Treatment always involves the child and the parents. The parents are involved in all treatment. They are either in the therapy room directly or are watching therapists work with the child from an observation room. Many of the parents are feeling "burned out" by their child's pathology. They have often been emotionally abused, particularly the mother. Since one of the goals of therapy is to help the parents get "in charge" in a good way, the parenting coalition must be solid. To that end, sometimes the therapy process will focus on the parents' release of old anger, on relationship issues, and sometimes on un-addressed emotional issues of one or both parents, which inhibit the formation of strong attachment bonds.
In addition to using standard verbal psychotherapy techniques, use of techniques designed to engage the child in corrective emotional experiences are used. Child clients made decisions about trust early in their lives. These survival decisions were made as infants or very young children, made before they had language to encode the meaning of what was happening, even to themselves. Their trauma is locked into the experience of having felt pain at a time when they were powerless to get the help they needed. A variety of therapeutic techniques (psychodrama, imagery, social skill-building) are used to elicit and correct the child's pathology.
A major dynamic in treatment is to help the child address the trauma that produced the pathology. This allows the child to access deep, genuine, and intense emotions associated with the events and people who created those feelings. The corrective experience is orchestrated to allow the child to express these feelings, recognize and recall them, and identify the events and the people involved. This experience then provides an opportunity for resolution of significant old pathological emotions while simultaneously creating powerful new bonds with trustworthy and reliable parents.
Dyadic Developmental Psychotherapy has a major emotional or affective emphasis. We operate with the philosophy that emotions have a major causative effect on behavior. It is believed that when the emotions that cause the behavior change, the behaviors will change, often with little or no discussion. The trauma the children have experienced, which often includes the loss of their birth mothers, neglect, and abuse, produces three major emotions: fear, sadness, and anger. These emotions provide the causal energy for most of the child's pathological behavior. These emotions underlie their avoidance of attachment. Consequently, the regressive work that helps them access their fear, sadness, and anger is a process that helps them heal from their emotional trauma(s).
In contrast to play therapy or talk therapy, in which the child chooses the subject matter, the therapists and parents are in charge and direct the course of therapy. Often, the children with attachment disorder will not voluntarily face their painful emotions. Denial, avoidance, and dissociation are the defenses that allowed them to survive their trauma and they are not disposed to give them up easily.
"Confrontive" does not mean hostile or punishing. It means dealing directly with the heart of the child's experience. A contract made with the child includes an agreement that the therapists direct the therapy. The child is given the difficult choice of facing the consequences of not resolving problems or going through the painful work of solving them. This choice is given to the child genuinely and repeatedly but in a compassionate, understanding, and supportive manner. Consequently, therapy is quite confrontive and the child, as part of the contract, must agree to acknowledge the problems that brought the family to treatment and ask us for help. In our experience, when addressed in a forthright, open, and realistic manner, children almost always respond in the affirmative.
In essence, all therapy is done under three clear contracts. The most essential is the one between the parent and the child. The parent must be able to get the child to acknowledge and accept the reality of the problems and get the child to know that, while not responsible for the cause, he/she must accept responsible participation in its cure. The other two contracts are between the parents and the therapists and between the therapists and the child.
The course of therapy takes into account the unique needs of each family and child. Perhaps the most critical factor in positive treatment outcomes are parents who are strong, committed, compassionate, and open to their own emotional growth and to learning and applying parenting skills specific to their child's needs. The skill of the clinicians in selecting and implementing treatment strategies most appropriate to each child and family is also a considerable factor in outcomes of this therapy.
Dyadic Developmental Psychotherapy, an attachment-based therapy is often the treatment of choice in cases where able parents have a child who had a traumatic first two years of life and defends against accepting parental control and good judgment.
Children do heal, there is hope.