Atlas›Domain V · Systemic, relational, group & community›Guide 053
Guide V-053

Dyadic developmental psychotherapy

Daniel Hughes
A 47 · L 29 · M 2428 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Dyadic Developmental Psychotherapy as taught by DDPI Worldwide (the DDP Network), the model developed by Daniel Hughes. I worked from the DDPI programme description on CEBC, DDP Level One and Level Two training slides (Kim Golding and colleagues, hosted by the Australian Childhood Foundation), a Golding masterclass, Becker-Weidman's components summary, and Hughes (2004). The current DDPI manuals are Hughes & Golding (2024), Healing Relational Trauma Workbook, and Golding (2026), DDP Guide: Healing Childhood Trauma. Neither book is drawn on [uncertain]. Where the training slides and the 2004 paper differ in emphasis, I follow the DDPI training version.

DDP is a caregiver-child psychotherapy for children aged about 2 to 18. It is meant for children hurt or neglected within their early relationships: developmental trauma, reactive attachment disorder, disinhibited social engagement, and children in foster, kinship, adoptive or residential care. It is attachment-based and draws on intersubjectivity theory and interpersonal neurobiology. The theory of change: the child learns who they are from how attuned adults experience them. The therapist and caregiver build repeated moments of felt safety, shared emotion (attunement), shared attention and shared intention. Within those moments, two things happen together. Adults co-regulate the child's fear and shame, and adult and child co-create new meanings for the child's experience. Over time this produces regulation, reflective capacity, trust in caregivers and a more coherent, less shame-based life story. Hughes (2004) states the core directly: "The co-regulation of affect and the co-construction of meaning are central". [source: CEBC DDPI entry; Level Two slides 4–8, 29; Hughes 2004; Becker-Weidman components]

The same principles are used outside therapy. DDP-informed parenting means parenting with PACE, and Dyadic Developmental Practice covers schools, residential care and social care. This guide covers the psychotherapy and the caregiver work inside it. [source: Oxfordshire DDP page; CELCIS review of Golding, Thompson & Grant 2024]

2. Framework

DDP has no fixed session-by-session protocol. The sources describe a caregiver-first sequence, a flexible mix of formats, and a developmental order of treatment goals. [source: CEBC; Christopher et al. 2025; Level Two slides]

Stage A: assessment and caregiver-only work (always first)

  • Goals:
    • build a collaborative, trusting therapist-caregiver alliance;
    • hear the caregiver's story of the child and of the relationship;
    • explore the caregiver's own attachment history and current struggles (anxiety, hypervigilance, burnout, secondary stress, low mood, feeling close to breakdown);
    • help the caregiver with their own feelings first;
    • give the caregiver the experience of PACE so they can offer it in turn.
  • If the caregiver harmed the child or failed to protect them, the caregiver must fully accept responsibility before joint work.
  • [source: CEBC; Golding masterclass slides 19, 28–29; Hughes 2004]
  • Criterion for moving on: dyadic sessions begin only when the caregiver can be "open and curious with their child in the room" (CEBC). Christopher et al. (2025) describe the same order: joint sessions once the caregiver-therapist alliance is established.

Stage B: dyadic (caregiver + child) sessions, with caregiver-only sessions as needed

  • Each dyadic session opens with a caregiver check-in. Attention then shifts to the child.
  • The therapist uses affective-reflective dialogue, talking-for and talking-about, and helps the caregiver practise co-regulation.
  • Caregiver-only sessions continue alongside, or alternate, according to need. [source: CEBC]
  • Children valued routines such as games, drinks and snacks, the caregiver's presence, choice, and a mix of lightness and depth. [source: Christopher et al. 2025]

Developmental order of treatment goals (Level Two slide 4; treat this as an order of priorities, not timed phases [uncertain]):

  1. Safety.
  2. Regulation.
  3. Reflection.
  4. Relational engagement.
  5. Integration of trauma experience.
  6. Enhancement of positive affect.

The slides describe a chain: safety allows synchronised back-and-forth interaction; that supports conversations; conversations become stories; stories build an integrated self and a coherent autobiographical narrative. Do not move to trauma themes while the child has no felt safety or no regulating adult. [source: Level Two slides 4, 8; synthesis for the last sentence]

Format and dose

  • Sessions: usually 1–2 hours, weekly, fortnightly or monthly by clinical need.
  • Settings: clinic, home, foster or kinship care, residential care, schools, or video.
  • Who attends: extra carers (grandparents, residential staff) may join.
  • Between sessions: no formal homework.
  • Recording: sessions are video-recorded for supervision. [source: CEBC]
  • Length of therapy: no recommended number of sessions. About 20 is considered typical. In one UK sample, children attended between 4 and 60 sessions (mean 36.7). [source: Christopher et al. 2025]

Without a caregiver

  • Individual DDP is possible, usually with adolescents who have no available attachment figure. It needs more attention to safety and a slower pace, because the child is emotionally alone between sessions. [source: Hughes 2004; Becker-Weidman components]
  • In residential care, a specially selected care worker with training, commitment, continuity and attachment security can take the caregiver role. [source: Hughes 2004]

Ending

  • The sources give no ending criteria [uncertain].
  • Suggested markers [synthesis]: the child seeks comfort from the caregiver when distressed; the caregiver can do PACE and repair at home without prompting; the child can join an affective-reflective conversation about hard events without collapsing into shame. Then taper the frequency rather than stopping abruptly.

