the past twelve years I have actively worked to
develop a model of treatment and parenting for
children with problems secondary to abuse,
neglect, and multiple placements. This model has
evolved over those years, incorporating both my
experiences in providing such treatment and in
teaching other therapists as well as my ongoing
readings from attachment and trauma studies in
both academic and clinical literature. The
purpose of this paper is to clearly state the
nature of this treatment and parenting model and
to differentiate it from other models. I did not
make these differences clear in my two books. In
addition, the books were published in 1997 &
1998 and the model has continued to evolve. I
will also present the main features of the
changes that have occurred over the past 6-7
have chosen to call this model of treatment
Dyadic Developmental Psychotherapy because it is
based on the premise that the development of
children and youth is dependent upon and highly
influenced by the nature of the parent-child
relationship. Such a relationship, especially
with regard to the child?s attachment security
and emotional development, requires ongoing,
dyadic (reciprocal) experiences between parent
and child. Such experiences are affectively and
cognitively matched to the developmental,
age-appropriate needs of the child. The parent
is attuned to the child?s subjective experience,
makes sense of those experiences, and
communicates them back to the child. This is
done nonverbally as well as verbally. It is done
with playfulness, acceptance, curiosity, and
empathy. These interactions are contingent,
i.e., when the parent initiates an interaction,
the child?s response determines the parent?s
subsequent action based on the feedback of the
child?s subjective experience of the first
action. In that way, the parent constantly
fine-tunes his/her interactions to best fit the
needs of the child. The primary context in which
such dyadic interchanges occur is one of real
and felt safety. Without such actual and
perceived safety, the child?s neurological,
emotional, cognitive, and behavioral functioning
a child?s early attachment history consists of
abuse, neglect, and/or placements, s/he has
failed to experience the dyadic interactions
that are necessary for normal development and
s/he often has a reduced readiness and ability
to participate in such experiences. Many
children, when placed in a foster or adoptive
home that provides appropriate parenting, are
able to learn, day-by-day, how to engage in and
benefit from the dyadic experiences provided by
the new parent. Other children, having been much
more traumatized and compromised in those
aspects of their development that require these
dyadic experiences, have much greater difficulty
responding to their new parents. For these
children, specialized parenting and treatment is
such treatment and parenting to be effective I
strongly believe that they must be based on
parenting principles that facilitate security of
attachments and which incorporate an attitude
based on playfulness, acceptance, curiosity, and
empathy. The foundation of these interventions
-- both in home and in treatment -- must
incorporate the above principles and never
involve coercion, threat, intimidation, and the
use of power to force submission.
following represents a list of general
principles that are characteristic of my
treatment and parenting model and, I believe,
congruent with attachment and trauma literature.
contact, voice tone, touch (including
nurturing-holding), movement, and gestures are
actively employed to communicate safety,
acceptance, curiosity, playfulness, and
empathy, and never threat or coercion. These
interactions are reciprocal, not coerced.
for enjoyment and laughter, play and fun, are
provided unconditionally, throughout every day
with the child.
are made for the purpose of providing success,
become the basis for the development of
child?s symptoms or problems are accepted and
contained. The child is shown how these simply
reflect his history and how they need not be
experienced as shameful.
child?s resistance to parenting and treatment
interventions is also accepted and contained
and is not made to be shameful by the adults.
are developed in a patient manner, accepting
and celebrating ?baby-steps? as well as
adults? emotional self-regulation abilities
must serve as a model for the child.
child needs to be able to make sense of
his/her history and current functioning. The
understood reasons are not excuses, but rather
they are realities necessary to understand the
developing self and current struggles.
adults must constantly strive to have empathy
for the child and to never forget that, given
his/her history, s/he is doing the best s/he
child?s avoidance and controlling behaviors
are survival skills developed under conditions
of overwhelming trauma. They will decrease as
a sense of safety increases, and while they
may need to be addressed, this is not done
with anger, withdrawal of love, or shame.
child may be held at home or in therapy for
the purpose of containment when the child is
in a dysregulated, out-of-control state only
when less active means of containment are not
successful in helping him/her regain control,
and only as long as the child remains in that
state. The therapist/parent?s primary goal is
to insure that the child is safe and feels
safe. The goal is never to provoke a negative
emotional response or to scold or discipline
the child. The model for this type of holding
is that of a parent who holds an overtired,
overstimulated, or frightened preschool child
and helps him/her to regulate his distress
through calm, comforting, assurances and
through the parent?s own accepting and
is easier to list interventions that I never use
in therapy nor recommend that a parent use at
home, than to list all of the possible
interventions that I might use. I am confident
that all interventions I use are consistent with
principles of attachment and trauma, theory and
Modified on: Saturday, August 08, 2009
following interventions are NOT found within my
treatment and parenting model:
a child and confronting him/her with anger.
