Dyadic developmental psychotherapy

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Dyadic developmental psychotherapy is a psychotherapeutic treatment method for families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. [1] It was originally developed by Arthur Becker-Weidman and Daniel Hughes [2] as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers. [3] [4] Hughes cites attachment theory and particularly the work of John Bowlby as theoretical motivations for dyadic developmental psychotherapy. [4] [5] [6]

Contents

Dyadic developmental therapy principally involves creating a "playful, accepting, curious, and empathic" environment in which the therapist attunes to the child's "subjective experiences" and reflects this back to the child by means of eye contact, facial expressions, gestures and movements, voice tone, timing and touch, "co-regulates" emotional affect and "co-constructs" an alternative autobiographical narrative with the child. Dyadic developmental psychotherapy also makes use of cognitive-behavioral strategies. The "dyad" referred to must eventually be the parent-child dyad. The active presence of the primary caregiver is preferred but not required. [4]

A study by Arthur Becker-Weidman in 2006, which suggested that dyadic developmental therapy is more effective than the "usual treatment methods" for reactive attachment disorder and complex trauma, [7] [8] has been criticised by the American Professional Society on the Abuse of Children (APSAC). According to the APSAC Taskforce Report and Reply, dyadic developmental psychotherapy does not meet the criteria for designation as "evidence based" nor provide a basis for conclusions about "usual treatment methods". [9] [10] A 2006 research synthesis described the approach as a "supported and acceptable" treatment, [11] but this conclusion has also proved controversial. [12] A 2013 review of research recommended caution about this method of therapy, arguing that it has "no support for claims of effectiveness at any level of evidence" and a questionable theoretical basis. [13]

Theoretical basis

Dyadic developmental psychotherapy grounded in Bowlby's attachment theory and is based on the theory that maltreated infants not only frequently have disorganized attachments but also, as they mature, are likely to develop rigid self-reliance that becomes a compulsive need to control all aspects of their environment. Hughes cites Lyons-Ruth & Jacobvitz (1999) in support of this theory. Caregivers are seen as a source of fear with the result that children endeavour to control their caregivers through manipulation, overcompliance, intimidation or role reversal in order to keep themselves safe. Such children may also suffer intrusive memories secondary to trauma and as a result may be reluctant or unwilling to participate in treatment. It is anticipated that such children will try to actively avoid the exposure involved in developing a therapeutic relationship and will resist being directed into areas of shame and trauma. Hughes proposes that an attachment based treatment may be more effective for such foster and adoptive children than traditional treatment and parenting interventions. [4]

It is stated that once an infant's safety needs are met (by attachment) they become more able to focus on learning and responding to the social and emotional needs of caregivers. (Schore, 2003ab). Hughes posits that this 'affective attunement', described by Stern (1985) is crucial in the development of both a secure attachment as well as a positive, integrated sense of self. Attunement is a primarily a non-verbal mode of communication between infant and carer, and synchrony in the degree of arousal being expressed, as well as empathy for the child's internal experience. Hughes states "Whether it is a motivational system separate from attachment as is suggested by Stern (2004), or a central aspect of a secure attachment dyad, it remains vital in the child's overall development." [4]

The therapy attempts to replicate this or fill in the gaps in a maltreated child's experience.

Methods

Firstly the therapist becomes 'non-verbally attuned' with the child's affective state. The therapist then attempts to explore 'themes' with the child whilst remaining attuned. Whilst this is done, the therapist then 'co-regulates' (helps the child to manage) the child's emerging affective states with 'matched vitality affect', and develops secondary affective/mental representations of them which is co-constructed with the child for purposes of integration (the therapist tries to help the child gain a coherent narrative about their experiences and an awareness of the positive aspects of themselves). According to Hughes "The therapist allows the subjective experience of the child to impact the therapist. The therapist can then truly enter into that experience and from there express her/his own subjective experience. As the therapist holds both subjective experiences, the child experiences both. As the child senses both, the child begins to integrate them and re-experience the event in a way that will facilitate its integration and resolution." [4] In the anticipated frequent disruptions, due to the child's traumatic and shaming experiences, the therapist accepts and works with these and then 'repairs' the relationship.