Certification and name use

  • To practise under the DDP name you need:
    • a mental-health, social-care or education qualification;
    • licensing or registration (e.g. HCPC, BACP, UKCP, Social Work England), or the attestation route;
    • DDP Level One (28 h) and Level Two (28 h) training from a DDPI-certified Trainer, normally at least six months apart;
    • a DDP Primary Consultant;
    • an initial session recording reviewed against the DDP Rating Scale;
    • a supervised practicum leading to Practitioner certification.
  • Certificates limited to parents or caregivers only, or to educational settings only, must say so in any DDP title.
  • Practicum rules are due to change on 1 January 2027.
  • Fidelity is checked by reviewing recorded sessions with a DDP consultant. [source: DDPI practicum page; CEBC]

3. Guiding principles

[source for this section: Becker-Weidman components; Level One slides 11–32; Level Two slides 6–38; Golding masterclass; Hughes 2004; CEBC]

  • Intersubjectivity is the heart of DDP. In practice: aim every exchange at shared emotion, shared focus and a shared purpose with the child; this, not insight, is the active ingredient.
  • PACE is the stance, and every technique sits inside it. PACE means Playfulness, Acceptance, Curiosity, Empathy. In practice: any technique delivered without PACE can dysregulate the child, so when in doubt, return to PACE rather than to technique.
  • Safety is physiological and comes first. In practice: change the child's nervous-system state before expecting social engagement. Telling a child to feel safe or to trust does not work; they must experience safety many times.
  • Cues of safety travel through voice, face and rhythm. In practice: use a varied, prosodic voice, soft eyes and an animated face. A still, blank face is disorganising for these children.
  • Experience over content. In practice: stay with what an event meant and felt like to the child, not with its facts or details.
  • The adults' attachment states matter. In practice: assess and support the caregiver's own history, and reflect on your own in supervision. An unresolved adult cannot hold the child's distress.
  • Caregiver as primary source of safety, and as co-therapist. In practice: the child explores fear and shame while leaning on the caregiver. Your job is to help the caregiver understand and say what they think, feel and intend.
  • Offer PACE to the caregiver before asking them to offer it. In practice: parent sessions use the same stance you use with the child.
  • Intend acceptance, not change. In practice: children sense a change agenda and resist it. Accept the inner experience (thoughts, feelings, wishes) without evaluating it, while still limiting behaviour.
  • Separate the person from the behaviour. In practice: this reduces shame. Acceptance does not mean tolerating harmful behaviour.
  • Shame is the main barrier. In practice: when shame rises, respond with empathy and curiosity about its impact, never with lecture or correction.
  • "Resistance" signals distress, not low motivation. In practice: meet it with curiosity and empathy, not pressure.
  • Do not force engagement. In practice: offer choices, accept refusals, and drop a theme the child rejects.
  • Adults own repair. In practice: "The attachment figures – parent and therapist – are responsible for the initiation of repair" (Becker-Weidman). Never wait for the child to make amends.
  • No correction without connection (two hands). In practice: one hand gives warmth, nurture and curiosity; the other gives structure, limits and consequences. Use both, with connection before, during and after correction.
  • Emotional age, not chronological age. In practice: pitch expectations and language to how old the child is emotionally.
  • "If your client/child could do better they would" (Golding). In practice: assume a missing capacity, not an unwillingness.
  • Find something to like. In practice: look for genuine moments of delight; the child needs to see that delight in the adult's eyes.
  • Curiosity means not-knowing. In practice: wonder rather than interpret. Offer guesses tentatively and let them go if they do not fit.
  • Empathy without dysregulation. In practice: feel the child's anger or fear with them without becoming angry or frightened yourself.
  • Move between lightness and depth, at the child's pace. In practice: follow intense moments with relaxed connection.
  • Commitment. In practice: the adults convey they will stay through conflict. Becker-Weidman lists commitment as a component; the sources do not detail it [uncertain].

4. Intervention inventory

All example language below is my own illustrative wording unless it is in quotes with a source. Steps are paraphrased from the cited sources. Where I added detail to make a step usable, it is tagged [synthesis].

A. Caregiver-only work

4.1 Caregiver alliance and assessment sessions

  • Purpose / when: the first sessions of every case, before the child attends, and again whenever the caregiver is struggling. [source: CEBC; Christopher et al. 2025]
  • Steps:
    1. Meet the caregiver(s) without the child. Offer PACE to them: be curious about their experience, not just the child's behaviour.
    2. Gather the caregiver's story of the child and of the relationship: what it is like to live with this child, what they hoped for, and what has hurt.
    3. Explore the caregiver's own attachment history and current stress (anxiety, hypervigilance, burnout, low mood).
    4. Help the caregiver with their own feelings first. Notice their state of mind about attachment (organised and resolved, or not).
    5. Gather the child's history (early care, placements, losses) so you can later hold it in mind with the caregiver [synthesis: standard practice; the sources say treatment uses the child's history but do not list an intake format].
    6. Decide the format (caregiver-only, dyadic, or both) and whether the caregiver is ready for joint sessions.
    • [source: CEBC; Becker-Weidman components, principle 1; Hughes 2004]
  • Example language (illustrative): "Before we think about him, I'd like to understand what these months have been like for you." "When he pushes you away like that, what happens inside you?"
  • Watch for:
    • signs of unresolved loss or trauma in the caregiver's own story;
    • defensiveness or a rigid behavioural focus;
    • whether the caregiver can wonder about the child's mind.
    • Readiness to move on is shown when the caregiver can be open and curious with the child in the room (CEBC).