a child to provoke a negative emotional
a child until s/he complies with a demand.
a child on any part of his/her body to get a
against ?pressure points? to get a response.
a child?s mouth/nose with one?s hand to get a
a child repeatedly kick with his/her legs
until s/he responds.
a child in a blanket and lying on top of
actions based on power/submission, done
repeatedly, until the child complies.
actions that utilize shame and fear to elicit
a child from treatment because s/he is not
a child at home for being ?fired? from
such as saying, ?sad for you,? when the adult
actually feels no empathy.
at a child over the consequences which are
being given for his behavior.
the child as a ?boarder? rather than as one?s
shepherd training,? which bases the
relationship on total obedience.
the child for one?s own rage at the child.
a child?s behaviors as meaning that s/he ?does
not want to be part of the family,? which then
elicits consequences such as:
the above consequences in a ?loving, friendly
tone? does not make them appropriate. That
tone may actually cause greater confusion
about the meaning of love, parenting, and
safety, which we want children to understand.
sent away to live until s/he complies.
put in a tent in the yard until s/he
to live in his/her bedroom until s/he
to eat in the basement or on the floor until
?peanut butter? meals until s/he complies.
to sit motionless until s/he complies.
an intervention is not on that list, I may or
may not use it. A rule of thumb is always that
the intervention is something that is congruent
with how secure attachments are formed and how
traumas are resolved. If one is still uncertain,
please contact me rather than assuming that I
would recommend that intervention.
model was primarily developed in working with
children and their foster or adoptive parents.
If it is used when working with children with
parents who previously abused and neglected
them, it requires confidence that the parents
are no longer engaged in such actions of abuse
or neglect, that they have acknowledged and
accepted responsibility for their actions, and
that they are able to actively work to assist
their child in resolving the effects of the
abuse in a manner that is in the best interests
of the child.
while the above represents the basic premises of
this intervention model that have been constant
over the past twelve years, there are three
areas where the model has gradually changed.
the past I did occasionally incorporate some
interventions that emphasized obedience in
order to facilitate a parent being ?in
control? of the child?s behavior in the home.
For many years now, however, I have avoided
recommending such interventions, unless they
are necessary for safety as an immediate
response to a given situation. I believe that
they are inherently dangerous and leave the
adult vulnerable to becoming emotionally
abusive. If the child does not obey, the
parent is left with only one option, which is
to escalate the consequences until the child
finally submits. These escalations, such as
two weeks of ?solitary confinement,? can only
traumatize a child, destroy his/her ability to
trust the parent, and confuse him/her as to
the true nature of parenting and the parents?
motives toward the child. I am certainly not
advocating total permissiveness since part of
good parenting necessitates that the child
obey in many circumstances. However, I am
stressing that obedience is not the foundation
of a secure attachment nor is it the
foundation of effective long-term treatment
the years I have discovered more ways of
preventing children from becoming dysregulated
in the therapy setting. Trauma clinicians
stress the importance of directing children to
address their past traumas, but doing it in a
manner that is neither too fast nor too slow.
I am now more able to determine and effect the
optimum speed at which such work is done to
avoid both dysregulation on the one hand and
defensive avoidance on the other. I have never
held children in a coercive manner for the
purpose of confronting them in anger or
provoking them into rage. Yet, I was not
sufficiently aware of active ways of assisting
them in remaining regulated and in control
while engaging in a treatment and I held
children more then than I do now. Today I
proceed in treatment in slower and smaller
stages, providing more structure, reassurance,
and options so that the child is more likely
to actively engage in treatment without
dysregulation. Causing dysregulation is never
a treatment goal, nor has it ever been.
Actively working to prevent the child?s
dysregulation is now a primary treatment goal.
also have steadily increased my focus on the
child?s adoptive or foster parents? own
attachment histories. I am more aware that a
child?s serious attachment and trauma problems
may well elicit unresolved issues in the
parents? histories which then make it
difficult for the parent to assist the child
in regulating and integrating areas of his- or
herself that are unresolved. I am not
suggesting that a parent?s own coherence and
resolution with respect to his/her attachment
history is a necessary, though often not
sufficient, factor in their child?s ability to
resolve their own past issues.
hope this clarifies the nature of my treatment
and parenting model, differentiating it from
other models and explaining how it has changed
over the years. If there are any questions
about my model, please contact me.
a resident of Maine, Dr. Hughes now resides in
Pennsylvania, the state of his birth; and is the
Hughes can be reached at Dyadic