Dyadic Developmental Psychotherapy

Children who experience early relational trauma often struggle in ways that extend far beyond behavior alone. Histories of abuse, neglect, disrupted caregiving, or chronic instability can affect emotional regulation, attachment security, identity development, trust, and the ability to form healthy relationships.

Summary

• Dyadic Developmental Psychotherapy (DDP) is a trauma-informed, attachment-focused therapy designed to help children and adolescents who have experienced developmental trauma, abuse, neglect, or disrupted caregiving relationships.
• DDP emphasizes strengthening the caregiver-child relationship through emotional safety, co-regulation, attachment repair, and the PACE framework: Playfulness, Acceptance, Curiosity, and Empathy.
• Unlike behavior-focused approaches, DDP views many challenging behaviors as adaptations to trauma and seeks to build trust, emotional regulation, and relational security through attuned interactions. Download my free list of emotions worksheet.
• Caregivers play an active role throughout treatment, helping children develop healthier attachment patterns, emotional awareness, and stronger family relationships over time. Using an EHR can help therapists manage communication with caregivers securely.

Streamline your practice with One EHR

• Scheduling
• Flexible notes
• Template library
• Billing & payments

• Insurance claims
• Client portal
• Telehealth
• E-fax

Learn More

For many of these children, traditional behavioral interventions may not fully address the underlying relational wounds contributing to emotional and interpersonal difficulties. This has led clinicians and researchers to increasingly explore attachment-focused and trauma-informed approaches designed to support both children and caregivers together.

Dyadic Developmental Psychotherapy (DDP) is an example of one of these approaches. Developed by psychologist Dan Hughes, DDP is a family-based therapeutic model designed primarily for children with developmental trauma and attachment disruptions.

The model emphasizes emotional safety, attunement, co-regulation, and strengthening the relationship between children and caregivers.

Although research on DDP continues to evolve, the approach has gained increasing recognition within adoption, foster care, attachment, and developmental trauma treatment settings. Current literature suggests that DDP may support improvements in emotional connection, relational trust, and family functioning when delivered within a structured, trauma-informed framework.

What is Dyadic Developmental Psychotherapy or DDP?

Dyadic Developmental Psychotherapy (DDP) is an attachment-focused, trauma-informed psychotherapy designed to help children and adolescents who have experienced developmental trauma, disrupted attachment relationships, abuse, neglect, or chronic caregiving instability.

DDP is fundamentally relationship-based.

Rather than focusing primarily on behavior modification, the model emphasizes creating emotional safety and strengthening attachment relationships between children and caregivers.

The approach draws heavily from:

• Attachment theory
• Developmental psychology
• Interpersonal neurobiology
• Trauma theory
• Family systems approaches

DDP was originally developed to support adopted and foster children who experienced significant early adversity and struggled to trust caregivers or maintain emotional connection within families.

DDP seeks to address the emotional and relational impacts of developmental trauma by helping children experience safe, attuned, emotionally responsive relationships.

A central feature of DDP is the active involvement of caregivers within the therapeutic process. Rather than treating the child alone, therapy focuses on strengthening the caregiver-child relationship itself.

The model is also known for its use of the “PACE” framework, which emphasizes:

• Playfulness
• Acceptance
• Curiosity
• Empathy

These relational qualities help create an emotionally safe therapeutic environment where children can begin to explore difficult emotions and attachment experiences without fear of rejection or punishment.

Practice Management + EHR + Telehealth

Manage more in less time in your practice with TheraPlatform

Start Free Trial

Who benefits from Dyadic Developmental Psychotherapy?

DDP was specifically designed for children and adolescents affected by developmental trauma and attachment disruptions. The model is most commonly used with children in foster care, adoption, kinship care, or families impacted by significant early relational adversity.

Children with trauma

Many children referred for DDP have experienced complex developmental trauma rather than a single isolated traumatic event.

Developmental trauma may include experiences such as:

• Chronic neglect
• Emotional abuse
• Physical abuse
• Exposure to domestic violence
• Repeated caregiver disruptions
• Institutional care
• Inconsistent caregiving environments

Early trauma can significantly affect emotional regulation, attachment development, and nervous system functioning. Children may develop survival strategies that are adaptive in unsafe environments but later interfere with relationships and emotional functioning in safer settings.

Children affected by developmental trauma may present with:

• Emotional dysregulation
• Aggression or withdrawal
• Hypervigilance
• Difficulty trusting caregivers
• Shame and low self-worth
• Dissociation
• Controlling behaviors
• Difficulty with reciprocity and connection

DDP conceptualizes many of these behaviors as adaptations to early relational trauma rather than willful defiance, an important distinction.