4.2 Parent support session (Golding's sequence)

  • Purpose / when: a structured way through a caregiver-only session when the caregiver arrives stressed or stuck. Golding's worked example (Sue) runs about 90 minutes. [source: Golding masterclass slides 20–26]
  • Steps:
    1. Connect and explore their current experience (a hard week, an incident).
    2. Explore the impact on the caregiver: slow them down and notice the feelings the child stirs in them.
    3. Draw out and co-regulate the feeling underneath (shame, fear, despair, anger), holding it steady with them.
    4. Explore links to past relationships in the caregiver's own life, if they are ready.
    5. Co-create new meanings for the caregiver's own reactions.
    6. Connect emotionally to the child's experience: what makes this so hard for the child?
    7. Explore how the caregiver can connect with and respond to the child.
    8. Only then, explore behaviour support (see 4.19–4.21).
  • Example language:
    • From Golding's slides: "It must be hard to feel you are making any difference?" and "I am guessing that has to hurt?".
    • Illustrative: "I'm wondering if part of you feels you have to get this exactly right, and that's exhausting."
  • Watch for:
    • Do not jump to strategies at step 1.
    • Working signs: the caregiver softens, moves from blame to curiosity, and starts asking about the child's inner world.

4.3 Identifying and addressing blocked care

  • Purpose / when: the caregiver tries to stay open to the child but it has become too painful, and parenting has become survival. [source: Level One slides 7–8; Golding masterclass slides 34–37]
  • Steps:
    1. Look for the signs:
      • defensive rather than open parenting;
      • reactive responses;
      • correction outweighing connection;
      • shame, despair or resentment;
      • shrinking hopes for the child;
      • little enjoyment of the child.
    2. Identify the type: chronic (often linked to the caregiver's own attachment history), acute (a current stressor drains their capacity), or child-specific (this child's rejection wears them down).
    3. Name it without blame. Explain blocked trust in the child and blocked care in the adult as linked, understandable reactions.
    4. Strengthen care for the carer:
      • practical and emotional support;
      • self-regulation practices (mindfulness or relaxation);
      • accepting care from their own attachment figures;
      • referral for their own therapy for unresolved losses where needed.
    5. Delay or reduce dyadic intensity until some capacity returns [synthesis].
  • Example language (illustrative): "What you're describing sounds like what happens to many devoted carers. When a child keeps rejecting care, the caring system protects itself by shutting down. It's not a failure of love."
  • Watch for:
    • shame in the caregiver at being "found out" (offer acceptance);
    • recovery shown by moments of enjoyment and renewed curiosity about the child.

4.4 Psychoeducation for caregivers: blocked trust and survival strategies

  • Purpose / when: early on, to reframe the child's controlling, avoidant or aggressive behaviour as survival adaptations. [source: Level Two slides 27–41; Oxfordshire DDP page]
  • Steps:
    1. Explain that the child's nervous system detects threat without conscious awareness, and that friendliness and eye contact appear only when the child feels safe.
    2. Describe common consequences of disconnection:
      • hypervigilance;
      • not noticing when they are safe;
      • a strong need for control;
      • resisting authority;
      • looking after themselves rather than seeking care;
      • suppressed curiosity, joy and comfort-seeking.
    3. Explain the child's likely internal working model ("I am bad and unlovable; adults are unsafe and unreliable").
    4. Use the training's metaphors if helpful: the Tiger, Possum and Chameleon survival strategies.
    5. Link each explanation to a specific incident the caregiver has described.
  • Example language (illustrative): "When she takes charge of everything, it may be the safest thing she ever learned. Adults in charge used to mean danger."
  • Watch for: psychoeducation used to excuse behaviour or to argue with the caregiver. Keep it brief and tie it to their experience.

4.5 Caregiver arousal-state guide (regulation-based parenting)

  • Purpose / when: coaching caregivers to match their response to the child's (and their own) arousal. [source: Golding masterclass slides 32–33, 53]
  • Steps: teach the gradient:
    • Calm: the child can reflect, and mind-minded conversation is possible.
    • Aroused: thinking narrows and becomes concrete.
    • Alarmed: be curious on the child's behalf, with acceptance and empathy.
    • Fearful: use clear, simple, accepting words.
    • Terror: keep self and child safe with structure and nurture; reflection waits until later.
    • Rehearse with recent incidents.
  • Example language (illustrative): "In that moment he was past talking. What did he need from you then, and what could wait until he was calm?"
  • Watch for: caregivers attempting reflective talks during meltdowns. Success shows when they describe holding off reflection until later.

B. The PACE stance as moment-to-moment moves

[source for 4.6–4.9: Golding masterclass slides 28–46; Level One slides 11, 31–32; Hughes 2004]

4.6 Playfulness

  • Purpose / when: to bring lightness, hope and shared enjoyment, and to help the child tolerate positive emotion. Use it to open sessions, after intense moments, and as a regulator.
  • Steps:
    1. Use a light, spontaneous tone, humour and shared delight (the "shining eyes" of an adult who enjoys the child).
    2. Keep it brief and attuned. Drop it at once if the child experiences it as mocking or minimising.
    3. Help the child manage the shift between play and adult authority, which can trigger rapid anger (Golding's principle seven).
  • Example language (illustrative): "Hang on, you beat your mum at this game three times? I think we need a rematch with new rules."
  • Watch for:
    • Playfulness during the child's distress, or about trauma content, is misattunement [synthesis].
    • Working signs: shared laughter, the child relaxing, the child looking at the caregiver's face.

