Dyadic Developmental Psychotherapy (DDP) is a treatment approach for families of traumatized children or those with disorders of attachment. It was originally developed by Daniel Hughes, an expert in attachment and trauma. DDP principally involves creating a PLACE (playful, loving, accepting, curious, and empathic) environment in which the therapist and the parent attune to the child’s emotions 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.

The therapy is family-focused and parents are actively involved in the treatment. Parents’ own emotional and relationship problems are addressed during the treatment process. Parents are coached in the model and taught parenting strategies that promote safe and appropriate management of behaviors and a healthy attachment. Being able to have empathy for the child, accept the child and be curious and playful are all parts of the “attitude” that heals.

Attunement is a cornerstone of this therapy. Attunement simply means to bring yourself into a receptive or harmonious relationship. In DDP, the therapist (and the parents as they are coached by the therapist) will seek to attune themselves with the child, to better create a safe environment for healthy attachment.

DDP is an experiential therapy, meaning that it involves continuous reciprocal experiences between the therapist and child and the parent and child, with the adult reading non-verbal cues and providing a response to the child, adjusting his interactions to meet the child’s needs. The approach recognizes that the roots of attachment disorder are pre-verbal, so experiences not talk therapy are necessary for healing.

Trauma is directly addressed, in a safe and secure environment, with the goal being to resolve the child’s painful and shameful emotions. Holding is one of the experiential methods used as a way to cradle the child, providing a multi-sensory experience to facilitate attunement. Restrictive, invasive and constricting holds are not used.

The child’s avoidance, resistance and controlling behaviors are viewed as survival skills that were developed when the child was under overwhelming trauma. These behaviors are met with empathy and adults who remain emotional regulated themselves to model self-regulation for the child.

Research has been done on DDP that show statistically significant improvements.

View research article here

Attachment Focused Treatment Institute- certification program for therapists
Center for Family Development
Daniel Hughes Website
California Evidence-Based Clearinghouse for Child Welfare – DDP


Dyad Therapy – Dyadic Developmental Psychotherapy (DDP)

A picture showing two individuals engaged in dyad therapy session for better understanding and communication

The bond between a parent and a child is undeniably one of the most powerful connections in the human experience. This relationship plays a crucial role in a child’s emotional, social, and cognitive development. However, when challenges arise, such as emotional trauma or attachment issues, it can be difficult for parents and children to navigate these complexities alone. This is where Dyadic Developmental Psychotherapy (DDP) and Dyad Therapy come into play, offering evidence-based therapeutic approaches that focus on the parent-child relationship to address these challenges and promote healthy attachment.

DDP and Dyad Therapy have shown remarkable success in transforming the lives of children and families, helping them overcome emotional trauma and build stronger, healthier relationships. By understanding and applying the principles of attachment theory, these therapies empower both parents and children to heal and grow together.

We will dive deep into the world of DDP and Dyad Therapy, exploring their foundations, techniques, and approaches, as well as the evidence supporting their effectiveness. We will also discuss the challenges and limitations of these therapies and share real-life success stories that demonstrate their transformative power. So, let’s begin our journey into the realm of Dyad Therapy and its life-changing potential.

Key Takeaways

Understanding DDP and Dyad Therapy


Dyadic Developmental Psychotherapy (DDP) and Dyad Therapy are therapeutic approaches that focus on the parent-child relationship, aiming to address emotional trauma and foster healthy attachment in young children. At the core of these therapies is the concept of attunement, which refers to the capacity of the parent to comprehend and empathize with their child’s inner experiences, providing the child with a sense of safety and emotional alignment necessary for emotional security and regulation.

One type of Dyad Therapy is Toddler-Parent Psychotherapy, which specifically aims to reorganize attachment in young children of mothers with major depressive disorder. Another approach, Child Parent Psychotherapy, also contributes to enhancing early childhood mental health by addressing the emotional needs of both the child and parent. Incorporating Infant Parent Psychotherapy as an additional method, Dyad Therapy, by reaching out to these vulnerable groups, significantly promotes secure parent-child bonds, especially for a young child.

The foundation of Dyad Therapy lies in attachment theory, which emphasizes the importance of secure attachment for a child’s emotional and psychological well-being. Dyad Therapy addresses children’s behavior, emotional regulation, and overall development by concentrating on the parent-child relationship. This approach assists both parent and child in understanding their complex relationship and healing from past traumas.

The Importance of Attachment Theory in Dyad Therapy

A parent and child interacting, demonstrating the importance of attachment theory in dyad therapy

Attachment Theory, formulated by British psychoanalyst John Bowlby, explains the emotional bonds and relationships between people, particularly between a child and their primary caregiver. This theory postulates that individuals are innately predisposed to form attachments and seek closeness with others, highlighting the significance of secure attachment bonds for mental health and development.

