By Arthur Becker-Weidman, Ph.D.

Click here to contact Arthur and/or see his GoodTherapy.org Profile

DYADIC DEVELOPMENTAL PSYCHOTHERAPY is a treatment approach to trauma, neglect, loss, and/or other dysregulating experiences that is based on principles derived from Attachment Theory and Research.

DYADIC DEVELOPMENTAL PSYCHOTHERAPY involves creating a safe setting in which the client can begin to explore, resolve, and integrate a wide range of memories, emotions, and current experiences, that are frightening, stressful, avoided or denied. Safety is created by insuring that this exploration occurs with nonverbal attunement, reflectivenonjudgmentaldialogue, along with empathy and reassurance. As the process unfolds, the client is creating a coherent lifestoryor autobiographical narrativewhich is crucial for attachment security and is a strong protective factor against psychopathology. Therapeutic progress occurs within the joint activities of coregulating affect and coconstructing meaning.

Nonverbal attunement refers to the frequent interactions between a parent and infant, in which both are sharing affect and focused attention on each other in a way such that the child’s enjoyable experiences are amplified and his/her stressful experiences are reduced and contained. This is done through eye contact, facial expressions, gestures and movements, voice tone, timing and touch. These same early attachment experiences, which are fundamental for healthy emotional and social development, are utilized in therapy to enable to the client to rely on the therapist to regulate emotional experiences and to begin to understand these experiences more fully. Such understanding develops further through engaging in a conversation about these experiences, without judgment or criticism. The therapist will maintain a curious attitude about the memories and behaviors, encouraging the client to explore them to better understand their deeper meanings in his life and gradually develop a more coherent lifestory. This process may be stressful for the client, so the therapist will frequently “take a break” from the work, provide empathy for the negative emotion that may be elicited, and reassure the client about his efforts and the therapeutic relationship.

The primary therapeutic attitude demonstrated throughout the sessions is one of playfulness, acceptance, empathy and curiosity (PACE).

For the purpose of increasing the client’s safety, his/her readiness to rely on significant attachment figures in his life, and his/her ability to resolve and integrate the dysregulating experiences that are being explored, a person who an important attachment figure to the client will be actively present. When the client is a child, this most often will be the child’s parent or guardian. When the client is an adult, this most often will be the adult’s partner.

The role of the parent in his/her child’s psychotherapy is the following:

1. Help him to feel safe.
2. Create a healing PLACE (Playful, Loving, Accepting, Curious, and Empathic), both nonverbally and verbally.
3. Help him to regulate any negative affect such as fear, shame, anger, or sadness.
4. Validate his/her worth in the face of trauma and shamebased behaviors.
5. Reassure him/her that your relationship remains strong regardless of the issues.
6. Help him/her to make sense of his/her life so that it is organized and congruent.
7. Help him/her to understand your perspective and motives with respect to him/her.

The parent’s role is not to criticize, lecture, nag, or amplify shame. Periodic confrontation may be necessary and needs to be integrated into the overall treatment session. Reassurance and repair of the relationship after confrontation is crucial. The child will not participate fully in therapy, and will not benefit much from the process if s/he does not feel safe in a setting primarily characterized by PACE.

Frequently a person’s symptoms are his/her unsuccessful ways of regulating frightening or shamebased memories, emotions, and current experiences. Angrily telling a person to stop engaging in these symptoms may actually increase their underlying causes. In helping the child in therapy and at home to regulate the affect associated with the symptoms, and to understand the deeper meanings of the symptoms, we are increasing the likelihood that the symptoms will decrease. At the same time it may certainly be necessary to address the symptoms through increased supervision or through applying natural consequences for them. Again, however, the issues will be addressed more effectively when done with PACE rather than habitual anger, rejection, or other shameinducing actions.

When we are asking a client to address frightening or shamebased memories, emotions, and current experiences, when are asking him/her to engage in an activity that will be emotionally painful. In do so it is crucial that we maintain an attitude characterized by PACE in order to insure that the client is not alone while entering that painful experience. The client has developed significant symptoms and defenses against that pain, most often because s/he was alone in facing it. When we help to carry and contain the pain with him/her, when we coregulate it with him/her, we are providing him/her with the safety needed to explore, resolve, and, integrate the experience. We do not facilitate safety when we support a client’s avoidance of the pain, but rather when we remain emotionally present when he is addressing the pain.

The following statements reflect routine features of DYADIC DEVELOPMENTAL PSYCHOTHERAPY:

1. Playful interactions, focused on positive affective experiences, are never forgotten as being an integral part of most treatment sessions, when the client is receptive. When the client is resistant to these experiences, the resistance is met with PACE.
2. Shame is frequently experienced when exploring many experiences of negative affect. Shame is always met with empathy, before considering interventions to question it.
3. Emotional communication that combines nonverbal attunement and reflective dialogue and is followed by relationship repair when necessary is the central therapeutic activity.
4. While supporting the reduction of shame, we also support the increase of guilt.
5. Resistance is met with PACE, rather than being criticized and/or punished.
6. Treatment is directive and clientcentered. Directives are frequently modified delayed, or setaside in response to resistance which is met with PACE.

DYADIC DEVELOPMENTAL PSYCHOTHERAPY involves the process having a conversation with the client and his/her attachment figure about a wide range of memories, emotions, and current experiences. This conversation occurs within the safety created by nonverbal attunement, reflective dialogue, and interactive repair.

The purpose of this dyadic conversation is to facilitate the development of a coherent autobiographical narrative that involves: a. Coregulation of affect elicited during the conversation. b. Dyadic construction of meaning regarding the focus of the conversation. c. Development of a sense of efficacy regarding being able to have a conversation about the full range of experiences, memories and emotions in one’s personal narrative.

To facilitate this process the therapist will consisting maintain an attitude that involves communicating Playfulness, Acceptance, Curiosity and Empathy (PACE).

©Copyright 2008 by Arthur Becker-Weidman, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Arthur and/or see his GoodTherapy.org Profile

This entry was posted on Thursday, January 22nd, 2009 at 12:24 am and is filed under Mental Health, Psychology, Psychotherapy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.