4.7 Acceptance

  • Purpose / when: constantly. It communicates that the child's inner life (wishes, thoughts, feelings, beliefs, perceptions) is neither right nor wrong. It is simply theirs.
  • Steps:
    1. Reflect the child's experience without evaluating, correcting or reassuring it away.
    2. Separate the child from the behaviour: accept the feeling and the motive, and limit the act.
    3. Accept "I hate you" or "I don't care" as the child's experience right now, and stay engaged.
  • Example language (illustrative): "You really believe Mum likes your sister more. That must feel awful. I'm glad you told us."
  • Watch for:
    • caregivers arguing the child out of their perception;
    • acceptance mistaken for permissiveness.
    • Working sign: the child keeps talking rather than escalating.

4.8 Curiosity (wondering aloud)

  • Purpose / when: to discover the meaning beneath behaviour together, from a not-knowing stance.
  • Steps:
    1. Wonder rather than interpret. Make tentative guesses and be ready to drop them.
    2. Avoid interrogating "why?" questions [synthesis: consistent with "wondering" and "tentative exploration"; the slides give stems instead].
    3. Use stems from the training slides: "I wonder what's going on…?", "How come…?", "No wonder you… if…".
    4. Look for alternative stories about the event that are less shaming.
  • Example language (illustrative): "I wonder if when Dad said no, it felt like he didn't care about you at all. No wonder you got so angry, if that's what it felt like."
  • Watch for: curiosity that is really a hidden lecture. Working sign: the child corrects or adds to your guess.

4.9 Empathy

  • Purpose / when: after curiosity has found the meaning, so the child feels felt and not alone with it.
  • Steps:
    1. Share the emotion visibly through face, voice and rhythm, while staying regulated ("experience anger without getting angry", Golding).
    2. Show your own sadness or concern about what the child lived through; Hughes describes doing this openly.
    3. Stay with the feeling. Do not rush to fix it or reassure.
  • Example language (illustrative): "That's so sad. You were only little and nobody came. I feel sad just thinking about it."
  • Watch for: overwhelm (shift to talking-about, 4.13). Working signs: softening, tears, eye contact with the caregiver, leaning in.

C. Core dyadic-session techniques

4.10 Session opening: caregiver check-in, then turning to the child

  • Purpose / when: at the start of every dyadic session. [source: CEBC; Christopher et al. 2025]
  • Steps:
    1. Briefly check in with the caregiver about the week and anything the child may want to talk about.
      • [synthesis] Agree beforehand, in a caregiver-only contact, what will be raised. That way the child is not ambushed with reports of misbehaviour.
    2. Turn attention to the child with warmth and lightness: a game, drink or snack ritual if the family uses one.
    3. Offer choice about where to sit, whether to continue, and whether to stop early.
  • Example language (illustrative): "Mum's told me you had your cousin's party this week. Before anything else, who won musical chairs?"
  • Watch for: a caregiver opening with a list of complaints. Redirect gently and take it up in the next caregiver-only contact.

4.11 Affective-reflective (A-R) dialogue

  • Purpose / when: the main vehicle of DDP. It is a conversation that integrates the emotional meaning and expression of an experience with cognitive understanding, keeping the emotional experience alive while making sense of it. It is the main way to create and deepen intersubjective experience. [source: Level One slide 15; Level Two slides 31, 35]
  • Steps:
    1. Start from a small, current event or something the child mentions.
    2. Use a storytelling voice: vary your rhythm, pace and intensity, and match the vitality of the child's affect.
    3. Track the child's nonverbal cues constantly.
    4. Explore with curiosity, then respond with acceptance and empathy as meaning emerges.
    5. Alternate deepening the feeling (talking-for, 4.12) with stepping back to reflect (talking-about, 4.13).
    6. Stay with the experience of the event, not its facts.
    7. Move between relaxed connection and more intense exploration (4.15).
  • Example language (illustrative): "So the teacher moved your seat… and something in you went, here we go again, I'm the bad kid. Is that a bit like it was?"
  • Watch for the obstacles the training lists (Level One slide 18):
    • angry criticism and defensiveness;
    • competing monologues or venting;
    • lectures and evaluations;
    • distancing ("I don't care");
    • problem-solving too early.
    • Working signs: the child joins the rhythm, adds their own words, and stays regulated while emotion is present.

4.12 Talking-for

  • Purpose / when: to put the child's likely inner experience into words, which tends to deepen the felt experience. Use it when the child cannot find words but is regulated enough. [source: Level One slide 15; Level Two slide 35; Hughes 2004]
  • Steps:
    1. Ask permission or signal the move: "Can I guess what you might want to say to Mum?"
    2. Speak in the first person as the child, often addressed to the caregiver, using a voice and pace that match the child's affect.
    3. Check it: invite the child to correct you or say it in their own words.
    4. If the child rejects the role or disputes the words, stop speaking for them and invite their own words (Hughes 2004).
  • Example language (illustrative), to the caregiver as the child: "Mum, sometimes when you're cross I think you're going to send me away like before. So I get cross first." Then to the child: "Did I get that right, or is it different?"
  • Watch for:
    • the child rejecting the role or going blank;
    • heightened arousal (switch to talking-about).
    • Working signs: the child nods, corrects details, or takes over the words.
    • The caregiver's response afterwards matters most; coach them to respond with acceptance and empathy, not reassurance or correction [synthesis].

