Evidence
In two studies by Becker-Weidman, the second being a four year follow up of the first, dyadic developmental psychotherapy was reported to be an effective treatment for children with complex trauma who met the DSM IV criteria for Reactive attachment disorder. The first study concluded that children who received dyadic developmental psychotherapy had clinically and statistically significant improvements in their functioning as measured by the Child Behavior Checklist (Achenbach ), while the children in the control group showed no change one year after treatment ended. The study also used the Randolph Attachment Disorder Questionnaire as a measure. Statistical comparisons employed multiple t-tests rather than analysis of variance, and no tests for homogeneity of variance were reported.
The treatment group comprised thirty-four subjects whose cases were closed in 2000/01. This was compared to a 'usual care group' of thirty subjects. The published reports on this work do not specify the nature of "usual care" or clarify why the "usual care" group, who were assessed at Becker-Weidman's clinic, did not have treatment there. Treatment consisted of an average of twenty three sessions over eleven months. The findings continued for an average of 1.1 years after treatment ended for children between the ages of six and fifteen years. There were no changes in the usual care-group subjects, who were re-tested an average of 1.3 years after the evaluation was completed. 82% of the treatment-group subjects and 83% of the usual care-group subjects had previously received treatment with an average of 3.2 prior treatment episodes.
In the follow-up study the results from the original study were maintained an average of 3.9 years after treatment ended. There were no changes in the usual care-group subjects, who were re-tested an average of 3.3 years after the evaluation was completed.
Becker-Weidman's first (2006) study was considered by the APSAC Taskforce in their November 2006 Reply to Letters following their main report on attachment therapy. The Taskforce had in their original report criticised Dr Becker-Weidman for claiming an evidence base to his therapy, and indeed for claiming to be the only evidence based therapy, where the Taskforce considered no evidence base existed. Dr Becker-Weidman responded to this with an open letter citing his study. The Taskforce examined the (2006) study, criticized the methodology and stated that although the study was an important first step towards learning the facts about DDP outcomes, it fell far short of the criteria that must be met before designating a treatment as evidence based.
Between the Taskforce report and Reply to Letters, Craven & Lee (2006) undertook a literature review of 18 studies of interventions used for foster children and classified them under the controversial Saunders, Berliner, & Hanson (2004) system. They considered only two therapies aimed at treating disorders of attachment, each of which was represented by a single study: dyadic developmental psychotherapy and holding therapy. They placed both in Category 3 as "supported and acceptable". This classification means that the evidence basis is weak, but that there is no evidence of harm done by the treatment. The Craven & Lee classification report has been criticized as unduly favourable (Pignotti & Mercer 2007) ) This critique noted the absence of a comprehensive manual giving details of the dyadic developmental psychotherapy intervention - one of the necessary criteria for assessment using the Saunders et al. guidelines, and one without which no outcome study can be placed in any of the available categories. Craven and Lee rebutted this paper in a reply that concentrated on holding therapy rather than dyadic developmental psychotherapy.
It also appears from the studies that accompanying attachment therapy parenting techniques from sources such as Facilitating Developmental Attachment (1997) by Daniel Hughes, and works by Nancy Thomas and Deborah Hage were used.
In Hughes' own work, the children being treated are not identified as diagnosed with Reactive Attachment Disorder, but as having a "rigid self-reliance that becomes a compulsive need to control all aspects of their environment" (p. 263). Hughes comments that "Such children present a diagnostic puzzle" (p. 263). The Becker-Weidman material presents only a diagnostic category rather than describing specific behavioral and emotional disturbances.
The results of Becker-Weidmans studies have been recently republished.
Read more about this topic: Dyadic Developmental Psychotherapy
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