In Dyad Therapy, Attachment Theory plays a paramount role, as it serves as the theoretical foundation for understanding the formation, growth, and dynamics of relationships. Dyad Therapy focuses on complex trauma, reactive attachment issues, and other attachment-related issues in infant mental health. The therapist assists the parent or caregiver in distinguishing current behaviors from past attachment experiences and strives to mend and strengthen the attachment bond between the parent and child. In this way, Dyad Therapy employs the tenets of Attachment Theory to foster healing and secure attachment relationships.

Dyad Therapy nurtures secure attachment in children, thereby aiding parents in fulfilling their children’s psychological and practical needs and enabling them to respond fully to their children. This approach creates a high-quality parent-child relationship and encourages secure attachment, which is essential for healthy social and emotional development.

In essence, Attachment Theory serves as the backbone of Dyad Therapy, guiding therapists and families towards healthier, more fulfilling relationships.

Parent-Child Dyads: The Core of Dyad Therapy

A parent and child in a dyad therapy session, demonstrating the core of dyad therapy

A Parent-Child Dyad in the context of Dyad Therapy is a therapeutic relationship between a parent and their child, serving as the core focus of Dyad Therapy. The therapy sessions are designed to improve the quality of the parent-child dyad and promote healing through the therapeutic relationship. The therapist works collaboratively with the parent and child to strengthen their connection, communication, and mutual understanding.

In Dyad Therapy, particularly when dealing with adopted and foster children, the parent takes an active role. They are actively engaged in the therapeutic process and are briefed by the therapist on their role. The therapy centers on the parent-child relationship and seeks to effectively tackle both the parent and the child.

Dyad Therapy aims to delve into the attachment backgrounds of both the parent and the child, seeking a deeper comprehension of their bond. Furthermore, the therapist encourages changes in their interactions to improve the bond between the parent and child. While there is evidence supporting the effectiveness of Dyad Therapy, more randomized controlled trials are needed to further validate its efficacy.

Types of Dyad Therapies

Various types of Dyad Therapies exist, each targeting specific issues and populations. Dyadic Developmental Psychotherapy (DDP) is an evidence-based treatment for complex trauma and attachment issues. In addition, there are other evidence-based dyadic psychotherapies for young children, which seek to effectively address both the parent and the child in the therapeutic process.

Foster/Adoptive Family Dyad Therapy, also known as Dyadic Developmental Psychotherapy (DDP), is a form of therapy specifically created to assist children and young people who have suffered trauma and have ensuing psychological difficulties. It focuses on the particular needs and challenges faced by foster and adoptive families. By contrast, standard Dyad Therapy refers to any therapy involving treatment given to a parent and child simultaneously, and may not be specifically tailored to address the intricate issues in foster and adoptive families.

Abuse/Neglect Dyad Therapy, on the other hand, is geared towards treating children who have experienced trauma, abuse, or neglect within their families. Its objective is to address the developmental deficits resulting from these occurrences and to offer healing and assistance to the child and their caregiver simultaneously. By providing a range of Dyad Therapies tailored to various needs and populations, therapists can offer targeted, effective help to those who need it most.

Dyadic Developmental Psychotherapy (DDP)

DDP is a psychotherapeutic treatment approach designed to help families with children who are struggling with emotional issues, such as complex trauma and attachment disorders. It offers an invaluable resource to those in need of support and guidance. DDP relies on a variety of theoretical foundations, encompassing:

These theories have all been integrated to form the groundwork of DDP.

DDP treatment follows a certain structure. This structure ensures effectiveness of the required steps. The therapist works to ensure safety in DDP by inquiring into memories, experiences, and emotions with nonverbal attunement, reflective and impartial dialogue, empathy, and consolation. DDP therapists strive to reconstruct and restore the relationship by teaching the parents a form of parenting that accommodates the individual needs of their children.

Creating an autobiographical narrative plays a key role in fostering secure attachment in DDP. The therapist creates a nurturing environment in order to connect with the child’s feelings. This connection is formed through their body language, vocal expressions and timing. Together they regulate emotion and create a new narrative around the child’s life.

Implementing Dyad Therapy: Techniques and Approaches

In Dyad Therapy, the implementation of PACE (Playfulness, Acceptance, Curiosity, and Empathy) is common. The therapist strives to develop a secure, nurturing environment using:

PACE parenting, which is closely related to parent child interaction therapy, assists parents in staying emotionally engaged and available to their preschool children, thereby fostering attunement, attachment security, and positively influencing the child’s behavior.

Establishing safety when exploring memories and emotions in Dyad Therapy involves:

Dyad Therapy also utilizes techniques such as visual contact, nonverbal communication, and psychoeducation. Usually, individual sessions for the child and the caregiver are conducted before conjoint sessions. The purpose is to reinforce the attachment bond between the child and caregiver and facilitate recovery from prior trauma.

