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Foster Carers' TSD Standards covered:

Author Details

Kim Golding

Name: Kim Golding

Job Title: Clinical Psychologist

Specialist Therapy: DDP

Current place of work: Worcestershire

Can you explain, in brief, what DDP is and what sessions entail?

Dyadic Developmental Psychotherapy (DDP) was originally developed by Dan Hughes (1) as a therapeutic intervention for families who are fostering or have adopted children with significant developmental trauma. This means children who have experienced trauma from early in life and from within their birth family; as a result they struggle to feel safe with parents and thus demonstrate attachment difficulties.

DDP is a therapy but it is also a broader approach for parenting and caring for children. Dyadic Developmental Practice provides a particular framework for helping children who are recovering from trauma through the parenting and support they receive. This support is supplemented by the therapy when appropriate.

Dyadic Developmental Practice provides a framework for supporting children to recover from trauma through the parenting and support they receive; supplemented by the therapy when appropriate.

Thus DDP helps family members to develop healthy patterns of relating and communicating which help them all to feel safe and connected. Of central importance is supporting parents with what can be, at times, very challenging behaviour. This is achieved by helping parents with day-to-day parenting based on principles of PACE (playfulness, acceptance, curiosity and empathy), as well as through therapeutic sessions.

Parenting with PACE helps the parent to remain emotionally engaged and available to the child (2). The parent becomes attuned to the child through a stance of acceptance and curiosity, empathy and/or playfulness. This combined with unconditional love for the child means that the parent is meeting the emotional needs of the child to be loved, nurtured, protected and understood.

Therapeutic sessions can complement this parenting support; initially the therapist will meet with the parents alone. These sessions help the therapist and parents to get to know each other. The therapist helps the parents to get a better understanding of the impact on themselves from parenting the child; this includes some exploration of the parents’ own attachment history. This is an important part of the therapy as this understanding can help the parent to remain empathic with the child even when this is challenging. These sessions also give the therapist an opportunity to help the parents understand the therapeutic process and what their role will be in the sessions when the child joins them.

When the therapist judges the parents are ready the child will join the sessions.

Typically the therapist talks to the parents before the session, this may be by phone during the week or at the beginning of the sessions. This allows the parents to update the therapist. It avoids the need for the parents to talk about events that have occurred in front of the child in a way which might be shaming for the child. The therapist will also offer regular parent sessions at agreed intervals when progress can be discussed. This provides an opportunity to discuss the work, and any concerns the parents have, without the child present.

With the child present the therapist will seek to understand the child in the moment and to communicate that understanding back to him or her. As the child experiences his inner world being understood the therapist helps him or her to remain emotionally regulated (co-regulation) whilst exploring and finding meaning in experience past or present (co-construction of meaning). The therapist additionally helps the child to communicate with the parents so that emotional co-regulation and co-construction of meaning become a shared process between parents, child and therapist. In this way the child is helped to feel more secure with parents so that he or she can reduce the need to control the relationship and instead can seek comfort in a straightforward way. Family members can enjoy reciprocal relationships in which each are open to the experience of the other.

The safety and connection that results leads to a reduction in the level of fear, shame or coercion that family member’s experience. Through engaging in this therapeutic approach family members learn to be open to each other’s inner life, as well as the outward behaviour. This builds safety and develops reciprocal relationships.

Building on this relationship experience the child is enabled to respond to current experience and memories of past experience flexibly instead of through habitual rigid, chaotic and repetitive responses.

What kind of changes do you aim to achieve with DDP for adopted and fostered children?

DDP aims to increase the safety and security of attachment the child has with his or her parents. This leads to an improved ability to enter into relationships rather than to remain controlling of relationships. This relationship experience provides a foundation from which the child can develop emotional regulation abilities and can gain an increased understanding of his or her own subjective experience. This in turn provides healing from past trauma and the child becomes more emotionally healthy.

How does DDP work for adopted and fostered children?

Children who are adopted or fostered have often had experiences with parents that compromise their sense of safety in families. They develop ways of relating, often centred upon attempts to control relationships as a defence, a way of experiencing safety without relying on parents. These patterns of relating are brought with them into their new homes. Relationships based upon control become central to the way the children live within the families. This means that children cannot enter the more healthy reciprocal relationships within which children remain open to the influence of the parents. Relationships based on reciprocity are central to DDP. The therapist builds a relationship with the child and parents which helps increase feelings of safety and provides healing from earlier trauma.

Who does DDP? / What kind of training do DDP therapists have?

DDP therapists are already trained as therapists and have then received additional training and supervision to develop skill in providing DDP as a therapy.

DDP non-therapists have a general training, for example in social work; parent mentoring or a related profession. They then receive additional training and supervision to develop skill in applying the principles of DDP to this work.

Why are you passionate about DDP for fostered and adopted children?

When children can’t be cared for by the families they were born into they are subject to the most drastic interventions that society can provide; removal from their family of origin. These children deserve the very best help and support we can offer. Parents who take on the challenge of parenting children who have been traumatized by their early experience, and the subsequent loss and separation, open up their hearts and their homes sometimes with devastating consequences. They too deserve the best support possible. I believe that DDP provides a framework for providing this help. DDP can help parents have deeper, reciprocal relationships with their children which are deeply rewarding for both of them. Relationships which provide security for the child, and also an experience of deep connection with another are the foundation of healthy emotional development. I passionately believe that if we don’t look after the emotional health of our children then our society will be weakened as a consequence.

PAFCA's DDP Top 5 Tips

Develop a mind-minded approach to parenting. This means connecting with the emotional experience of the child (understanding and accepting the thoughts, feelings, beliefs, fears, wishes and desires of the child) as well as managing the behaviour which is an expression of this experience. This can be expressed as ‘connection before correction’. Whilst parents might need to give a consequence for behaviour (discipline, correction) this is likely to be more successful when the child feels understood and accepted by the parent (connection). Connection relies on PACE providing a strong relationship within which children can manage and learn from parental boundaries and discipline.

DDP informed parenting therefore relies on being able to understand the child’s inner experience. This is accepted as neither right nor wrong; it is the child’s experience. Once understood this knowledge can help the parent to find empathic ways to manage the child’s behaviour. This can be expressed as ‘No correction without understanding’. If the parent responds without understanding the child will feel less secure, and will not build trust in the parent. This is not finding an excuse for the behaviour, but is about seeking an explanation. The explanation helps the parent to get the consequences right.

Start with the child’s experience; Successful behaviour change comes from being understood within the relationship so that boundaries are experienced with warmth and empathy. Following this children might be able to join in with some problem solving; considering how they might have managed something differently. This requires them to think about the experience of others; but they are less likely to engage with this until they really experience parents as understanding their own experience.

Don’t punish with the relationship; Children who are insecure are quick to assume that they are no good and that they are not loved. If the parent withdraws the relationship as a consequence or in anger then the child might see this form of discipline as confirming these beliefs. This increases insecurity further and moves the child even further away from developing a trusting relationship with the parent. Judgemental disciplinary methods are therefore ineffective (eg discipline that communicates that I am disappointed with you, or my relationship with you is conditional on your behaviour).

Adult takes responsibility for relationship repair. Parents are only human and it is inevitable that they will get cross or frustrated at times. They will not always provide the best response to the child; and of course they do need to provide discipline and boundaries for the child. All of these things can lead to a rupture in the relationship between the child and parent. It is important that these times are followed by relationship repair led by the adult. This helps the child to learn that things can go wrong but the relationship is still strong. This is the foundation of unconditional love and acceptance.

Reading List

  1. Attachment focused family therapy
  2. Creating Loving Attachments

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