Dyadic Developmental Psychotherapy (DDP) is a caregiver-child approach designed to address attachment insecurity and developmental trauma (Hughes, 2007; Golding, 2025), particularly in children from the care system who have experienced abuse or neglect (Selwyn et al., 2015; Burch et al., 2022). It aims to enhance relational safety through principles of playfulness, acceptance, curiosity, and empathy, supporting emotional regulation and cognitive development.
While DDP has a solid theoretical foundation and extensive training for therapists, it has not been rigorously tested through randomised controlled trials (RCTs), limiting its classification as a proven intervention (Christopher et al., 2025). Additionally, qualitative feedback from caregivers suggests increased understanding and acceptance, indicating potential benefits for caregiver-child relationships (Wingfield & Gurney-Smith, 2019).
The current study aimed to address a research gap in understanding children’s perspectives on their DDP experiences (Christopher et al., 2025).
Dyadic Developmental Psychotherapy (DDP) is a caregiver-child approach designed to address attachment insecurity and developmental trauma.
Methods
The study used semi-structured, play-based interviews with six children (one male; rest female) aged 8-12 years old. Participants were either adopted or under a Special Guardianship Order and had completed at least four sessions of a DDP intervention.
Data collection employed Narrative Story Stem Methodologies (NSSM) to encourage children to express their experiences through story enactments (Woolgar, 1999), supplemented by drawing and emotion stickers to ease communication (Fane et al., 2018). Four stems were developed, adapted from Hodges et al.’s (2000) Story Stem Assessment Profile (SSAP), presenting typical therapy scenarios or dilemmas.
Recruitment involved accredited therapists promoting the study, with caregivers informed via video calls.
Sessions, lasting from 35 minutes to nearly three hours (mean 1.15h), aimed to be conversational, fostering a relaxed environment for children to share their thoughts and feelings.
Data analysis used Interpretative Phenomenological Analysis (IPA), previously used in studies exploring DDP experience with adoptive parents (e.g., (Wingfield & Gurney-Smith, 2019). The analysis followed Smith et al.’s (2021) framework and Nizza et al.’s (2021) quality indicators for IPA studies. It involved an iterative process of familiarisation with the data, line-by-line coding, and identifying patterns of convergence, divergence, commonality, and nuance both within and across cases. To acknowledge the influence of biases (Yardley, 2000), supervision, bracketing, and reflexive exercises were part of the data handling.
Results
A total of two main themes and eight subthemes were identified.
Theme 1: “They’re telepathic” – Attuned emotional connection
1.1 Curiosity, empathy, acceptance, and flexibility
In five of the six accounts, therapists were depicted as warm, empathetic, and flexible. During moments of discomfort, such as when children cried outside, therapists approached the situation with curiosity rather than simply trying to solve the problem.
…they’d {child} say ‘I don’t really feel comfortable sharing this’. And then the adults would maybe do something different and make them{child} comfortable.” (Asher)
1.2 Lightness and play
Lightness and playfulness fostered relational conditions that support emotional regulation, allowing children to engage in therapeutic dialogue.
They {therapist/caregivers) just like instead of carrying on talking about stuff {the child} doesn’t feel comfortable talking about, they like helped them relax…. They played with {the child}, instead of just carrying on.” (Scout)
1.3 Individualised, comforting rituals and rhythms
Children’s stories often highlight familiar, non-verbal comforting rituals, like games, drinks, and snacks, which help build trust and safety.
1.4 Caregivers as co-therapists
Participants indicated that caregivers played active roles in therapy, often depicted as emotionally attuned and nurturing.
Theme 2: Moving towards psychological safety and shared intentions
Participants initially experienced hesitation and mistrust during their early therapy sessions.
2.1 Mistrust, misattunement and the role of interactive repair
For some children, exploration can feel vulnerable, leading them to defend against this feeling. For example, one participant expressed feeling scared:
I drew a scared face. Good and scared the first time, so I drew a scared face. They {therapist} don’t know you. And they don’t know me and you don’t know who they are and you don’t know what they’ll do.” (Kirby)
2.2 Possibilities for increases in trust
Responses indicated that all participants experienced changes, moving from initial mistrust to increased trust. Over time, conversations with caregivers and therapists became easier.
2.3 Increased caregiver closeness
Carter observed some changes in their relationships with their caregivers and explained that this behaviour was initially modelled by the therapist.
