October 12, 2018

Taking Developmental Dyadic Psychotherapy to the next level

This blog post was written by Jaclyn Guest
Senior Counsellor,
Child Trauma Service.

How many traumatised children do you know that can tell you about their inner emotional experiences using words? Trauma attacks stories. It scrambles our ability to tell our stories. It steals our opportunities to have our stories heard and validated. The pain of children who have been fostered, or adopted, is often impossible to put into words. Standard talking techniques in therapy can struggle to reach these underlying, unspeakable experiences. Developmental Dyadic Psychotherapy (DDP) provides a framework to find the words, and non-verbal communication, so that a child can share this pain with their carers; and receive the comfort and witnessing that they desperately needed at the time of their trauma.

The central tenet of DDP is PACE. PACE stands for Playfulness, Acceptance, Curiosity and Empathy. This combination of responses in the face of dysregulated behaviour, conflict, fear and anger is almost magical. PACE can be used in therapy, parenting, schools or any relationship to convey unconditional positive regard and prioritising the relationship and connection. It demonstrates a willingness to understand another and their behaviour, rather than to just change or influence them.

Other important aspects of DDP are the use of “talking for” and “talking about”. “Talking for” a child is used to increase the emotional intensity in the session, often when a child is avoidant or hypo-aroused. Whereas “talking about” a child which is used to decrease the emotional intensity when a child is overwhelmed. This lead-follow-lead technique allows you to titrate the intensity of the session to keep it an optimal level for therapeutic connection and processing.

Another technique is the use of prosody. Prosody is using the lilt and expression in your voice to non-verbally match the intensity of the child’s experience. It’s the tone of voice and energy that parents use to communicate attunement with their babies. More than one child has commented on my “funny voice” while I was getting the hang of this technique.

My DDP journey began in 2007. Once I’d read the seminal case study “Building the Bonds of Attachment” I knew I had discovered a unique approach for treating attachment trauma.  I wanted to train in this technique, but it would require some significant departures from my psychology training.

I wondered if I would ever be so bold as to “talk for” a child, could I be playful in the face of such difficult feelings and balance the intensity of emotions in the room, all in the same session.

I could not believe my luck when Dan Hughes and the DDP network partnered with my organisation, the Australian Childhood Foundation, in 2013. There are three levels of training to become certified in this technique. Hundreds of people have been trained in Level 1 and 2 around Australia. In 2016 I signed up for Level 3 and completed it earlier this year. As far as I know I’m the first person in Victoria and the third person in Australia to do so. Level 3 requires video supervision of your sessions and live feedback. Many people feel anxious showing their work in this way via a role play or video. However, the level of vulnerability means it can’t be beaten as a learning experience. The value of getting such specific feedback on your own work cannot be overstated. Videoing myself also forced me to stay true to the technique for the entire session, instead of dipping in and out as I often do.

For anyone that has seen a video of Dan Hughes using DDP, his vivacious personality and playful boldness is such a big part of his sessions. A challenge for all DDP practitioners is finding their own version of DDP, that holds true to the principles of DDP and yet feels authentic to them.

The biggest challenge I’ve found in implementing DDP is supporting parents (biological or foster) to genuinely accept some very strong negative feelings. This is a lot easier said than done and is not the same as accepting the behavioural communications of these feelings. In turn it can be hard for us to genuinely accept some of the feelings and projections of parents towards their children. In our rush to change or improve the parents we can be mirroring the misattunement and misunderstanding that our child clients are dealing with. It is especially difficult if we need to tolerate and sit with some less than ideal feelings in the parent-child dynamic.

It has been such a privilege to witness the children, and their parent/carers, find a way to share such difficult stories and the painful feelings that go with them.

When their stories are shared and responded to therapeutically they no longer need to rely on behaviour to communicate their level of pain and dysregulation, which frees carers up to respond therapeutically, building connection and trust. I am so grateful that I was able to be part of their process, and grateful that by learning DDP I was able to make a difference to the lives of children and parent/carers that I work with.

If you are interested in studying Dyadic Developmental Psychotherapy, you can do so in Australia through our partnership with the institute. Find out about upcoming courses here.