When families reside far away from the Center, they may decide to engage in a Two-Week Intensive. In some instances, a child does not respond to weekly Dyadic Developmental Psychotherapy, an attachment-based therapy and requires more intensity, in which case a Two-Week Intensive may be indicated. In the Intensive Program, we work for ten consecutive days (two weeks), three hours per day. This is an outpatient facility. Families stay at local hostelries or with friends or family nearby. Two
therapists are used. If indicated, the child may stay in a therapeutic foster family for all or part of the two weeks. The time in therapy is divided between working with the parents, with the child/adolescent, and sometimes with other members of the family. Referring therapists are encouraged to come with the family and be a part of the therapeutic team, if they are available to follow-up with the family after the two-week intensive. The treatment team includes the therapists, parents, family, specialist, and others.
Treatment always involves a child and the parents. Sometimes we involve siblings as the child has often abused them and corrective work is needed for these relationships. The parents are involved in all treatment. They are either in the therapy room directly or are watching therapists work with the child from an observation room.
Many of the parents are feeling "burned out" by their child's pathology. They have often been emotionally abused, particularly the mother. Since one of the goals of therapy is to help the parents get "in charge" in a good way, the parenting coalition must be solid. To that end, sometimes the therapy process will focus on the parents' release of old anger, on relationship issues, and sometimes on un-addressed emotional issues of one or both parents, which inhibit the formation of strong attachment bonds.
Dyadic Developmental Psychotherapy, an attachment-based therapy
Therapy has three components. The first is educational, designed to help parents understand children with attachment disorder: how they feel, how they think, and their internal psychological dynamics. The teaching of consequential parenting skills comprises the second part. These skills are designed to help the parents protect themselves from the child's pathology and to provide necessary corrective parenting experiences for the child. Consequential parenting also serves to heighten
the child's motivation for treatment by allowing them to experience the pain of their condition rather than displacing it on the parents. The third component involves intensive emotional work with the child. This part constitutes a significant portion of the treatment.
The basic purpose of treatment is to help the child resolve a dysfunctional attachment and develop a healthy attachment. The goal is to help the child bond to the parents and to come to grips with the disappointment and anger at his/her first attachment figure(s) and their failure to parent (well). Said another way, the goal is to resolve the fear of loving and being loved. All of the children who come for treatment have authority or control issues. Control, trust, and intimacy issues are prominent features of their pathology and the resolution of these issues is a major treatment objective.
In addition to using standard verbal psychotherapy techniques, we use techniques designed to engage the child in corrective emotional experiences. Our child clients made decisions about trust early in their lives. These survival decisions were made as infants or very young children, made before they had language to encode the meaning of what was happening, even to themselves. Their trauma is locked into the experience of having felt pain at a time when they were powerless to get the help they needed. A variety of therapeutic techniques (psychodrama, imagery, social skill-building) are used to elicit and correct the child's pathology.
A major dynamic in treatment is to help the child address the trauma that produced the pathology. This allows the child to access deep, genuine, and intense emotions associated with the events and people who created those feelings. The corrective experience is orchestrated to allow the child to express these feelings, recognize and recall them, and identify the events and the people involved. This experience then provides an opportunity for resolution of significant old pathological emotions while simultaneously
creating powerful new bonds with trustworthy and reliable parents.
The therapy has a major emotional or affective emphasis. We operate with the philosophy that emotions have a major causative effect on behavior. We believe that when the emotions that cause the behavior change, the behaviors will change, often with little or no discussion. In our experience, the trauma the children have experienced, which often includes the loss of their birth mothers, neglect, and abuse, produces three major emotions: fear, sadness, and anger. These emotions provide the causal energy for most of the child's pathological behavior. These emotions underlie their avoidance of attachment. Consequently, the regressive work that helps them access their fear, sadness, and anger is a process that helps them heal from their emotional trauma(s).
In contrast to play therapy or talk therapy, in which the child chooses the subject matter, the therapists and parents are in charge and direct the course of therapy. In our experience, children with attachment disorder will not voluntarily face their painful emotions. Denial, avoidance, and dissociation are the defenses that allowed them to survive their trauma and they are not disposed to give them up easily.
"Confrontive" does not mean hostile or punishing. It means dealing directly with the heart of the child's experience. A contract made with the
child includes an agreement that the therapists direct the therapy. The child is given the difficult choice of facing the consequences of not resolving problems or going through the painful work of solving them. This choice is given to the child genuinely and repeatedly but in a compassionate, understanding, and supportive manner. Consequently, therapy is quite confrontive and the child, as part of the contract, must agree to acknowledge the problems that brought the family to treatment and ask us for help. In our experience, when addressed in a forthright, open, and realistic manner, children almost always respond in the affirmative.
In essence, all therapy conducted at The Center For Family Development is done under three clear contracts. The most essential is the one between the parent and the child. The parent must be able to get the child to acknowledge and accept the reality of the problems and get the child to know that, while
not responsible for the cause, he/she must accept responsible participation in its cure. The other two contracts are between the parents and the therapists and between the therapists and the child.
The course of therapy takes into account the unique needs of each family and child. Perhaps the most critical factor in positive treatment outcomes are parents who are strong, committed, compassionate, and open to their own emotional growth and to learning and applying parenting skills specific to their child's needs. The skill of the clinicians in selecting and implementing treatment strategies most appropriate to each child and family is also a considerable factor in outcomes of this therapy.
Dyadic Developmental Psychotherapy, an attachment-based therapy at The Center For Family Development is often the treatment of choice in cases where able parents have a child who had a traumatic first two years of life and defends against accepting parental control and good judgment.
Children do heal, there is hope.
See our Informed Consent Document
See our Reading Resources page and our follow-up study in Child and Adolescent Social Work Journal, a professional peer-reviewed journal for more information.
Two week Intensive
The Center for Family Development adheres to the American Academy of Child and Adolescent Psychiatry's "Practice Parameter for the Assessment and Treatment of Children and Adolescents with Reactive Attachment Disorder of Infancy and Early Childhood".
The Center For Family Development adheres to the APSAC Report and Recommendations regarding the evaluation and treatment of children with attachment disorders.
ASSOCIATION FOR TREATMENT AND TRAINING IN THE ATTACHMENT OF CHILDREN
COALITION OF ADOPTION SERVICES IN ERIE AND NIAGARA COUNTIES
AMERICAN ADOPTION CONGRESS
ADOPTION RESOURCE NETWORK
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Dr. Emily Becker-Weidman, Clinical Director
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Last updated on:
January 20, 2015