The aim is for the child to be able to construct a new and coherent autobiography that enables the child to be in touch with their inner feelings. "As the therapist gives expression to the child's subjective narrative, s/he is continuously integrating the child's nonverbal responsiveness to the dialogue, modifying it spontaneously in a manner congruent with the child's expressions. The dialogue is likely to have more emotional meaning for the child if the therapist, periodically, speaks for the child in the first person with the child's own words." (Hughes 2004 p18) [4] The active presence of one of the child's primary caregivers is considered to greatly enhance psychological treatment. However Hughes considers that attachment based treatment can be undertaken with just the therapist.(Hughes 2004 p25) [4]

Controversy

DDP has been criticised for the lack of a comprehensive manual or full case studies to provide details of the process. Its theoretical basis has also been questioned. [13] Although non-verbal communication, communicative mismatch and repair, playful interactions and the relationship between the parents' attachment status and that of a toddler are all well documented and important for early healthy emotional development, Hughes and Becker-Weidman are described as making "a real logical jump" in assuming that the same events can be deliberately recapitulated in order to correct the emotional condition of an older child. [12]

Similarities to certain attachment therapy practices have also provoked controversy. [13] It has been suggested that the therapy appears to use age regression and holding techniques—features of attachment therapy not congruent with attachment theory. [12] Becker-Weidman cites Daniel Hughes's 1997 book "Facilitating Developmental Attachment", which contains sections on the use of age regression and holding therapy, as a source document for dyadic developmental psychotherapy. [7] The advocacy group Advocates for Children in Therapy include dyadic developmental psychotherapy in their list of "attachment therapies by another name", and continue to list Hughes as a proponent of attachment therapy, citing statements of his that appear to endorse holding therapy. [14] In particular, they cite material from Hughes's website about the use of physical contact in therapy. [15] However a recent academic study found that, "Such practices were not reported by any of the parents" who took part in the study, "and indeed many identified DDP as being child-led, meeting the needs of their family with good results and in a climate of safety." [16]

The APSAC Taskforce report on attachment disorder, reactive attachment disorder and attachment therapy, published in 2006, places Hughes and Becker-Weidman within the attachment therapy paradigm and indeed specifically cites Becker-Weidman for, amongst other things, the use of age regression, though not for coercive or restraining practices (p. 79). They also describe DDP as an attachment therapy in their November 2006 Reply to Letters. [9] [17] Becker-Weidman had stated in his letter to the Taskforce that it was essential to treat a child at its developmental rather than chronological level, but the Taskforce in its November 2006 Reply to Letters disagreed (p. 382). [10] [18]

The Taskforce in their Reply to Letters describe Hughes as "a leading attachment therapist" and cite Hughes (together with Kelly and Popper) as examples of attachment therapists who have more recently developed their practices away from the more concerning attachment therapy techniques (p. 383). [19]

The Kansas University/SRS Best Practices Report (2004) considered that dyadic developmental psychotherapy as described by Becker-Weidman, appeared to be somewhat different from that as described by Hughes. They state that in 2004 Becker-Weidman's claim that dyadic developmental psychotherapy was "evidence based" cited studies on holding therapy by Myeroff, Randolph and Levy from the Attachment Center at Evergreen. [20] [21] Hughes' model is described as more clearly incorporating researched concerns about 'pushing' children to revisit trauma (as this can re-traumatize victims) and as having integrated established principles of trauma treatment into his approach. Avoiding dysregulation is described by Hughes as a primary treatment goal. [21]

Prior and Glaser state that Hughes's therapy 'reads' as good therapy for abused and neglected children, though with 'little application of attachment theory', but do not include it in their section on attachment therapy. [22]