They’re calmer. But {therapist} is always calm[…] Less arguments I guess […] and lots and lots and lots and lots of fun! And new games.” (Carter)
2.4 Contemplating loss
Contemplating the end of therapy can evoke feelings of loss, especially once safety is established, as children may anticipate this future transition. Four participants mentioned loss in their accounts. In one story from Carter, a child was confused when a new person answered the therapy room door instead of the usual therapist.
This study on DDP found that building a sense of trust with the therapist required time for the children.
Conclusions
This is the first academic study focussing on the qualitative experiences of children undergoing DDP interventions. Findings suggest that the qualities of attuned relationships with the therapeutic adults were salient over any event or technique. Consistent with preliminary and somewhat limited literature supporting DDP (Purrington et al., 2023), and in alignment with DDP’s core aims, findings infer that the attuned presence of the therapeutic adults may influence the degree of perceived change in attachment security.
DDP may foster opportunities for increased attachment security, facilitate trauma resolution, and support children and their families to learn to thrive.
Strengths and limitations
The study employed a play-based methodology alongside a phenomenological philosophy to explore the children’s experiences, focusing on attachment security and perceived differences. Such innovative approach enabled children to express their experiences through play, alleviating the stress associated with direct questioning. The use of diverse data collection methods captured rich insights, reduced power imbalances, and fostered comfort for the children involved. The research underscores the importance of including young children with trauma histories in studies, provided that the methodology is sensitive and thoughtful. The study highlights the need for understanding children’s perspectives, which are often overlooked in research related to services and interventions.
However, there are notable limitations, such as the sampling bias of including only those children who advanced in DDP (i.e., purposive sampling strategy). This focus may have resulted in a skewed view of experiences, leaning towards predominantly positive outcomes. Identifying the mechanisms of change in DPP practice is also challenging due to the nature of this intervention.
Future research on Dyadic Developmental Psychotherapy can focus on understanding moderating factors such as trauma history, treatment duration, gender, age, and relational context.
Implications for practice
The findings from Christopher et al. (2025) indicate that this new evidence should influence clinical practice for children with developmental trauma histories. The study emphasises that the responsive presence of therapeutic adults and the active involvement of caregivers are crucial for improving children’s relationships and enhancing attachment security. This highlights the importance for clinicians to prioritise relational qualities, such as attunement, responsiveness, and interactive repair, rather than focusing solely on technique-driven approaches.
Clinicians and service providers should more systematically integrate DDP principles into their therapeutic offerings for trauma-affected children, particularly in contexts involving adoption, foster care, or special guardianship. Training programmes should focus on teaching the development of therapeutic alliances with both the child and the caregiver, promoting reflective functioning, and developing relational co-regulation skills, rather than concentrating narrowly on symptom reduction.
From a policy perspective, funders and service commissioners should consider directing resources toward longer-term, relationship-centered interventions like DDP and ensure that caregivers receive explicit support and are included in treatment plans. Policies should also require ongoing supervision and skill development for clinicians to maintain high-quality relational practices, as outcomes appear to be influenced by therapist effects.
Enhancing therapeutic practices for trauma-affected children requires prioritising relational quality and caregiver involvement.
Statement of interests
Anamarija Veic has no conflicting interests to declare. She acknowledges the use of AI in assisting with the revision of the text to enhance clarity and correctness. This tool has helped with grammar checks and rewriting long sentences to increase the overall quality of the blog.
Edited by
Dafni Katsampa.
Links
Primary paper
Christopher, J., Cresswell, C., & Davies, J. (2025). Dyadic developmental psychotherapy for children with developmental trauma histories: An exploration of children’s therapeutic experiences. Clinical Child Psychology and Psychiatry, 13591045251348709.
Other references
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Fane, J., MacDougall, C., Jovanovic, J., Redmond, G., & Gibbs, L. (2018). Exploring the use of emoji as a visual research method for eliciting young children’s voices in childhood research. Early Child De velopment and Care, 188(3), 359–374.
Golding, K. S. (2025). Dyadic developmental psychotherapy. In The Handbook of Complex Trauma and Dissociation in Children (pp. 328-344). Routledge.
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Hughes, D. A. (2007). Attachment-focused family therapy. WW Norton & Company.
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Purrington, J., Goodall, S., & Lynch, J. (2023). Family-based psychological interventions for domestically adoptive families: A systematic review (pp. 1–18). European Child & Adolescent Psychiatry.
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