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This pack includes handouts adapted with permission from Dan Hughes, Julie Hudson, Geraldine Casswell &

Kim Golding © 2018, DDPI

Dyadic Developmental Practice,

Psychotherapy and Parenting

(DDP)

Level Two

Exploring the DDP Framework for Therapy and Parenting

Developmentally Traumatized Children

Training Handout

Venue: 675 Victoria street Abbotsford

Organisation: Australian Childhood Foundation

Dates: 22-25 November 2019

Trainer: Dr Sian Phillips

Training Institute - Dyadic Developmental Psychotherapy Institute (DDPI®)

UK Community Interest Company - DDP Connects UK (CIC)

Information about both these organisations is included in the DDP Network website: www.ddpnetwork.org

DDP Level Two Handout

This pack includes handouts adapted with permission from Dan Hughes, Julie Hudson and Kim Golding © DDPI, 2018

CONTENTS

Page

Programme 3

Your trainer 4

Revision of DDP principles and practice 5

Eight features of the sequential process 6

Factors to be aware of during assessment 7

Managing breaks in the flow of the dialogue 8

Open and engaged 9

Am I doing DDP? 10

Reading: Brain; Biology and DDP: Brain-Based Parenting 12

Parental compassion and attachment focused treatment 17

DDP informed Resources 18

Additional reading list 20



DDP LEVEL TWO: PROGRAMME

This four-day Level Two training follows on from the ideas and skills introduced in Level One and is

suitable for those who are beginning to use the principles and interventions in their work. Level Two

represents a further 28 hours of DDP training, building to a total of 56 hours. This will provide the

knowledge and practice necessary for attendees to develop their use of DDP principles to their work

with developmentally traumatised children and their families. Level Two is a stand-alone training. It

is also the second step toward certification as a Practitioner in DDP. While Level Two is a necessary

training, it does not enable participants to advertise or say that they are Practitioners in DDP or that

they provide DDP-informed practice. This is stated on your certificate of attendance:

“This training equips the participant to understand the DDP principles and to develop their use

within his or her practice. Individuals need to attend Level One, Level Two and complete the DDP

certification process before they are certified Practitioners in DDP”

This four-day Level Two training deepens the exploration of Dyadic Developmental Practice,

Psychotherapy and Parenting (DDP) begun in the level one training. The trainer will tailor the course

to meet the consultation and skills-training needs of the group. Participants will have opportunities to

discuss aspects of their work. They will be expected to engage in ‘practice in action’ during whole

and small group practices. Participants are invited to bring a recorded example of their work to the

training with them. They will show selected clips of this, up to 20 minutes of a session. All

participants need to be prepared to spend some time reflecting upon their own attachment history in

small groups of three Next steps Attending Level Two does not enable you to advertise that you or your organization provides Dyadic

Developmental Psychotherapy. After Level Two you can apply to become certified as a practitioner in

DDP, providing you have a relevant degree and are a member of a relevant professional organization.

If you complete both Level One and Level Two and receive regular supervision or consultation from a

Consultant or experienced Practitioner in DDP you can say you offer DDP-informed practice.

It is also possible for an organisation to become formally recognised as practicing using DDP principles

via the process of Organisational Certification. There is detailed information about the training and all

certification processes in the DDP Network website http://www.ddpnetwork.org

Objectives

To gain a deeper understanding of the theory behind, and practice of, the interventions and

parenting principles used in this approach.

To follow up on relevant themes that participants would like more teaching on.

To develop skills in using the DDP practice and therapy model within your area of work.

For participants to have opportunities to focus on the successes and barriers experienced in

applying the model in their practice via discussion, practice and supervision of their work

with families.

To provide participants with the opportunity to explore (in small groups of 3) how their own

attachment history and experiences may inform and have an impact on their work.

Suitable for

Therapists working with developmentally traumatised children and their families or substitute

families e.g. Clinical Psychologists, Child and Adolescent Mental Health Services (CAMHS),

Independent Practitioners

Professionals supporting children and young people who have experienced developmental

trauma and their families e.g. Social workers in fostering, adoption, children in care, children

in need services and residential care settings, CAMHS, Education services, Paediatric services

http://www.ddpnetwork.org/



YOUR TRAINER

Sian Phillips, Ph.D.,C.Psych. is a psychologist in private practice in Kingston. She received her Ph.D. from University of Toronto in 1996 and has been working with children and families in Kingston since that time. She specializes in the assessment of trauma and attachment difficulties and works with children, foster parents and adoptive parents using Daniel Hughes model of Dyadic Developmental Psychotherapy ®©. This exciting way of working helps the parent understand what lies behind difficult behaviour and to provide a safe, empathic relationship in which the child can begin to explore traumatic, hurtful and shameful experiences and importantly learn to experience themselves differently. Sian is a certified DDP therapist, consultant and international trainer. She is also an adjunct professor at Queens, supervising students in their clinical placements. Currently she is trying to help the education system better understand children who have experienced chronic stress and has developed a specialized school program to work with children who cannot manage the regular school system due to their trauma and attachment difficulties. She is also consulting with local school boards to develop trauma informed schools and completing research examining the efficacy of a DDP approach in schools. She has two chapters in Art Becker Weidman’s book The Dyadic Developmetnal Psychotherapy Case Book (2011) and is currently writing a book for educators about how to use DDP principles to create trauma informed classrooms. She has also written a book for children and adults to help them understand developmental trauma from a non-shame based perspective.