Trowell, while admiring Hughes's clinical skills, stated that "Parents and carers need their own specific parent work and the children and young people need specific work tailored to their needs ... parents with their own unmet attachment needs from childhood may significantly inhibit their ability to speak frankly with, and feel supported by professionals aiming to help their children". [23] Referring to the use of facial expressions in attempts at attunement, Trowell noted, "although the therapist may look and feel sad, the young person may see this as a provocation—either hit out or the therapist may be perceived to be triumphant (the facial expression may be misread)" (p. 281). Trowell emphasized the value of many of Hughes's ideas for clinical work, but she concluded that "There is a need for caution. Experienced, well-trained clinicians can, with supervision, take these ideas forward into their clinical practice. But the ideas in [Hughes's 2004 paper] do not provide a sufficient basis for a treatment manual, and are not to be followed uncritically."

Evidence

Two research reports by Becker-Weidman, the second being a four-year follow-up of the first, are the only empirical examination of dyadic developmental psychotherapy. [13] They reported DDP to be an effective treatment for children with complex trauma who met the DSM IV criteria for reactive attachment disorder. [7] [8] The first report concluded that children who received dyadic developmental psychotherapy had clinically and statistically significant improvements in their functioning as measured by the Child Behavior Checklist, while the children in the control group showed no change one year after treatment ended. The study also used the Randolph Attachment Disorder Questionnaire as a measure, [7] which has not been empirically validated for reactive attachment disorder. [24] Statistical comparisons were performed using multiple t-tests rather than an analysis of variance; this has been criticized because t-tests increase the chance of finding any significant differences. [24]

The treatment group comprised thirty-four subjects whose cases were closed in 2000/01. This was compared to a "usual care group" of thirty subjects, who were treated elsewhere. The published reports on this work do not specify the nature of "usual care" or clarify why the "usual care" group, who were assessed at Becker-Weidman's clinic, did not have treatment there. Treatment consisted of an average of 23 sessions over eleven months. The findings continued for an average of 1.1 years after treatment ended for children between the ages of six and fifteen years. There were no changes in the usual care-group subjects, who were re-tested an average of 1.3 years after the evaluation was completed.

In the follow-up study the results from the original study were maintained an average of 3.9 years after treatment ended. There were no changes in the usual care-group subjects, who were re-tested an average of 3.3 years after the evaluation was completed.

Becker-Weidman's first study was considered by the APSAC Taskforce in their November 2006 Reply to Letters following their main report on attachment therapy. [10] The Taskforce had in their original report criticised Becker-Weidman for claiming an evidence base to his therapy, and indeed for claiming to be the only evidence based therapy, where the Taskforce considered no evidence base existed. [9] Becker-Weidman responded to this with an open letter citing his study. [25] The Taskforce examined the (2006) study, criticized the methodology and stated that although the study was an important first step towards learning the facts about DDP outcomes, it fell far short of the criteria that must be met before designating a treatment as evidence based. [26]

Between the Taskforce report and Reply to Letters, Craven & Lee (2006) undertook a literature review of 18 studies of interventions used for foster children and classified them under the controversial Saunders, Berliner, & Hanson (2004) system. [11] [27] [28] They considered only two therapies aimed at treating disorders of attachment, each of which was represented by a single study: dyadic developmental psychotherapy and holding therapy. [29] [30] They placed both in Category 3 as "supported and acceptable". This classification means that the evidence basis is weak, but that there is no evidence of harm done by the treatment. The Craven & Lee classification report has been criticized as unduly favourable. [12] This critique noted the absence of a comprehensive manual giving details of the dyadic developmental psychotherapy intervention—one of the necessary criteria for assessment using the Saunders et al. guidelines, and one without which no outcome study can be placed in any of the available categories. Craven and Lee rebutted this paper in a reply that concentrated on holding therapy rather than dyadic developmental psychotherapy. [31]

