The impact of intrafamilial, relational trauma on the development of children is severe and pervasive, affecting all aspects of the child's functioning. The psychological treatment of children who have experienced such trauma may well have the greatest impact in facilitating their development when it adopts a relational approach incorporating central features of attachment theory while also including their caregivers when they are able to provide safety. Dyadic developmental psychotherapy (DDP), an attachment-focused family therapy, has two phases. In the first, the therapist sees the caregivers alone to ensure that they have the motivation and ability to relate with the child in ways that facilitate attachment security. This stage includes a description of the process of the treatment and the caregivers' central role in the co-regulation of emotional states, reducing the impact of the trauma on the child, assisting the child in turning to them for comfort and safety, and assisting in the development of new meanings of the trauma itself and its effect on the child's future. During the joint sessions, the therapist, utilising an intersubjective stance, actively facilitates a dialogue between therapist, child, and caregiver that incorporates the goals mentioned above and, within an open-and-engaged conversational tone, helps the child to develop a coherent autobiographical narrative that is not fragmented by terror and shame.Keywords: developmental trauma, attachment, co-regulation of emotion, autobiographical narrative, safety in family therapy
Key Points1 Childhood abuse and neglect presents pervasive developmental impairments that are very difficult to treat and resolve because it makes it difficult for the child to trust treatment providers and caregivers. 2 Dyadic developmental psychotherapy (DDP) is a treatment based on principles of attachment and intersubjectivity that is designed to enable traumatised children to trust their therapist and caregiver in order to turn to them for comfort and support. 3 The DDP therapist strives to maintain an open and engaged therapeutic stance to assist the traumatised child to experience safety and to reduce his defensive stance toward new relationships. 4 The therapeutic attitude of PACE (playfulness, acceptance, curiosity, empathy) facilitates the open and engaged, intersubjective, therapeutic stance. 5 DDP facilities the development of healing and integrative conversations with children that explore all aspects of their past and current lives. 6 DDP facilitates safety through the co-regulation of affect and then addresses events characterised by fear and shame through the co-creation of new meanings of those events. 7 DDP develops the capacity of abused and neglected children to experience comfort and joy with their caregivers.Jenny had just turned three when her father first hit her on the side of her head, sending her flying to the floor in an explosion of shock, terror, and pain. That was immediately followed by her mother screaming at her father and her father hitti...