Contact trainer at: [email protected]

mailto:[email protected]



Level 2 (This following outline is illustrative and may be amended in response to the needs of the group

during the training)

Day One Day Three

Introductions and Ground Rules

Topic: Review of DDP principles and

practice

Case discussion based on recorded clips

and/or reflective practice.

Exploration of Attachment History

Skills practice: PACE

Brain; biology and DDP

Mindfulness and Mentalization


and/or reflective practice


Skills practice: Using DDP principles

Day Two Day Four

Topic: working with parents




Skills practice: staying open and engaged

Topic: DDP-informed parenting




Skills practice: story telling

Exploration of Attachment History – time for

reflection.



REVISION OF DDP PRINCIPLES AND PRACTICE

Intersubjectivity:

The heart of DDP is the intersubjective relationship. This is the Verbal and Non-Verbal connection

which is so essential to our survival, but is such a source of fear for the developmentally traumatized

child. If the child is to experience security in relationships, then he or she needs to feel safe in

connection; to experience influencing and being influenced within healthy relationships. Often the

child, in a state of fear, has led the parent away from such intersubjective connection; all becoming

weaker in the process; within DDP the therapist by connecting with parents and child can lead them

back into connection again and they all grow stronger.

PACE:

If intersubjectivity is the heart of DDP then PACE helps the heart to beat. The attitude of PACE offers

an unconditional relationship expressed through playfulness, acceptance, curiosity and empathy. It

expresses a deep interest in the inner lives of the family communicated through curiosity about and

acceptance of this experience alongside empathy for the struggles this experience can bring. It

demonstrates the fun and joy in the relationship alongside a willingness to share and support the

family in their struggles.

Affective-reflective dialogue:

The A-R dialogue brings the heart into connection with the mind creating a rich story within which

the inner lives of the family members are explored, deepened, elaborated and made more coherent

through a process of co-construction of meaning. The child or parent feels safe in the emotional co-

regulation allowing his or her experience to emerge in a rich story which can touch and change the

experience of those witnessing it. The Storytelling which emerges from the A-R dialogue provides a

deepening of connection which is both safe and healing.

Follow-lead-follow:

If the child or parent’s story is to be co-constructed, to emerge out of joint storytelling, then the

therapist as conductor in the telling must both follow and lead in turn. In this way the therapists find a

balance between being non-directive and directive, following the themes that emerge and leading

family members to a deeper understanding. The therapist sets a rhythm to the telling which allows the

story to emerge.

Talking with, for and about:

A central goal of DDP with children is to help the child experience security within an intersubjective

relationship with the parents. The A-R dialogue generates new experience of events often leading to

change in interaction patterns within the family. This leads to increased attachment security and the

development of coherent narratives. Ultimately the therapist makes him or herself redundant as the

child is able to directly share his or her inner experience with the parents. On the way to this goal the

therapist orchestrates the communication so that the child learns to tolerate the affective experience

without becoming overwhelmed by it. The therapist chooses when to talk with, for or about the child.

‘Talking for’ tends to increase the affective, and can help a child move into a deeper affective

experience. ‘Talking about’ tends to increase the reflective. The therapist will choose this when the

child is at his limit for experiencing affect, and there is not enough reflection happening. This reduces

the danger of dysregulation. In this way the child remains emotionally regulated and can participate in

the story telling. He or she learns to trust the parents to help them with this experience. The therapist

talks with, for and about the child so that the child ultimately learns to talk to the parents.

Relationship Repair:

It is important to maintain connection with the child or parent, but inevitably there will be times when

there is a rupture in this relationship. The therapist picks up the discomfort which is expressed

verbally and/or non-verbally and then takes responsibility for repairing the relationship.



EIGHT FEATURES OF THE SEQUENTIAL PROCESS1

With the cyclical repetitions of the A-R dialogues, expressed within an attitude of PACE, the therapist aims to

develop deeper, safer and more meaningful interactions. It is important to attend to these elements of the

interaction in order to facilitate the relationship between the therapist and the parent and child.

1. The process of the A-R dialogue precedes any focus on the content of the dialogue:

The therapist aims to keep the rhythm going, to maintain an attitude that is both open and engaged. Experiences

are welcomed but not judged as right or wrong and at all times there is a readiness to express empathy for any

distress. The therapist needs to check that the process of A-R dialogue is ongoing as this will serve as a

barometer for any blocks due to defensiveness, criticisms, emotional dysregulations etc.

2. Safety precedes exploration:

The therapist is alert at all times to each member feeling safe before exploring more difficult themes. If safety is

not present, the quality of the inter-subjective dialogue will be impaired.

3. Co-regulation of affect precedes co-creation of meaning:

This helps the sense of safety. The therapist seeks to match the affect (not the emotion) so that the person can

experience acceptance and empathy. This paves the way for developing a new meaning around the event that

may have been experienced as frightening or shameful.

4. Establishing safety for the parent precedes establishing safety for the child:

The parent needs to feel safe in order to help the child. If the parent is not feeling safe there is a greater

likelihood of criticism or anger being expressed. It is important to prepare the parent before therapy starts and to

connect with the parent before each session so that any lack of safety can be addressed.

5. Lighter, positive, casual themes precede shameful, frightening themes:

This enables a connection to be made before difficult areas are addressed. It also enables the therapist to

demonstrate non- verbally that all communications are important and of value.

6. Easier shameful, frightening themes precede more difficult ones:

This develops the safety and capacity for everyone to talk about the hard stuff. If a parent is insistent on raising

an issue (and is angry, distressed) it would be important to help them with this before the child joins the session.

