Dyadic Developmental Psychotherapy: (Part III)

An Effective Treatment for Children with Trauma-Attachment Disorders - Part III

PART III RESULTS
Before treatment, RADQ scores and Child Behavior Checklist scale scores were elevated and in clinically significant ranges (more than two standard deviations above the mean for the CBCL). The extent and severity of these children's disorder is underscored by the fact that 82% had received prior treatment using other methods. The average number of previous treatment episodes was 3.2. The results were achieved among children aged six to fifteen years, averaging 9.4 years, who received an average of twenty-three sessions over eleven months. Results are presented in Table 2. T-test results were all statistically significant and in the expected direction. In addition, the results were clinically significant in that the post-treatment CBCL scores were all less than 2 standard deviations above the mean.

STATISTICAL ANALYSIS

N=34, df=33

MEASURE
meanPre-test / SDPre-test / meanPost-test / SDPost-test / T-VALUE / P-VALUE

RADQ
65 / 20.3 / 20 / 12.1 / 12.822 / <.0001
CBCL Syndrome Scale Scores
Withdrawn
65 / 11.8 / 54 / 6.0 / 4.897 / <.0001
Anxious/Depressed
62 / 10.5 / 58 / 8.1 / 2.665 / .006
Social Problems
67 / 9.7 / 59 / 5.5 / 4.376 / <.0001
Thought Problems
68 / 9.5 / 56 / 3.9 / 6.133 / <.0001
Attention Problems
72 / 12.5 / 57 / 6.1 / 5.836 / <.0001
Rule-Breaking Behavior
69 / 6.9 / 53 / 3.8 / 12.181 / <.0001
Aggressive Behavior
71 / 9.1 / 55 / 4.5 / 10.576 / <.0001

DISCUSSION
The purpose of the present study was to demonstrate the outcome of Dyadic Developmental Psychotherapy with children who have trauma-attachment disorders in an outpatient setting when provided by a trained clinician. While residential treatment and intensive forms of treatment have been used to treat this population, a method that is usable by trained clinicians in a general office or clinic setting would allow for more efficient and widely available treatment for these children.

Children with the symptoms of attachment disorder and antisocial behaviors are very likely to continue these behaviors in adulthood. In addition, children with trauma-attachment disorders are more likely to develop severe personality disorders, such as Borderline Personality Disorder, Sociopathic Personality Disorder, Narcissistic Personality Disorder, and other personality disorders in adulthood20. For these reasons, it is vital that effective treatment for children with trauma-attachment problems be developed and validated. Affective-Developmental-Psychotherapy, also known as attachment therapy, appears to be one such treatment. Prior to this study, there have been no quantitative studies using an outpatient model, which verified the effectiveness of this type of treatment.

Arthur Becker-Weidman, Ph.D.
Center For Family Development
5820 Main Street, suite 406
Williamsville, NY 14221
http://www.adoptionforums.com/forumdisplay.php?s=&forumid=50
716-810-0790
Aweidman@Concentric.net
http://www.Center4FamilyDevelop.com

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This study found statistically and clinically significant reductions in outcome variables that followed treatment. The results achieved may be due to the effects of Dyadic Developmental Psychotherapy. The basis for these changes is based on the theory that an affectively based treatment will result in integration of trauma, improved affect regulation, and an enhanced, integrated, and coherent autobiographical sense of self. It is suggested that treatment allows the child to develop a healthier attachment to the child's parent, increase the child's capacity for self-regulation, empathy, remorse, and toleration of higher levels of stress. The measurable dimensions of these changes are seen in a number of areas: 1) increased capacity to use the parent as a secure base for comfort and security as measured by a decrease in the Withdrawn/Depressed scale on the Child Behavior Checklist (CBCL)34; 2) reduction in grief and loss issues associated with abuse, neglect, and foster/adoptive placements as measured by a reduction in the Depressed/Anxious Problems scale on the CBCL; 3) improved ability to form social relationships as measured by a reduction on the Social Problems scale on the CBCL; 4) improved cause-effect thinking as measured by a decrease in the Thought Problems scale of the CBCL; 5) reduced aggression as measured by a decrease in the Aggression scale of the CBCL; 6) increased adherence to generally acceptable social behavior as measured by a reduction in the Delinquent Behavior scale of the CBCL.

SUMMARY
It is suggested that Dyadic Developmental Psychotherapy is effective because of its reliance on and development of affective attunement between therapist and child and parent and child. The process of maintaining affective attunement allows for dyadic regulation of affect between child and therapist so that the child feels a sense of safety and security and can experience the affect associated with past traumas, allowing for integration of these experiences rather than dissociation of the affect and memory. Furthermore, Dyadic Developmental Psychotherapy's significant involvement of parents in treatment facilitates the development of an affectively attuned relationship between the child and parent. An affectively attuned relationship may be described as a relationship in which the two persons are experiencing the same affect and that their affect co-varies. Within the safety of the attuned relationship the shame of past trauma and current misbehaviors are explored, experienced, and integrated. The parent-child interactions build on a dyadic affect regulation process that normally occurs during infancy and the toddler years. The child's past traumatic history of abuse and neglect strongly suggests that such interaction, which facilitates a health attachment and a trusting and safe relationship, did not occur or occurred in an inadequate manner. Dyadic Developmental Psychotherapy facilitates the development of a healthy attachment between child and parent, enables the child to affectively trust the parent, and allows the child to secure comfort and safety from the parent. This study suggests that Dyadic Developmental Psychotherapy is an effective intervention for children with trauma-attachment problems.

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