Dyadic Developmental Psychotherapy - Controversy

Controversy

DDP has been criticised for the lack of a comprehensive manual or full case studies to provide details of the process. In addition, although non-verbal communication, communicative mismatch and repair, playful interactions and the relationship between the parents attachment status and that of a toddler are all well documented and important for early healthy emotional development, Hughes and Becker-Weidman are described as making "a real logical jump" in assuming that the same events can be deliberately recapitulated in order to correct the emotional condition of an older child. It is also suggested that the therapy appears to use age regression techniques to bring about such recapitulation - a feature of attachment therapy not congruent with attachment theory. Dr Becker Weidman cites Daniel Hughes 1997 book "Facilitating Developmental Attachment", which contains a section on the use of age regression, as a source document for dyadic developmental psychotherapy.

Opinion is divided as to whether Dyadic Developmental Psychotherapy is in fact an attachment therapy. The APSAC Taskforce report on Attachment disorder, Reactive attachment disorder and Attachment therapy, published in 2006, places Hughes and Becker-Weidman within the attachment therapy paradigm and indeed specifically cites Becker-Weidman for, amongst other things, the use of age regression, though not for coercive or restraining practices (p. 79). They also describe DDP as an attachment therapy in their November 2006 Reply to Letters. Becker-Weidman had stated in his letter to the Taskforce that it was essential to treat a child at its developmental rather than chronological level, but the Taskforce in its November 2006 Reply to Letters disagreed (p. 382).

The Taskforce in their Reply to Letters describe Hughes as "a leading attachment therapist" and cite Hughes (together with Kelly and Popper) as examples of attachment therapists who have more recently developed their practices away from the more concerning attachment therapy techniques (p. 383). Indeed they use Hughes' list of specific techniques that he believes should be or have been excluded from the practice of DDP as an example of concerning treatment behaviors.

The Kansas University/SRS Best Practices Report (2004) considered that dyadic developmental psychotherapy as described by Becker-Weidman, appeared to be somewhat different from that as described by Hughes. They state that in 2004 Becker-Weidman's claim that dyadic developmental psychotherapy was 'evidence based' cited studies on holding therapy by Myeroff, Randolph and Levy from the Attachment Center at Evergreen. Hughes' model is described as more clearly incorporating researched concerns about 'pushing' children to revisit trauma (as this can re-traumatize victims) and as having integrated established principles of trauma treatment into his approach. Avoiding dysregulation is described by Hughes as a primary treatment goal.

The advocacy group Advocates for Children in Therapy include dyadic developmental psychotherapy in their list of "attachment therapies by another name", and continue to list Hughes as a proponent of attachment therapy citing material relating to holding therapy from earlier publications in addition to Hughes more recent works. In particular, they cite material from Hughes website about the use of physical contact in therapy as follows:

"To be effective, the child must be engaged by the therapist at the level of preverbal attunement rather than in a setting of rational discussions. The therapy must also involve a great deal of physical contact between the child and the therapist and parent. During much of the most intense therapeutic work, the child is being touched or held by the therapist or parent. His intense emotions are received, accepted, and integrated into the self. Within a therapeutic atmosphere based on attunement, he is able to begin to explore aspects of himself and his relationships with his parents that have previously not been accessible. The development of both the child's attachment to his parents and his integrated self is the primary goal of the therapist; all else is secondary."

Dr Becker-Weidman cites Daniel Hughes 1997 book "Facilitating Developmental Attachment", which contains a chapter on the use of holding therapy, as a source book for dyadic developmental psychotherapy.

According to the author of this article on dyadic developmental psychotherapy "Holding is one of the experiential methods used, but it is not a restrictive, invasive, or constricting holding. The holding used is better described as cradling much as one would cradle an infant or toddler. Cradling creates a multi-sensory experience to facilitate attunement, emotional reciprocity and stability, enhances empathic responses, safety and re-enactment of the nurturing holding of infancy to provide a corrective cognitive-emotional experience." According to Hughes's website,

"The child may be held at home or in therapy for the purpose of containment when the child is in a dysregulated, out-of-control state only when less active means of containment are not successful in helping him/her regain control, and only as long as the child remains in that state. The therapist/parent's primary goal is to insure that the child is safe and feels safe. The goal is never to provoke a negative emotional response or to scold or discipline the child. The model for this type of holding is that of a parent who holds an overtired, overstimulated, or frightened preschool child and helps him/her to regulate his distress through calm, comforting assurances and through the parent's own accepting and confident manner."

Prior and Glaser state that Hughes's therapy 'reads' as good therapy for abused and neglected children, though with 'little application of attachment theory' but do not include it in their section on attachment therapy.

Trowell, while admiring Hughes's clinical skills, stated that "Parents and carers need their own specific parent work and the children and young people need specific work tailored to their needs ... parents with their own unmet attachment needs from childhood may significantly inhibit their ability to speak frankly with, and feel supported by professionals aiming to help their children". Referring to the use of facial expressions in attempts at attunement, Trowell noted, "although the therapist may look and feel sad, the young person may see this as a provocation-- either hit out or the therapist may be perceived to be triumphant (the facial expression may be misread)" (p. 281). Trowell emphasized the value of many of Hughes's ideas for clinical work, but she concluded that "There is a need for caution. Experienced, well-trained clinicians can, with supervision, take these ideas forward into their clinical practice. But the ideas in do not provide a sufficient basis for a treatment manual, and are not to be followed uncritically."