7. Experience precedes reflection:

Start with the here and now awareness of what has been talked about and how that has impacted on everyone

before turning to the reflection. Reflection describes an experience from a more distant stance and put into a

wider context. This helps put the experience into a narrative but will be more effective having explored the

experience first.

8. Coregulation and meaning making precede autoregulation and meaning making:

As the child develops, his learning moves from being primarily based on his early experiences to new learning

from his parents. The parents too will develop a greater understanding and perspective and this will often herald

the time when therapy is no longer needed.

But remember:

Each session is unique and it is not uncommon to meet resistance following a productive session. Parents can

become discouraged at setbacks and children will need repeat opportunities to experience the adults interest and

value of them, in spite of their behaviour and past.

1 See Attachment Focused Family Therapy Workbook, chapter 5



FACTORS TO BE AWARE OF DURING ASSESSMENT2

History: consider abuse, neglect, placements, attachments.

Present Symptoms.

Physical: Eating, sleeping, pain thresholds, boundaries, sensori-motor, language, nonverbal

communication.

Affect: Regulation, expression, range of positive & negative (excitement, joy, affection,

terror, shame, rage, despair), intensity/duration.

Behaviour: Impulsive, reactive, submissive, passive, explorative, assertive

Cognitive: Negative attributions, reflective functioning, desires-intentions, reciprocity, taking

other’s perspective, cause-effect.

Parental functioning:

Own attachment history

Presence of attitude of playfulness, acceptance, curiosity, empathy

Child’s behaviors as triggers to own attachment history?

Blocked care, resentful, dejected/ persistent, committed?

Personalize child’s behavior?

Child’s problem, not their problem?

Need child to make them happy?

Reject aspects of child?

Relationship: Do the child’s interactions with me differ from interactions with parents? How

do interactions change under stress? How are attachment and exploration needs expressed?

Nonverbal communication: eye contact, facial expressions, gestures/posture, touch

Humour?

Empathy?

Inner State: access to affective life, regulation of affect/cognition/behavior, accepts co-

regulation of affect, co-creation of meaning

Inner State Communication?

Attunement—Shame—Interactive Repair

Motivation/Hopefulness

Overall response to session: affect/reflection/behavior/interpersonal

2 Adapted from Dan Hughes



MANAGING BREAKS IN THE FLOW OF THE DIALOGUE

The intersubjective dialogue can be easily broken. The first sign of it may be a non-verbal

one e.g. child looks away, parent sighs heavily. It may be more obvious with an angry

remark made by parent or child. If not attended to the session can easily become flat, lifeless

and the parent and child become more distant or disengaged. A therapist may become more

cognitive and try to explain things too much, which will in all likelihood lose the interest of

the child and possibly the parent.

Breaks in the intersubjective dialogue can happen for a variety of reasons; the subject matter

may be too hard to talk about; one person may misunderstand the intention of the other or

there may be a theme of shame around. Sometimes the parent finds it hard to cope with the

child’s affect and may try and reassure but then the child does not feel properly heard or

understood.

The result of such breaks is that the rhythm gets broken and people are more likely to become

defensive, including the therapist!

To help restore the dialogue it may be sufficient to help the family accept that there are

different viewpoints that it is hard to talk about things. In other words, helping them to

accept the inner world of each other so that a more productive dialogue can happen.

Example:

Robbie: why have I got to stay at home when Grandma visits? All the other kids will be at the

skate park. (Robbie huffs and puffs angrily)

Mum: she doesn’t visit often and she wants to see you. (Mum looks to therapist for help)

Therapist: (seeks to clarify what each one is wanting without taking sides) Seems like Robbie

really enjoys time spent with his mates at the skate park and perhaps can’t imagine why

Grandma would be interested in seeing him, whilst mum seems proud of her boy Robbie and

is really keen to show him off to Grandma.

Sometimes the therapist is the cause of the dialogue flow getting broken. Maybe you have

moved too fast or misunderstood a situation. In these events it is important to make an

immediate repair and a sincere apology, taking full responsibility for the rupture.

Example:

Therapist: (session with parent) I’m so glad we have a chance to chat about Simon’s

behaviour and how you must be feeling.

Parent: Why? Do you think we caused that meltdown? It’s what the social workers think.

Therapist: I’m sorry. Did you think I wanted to correct you or tell you off for your son’s

behaviour?

Parent: Well we seem to be getting it all wrong at present. Nobody seems to understand how

difficult this child is. We have tried everything and he still breaks things, answers back and

hits us.

Therapist: I am sorry if I wasn’t clear enough or if I implied any sense of judgment. I really

want to get to know what it is like for you living with Simon 24/7. You are the people who

know him best and it is important to me that we can talk openly about how it is. Will you

help me in this?



OPEN AND ENGAGED

When parents or children become closed, defensive, angry and/or hopeless it can be easy for the

practitioner to join them in this closed, non-engaged state. We can also become defensive; we might

feel angry, irritated or frustrated and we too can end up feeling hopeless with a sense that we are not

able to help this family.

All of these responses will close down the intersubjective relationship. We lose our attitude of PACE

become evaluative or judgmental of ourselves and/or of the family members and the therapeutic work

stops.

Family member

Open and Engaged

Family member

Defensive

Open to influence Not with you in your experience of them

Here and now experience Fear of future, despair of past

Connected; Good eye contact Poor eye contact

Playful and enjoyment in relationship No enjoyment or ability to be playful

Feels understood and accepts our acceptance Feels misunderstood and tries harder to

communicate this through anger, frustration or

becoming non-communicative

Curious and reflective Incurious and reactive

Open and receptive to empathy Experiences anger/Shame

In these situations, the practitioner needs to work hard at staying open and engaged to the family

member; having patience that by maintaining this stance the family member will in time become open

and engaged again.