The therapy focuses less on punishment or compliance and more on helping children experience emotional safety and relational trust.

Attachment disorders and attachment difficulties

DDP is also commonly used with children experiencing attachment disruptions or attachment-related difficulties.

These children may struggle to seek comfort from caregivers, maintain emotional closeness, or regulate emotions within relationships. In some cases, children may meet criteria for attachment-related diagnoses such as Reactive Attachment Disorder (RAD), although DDP is often used more broadly with attachment insecurity and relational trauma presentations.

Research describes DDP as a caregiver-child psychotherapy intended to address both attachment insecurity and developmental trauma through relational healing experiences.

Children with attachment difficulties may demonstrate:

• Fear of vulnerability
• Avoidance of emotional closeness
• Controlling relational behaviors
• Difficulty accepting nurturance
• Intense fear of rejection or abandonment
• Contradictory attachment behaviors

By strengthening caregiver attunement and emotional responsiveness, DDP aims to help children gradually develop increased trust, emotional regulation, and attachment security.

Core principles of Dyadic Developmental Psychotherapy

Several foundational principles guide DDP interventions and shape the therapeutic process.

Safety

Emotional safety is one of the most essential components of DDP.

Children with developmental trauma often perceive relationships as unsafe or unpredictable. Many have learned through experience that caregivers cannot reliably provide comfort, protection, or emotional attunement.

Due to this recognition, therapy prioritizes creating an environment where children experience:

• Emotional acceptance
• Predictability
• Nonjudgmental curiosity
• Co-regulation
• Relational consistency

The therapist works to reduce shame, defensiveness, and fear while helping both caregivers and children remain emotionally engaged during difficult conversations or emotional states.

Research exploring children’s experiences of DDP found that many participants described feeling understood, emotionally supported, and safer within relationships over time.

An important side note, trust is understood as something that develops gradually and may be easily disrupted in traumatized children. DDP therapists actively attend to relationship ruptures and repair processes throughout treatment.

Attachment

Attachment is central to the DDP model. Rather than focusing exclusively on symptom reduction, DDP seeks to strengthen the emotional bond between caregivers and children.

Therapy emphasizes the idea that healing occurs primarily through safe relational experiences. Caregivers are therefore not viewed as peripheral participants but as essential therapeutic partners.

Therapists help caregivers better understand trauma responses, attachment behaviors, and emotional communication patterns. Caregivers are encouraged to respond with empathy and curiosity rather than punishment or rejection.

Over time, repeated experiences of emotional attunement and co-regulation may support increased attachment security and emotional trust. DDP is consistently described as a relationship-focused intervention grounded in attachment theory and intersubjective emotional connection.

Emotional connection

Another core principle of DDP is emotional connection and shared emotional experience.

Children affected by developmental trauma often struggle to identify, tolerate, or communicate emotions. They may avoid vulnerability or disconnect emotionally during stressful interactions.

DDP therapists help children and caregivers remain emotionally present with one another while exploring difficult experiences.

This process often includes:

• Naming emotions
• Reflecting emotional experiences
• Exploring relational meaning
• Supporting co-regulation
• Building autobiographical narratives

Free Resources for Therapists

Click below and help yourself to peer-created resources:

• Ready-to-use worksheets, checklists, assessments & more!
• Master insurance billing with our expert-led course
• Telehealth 101: On-demand videos
• Curious how TheraPlatform solves private practice pain points?

PACE framework

The PACE framework helps guide these interactions.

Playfulness

Playfulness involves bringing a light, warm, and emotionally safe tone to interactions. In DDP, playfulness is not about minimizing difficult experiences or forcing positivity. Instead, it helps reduce fear, shame, and defensiveness while creating opportunities for connection.

A playful approach can make challenging conversations feel less threatening and helps children experience relationships as safe and enjoyable rather than stressful or punitive. Research and DDP training materials emphasize that appropriate playfulness can support engagement and strengthen attachment relationships.

Acceptance

Acceptance refers to communicating that a child's thoughts, feelings, wishes, and internal experiences are understandable and worthy of respect, even when certain behaviors require limits or correction.

Acceptance does not mean approving of harmful actions; rather, it involves separating the child's worth and emotional experience from their behavior. By responding with acceptance, caregivers and therapists help reduce shame and create an environment where children feel safer exploring difficult emotions and experiences.

Curiosity

Curiosity involves approaching a child's experiences with genuine interest rather than judgment, criticism, or assumptions. Therapists and caregivers seek to understand the meaning behind behaviors by asking questions and making observations in a respectful, non-threatening way.