4.13 Talking-about

  • Purpose / when: to step back and reflect on the child's experience, which gives the child a break to regulate and increases reflection. Use it when the child is overwhelmed, avoidant or not ready to engage directly. [source: Level One slide 15; Level Two slide 35]
  • Steps:
    1. Turn to the caregiver and talk about the child's experience with the child present, in a warm, storytelling voice. Avoid a clinical tone.
    2. Keep it accepting and empathic; never talk about the child's faults.
    3. Invite the caregiver to wonder aloud with you.
    4. Leave space for the child to join, correct or listen.
  • Example language (illustrative), to the caregiver: "I've been thinking how brave Sam has been, coming to a new family after so many moves. I wonder if part of him is still waiting to see whether this one lasts."
  • Watch for:
    • talking-about that turns into a complaint about the child;
    • the child feeling excluded.
    • Working signs: the child calms down, listens, or interjects.

4.14 Follow-lead-follow

  • Purpose / when: throughout, to balance the child's autonomy with the therapist's responsibility to approach difficult themes. [source: Level One slide 15; Level Two slide 35; Becker-Weidman components]
  • Steps:
    1. Follow: join the child's topic, mood and rhythm.
    2. Lead: gently introduce a related, more meaningful theme, such as an event the caregiver mentioned or the feeling under a story.
    3. Follow again: track the child's response. If they move away, go with them and return later if appropriate.
  • Example language (illustrative): "That Lego dragon is fierce. Is he guarding something?" (follow). "Mum said Tuesday was a tough day for you two" (lead). If the child changes the subject: "OK, back to the dragon. We can come back to Tuesday another time" (follow).
  • Watch for: leading that keeps pressing after the child signals no. The children in one study described adults who pushed a topic as having "seemed like enemies" (Christopher et al. 2025).

4.15 Relax and connect

  • Purpose / when: before and after active or intense exploration. An open, engaged, unhurried shared space consolidates new self-understanding and resets regulation. [source: Level Two slide 33]
  • Steps:
    1. After an intense stretch, slow down: lower your voice, show warmth, share something light or simply be together.
    2. Name what was just shared, briefly and appreciatively.
    3. Let the caregiver offer comfort (sitting close, a drink). Return to exploration only if the child signals readiness.
  • Example language (illustrative): "That was a lot to talk about. Let's just sit for a minute. You did something really hard there."
  • Watch for: therapists filling silence too fast. Working sign: the child stays near the caregiver and stays calm.

4.16 Nonverbal attunement and cues of safety

  • Purpose / when: constantly. In DDP, the nonverbal channel carries more than words. [source: Level One slide 14; Level Two slides 17–20, 35–36; Hughes 2004]
  • Steps:
    1. Track the child's face, posture, breathing and voice moment by moment.
    2. Match the vitality (intensity, rhythm) of the child's affect, then gently regulate it down or up.
    3. Use a varied, prosodic, storytelling voice and an animated face with soft eyes. Avoid a flat, still face or a motionless head.
    4. Let words "name the nameless" only when they are carried by the nonverbal affect (Hughes 2004).
  • Example language: not verbal. Illustrative: a quick, rising voice to match excitement; a slower, softer one as the child's sadness emerges.
  • Watch for:
    • Mismatched affect (cheerful voice to a sad child) is misattunement; repair it (4.18).
    • Working sign: the child's own rhythm syncs with yours.
    • Touch is listed among attunement channels (Hughes 2004; Level One slide 17), but the sources give no rules for it [uncertain]. My guidance [synthesis]: touch should come from the caregiver, be comforting and welcomed by the child, and stop at any sign of reluctance. Never use restraint, holding against the child's will or coercive physical contact as a therapeutic method. Follow your service's touch policy.

4.17 Naming the elephant in the room

  • Purpose / when: when something important is unspoken (a recent incident, a contact visit, an upcoming move) and the avoidance itself is creating tension. [source: Level One slide 17; Level Two slide 37; names the technique only, steps are synthesis]
  • Steps [synthesis]:
    1. Agree with the caregiver beforehand that the topic may come up.
    2. Name it lightly and without blame.
    3. Acknowledge how hard it is to talk about.
    4. Offer choice about how much to say.
    5. Use talking-about if the child freezes.
  • Example language (illustrative): "I think we all know there's something big in the room today: the phone call from your birth mum. We don't have to talk about all of it. But it feels weird to pretend it isn't there."
  • Watch for: shame spikes or shutdown. Working sign: relief, or the child adding to it.

4.18 Interactive repair (connect–break–repair)

  • Purpose / when: whenever attunement breaks: you misread the child, push too hard, the child is corrected, or conflict happens between child and caregiver or between therapist and caregiver. Repair teaches the child that conflict does not end relationships and that they need not face stress alone. [source: Becker-Weidman components, principle 4; Level Two slide 37; Golding masterclass slides 56–57; Christopher et al. 2025]
  • Steps:
    1. Notice the break: withdrawal, a flat face, anger, a topic change.
    2. The adult initiates repair; never wait for the child.
    3. Name what happened and own your part.
    4. Return to PACE: be curious about the impact and empathic about the feeling.
    5. Check the child's state (for example, whether they are tired) and offer a choice to pause or stop.
    6. Make sure the child knows the relationship is intact.
  • Example language (illustrative): "I think I kept going on about school when you'd had enough. That was my mistake, not yours. Are you tired? We can stop there."
  • Watch for: the child testing whether repair is real. Working signs: the child re-engages, or leaves connected (one family in Christopher et al. left "holding hands" after a repair).