Therapist Child/Parent

Stays open and engaged Moves into this state also

Via appropriate playfulness; radical acceptance;

maintaining curiosity and conveying empathy

Feels better understood

Avoids evaluation Acceptance rather than evaluation reduces

defensiveness

Hold their mind with your mind; stay

intersubjectively present

Help client become open and engaged either

with present experience or with past memory.

Use story telling voice, and the intersubjective

relationship to connect with the child/parent –

mind- to- mind.

This allows the child/parent to become open

and engaged to your experience of him and

therefore of his own experience

Build up a narrative of the experience that is

being communicated and explored

Help child/parent to know and to feel their story



AM I DOING DDP?3 DDP is a therapy but it is also an approach that can inform and enrich other therapeutic and parenting

approaches. Maybe it is this multiplicity which is at the heart of our struggles to know ‘are we doing

DDP?’ It is also what makes DDP so attractive to such a broad range of professionals.

What is the essence of DDP?

Whether as therapy or applied as a set of principles in a range of ways of working, at the core of DDP

is its therapeutic stance based on intersubjectivity and PACE. This contrasts with other approaches

that are based on a stance of therapeutic neutrality and ambiguity. Similarly, DDP is based on

relationship and connection rather than on providing information, problem-solving, and reassurance.

What is DDP therapy?

Pure DDP is a session which incorporates the majority of the DDP principles with adults, or adults

and child together. The clients have an experience of a relationship with a therapist which helps them

to explore their subjective experience at a deeper level because the therapist provides co-regulation of

the arousal that exploration of this experience creates; this in turn helps the client or clients to have a

new understanding of their experience through the co-construction of meaning. In addition, a child

benefits by experiencing increased safety and security with his or her parent. The creation of meaning

together is a powerful way of helping the child to experience trust in the parents and to develop a

different relationship with them.

DDP therapy session for the parents focuses on the parents’ experience of relationships, including

their relationship to the child they are parenting. The parent is helped to understand the impact of their

previous experience upon the current relationship.

What is DDP informed parenting support?

A parenting support session informed by DDP principles will have a large focus on the experience of

parenting the child; especially the impact on the parent of the child. The parents will be helped to

understand their experience of the child and of parenting the child, and this understanding will inform

their thinking about how they might parent the child in the future. It involves the therapist connecting

with the parents and helping them in turn to make connections eg with their attachment history, past

experience of relationships including other parenting relationships, and their current experience of

parenting the child. This will elicit the parents own experience of anger, fear, despair, and shame with

the therapist co-regulating their affective expressions of these experiences. This in turn will help them

to co-create new meanings of their own and their child’s behaviors; which may in turn lead to some

specific thinking about different ways to parent the child.

What is DDP informed residential child care?

(Developed by staff working within Clover Childcare Services in Norfolk, UK)

Residential child care is unique in that it provides a collaborative ethos involving a team of people

who are parenting the young people. A DDP approach allows the team to follow the same attitude

helping them to emotionally connect with the young people and therefore enriching these

relationships. This encompasses all relationships and connections between the adults; the adults and

young people and facilitating this between the young people. Staff develop an understanding of their

own reactions and triggers so that they can remain reflective even when young people are in crisis.

This provides the children with a consistent experience of reciprocity and being kept in mind. This

incorporates the principles of DDP into daily interactions which helps to build the relationships and

3 Based on a paper written by Kim Golding in March 2013



from this to lead the young people to develop an understanding of their current and past experience

and, over time, to give them a more hopeful, positive future.

This can be achieved by:

Encouraging self-reflection for staff at the start of shift so that they move into the shift

understanding their own internal experience and how this might impact on their ability to

remain open and engaged with the young people.

The change-over focuses on understanding the emotional tone of the home; and the young

people’s current emotional experience; encouraging acceptance of this.

Staff take the time to reconnect with each individual young person as they work their shift so

that their relationships are intersubjectively focused (relationship based) with an attitude of

PACE.

Colleagues are supportive and use the DDP principles with each other.

Staff help the young people to experience the world safely and with enjoyment.

Staff take the time to sit with uncomfortable feelings and help the young people to develop

their ability to regulate these through the experience of co-regulation; and understand these

through developing abilities to reflect on this experience.

Staff ensure safe spaces are made so that young people can explore their difficult emotions

within the context of living within a household and the multiple tasks this involves.

Staff accept that there will be ruptures to their attunement with the children both because of

the need to provide discipline and because of the impact on the children of their traumatic

histories which in turn impacts on the staff. Staff will ensure that relationship repair occurs at

these times.

Staff keep in mind the four key areas of fear for the children (Mistrust; fear of reciprocity

involved in intersubjective relationships; experience of shame and attachment fears which

lead to miscuing of needs). An understanding of these help staff to remain compassionate,

open and engaged towards the children and ensure that any consequences focus on reparation

of relationships and building of trust.

‘I know that I am using DDP because I feel more comfortable, less anxious and more confident when

at work. I feel a connection between me and the young people. Through this connection the young

people are more able to accept nurture, my help, advice and support.’

In what ways can DDP be combined with other therapeutic approaches?

DDP is a framework for therapy which can be combined with other interventions. Thus play, art,

drama and narrative work have all been successfully incorporated into DDP sessions. These

additional media allow a rich story making process which enhances the exploration of experience and

development of relationship. In addition, some therapists are combining DDP with Theraplay and

with sensory integration techniques. This provides a greater degree of regulation for the child;

increases the security the child experiences with parents and thus allows a deeper verbal and non-

verbal exploration of experience.

