20 October 2006 (UTC)

RfC

I've made a request for comments about this article to gather some outside opinions. shotwell 19:17, 21 October 2006 (UTC)

Comments copied from WP:RFC\SCI:

Can broad claims of therapeutic efficacy and evidential basis be supported by the conclusions of a single peer-reviewed paper? Can we say this therapy satisfies criteria set by the APSAC and APA if only a single proponent of this therapy has made the assertion? 19:15, 21 October 2006 (UTC) (Original unsigned RfC summary)

There are several prublications in peer-reviewed publications and books as well. Several "proponents" have made that statement, and the articles and books referenced provide the support for the statements. RalphLender 20:01, 21 October 2006 (UTC) (Response later removed from RfC page)

I took the liberty of placing them here to help start discussion. Hope this is acceptable to all. --Ginkgo100 20:45, 21 October 2006 (UTC)

1. I think that the several peer-reviewed journal articles and books make tha point that there is efficacy and an evidential basis for this treatment. Could there be more? Yes. But the fact is that there are two outcome studies in professional peer-reviewed publications. My reading of the articles and books shows that the approach is compliant with APSAC and APA criteria. DPeterson 21:27, 21 October 2006 (UTC)

One peer-reviewed study has asserted the efficacy of this therapy since the APSAC task-force report declared a lack of evidential basis for such treatments. They were aware of Hughes'/Becker-Weidman's work and made their conclusions anyhow. The APSAC task-force report is a highly credible source.

You are referring to Dr. Becker-Weidman's two papers, only one of which was published in a peer-reviewed journal. Each paper used questionable research methods and also centered on the same research group. The fact that the claims were published are not indicative of whether or not they are true. Their publication does not even imply that a wide spectrum of experts would agree they are true. This single paper does not appear to be cited in any of the literature. Moreover, references to DDP in the academic literature are completely lacking aside from this single paper.

The many other references being used in this article are either 1.)Being used to support claims that the authors did not intend to make, or 2.)Works that are self-published or published outside of the traditional academic publishing process.

In regards to the APSAC task-force guidelines, nobody notable has asserted that this therapy follows the guidelines set forth in the APSAC task-force report aside from Dr. Becker-Weidman and he is a leading proponent of this therapy. Moreover, the assertions appear to have been made solely in self-published or non-academic sources. This point is particularly important because proponents of this therapy seem to incorrectly use the APSAC task-force report as some sort of endorsement.

I could publish a paper refuting the evidential basis of this therapy and then post a very good essay on the Internet where I say that the therapy does not follow the APSAC guidelines using Hughes' work to cite my claims. Would it be acceptable for us to copy my assertions verbatim as encyclopedic facts? We can both agree that the answer would be a strong no. Similarly, Becker-Weidman's and Hughes' claims should not be taken as encyclopedic facts.

Let's make note of minority opinions without pushing them or discrediting them. Let's also refrain from turning wikipedia into an advertisment for treatments used by the Center for Family Development; this was, after all, the original purpose of this essay before it found its way into wikipedia. shotwell 22:04, 21 October 2006 (UTC)

'Please report the correct facts:'

1. Three peer-reviewed publications.
2. The authors of the report acknowledge in a recent article that they wrote the report before the peer-reveiwed publications were published and even state, "In fact, the term dyadic developmental psychotherapy is not mentioed anywhere in the body of the Taks Force report. Dr. Becker-Weidman ius cited three times in the body of the report, noe of which refer to coercive techniques...Regarding the issue of empirical support, it is encourgain to see that outcome research on DDP was recently published in a peer-reviewed journal...We congratulate Dr. Becker-Weidman on this work and hope he will continue to expand these efforts..." and there is substantially more. (Child Maltreatment, 11,4, Nov 2006).
3. See article for many other professional peer reviewed publications.

DPeterson 00:02, 22 October 2006 (UTC)

Wow, thank-you very much for bringing that to my attention. You are correct that DDP is not mentioned in the APSAC task-force report. Let me clarify that I was not attempting to label DDP as coercive, I was simply questioning its evidential basis. You are taking that quote from the recent reply to letters in Child Maltreatment, which can be found at: http://cmx.sagepub.com/cgi/reprint/11/4/381. They also go on to say:

In our estimation, DDP still does not meet criteria as an evidence-based treatment, although the published findings do raise hopes that DDP may be promising. Following that statement they say exactly what I said about the single study performed. They also say: Although we did not discuss DDP in the report, it is worth considering, whether DDP is a concerning, coercive, abusive attachment therapy or a promising, nonconcerning, and noncoercive treatment. We hope it is the latter; however, it can be difficult to judge.