This stance encourages exploration of emotions, thoughts, and relational experiences while helping children develop greater self-awareness. Curiosity can also reduce power struggles by shifting the focus from blame to understanding.

Empathy

Empathy communicates emotional understanding and attunement to the child's experience. Through empathetic responses, therapists and caregivers acknowledge the child's emotional reality and demonstrate that difficult feelings can be shared within a safe relationship.

Empathy helps children feel seen, understood, and supported, particularly when discussing painful or confusing experiences. Over time, repeated experiences of empathy may contribute to greater emotional regulation, trust, and attachment security.

Together, the PACE principles create a relational environment characterized by safety, attunement, and emotional connection. According to Hughes and colleagues, these experiences help support attachment security, emotional integration, and the development of healthier relational patterns for children affected by trauma and attachment disruptions.

Therapy process for Dyadic Developmental Psychotherapy

DDP typically unfolds gradually and involves significant collaboration between therapists and caregivers.

Initial assessment and relationship building

Early sessions focus on assessment, psychoeducation, and building a therapeutic alliance with

caregivers.

Therapists work to understand:

• Trauma history
• Attachment patterns
• Family dynamics
• Emotional regulation difficulties
• Caregiver stress and strengths
• Behavioral concerns

Caregivers are introduced to trauma-informed and attachment-focused concepts while therapists begin modeling PACE-based interactions.

According to DDP literature, the caregiver-therapist relationship itself is considered foundational to the treatment process.

Caregiver preparation

Before involving children directly in emotionally intensive relational work, therapists often spend time helping caregivers:

• Understand trauma responses
• Increase emotional attunement
• Develop co-regulation skills
• Respond with empathy rather than reactivity
• Strengthen emotional availability

This preparation helps create a safer relational environment for the child and directly improves successful therapeutic work.

Joint sessions

As treatment progresses, joint caregiver-child sessions become increasingly frequent and central in importance.

In these sessions, therapists facilitate emotionally attuned interactions while helping families process difficult experiences together.

The therapist may help:

• Slow down interactions
• Reflect emotions
• Explore misunderstandings
• Repair relational ruptures
• Support emotional regulation

Sessions are often less structured than traditional behavioral interventions and instead focus on relational process and emotional communication.

Children are not pressured to disclose trauma details before emotional safety and trust are established.

Role of therapists and caregivers

DDP relies heavily on collaboration between therapists and caregivers.

Role of therapists

DDP therapists function as both clinicians and relational guides. Their role involves maintaining emotional safety, modeling attuned interactions, and supporting co-regulation throughout treatment.

Therapists require training in:

• Attachment theory
• Developmental trauma
• Family systems
• Trauma-informed care
• Emotional regulation
• Relational interventions

Because children with developmental trauma may experience rapid emotional shifts, dissociation, or relational defensiveness, therapists must carefully pace interventions and monitor emotional activation.

Therapists also help caregivers reinterpret behaviors through a trauma-informed lens rather than viewing them solely as oppositional or manipulative.

Role of caregivers

Caregivers are considered active participants in treatment rather than passive observers.

Their involvement may include:

• Participating in sessions
• Practicing PACE interactions
• Learning co-regulation strategies
• Building emotional attunement
• Strengthening relational repair skills

Research exploring children’s experiences of DDP suggests that caregiver participation may contribute to increased feelings of trust, closeness, and emotional connection within relationships.

Caregivers themselves may need emotional support and psychoeducation throughout the process. Parenting children with developmental trauma can be emotionally demanding, and caregiver burnout is common.

Treatment planning and documentation

Because DDP is relational and attachment-focused, treatment planning often differs somewhat from more symptom-focused behavioral approaches.

Treatment planning

Treatment goals typically emphasize:

• Increasing emotional regulation
• Strengthening attachment security
• Improving caregiver-child attunement
• Reducing relational conflict
• Enhancing emotional communication
• Increasing felt safety within relationships

Interventions may include:

• PACE-based interactions
• Co-regulation exercises
• Reflective dialogue
• Narrative processing
• Attachment-focused psychoeducation
• Joint caregiver-child sessions

Goals should remain measurable and clinically relevant while acknowledging the relational nature of the work.

Documentation considerations

Documentation should clearly connect interventions to clinical goals and medical necessity.