This work would be considered to be DDP providing that the goals of the sessions are predominately

to explore the inner experience of the child, providing co-regulation of arousal and co-construction of

story in a way which enhances the child’s feelings of security and trust in the parents. The use of

different interventions combines with the exploration and narrative development of DDP to provide

an enriched DDP experience.

In conclusion DDP is both a unique stand-alone therapy and a framework which can be enhanced by

other therapies/interventions; and can enhance parenting support.



Reading: BRAIN; BIOLOGY AND DDP. Brain-Based Parenting

by Jonathan Baylin & Daniel Hughes4

It is recommended that attendees read this following day one, ready for discussion on

day two.

‘We’re two aging therapists who’ve worked with abused children and adolescents for many years and are keenly

interested in the neurobiology of attachment. We met a few years ago when we were both asked to work with a

mental health facility that wanted to incorporate an attachment-based model of treatment in their work with highly

stressed kids, teens, and their parents. This story of the new therapeutic path that emerged as a result of this

collaboration starts, as so many do, with a failure.

There was one case at that time that Dan had found particularly galling. He’d begun providing treatment for a young

mother, Rebecca, and her 4-year-old son, Eric. The family doctor described her as being a tense, discouraged

mother, overwhelmed by her day-to-day responsibilities of caring for her son. Still, she’d seemed to want help for

herself and her son, and agreed to see a therapist.

Yes, she said, when Dan did her intake---she was discouraged alright! And frustrated! Eric was impossible! Why

wouldn’t he just do what she asked? Why was everything a fight? Why wouldn’t he play by himself when she just

wanted to relax a bit? Why wouldn’t he eat? Sleep? The list of complaints seemed endless.

By contrast, Rebecca recalled how happy she’d been when he was born. He needed her! He loved her! She didn’t

think that she’d ever felt as close to anyone as she’d felt to him. Certainly, she told Dan, she’d never felt close to her

own parents. When they weren’t fighting with each other, they were finding reasons not to be home. Neither had

much time for her---they often left her alone for many hours, even at night. But after a while, she got used to it, she

said with a shrug, and really didn’t mind anymore. Then one day she met Billy---he really wanted her and, for a

while, the sex with him made her feel loved. And then she had Eric and she truly felt more love for another human

being than she’d ever felt before. But as he grew from a baby, who slept much of the time, into a toddler, he wasn’t

always so rewarding to be with anymore. He cried and flailed his arms and legs, resisting all her efforts to comfort

him. This made her feel helpless, overwhelmed, angry, and stressed out. Her initial loving feelings began to fade,

suppressed by her anger and sense of being chained by parenthood to this small, ungrateful boy. When Eric wanted

her attention, she began to tune out, using her old childhood strategy of shutting out the world and numbing her

feelings. Gradually, Eric stopped seeking her attention, which was just as well. She’d find reasons to drop him off at

her mother’s home so she could have time by herself or with her friends. Eric didn’t seem to mind, but it puzzled

Rebecca that her mother apparently enjoyed Eric more than she’d ever enjoyed her.

Dan was pleased and hopeful after his first few sessions with Rebecca. She demonstrated some genuine sadness

about her degenerating relationship with Eric and even appeared to understand how being ignored by her own

parents might have something to do with her struggle to parent her son effectively. She was all attention when Dan

told her that her son needed her attuned interactions, and that if she related with empathy while she set firm limits,

he was likely to begin to cooperate with her and accept her authority. However, she rarely seemed to put Dan’s

suggestions into practice, and kept bringing in the same problems week after week. Dan began to feel disappointed

and discouraged. Soon, Rebecca started saying resentfully that Dan’s ideas “weren’t working” as she grew even

more frustrated with her son’s unimproved behavior. She hinted that maybe Dan’s advice was off-base, that he

might be missing something and didn’t really understand Eric’s intensity. Furthermore, she began to suspect that

Dan was beginning to be disappointed in her---even suggesting perhaps that she wasn’t trying hard enough! When

she asked him one day if medication might be necessary for her boy, Dan’s frustration became clear to them both.

Finally, the session came when Dan asked why she’d reacted with so much anger instead of empathy when her son

screamed at her. The tone of Dan’s voice conveyed his impatience with her, as did his message that, by now, she

should’ve been responding to her son the way he’d tried to teach her. Dan began to dread his sessions with Rebecca

and, after a couple more of these stalemated meetings, she stopped coming. Her son went back to live at her

mother’s house. She went back to her defeated sense of resigned failure as a competent mother with a happy child.

And Dan went back to looking for parents who would appreciate what he had to offer.

The Journey Begins

At about the same time that Rebecca stopped coming for her sessions with Dan, he and I began to explore together

the practical clinical implications of all the interesting new brain research for the work we were already doing with

traumatized children. We are both steeped in the model of interpersonal neurobiology developed by Allan Schore

4 Psychotherapy Networker, January, 2012



and Daniel Siegel and felt we had a good grasp on the struggle that neglected and traumatized children faced in

making the shift from mistrust to trust. We knew the attachment research clearly linked the development of secure

attachment to the quality of caregiving the kids received---to connections with what Schore called a

“psychobiologically attuned caregiver.” In short, we knew what these hurt kids needed from their caregivers: the

ability to stay engaged and open with them, especially when the kids were “going defensive” and resisting the

closeness they so much needed, but instinctively avoided.