It appears from the reports that attachment therapy techniques may have been used in addition to standard DDP. The therapist in Becker-Weidman's study instructed parents to use the "attachment parenting methods" of two authors who are described by Jean Mercer as advocating "coercive and intimidating approaches to children in treatment", specifically physical restraint and withholding of food and drink. Because of this deviation from the modern presentation of DDP, Mercer argues that the study cannot be considered a test of DDP in its current form. [13] Mercer cites Becker-Weidman's research as an example of the Woozle effect, in which "flawed, limited, or exaggerated data" is uncritically repeated and republished until it achieves popular acceptance. [24]

See also

Related Research Articles

Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary care giving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.

Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".

<span class="mw-page-title-main">Play therapy</span> Childrens mental health therapy method

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Emotional dysregulation is a range of emotional responses that do not lie within a desirable scope of emotive response, considering the stimuli.

Attachment therapy is a pseudoscientific child mental health intervention intended to treat attachment disorders. It is found primarily in the United States, and much of it is centered in about a dozen clinics in Evergreen, Colorado, where Foster Cline, one of the founders, established his clinic in the 1970s.

Advocates for Children in Therapy (ACT) is a U.S. advocacy group founded by Jean Mercer and opposed to attachment therapy and related treatments. The organization opposes a number of psychotherapeutic techniques which are potentially or actually harmful to the children who undergo them. The group's mission is to provide advocacy by "raising general public awareness of the dangers and cruelty" of practices related to attachment therapy. According to the group, "ACT works to mobilize parents, professionals, private and governmental regulators, prosecutors, juries, and legislators to end the physical torture and emotional abuse that is Attachment Therapy."

Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.

Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Parent–child interaction therapy (PCIT) is an intervention developed by Sheila Eyberg (1988) to treat children between ages 2 and 7 with disruptive behavior problems. PCIT is an evidence-based treatment (EBT) for young children with behavioral and emotional disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns.

Attachment-based psychotherapy is a psychoanalytic psychotherapy that is informed by attachment theory.

Charles H. Zeanah Jr. is a child and adolescent psychiatrist who is a member of the council (Board) of the American Academy of Child and Adolescent Psychiatry (AACAP).

Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.

Neurological reparative therapy (NRT) is a new model of treatment synthesized from a compilation of literature and research on how to better the lives of individuals who have a wide range of mental, emotional, and behavioral disturbances – particularly children and adolescents. Although the term "neurological reparative therapy" is new, the foundation of this model is not.

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The dynamic-maturational model of attachment and adaptation (DMM) is a biopsychosocial model describing the effect attachment relationships can have on human development and functioning. It is especially focused on the effects of relationships between children and parents and between reproductive couples. It developed initially from attachment theory as developed by John Bowlby and Mary Ainsworth, and incorporated many other theories into a comprehensive model of adaptation to life's many dangers. The DMM was initially created by developmental psychologist Patricia McKinsey Crittenden and her colleagues including David DiLalla, Angelika Claussen, Andrea Landini, Steve Farnfield, and Susan Spieker.