D. Coaching the caregiver for daily life

4.19 Two hands and the discipline sandwich (connection with correction)

  • Purpose / when: when behaviour needs a limit or consequence. Connection comes before, during and after correction. [source: Level One slides 27–28; Golding masterclass slide 56; CELCIS review of Golding et al. 2024]
  • Steps:
    1. Teach the two hands. One hand: warmth, nurture, curiosity, age-matched autonomy. The other: structure, limits, boundaries, consequences. Both are always needed.
    2. Teach the sandwich: attunement first, then discipline, then relationship repair.
    3. Help the caregiver avoid lecturing and premature problem-solving.
    4. Reassure the child to give hope, not to ease the adult's own discomfort.
  • Example language:
    • From Golding's slides: "I don't think you will be able to punish him into being good."
    • Illustrative, for the caregiver to use: "You were so angry you threw the remote, and now it's broken. You'll help me fix it. And I still love you, angry bits and all."
  • Watch for: caregivers using PACE as permissiveness, or consequences as punishment. Working sign: incidents end with repair rather than prolonged withdrawal.

4.20 Parenting in the moment: the seven-step responding sequence

  • Purpose / when: a script-free decision sequence for caregivers (and staff) responding to difficult behaviour. [source: Level One slides 31–32; Golding masterclass slide 58]
  • Steps:
    1. Notice what is happening; step in if needed for safety.
    2. Notice the impact on yourself: am I regulated, irritated, defensive? Do I need a break? Show yourself compassion.
    3. Notice what the child needs: sensory or emotional regulation first, or are they ready to reflect with help?
    4. Be curious, tentatively.
    5. Connect through acceptance and empathy, making meaning of what lies beneath the behaviour.
    6. Respond to the behaviour: more structure or supervision, a collaborative consequence, problem-solving, or reflecting later. Ask whether PACE was enough.
    7. Repair the relationship.
  • Example language (illustrative), in caregiver rehearsal: "Step two: I'm furious. I'm going to take three breaths before I say anything."
  • Watch for: skipping steps 2–3. Rehearse recent incidents in caregiver-only sessions.

4.21 The S-list (increase / decrease)

  • Purpose / when: a quick audit of the home environment. [source: Level One slide 29]
  • Steps: review with the caregiver which of these to increase and which to reduce:
    • Increase: safety, structure, supervision, success, self-care, seeking meaning, soothing, stretch, sleep, storytelling, smiling, special time, sorry, sensory integration, humour.
    • Decrease: shame, shouting, "shoulds", sarcasm, smacking, seclusion, overstimulation.
    • Pick one or two to change.
  • Example language (illustrative): "Of these, which one would make the biggest difference this week?"
  • Watch for: caregivers feeling judged by the 'decrease' list. Present it with acceptance.

E. Deeper dyadic work: shame, trauma and narrative

4.22 Co-regulating shame

  • Purpose / when: when shame appears: hiding, blank looks, sudden rage, blaming, entitlement, going blank. Shame shuts down attachment seeking, and rage can be a way to get rid of it. [source: Level One slides 25–28; Golding masterclass slides 31, 42, 51; Hughes 2004]
  • Steps:
    1. Recognise shame behind blame or rage (Golding's example: being asked to say thank you triggered shame that came out as blame).
    2. Lower the intensity. Use face, voice and rhythm to signal that you are not disgusted or rejecting.
    3. Respond with empathy and curiosity about the shame itself, not about the misdeed.
    4. Separate the child from the act, and help them move from shame ("I am bad") toward guilt ("I did something that hurt"), which can be repaired.
    5. Bring in the caregiver's acceptance explicitly.
  • Example language (illustrative): "I think when Mum said thank you, something in you went, she thinks I'm rude, I'm bad. That's a horrible feeling. You're not bad. You're a kid who learned to be on guard."
  • Watch for: lectures, evaluations or reassurance offered too early, which deepen shame. Working signs: the child lifts their gaze, stays in the room, or seeks the caregiver.

4.23 Co-creating a coherent narrative (integrating trauma experience)

  • Purpose / when: once safety, regulation and caregiver readiness are established (goal 5 of the sequence). It helps the child build new, less shame-based meanings for past events and a more continuous autobiography. [source: Level Two slides 4, 8, 27–28; Hughes 2004; Becker-Weidman components]
  • Steps:
    1. Prepare the caregiver in a caregiver-only session: share what is known of the history, rehearse how they will respond, and check they can stay regulated.
    2. Approach the past through present-day links (a current reaction that echoes an old experience). Follow-lead-follow toward the past.
    3. Keep the focus on experience and meaning, not graphic detail. Past events are re-experienced in the here-and-now while both adults hold them with the child.
    4. Use A-R dialogue with talking-for and talking-about to regulate depth.
    5. Gently challenge the internal working model ("I am bad" / "adults are unsafe") by offering alternative stories.
    6. End with relax-and-connect and caregiver comfort.
  • Example language (illustrative): "You were only three. A three-year-old can't make a grown-up drink or shout. That wasn't because of you. It was the grown-ups' job to keep you safe, and they couldn't."
  • Watch for:
    • dysregulation or dissociation (stop, regulate, and shift to talking-about);
    • caregiver distress (see section 5).
    • Working signs: the child tells parts of the story themselves, and their self-description becomes less shaming.
    • Hughes's 2004 example of a 12-year-old who called herself "garbage" shifted over several sessions, then at home.