As we focused more on the new perspective attachment theory and interpersonal neurobiology were opening up on

failed cases like that of Rebecca, we began to look at parents in a different way. Early one morning, we had a shared

epiphany---we finally realized what we’d “known” for a long time: parents’ brains work the same way that their

children’s brains work! Just as a child has to feel safe to approach a caregiver, a parent has to feel safe to approach

and trust a therapist. Parenting isn’t a cookbook activity for managing children’s behavior, it’s an ancient

mammalian mind--heart process that allows the caregiver to stay engaged and regulated enough to sustain the mind-

to-mind, heart-to-heart connections that are vital for the child’s development. Parenting is rooted in openness and

safety, not in survival-mode self-defense. So, we wondered, what does it really takes to be a sensitive, attuned

caregiver and to sustain a parental state of mind through the thick and thin of childrearing? Why can some parents

provide the warmth, openness, and empathy that helps kids thrive, while others, despite having the best intentions,

start to shut down and get defensive when their kids roll their eyes or sass them. What is parental openness, anyway,

and how does a parent develop and sustain it? As we talked, the concept of parental blocked care came into focus as

a shorthand way of describing the suppression of parents’ potential to nurture a child, especially if the child is slow

to reciprocate warmth and love.

We realized, then, that just as our awareness of attachment and its neurobiological foundations informed our practice

with children, understanding the neuropsychological foundations of caregiving would make us more effective

therapists with their parents. First, we needed to learn what actually goes on in the parenting brain. Then, we needed

to understand how stress affects the parenting brain and sometimes leads to blocked care. With a brain-based model

of parenting and blocked care, we hoped to get better at helping stressed-out parents get unstuck and tap their

potential for caregiving.

The Healthy Parenting Brain

So, what does well-functioning brain-based parenting look like? It looks something like Sarah.

Sarah, mother of 12-month-old Vincent, is watching two different videos of her son while having her brain imaged.

In one scene, Vincent is laughing gleefully as Sarah blows big, wet bubbles at him. In the other, Vincent is crying

because Sarah has just left the room. As Sarah watches Vincent as a happy baby, parts of her left hemisphere,

including regions comprising her pleasure system, especially the nucleus accumbens, light up on the imaging screen.

This left-brain system is keeping Sarah in her brain’s Approach mode, fully engaged with Vincent, and is activating

her brain’s Reward system as well. Although we can’t see it on the screen, chemicals such as oxytocin and

dopamine are flooding the limbic regions of Sarah’s brain as she looks at her laughing baby. At the same time that

the oxytocin and dopamine in Sarah’s left brain activate her Approach and Reward systems, it’s going to the

amygdala on the right side of her brain, calming her threat-detection and self-defense system. Oxytocin is like

antianxiety medicine, helping to keep the parent’s defense system “OFF” and the approach system “ON,” which is

the real secret to staying parental toward your child.

In brain terms, Sarah is using what neuroscientist Stephen Porges calls the social engagement or “smart vagal”

system, that connects Sarah’s brain to her heart, lungs, voice, face muscles, and even hearing, allowing her to attune

to Vincent’s communication and be expressive in her response. This is the neural system that enables parents to stay

open and engaged enough with their children to develop the kind of robust connections and meeting of minds

(“intersubjectivity”) that are so uniquely human---the hallmark of healthy, enduring, bonded human relationships.

With her defense system “off,” her Approach and Reward systems “on,” Sarah uses areas in her temporal lobes that

are dedicated to reading emotions from facial expressions and gestures and to processing the pitch variations in the

human voice, remaining exquisitely attuned to Vincent’s internal states. She’s also using her “mirror” cells to

psychologically mimic her son’s reactions and help her to experience what he’s experiencing. Meanwhile, Sarah is

having loving thoughts about Vincent tied to her rich narrative about being his mother. Since becoming a mother,

she’s been using her brain’s Meaning Making System to construct strong beliefs about the value of parenthood and

the personal meaning of having Vincent in her life. Her own attachment history has contributed greatly to the

meaning she attributes to these interactions with her son, as do Vincent’s responses. These meanings---created with

the help of the uppermost region of Sarah’s brain, her dorso-lateral prefrontal cortex---enable her to hold steady and

provide sensitive, predictable parenting even when her child is upset, whiny, and resistant.

When Sarah watches the scene of Vincent in distress, parts of her brain on the right side, which are associated with

responding empathically to a loved one’s pain, become active. Now, different chemicals, including one much like

adrenaline, are spurting into regions of her brain that ramp up her parental vigilance, making her intensely aware of



Vincent’s distress. Her anterior cingulate cortex (ACC) becomes active, in conjunction with the insula or “visceral

brain,” helping her feel Vincent’s pain and causing her to experience a compelling urge to comfort him. The ACC

serves as a neural bridge between the limbic system and the higher regions of the prefrontal cortex---the Executive

System that support adaptive thinking, planning, self-monitoring, and conflict resolution. Here we’re seeing the “call

and response” system at work, with Vincent’s attachment system “on” and Sarah’s caregiving system robustly

responding. We’re watching the healthy parenting brain in action.

Vincent is a lucky child whose brain is thriving from interacting with Sarah, an adult who has the brain capacity to

feel safe with him through thick and thin; experience pleasure from being with him much of the time; read his

“mind” well and attune to his inner life; construct a positive, coherent narrative about being his parent; and regulate

and recover from the inevitable “unparental” reactions effectively.

Parenting well, as in Sarah’s case, involves five different, highly interactive brain systems that we call the parental

Approach, Reward, Child Reading, Meaning Making, and Executive Systems. Through the integrated functioning of

these systems, Sarah and Vincent will continue to synchronize the beating of their hearts, their breathing, and even

the firing of brain cells in their limbic systems.