Progress notes may include:

• Emotional themes explored
• Caregiver participation and responsiveness
• Co-regulation interventions utilized
• Attachment-related observations
• Emotional regulation progress
• Relational interactions and repair processes

Because DDP sessions often involve multiple participants, therapists should also document:

• Who attended sessions
• Family dynamics observed
• Safety concerns if present
• Caregiver engagement and implementation

Documentation should remain objective, clinically grounded, and trauma-informed.

Therapists should avoid pathologizing language and instead frame behaviors within the context of attachment and developmental trauma whenever clinically appropriate.

Dyadic Developmental Psychotherapy represents a relational and attachment-focused approach to working with children affected by developmental trauma and disrupted caregiving experiences.

Rather than centering solely on behavioral compliance, DDP emphasizes emotional safety, co-regulation, attachment repair, and strengthening caregiver-child relationships.

Although research on DDP continues to develop, current literature suggests that relationship-based interventions may support emotional healing and increased relational trust for children impacted by trauma and attachment disruptions.

For clinicians, effective DDP work requires more than familiarity with trauma concepts alone. It requires attunement, emotional pacing, caregiver collaboration, and an understanding of how developmental trauma affects relational functioning.

As trauma-informed and attachment-focused care continue to expand within mental health treatment, DDP remains an important model for clinicians working with children and families impacted by early trauma and adversity.

How EHRs can help with documentation

Modern EHR/practice management platforms (such as TheraPlatform) assist greatly with documentation by providing HIPAA‑compliant, integrated systems for note entry, storage, scheduling, and billing.

They allow therapists to:

• Use and customize templates (e.g., SOAP, DAP, and others) or build their own to streamline note writing and ensure consistency.
• Link notes to treatment plans, goals, and session history so client progress is easily tracked over time.
• Utilize e-fax and secure document sharing via client portal to safely exchange information with clients or other providers while maintaining confidentiality.
• Leverage dictation and telehealth transcription, which can automatically convert sessions into therapy or assessment notes, saving time and reducing manual entry.
• Take advantage of AI features that streamline documentation by automatically populating intake form data into assessment templates and generating complete therapy and assessment notes from the information you provide, all with a single click.

Meanwhile, AI‑assisted note tools are emerging which can further help clinicians by:

• Automatically transcribing session audio (if permitted) and highlighting key moments (e.g. emotional shifts, major themes).
• Suggesting draft notes or filling in objective or assessment sections based on observed data, freeing up clinicians’ time.
• Supporting consistency and reducing missing components in notes, which helps from both clinical, legal, and insurance perspectives.

Together, structured SOAP‑type notes, good EHR platforms, and smart AI tools support better therapeutic outcomes, more efficient workflows, and stronger accountability.

Streamline your practice with One EHR

• Scheduling
• Flexible notes
• Template library
• Billing & payments

• Insurance claims
• Client portal
• Telehealth
• E-fax

Learn More

Resources for mental health therapists

Theraplatform is an all-in-one EHR, practice management and teletherapy solution with AI-powered notes and Wiley Treatment Planners that allow you to focus more on patient care. With a 30-day free trial, you have the opportunity to experience Theraplatform for yourself with no credit card required. Cancel anytime. They also support different industries including mental and behavioral health therapists in group practices and solo practices.

More resources

• Therapy resources and worksheets
• Therapy private practice courses
• Ultimate teletherapy ebook
• The Ultimate Insurance Billing Guide for Therapists
• The Ultimate Guide to Starting a Private Therapy Practice
• Insurance billing 101
• Practice management tools

Free video classes

• Free on-demand insurance billing for therapist course
• Free mini video lessons to enhance your private practice
• 9 Admin tasks to automate in your private practice

References

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, 30(4), 874–892. https://doi.org/10.1177/13591045251348709

Hughes, D., Golding, K. S., & Hudson, J. (2015). Dyadic Developmental Psychotherapy (DDP): The development of the theory, practice and research base. Adoption & Fostering, 39(4), 348–364. https://doi.org/10.1177/0308575915610943

Hughes, D. (2017). Dyadic Developmental Psychotherapy (DDP): An Attachment-focused Family Treatment for Developmental Trauma. Australian and New Zealand Journal of Family Therapy, 38(4), 595–605. https://doi.org/10.1002/anzf.1273

Turner-Halliday, F., Watson, N., Boyer, N. R. S., Boyd, K. A., & Minnis, H. (2014). The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy. BMC Psychiatry, 14, 347. https://doi.org/10.1186/s12888-014-0347-z

DDP Network https://ddpnetwork.org

Evidence Base for DDP. (n.d.). DDP Network. https://ddpnetwork.org/research/evidence-base-for-ddp/

Child Trauma Academy https://www.childtrauma.org