4.24 Supporting the caregiver to communicate with the child

  • Purpose / when: whenever the child's experience has been understood in session. The caregiver, not the therapist, becomes the voice of acceptance and comfort. [source: Becker-Weidman components; Oxfordshire DDP page; Hughes 2004]
  • Steps:
    1. Help the caregiver attune to the child's subjective experience.
    2. Help them accept it as the child's reality.
    3. Help them understand it in light of the child's history.
    4. Help them communicate it back to the child in a contained way, in words and face to face.
    5. Prompt and model as needed. Pause the caregiver gently if they correct or reassure too fast.
  • Example language (illustrative), therapist to caregiver: "Could you tell her what you understand now about why she hides when you're upset?" Caregiver, coached: "I get it now. You hide because grown-ups' anger used to be dangerous. You don't have to hide from me."
  • Watch for: caregivers launching into explanation or promises. Working signs: eye contact between child and caregiver while a feeling is shared. Hughes's adopted-girl example describes exactly this.

4.25 Enhancing positive affect and delight

  • Purpose / when: throughout, and as the final treatment goal. Many children cannot tolerate joy, pride or closeness. [source: Level Two slide 4; Level One slides 11, 32; Golding masterclass slide 40]
  • Steps:
    1. Find something genuinely likeable and share delight in it.
    2. Notice the child's reaction to positive attention; many will spoil or deflect it.
    3. Gently stay with small doses of shared enjoyment, and be curious about discomfort with it.
    4. Encourage caregiver special time at home [source: S-list].
  • Example language (illustrative): "I love how you two laugh at the same daft things. It's hard to take compliments, isn't it? Let's just let that one sit for a second."
  • Watch for: sabotage after good moments. Normalise it, and repair if needed.

4.26 Storytelling and story-completion prompts

  • Purpose / when: with younger or less verbal children, or when direct talk is too threatening. The approach discovers stories together and adopts a storytelling attitude. [source: Golding masterclass slides 16, 19, 54]
  • Steps:
    1. Tell or co-create a story about a character whose experience parallels the child's, or use a picture prompt and ask how the character feels.
    2. Start from the child's own experience before considering other people's.
    3. Let the child shape the story; link it to their life only if they lead there.
  • Example language (illustrative): "This little bear has just moved to a new den. How do you think she's feeling on her first night?"
  • Watch for: stories that become thinly disguised lectures. The detail of story techniques in the DDPI manuals is not drawn on [uncertain].

F. Therapist and service-level procedures

4.27 Therapist self-reflection, recording and supervision

  • Purpose / when: ongoing. It covers the therapist's own attachment history, countertransference and fidelity. [source: Hughes 2004; CEBC; DDPI practicum page; Christopher et al. 2025]
  • Steps:
    1. Reflect on your own attachment history and reactions in supervision or personal therapy.
    2. Record sessions with consent and review them with a DDP consultant against the DDP Rating Scale.
    3. Watch especially for your PACE, follow-lead-follow and repair.
    4. Be aware that training without supervised development may not be enough.
  • Example language (illustrative), consent: "We record sessions so my consultant can help me do this well. Only we see them, and you can say no or ask me to stop."
  • Watch for: drifting into talk therapy without affect, or into behaviour management without connection.

4.28 Working without a caregiver, or with a residential key worker

  • Purpose / when: when no primary attachment figure can attend, for example adolescents in residential care. [source: Hughes 2004; Becker-Weidman components; CELCIS review of Golding, Thompson & Grant 2024]
  • Steps:
    1. Where possible, recruit a selected care worker with training, commitment, likely continuity and secure-enough attachment to act as the caregiver.
    2. Without one, see the young person individually and go slower. Prioritise safety and regulation, because you alone are co-regulating and they are emotionally alone between sessions.
    3. In residential settings, support PACE across every level of the organisation, and expect team tension over consequences. Work it through rather than avoid it.
  • Example language (illustrative): "I'd like Jo to come with you, because she's the one who's there at 2am. Would that be OK?"
  • Watch for: key-worker turnover. Plan endings carefully [synthesis].

5. Handling problems

Sourced guidance is cited. Items tagged [synthesis] are my own.