The Effects of Stress on Parental Care

As we thought about Sarah and how parents are likely to be functioning when they’re able to use their five

integrated brain systems to engage fully with their children, we reflected from a brain-based perspective on some of

our recent sessions with parents who weren’t so well engaged with their children.

Like Sarah, Rebecca had initially experienced a strong desire to be with her infant son and felt pleasure in providing

for his care. Oxytocin was being released in her brain at his birth and when he gazed into her eyes while she held

him in her arms and swayed as she hummed to him. This led to the release of dopamine, and she enjoyed being with

him and anticipated further pleasure from their interactions. Yet these systems of parental Approach and Reward

weren’t all that robust because they hadn’t been strengthened enough when Rebecca actively sought to connect with

her parents as a child. When her expectations of positive interactions were “violated” by Eric’s negative response to

her “offerings,” her dopamine system began to crash, causing her to feel rebuffed, frustrated, and angry. After a

while, she learned to turn off this reward-expectancy system, becoming more distant as a way to protect herself from

the intensely negative feelings of being rebuffed.

Rebecca’s Child Reading system—her intense interest in the moment-to-moment interactive experience of

mothering-- was also active during the first few weeks after Eric’s birth. As the stress of child-rearing intensified,

however, she became hypervigilant for any signs of distress, anger, or rejection in Eric’s facial expressions, body

language, and sounds. The smallest signs of anger in her son’s eyes or voice were enough to trigger her amygdala to

set off the defensive reactions that were already primed to be released. This threat-detection system is activated

within a tenth of a second, so Rebecca found herself becoming defensive without knowing what triggered it. The

stress of child-rearing, intensified by her own history, constricted her child-reading process and biased it toward

negative perceptions, leaving her feeling rejected by her infant.

Rebecca’s Meaning Making system was already weak because of the lack of positive meaning in her own

experience of being raised by her parents. When she now began to feel rejected by her son, she was prey to negative

thoughts about him, herself, and the entire enterprise of parenting and caring for her child. She defended against her

feelings of shame and discouragement by tuning out Eric’s needs, which suppressed activity in higher brain regions

that would have enabled her to reflect positively on being a parent, recall positive parent--child experiences, and

construct newer narratives while engaging with Eric. The stress-based meaning construction that Rebecca was

engaging in is similar to trauma-based processes that suppress activity in the left hemisphere, especially in the

regions used for generating speech and editing our stories. This is why Rebecca’s emerging parental story was so

resistant to change.

Finally, Rebecca’s defensive state---triggered by a failure to experience pleasure, interest, and positive meaning

around her child---impaired her capacity for self-regulation, her Parental Executive system. This effectively shut

down the higher regions of the brain that she needed in order to put the brakes on “unparental” feelings and actions.

As a result, her conflict-detection processes were suppressed, which blocked her ability to sense her misattunement

with Eric and make adjustments to repair the connection. With diminished executive capacity, Rebecca failed to pay

adequate attention to her child and to the relationship, and thus was unable to regulate her emerging negative

reactions to him.

As we came to better understand Rebecca’s reactions to her son, we began to realize that Dan’s reactions to Rebecca

had mirrored those of a parent experiencing blocked care. Dan’s Approach and Reward systems began to weaken

when Rebecca failed to consistently respond to his care. His client-reading system gradually began to take on a

negative bias, while the meaning that he came to give to his treatment of Rebecca became increasingly pessimistic,

restricting his own sense of possibility for her. He began to reflect less on Rebecca’s treatment, which meant not



perceiving the reasons for her lack of response to the treatment. The same process that had been occurring between

Rebecca and Eric had occurred between Dan and Rebecca in the early months of treatment.

Restoring Parental Care

Just as knowing the neurobiology of bonding and attachment had made us less likely to blame children for their

behavioral struggles, understanding the neurobiological foundations of parental caregiving helped us to stop blaming

parents who weren’t attuning to their kids. Applying the concept of blocked care, we began with the assumption that

insensitive parenting is often linked to stress and deficiencies in key brain systems, including the dopamine and

oxytocin systems. Parents with blocked care may want to like and enjoy their children, but don’t know how to

activate the “good chemistry” that would enable them to do so. Understanding the neurobiological causes of blocked

care helped us become more open and empathic to parents’ negative experiences and stories, more willing to listen

and validate their experiences.

Since we now knew that the parents were using similar brain systems to those of their children as they struggled to

connect with their kids, we thought that the same therapeutic interventions we used to engage children and create a

sense in them of “felt safety” with us might also work with highly stressed parents, especially in the early phase of

family-focused treatment. Why not put aside our agendas of changing parents’ behavior long enough to provide a

safe space for them to express their own needs for connection and activate their attachment functioning? If we

wanted parents to provide for their child, we needed to provide first for the parents.

The paradox of integrating complex information about the brain, with all its multi-syllabic terminology, into

treatment is that it actually heightens the importance of open-heartedness and safety as a precondition for change.

Parents with blocked care first need the intense support of an empathic therapist to venture into the realm of

forbidden feelings. But what the brain-based perspective also makes clear is that this kind of therapeutic work takes

time because it requires not only bringing up challenging feelings, but also helping parents strengthen the brain

systems that support more productive processing of emotions and thoughts. Therapy must address the neural

underdevelopment of the Parental Executive system in these parents. Otherwise, attempts to get the parent to bring

up and stay with difficult emotions and to trust the therapist will probably fail as the parent defaults to lower levels

of brain functioning and goes “defensive.”