This strongly supports what I've been saying all along. I'll carefully read the rest of this and then edit as I see fit. This is a very valuable resource and I appreciate that you've brought it to my attention. shotwell 00:16, 22 October 2006 (UTC)

I forgot to include this quote:

"Dr. Becker-Weidman (2006b) believed the report misrepresented DDP and his center as an example of dangerous or coercive techniques. We have been unable to locate this representation in the Task Force report. In fact, the term dyadic developmental psychotherapy is not mentioned anywhere in the body of the Task Force report. Dr. Becker-Weidman is cited three times in the body of the report, none of which refer to coercive techniques. The first citation references his Web site’s assertion that traditional therapies are either ineffective or harmful (p. 78). The second citation references his recommendation that children be encouraged to regress to an earlier age as part of treatment (p. 79). The third citation references his assertions, which we believe are unsupported, about practicing an evidence-based treatment (p. 85)."

My "facts" were quite right. shotwell 00:28, 22 October 2006 (UTC)

The report does not mention the other materials in peer-reviewed publications...again, because of the vagaries of publications dates and such. There are at least three peer-reviewed publications by Dr. Becker-Weidman and many others by other authors, such as Dr. Huges. Therefore, the statemets in the article are well sourced and referenced. You may quibble over whether there must be one, or two, or three, etc sources...but according to Wikipeida verifiable standard, the statements are, in fact, verifiable. DPeterson 01:17, 22 October 2006 (UTC)

As previously noted, the report states: 'The authors of the report acknowledge in a recent article that they wrote the report before the peer-reveiwed publications were published and even state, "In fact, the term dyadic developmental psychotherapy is not mentioed anywhere in the body of the Taks Force report. Dr. Becker-Weidman ius cited three times in the body of the report, noe of which refer to coercive techniques...Regarding the issue of empirical support, it is encourgain to see that outcome research on DDP was recently published in a peer-reviewed journal...We congratulate Dr. Becker-Weidman on this work and hope he will continue to expand these efforts..." and there is substantially more. (Child Maltreatment, 11,4, Nov 2006). '

While you may disagree, this does, in itself, represent a verifiable fact. JonesRD_talk 19:16, 22 October 2006 (UTC)

Avoid making Unilateral Changes that do on represent consensus

It would be best if user:shotwell did not edit this article until there is agreement on the edits. Building agreement is not facilitated by making unilateral changes that can only further discord and disagreement. DPeterson 01:25, 22 October 2006 (UTC)

There is so much wrong with this article that I couldn't possibly list everything here to be debated ad nauseum. Furthermore, the {{verify}} tag is highly justified given the above discussion. Please refrain from removing it. shotwell 01:31, 22 October 2006 (UTC)

All other editors seem to disgaree with you. The article is very fully sourced with verifiable facts. While you may not like this, the references and citations meet Misplaced Pages standards. So far the consensus is to remove the tag. DPeterson 01:40, 22 October 2006 (UTC)

No, about six highly tendentious editors disagree with me. The article at http://cmx.sagepub.com/cgi/reprint/11/4/381 supports the notion that DDP is not widely regarded as having a solid evidential basis, being an effective treatment for RAD, or compliant with APSAC task-force guidelines. Many of the assertions here are highly dubious and need to be removed. I figured that the Child Maltreatment article you brought to my attention was proof enough of this fact and I edited accordingly; I guess I was wrong.

Because the assertions made here are challenged by a highly credible source and referenced by a much less credible source, I am going to insist that the tag stay in place. There is nothing wrong with noting the minority scientific opinions on these matters, but we should not assert them as if they were encyclopedic facts.

If you disagree with me, I would like for you to very carefully read what I have written, read http://cmx.sagepub.com/cgi/reprint/11/4/381, and then provide a rational counter-argument. shotwell 02:48, 22 October 2006 (UTC)

There are several peer-reviewed professional publications supporting the statements in the article. I know that you and User:Sarner don't accept this, but the fact remains that theese are verifiable facts and so meet Misplaced Pages standards. The article you cite does not state anywhere that "DDP is not widely regarded as having a solid evidential basis...." Your language and sentance structure is the same as that of User:Sarner. The factual statements in the article are not "challenged by a highly crredible source." As User:Sarner does, you may "insist" that you are right...but the fact remains that you are alone in your opinion.

There is nothing wrong with you stating a minority view here, if you wish.

If you disagree with me, please state specific chapter and verse from the article to the contrary. The article states clearly that they were not disparaging Dyadic Developmental Psycotherapy. You are misreading the article and not providing verifiable and quotes to support your statements.

We can see how the poll plays out and then decide if the tag stays or is removed. Remeber, you don't own this article nor can you hold hostage the article to your position if a different consensus emerges. DPeterson 03:13, 22 October 2006 (UTC)

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