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References

  1. ↑ Becker-Weidman A., Hughes D. (2008). "Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment". Child & Adolescent Social Work. 13 (3): 329–337. doi:10.1111/j.1365-2206.2008.00557.x.
  2. ↑ https://www.cebc4cw.org/program/dyadic-developmental-psychotherapy/
  3. ↑ Hughes D (2003). "Psychological intervention for the spectrum of attachment disorders and intrafamilial trauma". Attachment & Human Development. 5 (3): 271–279. doi:10.1080/14616730310001596142. PMID   12944222. S2CID   33776982.
  4. 1 2 3 4 5 6 7 8 Hughes D (2004). "An attachment-based treatment of maltreated children and young people" (PDF). Attachment & Human Development. 6 (3): 263–278. doi:10.1080/14616730412331281539. PMID   15513268. S2CID   44452582. Archived from the original (PDF) on 25 July 2011.
  5. ↑ Bretherton I (1992). "The origins of attachment theory". Developmental Psychology. 28: 759–775. doi:10.1037/0012-1649.28.5.759.
  6. ↑ Holmes, J.(1993) John Bowlby and Attachment Theory, London:Routledge ISBN   0-415-07729-X
  7. 1 2 3 4 Becker-Weidman. Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy, Child and Adolescent Social Work Journal. 23(2), April 2006
  8. 1 2 Becker-Weidman, A., (2006b). Dyadic Developmental Psychotherapy: a multi year follow-up. in Sturt, S., (ed) New Developments in Child Abuse Research. NY: Nova
  9. 1 2 3 Chaffin M (2006). "Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems". Child Maltreatment. 11 (1): 76–89. doi:10.1177/1077559505283699. PMID   16382093. S2CID   11443880. |
  10. 1 2 3 Chaffin Mark, Hanson Rochelle, Saunders Benjamin E (2006). "Reply to Letters". Child Maltreat. 11 (4): 381–386. doi:10.1177/1077559506292636. S2CID   145525137.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. 1 2 Craven, Lee (2006). "Therapeutic Interventions for Foster Children: A systematic Research Synthesis". Research on Social Work Practice. 16 (3): 287–304. doi:10.1177/1049731505284863. S2CID   143942564.
  12. 1 2 3 4 Pignotti M., Mercer J. (2007). "Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions: A systematic research synthesis revisited". Research on Social Work Practice. 17 (4): 513–519. doi:10.1177/1049731506297046. S2CID   143261269.
  13. 1 2 3 4 5 Mercer Jean (2014). "Examining Dyadic Developmental Psychotherapy as a Treatment for Adopted and Foster Children: A Review of Research and Theory". Research on Social Work Practice. 24 (6): 715–724. doi:10.1177/1049731513516514. S2CID   144696855.
  14. ↑ Advocates for Children in Therapy - Daniel Hughes.
  15. ↑ Daniel A. Hughes (1997). Facilitating Developmental Attachment: The Road to Emotional Recovery and Behavioral Change in Foster and Adopted Children. Publisher Jason Aronson Inc. Retrieved 30 November 2014.
  16. ↑ Wingfield M, Gurney-Smith B. (2018). Adoptive parents’ experiences of dyadic developmental psychotherapy. Clin Child Psychol Psychiatry. 2019;24(4):661-679. doi:10.1177/1359104518807737
  17. ↑ Mark Chaffin, Rochelle Hanson and Benjamin E. Saunders "Reply to Letters Child Maltreat 2006; 11, 381 doi : 10.1177/1077559506292636 "Dr. Becker-Weidman is cited three times in the body of the report, none of which refer to coercive techniques. The first citation references his Web site's assertion that traditional therapies are either ineffective or harmful (p. 78). The second citation references his recommendation that children be encouraged to regress to an earlier age as part of treatment (p. 79). The third citation references his assertions, which we believe are unsupported, about practicing an evidence-based treatment (p. 85)."
  18. ↑ Becker-Weidman Arthur (2006). "Letter to the Editor". Child Maltreat. 11 (4): 379–380. doi:10.1177/1077559506292632. PMID   17043325. S2CID   220341990.
  19. ↑ "Hughes went on to describe how his own practice of attachment therapy has changed during the years, specifically in terms of less emphasis on parental victory in power struggles, less use of holding techniques, and rejection of cathartic or dysregulated ventilation of past trauma in favor of approaches that sound very similar to well-supported gradual exposure techniques. Along with this, he offered some discussion of how he came to reconsider some of his own past attachment therapy practices."
