Growing evidence suggests that Dyadic Developmental Psychotherapy, an attachment-focused family therapy, is effective in helping children to recover from developmental trauma. Edwina Grant, Certified DDP Trainer, explains how.

Ellie’s foster carer, Julie, described Ellie - 10 years old - with concern in her voice: as the ‘perfect child’ never putting a foot out of place, seemingly always being quietly watchful of the right things to do and to say, never asking for anything she needed or wanted. In contrast to Ellie’s wariness, her younger brother, Robert - 7 years old – also living with Julie and her husband David, was loudly and clearly demonstrating the impact of having been emotionally and physically neglected, and physically and sexually abused by their birth mother and her partners. For both Ellie and Robert, the very adults who should have provided them with love and safety and comfort, had instead traumatised them. Before going any further, I urge you to read Ellie’s story ‘Haunted’  written when she was 16-years-old. It’s challenging reading.  

Julie and David as experienced foster carers, had never seen anything quite like the extremity of behaviours that dominated their house on a daily basis, and few of their usual parenting behaviours appeared to have any impact on either Ellie or Robert.

ACEs and the mistrusting brain

The impact of Adverse Childhood Experiences (or ACEs) as experienced by children such as Ellie and Robert can lead to the ‘mistrusting brain’, a term coined by Dan Hughes and Jon Baylin, two US-based world clinical psychologists who are leading the neuroscience underpinnings of Dyadic Developmental Psychotherapy (DDP).

The term relates to the fact that the brains of children who have been traumatised in their early years are neurologically wired to survive in, and adapt to, what is perceived as a dangerous world where adult care and adult authority are not to be trusted but resisted. 

There are many behaviours associated with mistrusting brains: violence and picking fights; oppositional defiance – saying ‘no’ to everything; refusing comfort; being sneaky, manipulative, bossy or controlling; being charming to strangers; ‘sweat free’ lying; hiding your inner life from others and from yourself to avoid being hurt; asking for help and then rejecting it forcibly; competing with siblings and peers to make sure you get your needs met in a world of scarce resources. Issues with eating, sleeping, growth, urinating and defecating; and reacting to touch and noise are also common. These behaviours are very challenging to live with. Parenting can feel joyless, meaningless, a chore; parenting figures - foster carers, adoptive parents, kinship carers, residential workers - can move into a neurological position that Baylin and Hughes call ‘blocked care’.  

DDP and blocked care

Dyadic Developmental Psychotherapy, or DDP, was originated by clinical psychologist Dan Hughes as a psychotherapy for families with adopted or fostered children who have experienced neglect and abuse within their birth families, suffering significant developmental trauma.

It’s an attachment-focused family therapy and practice model which involves the child with their caregivers and helps to build up the bonds of secure attachment within family relationships.

The DDP practice model prioritises supporting the parenting figures. As Baylin and Hughes write:‘

'Early one morning, we had a shared epiphany - we finally realized what we’d “known” for a long time: parents’ brains work the same way that their children’s brains work! Just as a child has to feel safe to approach a caregiver, a parent has to feel safe to approach and trust a therapist.

'Parenting is rooted in openness and safety, not in survival-mode self-defence. So, we wondered, what does it really takes to be a sensitive, attuned caregiver and to sustain a parental state of mind through the thick and thin of childrearing? Why can some parents provide the warmth, openness, and empathy that helps kids thrive, while others, despite having the best intentions, start to shut down and get defensive when their kids roll their eyes or sass them. What is parental openness, anyway, and how does a parent develop and sustain it? As we talked, the concept of parental blocked care came into focus as a shorthand way of describing the suppression of parents’ potential to nurture a child, especially if the child is slow to reciprocate warmth and love.

'… we needed to learn what actually goes on in the parenting brain. Then, we needed to understand how stress affects the parenting brain and sometimes leads to blocked care. With a brain-based model of parenting and blocked care, we hoped to get better at helping stressed-out parents get unstuck and tap their potential for caregiving.’

Putting DDP theory into practice

The family were referred to me by the children’s social worker.  When I met with Julie and David it was clear to me that they were working hard to love and provide boundaries for Ellie and Robert; to start to heal the children’s terrified brains. They were beginning to despair, to move into ‘blocked care’, and their marriage was - as is not uncommon when trying to love challenging children - beginning to show the strain. As a DDP practitioner my first job is to build a relationship of trust and safety with the carers, to find out what personal and professional support network they have, and to ensure that the team around the children – social work, education and health – have a shared understanding of the impact of developmental trauma and of the process of DDP.  Working together is vital.