  • Child refuses to talk, is silent, or says the session is "awkward":
    • Expect early strangeness and mistrust; children describe therapy as odd at first. [source: Christopher et al. 2025; Golding masterclass slide 25]
    • Do not interpret refusal as low motivation; treat it as distress. [source: Hughes 2004]
    • Use lightness, games and snacks, and offer choice, including leaving early. [source: Christopher et al. 2025]
    • Switch to talking-about with the caregiver, so the child can listen without having to speak (4.13).
  • Child rejects talking-for or disputes your words: stop speaking for them at once and invite their own words. [source: Hughes 2004]
  • You pushed a topic and the child turned against you: this is misattunement. Initiate repair: name it, own it, check whether the child is tired, and drop or postpone the topic (4.18). [source: Christopher et al. 2025; Becker-Weidman components]
  • Child becomes overwhelmed, rages or dissociates in session:
    • Lower the intensity and shift from talking-for to talking-about.
    • Use relax-and-connect and the caregiver's comfort.
    • Reflection waits until the child is calm. [source: Level One slide 15; Level Two slide 33; Golding masterclass arousal states]
    • [synthesis] If dissociation is frequent, slow the trauma-integration goal, add grounding and stabilisation, and consider specialist dissociation assessment.
  • Shame spiral (blaming, "I don't care", walking out): respond to the shame, not the content: empathy, curiosity, and separating child from behaviour (4.22). Avoid lectures and early problem-solving. [source: Level One slides 18, 25–26]
  • Caregiver becomes dysregulated or triggered in session (own history activated): lower the emotional intensity at once. Explore the caregiver's distress separately in a caregiver-only session, and do not assume the caregiver can stay engaged. [source: Hughes 2004]
  • Caregiver not ready (rigid, punitive, cannot wonder about the child's mind):
    • Remain in caregiver-only sessions until they can be open and curious with the child present.
    • Work on blocked care (4.3), and refer for the caregiver's own therapy if unresolved loss or trauma dominates. [source: CEBC; Golding masterclass slides 34–37]
  • Caregiver obstacles in dyadic sessions (angry criticism, lectures, competing monologues, venting, distancing, premature problem-solving): [source: Level One slide 18]
    • Gently interrupt with PACE toward the caregiver, then redirect to the child's experience.
    • [synthesis] Agree a signal beforehand that lets you pause the caregiver without shaming them in front of the child.
  • Caregiver demands behaviour management or punishment: acknowledge their exhaustion, then teach the two hands and the sequence (4.19–4.20). Connection with correction is not instead of correction. [source: Golding masterclass slides 25, 56–58]
  • "Non-adherence": the caregiver does not use PACE at home:
    • DDP sets no homework, so treat this as blocked care or a mismatch of capacity, not defiance. [source: CEBC; Golding masterclass]
    • [synthesis] Be curious about what got in the way, and practise one small step through rehearsal of a real incident.
  • The parent harmed or failed to protect the child: the parent must accept full responsibility before dyadic work. [source: Hughes 2004]
    • [synthesis] Follow safeguarding procedures. Do not hold joint sessions where there is ongoing risk, or where the child is pressured to reconcile.
  • Play-to-authority shifts trigger meltdowns at home: prepare the child for transitions, and repair afterwards. [source: Golding masterclass slide 57]
  • No caregiver, or placement unstable:
    • Use a selected key worker, or individual work at a slower pace (4.28). [source: Hughes 2004]
    • [synthesis] Avoid deep trauma narrative work during a placement crisis; focus on safety and regulation, and on the network around the child.
  • Rupture between therapist and caregiver (caregiver feels blamed, judged or excluded): the therapist initiates repair with the caregiver too, using PACE. [source: Becker-Weidman components]
    • [synthesis] Ask directly whether anything you said felt critical.
  • Professional network or residential team disagreement (consistency, consequences): tension in teams is expected. Use the two-pillars / two-hands framing to align relationship and structure. [source: CELCIS review of Golding, Thompson & Grant 2024]
  • Therapist countertransference (rescuing, irritation with caregiver, despair): take it to supervision or personal therapy, and review recordings with your consultant. [source: Hughes 2004; CEBC]
  • Touch, holding and restraint [synthesis]: use touch only as caregiver-given comfort that the child welcomes. Do not use holding against the child's will, restraint, or prolonged forced eye contact as therapy. If a referrer or service describes "attachment therapy" involving coercion, do not deliver it under the DDP name. Discuss it with your DDP consultant. The sources do not set out DDPI's written position on touch [uncertain].
  • Self-harm, suicidality or risk at home [synthesis]:
    • Follow standard risk assessment and safety planning: involve the caregiver, and secure or remove medicines and other means in the home.
    • Run safeguarding alongside DDP, and pause trauma-narrative work while risk is acute.
  • Online sessions [synthesis]: CEBC lists virtual delivery. Keep sessions shorter, place the caregiver beside the child on camera, exaggerate prosody, and agree what happens if the child leaves the room.
  • Endings [synthesis]: taper sessions, review progress with the caregiver alone first, and plan a final session with a shared summary story of the work. Offer a review contact, because placement changes or adolescence can reactivate old patterns.

Sources

Sources:

Further reading (not drawn on unless listed above):

  • Hughes, D. A. (2004). An attachment-based treatment of maltreated children and young people. Attachment & Human Development, 6(3), 263–278.
  • Hughes, D. A., & Golding, K. S. (2024). Healing Relational Trauma Workbook: Dyadic Developmental Psychotherapy in Practice. Norton. (Current DDPI manual; not drawn on.)
  • Golding, K. S. (2026). DDP Guide: Healing Childhood Trauma. Jessica Kingsley. (Listed by CEBC as a manual; not drawn on.)
  • Golding, K. S., Thompson, G., & Grant, E. (2024). Working with Relational Trauma in Children's Residential Care: A Guide to Using Dyadic Developmental Practice. Jessica Kingsley. (Known via review only.)
  • Hughes, D. A., Golding, K. S., & Hudson, J. (2015). Dyadic developmental psychotherapy (DDP): the development of the theory, practice and research base. Adoption & Fostering, 39(4). (Abstract only.)
  • Christopher, C., et al. (2025). Dyadic developmental psychotherapy for children with developmental trauma histories. Clinical Child Psychology and Psychiatry [uncertain journal attribution; repository copy opened].
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