  20. ↑ Becker-Weidmann, A. (3/7/2004). Dyadic Developmental Psychotherapy, retrieved 3/20/2004 from http://www.center4familydevelop.com/developmentalpsych.htm Archived 16 January 2021 at the Wayback Machine
  21. 1 2 Uta M. Walter, U., M. and Petr, C. Best Practices in Children's Mental Health: "Reactive Attachment Disorder: Concepts, Treatment and Research" Produced by the University of Kansas School of Social Welfare in conjunction with Kansas Social Rehabilitation Services pp 10–18
  22. ↑ Prior, V., and Glaser, D. (2006). Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice, Jessica Kingsley Publishers, Child and adolescent mental health series. | p268 | ISBN   1-84310-245-5.
  23. ↑ Trowell J (2004). "Reflections on 'an attachment-based treatment of maltreated children and young people'". Attachment & Human Development. 6 (3): 279–283. doi:10.1080/14616730412331281566. PMID   15513269. S2CID   26974869.
  24. 1 2 3 Mercer J (2015). "Revisiting an Article About Dyadic Developmental Psychotherapy: The Life Cycle of a Woozle". Child and Adolescent Social Work Journal. 32 (5): 397–404. doi:10.1007/s10560-015-0399-z. S2CID   145079126.
  25. ↑ Arthur Becker-Weidman | Letter to the Editor | Child Maltreat 2006 No 11 | p379 |
  26. ↑ "In our estimation, DDP still does not meet criteria as an evidence-based treatment, although the published findings do raise hopes that DDP may be promising. Examining the study, it shares many of the same limitations noted in the Task Force's evaluation of the Myeroff study (p. 85). For example, the study used a small convenience sample, participants were self-selected into treatment versus comparison conditions, the age range of participants was very broad (5-16), there was no direct statistical analysis of differential group change over time, outcome data were not collected by blind or impartial reporters, and the study utilized completer only rather than intent-to-treat methods. Of course, no study is without limitations; however, the fact remains that a single study with these sorts of major limitations, although a first step, is far short of the criteria that must be met before designating a treatment as evidence based. In general, we believe that designating a treatment as evidence based is a job for an independent treatment review panel (e.g., American Psychological Association, Substance Abuse and Mental Health Services Administration [SAMHSA], Office for Victims of Crime Task Force, Cochrane Collaborative, etc.) applying accepted and established scientific review criteria. None has listed DDP as meeting accepted criteria. Thus, it is our opinion that practitioners should not characterize or advertise DDP as an evidence-based practice at this time." Reply to Letters p3.
  27. ↑ Saunders, B.E., Berliner, L., & Hanson, R.F. (Eds.). (2004). Child Physical and Sexual Abuse: Guidelines for Treatment (Revised Report: 26 April 2004). Charleston, SC: National Crime Victims Research and Treatment Center. "Archived copy" (PDF). Archived from the original (PDF) on 1 July 2007. Retrieved 2 August 2007.{{cite web}}: CS1 maint: archived copy as title (link) Quote "Category 1: Well-supported, efficacious treatment; Category 2: Supported and probably efficacious; Category 3: Supported and acceptable; Category 4: Promising and acceptable; Category 5: Novel and experimental; and Category 6: Concerning Treatment"
  28. ↑ Gambrill E (2006). "Evidence-based practice and policy: Choices ahead". Research on Social Work Practice. 16 (3): 338–357. doi:10.1177/1049731505284205. S2CID   16407858.
  29. ↑ Becker-Weidman, A. (2004). Dyadic developmental psychotherapy: An effective treatment for children with trauma-attachment disorders. Retrieved 10 May 2005 from http://www.Center4familyDevelop.com
  30. ↑ Myeroff; et al. (1999). "Comparative effectiveness of holding therapy with aggressive children". Child Psychiatry and Human Development. 29 (4): 303–313. doi:10.1023/a:1021349116429. PMID   10422354. S2CID   20560678.
  31. ↑ Lee R.E., Craven P. (2007). "Reply to Pignotti and Mercer: Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions". Research on Social Work Practice. 17 (4): 520–521. doi:10.1177/1049731506297043. S2CID   144651333.
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