In my work I carry four core DDP principles about parenting figures in my heart and mind: they are good people; they are doing the best they can; they want to love the children; they will need support.

I know that in parenting children with adverse childhood experiences, the parents’ own attachment and relationship histories will emerge. Parenting traumatised children demands an emotional and psychological ‘stretch’ that may well not have been needed for their own birth children. 

I want parents to feel safe to vent their frustrations, anger and their despair as well as share their success. I consider them as co-therapists on a journey of discovery about why the children are behaving as they are and how we, together, are going to figure out what to do and how to do it. I aim to offer parents the core DDP therapeutic attitude of PACE (Playful, Accepting, Curious, Empathy) – the same attitude as I will offer to a child when they join us in therapy and that is needed in day-to day-parenting.  

Warm up and cool down

Ellie joined therapy sessions after I had worked with Julie and David for six sessions. Robert was also in need of therapeutic support but it was not possible time-wise for me to work with both children and, in the DDP model, only one child is in the therapy room to ensure the focus is on her/his needs and unique story. A colleague worked with Robert and his carers. He and I worked closely together, communicating regularly, as themes and events in the children’s lives started to unfold. I had to work hard to support Ellie to ‘warm up’ from her numbness, my colleague had to work equally hard to support Robert to ‘cool down’. Both of us endeavoured to enable the children to accept physical comfort and experience joy in therapy and at home as they started to make sense of what had happened to them at the hands of their mother and her partners. Ellie and Robert slowly started to trust that when they needed something Julie and David would be there, that they could ask for what they needed and, when they asked, would not be abused or neglected. That when David and Julie put boundaries around them it was to keep them safe not to be intentionally mean to them, often the assumption of children who have experienced harm in their early years. Most importantly that they could have fun and enjoy being children!

As in the DDP model I met with Julie and, when possible, David, every week before Ellie joined us, I needed to find out how Julie and David’s week had been -  to celebrate successes and have acceptance and empathy for the challenges. We figured out the way forward together.  David had a full-time job; he attended therapy sessions when he could.  Julie, David and I would reflect with Ellie at the end of sessions about what we had talked about and what we had discovered. If David was not able to be there we would chat about who would let David know what we talked about in the session. 

DDP is often long-term therapy, at least a year.  Ellie was in therapy for 6 years.  Ellie, now 18 years old wrote this recently:

‘I wanted to write a few words about what my therapy meant to me. I started DDP when I was 10 or 11. When I first started I was a young girl who didn't know how to express herself. I struggled to feel anything other than guilt and shame. I blamed myself for the things that happened in my life, yet I struggled to even talk about them. I spent my life growing up as a carer for my younger siblings and my mother and due to that I didn’t have trust in anyone but myself. I couldn't rely on anyone, so I didn't.

‘I attended therapy with my foster mother and over the years I learned to trust again. I spent so much time when I was young being the perfect child. Trying hard not to make mistakes, I was more or less perfect. This is what I thought an adult wanted, and although I was told otherwise, it's only in recent years that I really understand it. Therapy has helped me build a relationship with my foster mother that I will have forever. Without therapy with not only me but my foster mum I would never have learned what being loved unconditionally is.’

Julie and David offered their experience of DDP therapy:

‘In therapy we have been able to figure out with Ellie and with Robert how their behaviours were an expression of their early life experiences; that they are not, as they thought, ‘bad kids’. Therapy has helped Ellie and Robert to learn that we love them even when they make mistakes and that we parents make mistakes too! Through therapy both Ellie and Robert became much more able to open up and share feelings on a day to day basis and to allow us to comfort them and to help them figure out what’s underlying their feelings. It has been a difficult journey and we have faced many challenges, and at times have felt like giving up, however individual support from our therapist has helped us to reflect and to reconnect.  We feel much more confident parents as a result of the input from our therapist and our increased knowledge and understanding.’

There is a growing and robust body of evidence that DDP is an effective intervention for children who have experienced adverse childhood experiences and that the providing of support for the parenting figures is a key factor.  

Edwina Grant is an Independent Chartered Educational Psychologist, Certified DDP Practitioner, Consultant and Trainer, and Chair of Scottish Attachment in Action.

Please note names have been changed throughout to protect identities.

Find out more about Dyadic Developmental Psychotherapy

How early years trauma affects the brain

A film on the Irris website show Dan Hughes explaining his summary of how the brain reacts to trauma and how an understanding of this process if helpful to foster and adoptive parents, as well as professional groups.

Watch the Dan Hughes webinar here

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