Evidence-Based Treatment and Research on Dyad Therapy

Research endorses the efficacy of Dyad Therapy in enhancing parent-child relationships and mitigating the effects of early trauma on children’s brain development and self-perception. A 2006 research synthesis described Dyadic Developmental Psychotherapy as a “supported and acceptable” treatment, with DDP being recognized as an evidence-based treatment by the California Evidence-Based Clearinghouse for Child Welfare.

Recent studies have corroborated the effectiveness of Dyad Therapy in improving parent-child relationships. For example, a study by SM Campbell et al. (2023) found that Dyad Therapy was efficacious in reducing children’s disruptive behaviors and improving parent-child relationships. Additionally, J Mattheß et al. (2021) conducted research on parent-infant psychotherapy (PIP), which utilizes a dyadic approach to improve the mother-child relationship and the infant’s attachment.

Despite the positive outcomes, there is a need for more randomized controlled trials to further validate the efficacy of Dyad Therapy. By conducting more research, including randomized controlled trial, and gathering additional evidence, the field of Dyad Therapy can continue to evolve and improve its ability to help children and families overcome emotional trauma and build stronger, healthier relationships.

Challenges and Limitations of Dyad Therapy

A potential shortfall of Dyad Therapy is its narrow scope, concentrating primarily on particular groups like foster and adoptive families. This restricts its applicability, as it may not be suitable or effective for individuals outside of those populations. The therapy is constructed to address the distinct needs and difficulties of specific groups, and may not be as successful when applied to individuals who do not possess those characteristics. Additionally, the techniques and interventions utilized in Dyad Therapy may not be applicable or relevant to individuals from different populations.

A further obstacle in Dyad Therapy is the requirement for additional randomized clinical trials to authenticate its efficacy. While there is already evidence supporting the effectiveness of Dyad Therapy, more robust research is necessary to confirm its benefits and identify areas for improvement.

Despite these limitations, Dyad Therapy has shown significant promise in helping children and families overcome emotional trauma and build stronger, healthier relationships. As research progresses and the field continues to evolve, Dyad Therapy can potentially transform the lives of countless children and families in need.

Real-Life Success Stories: Dyad Therapy Transforming Lives

A family smiling, demonstrating the success of dyad therapy in transforming lives

Real-life success stories demonstrate the transformative power of Dyad Therapy in helping children and families overcome emotional trauma and build stronger, healthier relationships. For example, the case of Cameron, a 9-year-old with Autism Spectrum Disorder (ASD), showcases the positive changes in his development and well-being attributed to dyadic therapy.

Families who have experienced the benefits of Dyad Therapy have reported positive outcomes and transformations in their lives. These testimonials highlight the potential of Dyad Therapy to make a significant impact on the emotional, social, and cognitive development of children and the overall well-being of families.

Although the success rate of Dyad Therapy in addressing emotional trauma in children is encouraging, the high attrition rates in dyadic therapies must also be recognized. Nevertheless, the life-changing potential of Dyad Therapy continues to inspire hope and healing for countless children and families.


In summary, Dyadic Developmental Psychotherapy (DDP) and Dyad Therapy offer valuable therapeutic approaches that focus on the parent-child relationship, addressing emotional trauma and fostering healthy attachment in young children. By understanding and applying the principles of attachment theory, these therapies empower both parents and children to heal and grow together.

As we have explored the foundations, techniques, and approaches of Dyad Therapy, along with the evidence supporting its effectiveness and the challenges and limitations it faces, it is clear that Dyad Therapy holds immense potential in transforming the lives of children and families. With continued research, development, and dedication to helping those in need, Dyad Therapy can truly make a lasting impact on countless lives.


Frequently Asked Questions

What are the goals of dyadic therapy?

The goals of Dyadic Therapy are to develop a more secure attachment pattern, resolve trauma symptoms, and secure a permanent connection with the caregiver.

What are the different types of dyadic therapy?

The three most commonly used dyadic therapies are Child-Parent Psychotherapy, Parent-Child Interaction Therapy and Attachment and Biobehavioral Catch-up (ABC). All of these models aim to improve young children’s emotional wellbeing and development.

What is dyadic effect in counseling?

The dyadic effect in counseling is the relationship between two individuals (e.g. therapist-patient) which affects interactions, coping strategies and emotional regulation. It is a powerful dynamic tool used by counselors to assist clients to better regulate their emotions and benefit from the experience.

How does Dyad Therapy facilitate secure attachment in children?

Dyad Therapy encourages parents to respond to their children’s psychological and practical needs, creating the foundation for a secure attachment.

What are the key techniques and approaches used in Dyad Therapy?

Dyad Therapy uses techniques such as PACE parenting, creating an autobiographical narrative, and establishing safety for exploring memories and emotions to help foster growth in a supportive environment.