The stressed-out adult is parenting in survival mode, using primarily the lower, more primitive brain systems that

are dedicated to day to day existence. Such parents need to calm the overreactive limbic and stress-response systems

and tame the amygdala before they can awaken the prefrontal cortex. In short, we must help them dial down their

automatic defensive reaction systems before they can access the higher brain systems needed for self-reflection,

emotional regulation, and empathy.

Brain-Based Parenting in Action

So what difference does incorporating this perspective make in the immediate experience of therapist and client in

the consulting room? Jon had seen Susan and her daughter, Kayla, 13, before in joint sessions and found himself

siding with Kayla and disliking Susan. Now, armed with our model of blocked care, he met individually with Susan,

determined to put this newer understanding of parenting into practice. As the session began, Susan’s facial

expression was flat and she held her body rigidly, as if ready for a fight. Despite his intentions, Jon began to feel

himself tensing up and starting to move away from Susan. But before shifting into a full-blown defensive state, he

caught his reaction and started breathing slowly to release his tension, regain his focus, and open himself more to

her.

Susan was well into a long complaint about how selfish, ungrateful, and disobedient Kayla was, but as Jon started to

engage his own Approach system and open up to her negative story about the miseries of being Kayla’s mother, he

felt more accepting of Susan and the validity of her experience. As his face and body language became more open

and relaxed, he noted that her face began to relax and her shoulders dropped. Jon, mirroring the shifts in Susan’s

face and body, found himself feeling closer to her, as if an invisible barrier between them were melting away. He

was able gradually to look deeply into Susan’s eyes, where a softening effect was apparent, signaling the lowering

of the chronic vigilance that had lined her brow.

Feeling interested now in Susan’s story, Jon asked her to describe the triggers for her intense anger toward her

daughter. She quickly replied, “Her stuck-out lip and that ‘whatever’ tone of voice. Makes me want to strangle her!”

“How have you kept from doing it?” Jon asked, truly curious to know.

“Sometimes, by locking myself in my room until my murderous feelings have passed,” Susan replied.

Jon nodded sympathetically, and said, “Somehow, you found the strength to get past your angriest feelings without

actually going after her.”



Blocked care involves the shutting down of the parts of the cingulate where emotional pain registers as part of a

parent’s empathic response to a child’s distress. If Susan was going to recover from her blocked care, she’d have to

reopen the pathways in her brain that would allow deeper, more vulnerable feelings to rise into consciousness, the

very feelings that she’d learned to suppress in self-defense.

In a quiet tone, Jon asked, “Susan, what was Kayla like as a baby?” After being silent for a moment, she began to

cry softly.

“She was beautiful, perfect. Everything I’d hoped for,” Susan said brokenly. She went on to describe the loving

feelings she’d experienced in those early days and weeks, clearly remembering them for the first time in many years.

Jon instinctively leaned closer to Susan, with some tears of his own welling up. At this point, he felt a level of

attunement with her that he hadn’t been close to experiencing previously. Now he had to try to keep this small

window of connection open.

Just as a parent needs to help a child regulate strong emotions and learn to “feel and deal,” Jon needed to stay

present to Susan’s internal struggle to tolerate the conflict between her desire to have a loving relationship with

Kayla and the defensive, self-protective wall she’d built to keep from feeling the pain of rejection and the sense of

failure as a mother. “Maybe it’s hard and good, at the same time, remembering those loving feelings,” Jon said.

“Yeah, good and hard,” Susan said with a slight smile. “Or maybe you just like making people cry.”

“Well, it used to bother me, but now I feel like I’m not really earning my keep if there are no tears,” Jon joked

gently.

Susan looked briefly into Jon’s smiling eyes and seemed to feel a bit of lightness herself, before she turned away

and sighed.

With the brain model of blocked care as a guide, Jon had a roadmap for slowing himself down, taking the time to

help Susan awaken the underused Approach and Reward systems she’d need to reconnect with Kayla. Jon would

continue to build upon this tentative trust-building process with Susan, postponing a more cognitive agenda focused

on parenting skills until she was ready for it. First she needed the chance to get her parenting brain systems working

again, particularly the executive ability to regulate the old negative feelings, thoughts, and impulses that would

inevitably be reactivated when they began meeting with Kayla.

Taking the Next Step

Once Jon saw signs that Susan was ready and able to move outside her rigid, defensive patterns of interacting with

her daughter, he invited Kayla to join Susan for family sessions. By then Susan’s anger was less easily triggered and

the next step was for her to learn to listen to her daughter more openly and less judgmentally. In the first session,

Susan clearly struggled not to lose it as Kayla resentfully told her mother, “You yell too much and you never want to

hear my side of the story.” Looking at Jon a little desperately, Susan said, “What do we do now? This is usually

when I go ballistic.”

The bond that Susan had begun to develop with Jon—her sense that he understood her and was truly on her side—

was now crucial to her able to shift her response to her daughter. As Susan looked at him, she seemed fortified by

his nonverbal support. Calmly, slowly Jon, said, “If it feels right to you, Susan, maybe now’s the time to tell Kayla

that you’re sorry you haven’t been listening to her and that you really want to understand her better; that you love

her and want to be closer.” Susan took a deep breath and turned toward Kayla. Tapping into the caring feelings

she’d been recovering in therapy, her voice quavering a little, but warm, she told Kayla that what Jon had said was

true.

“I really want to know what’s going on with you and I’m sorry for the times I haven’t listened to you. But I’m going

to try harder---I do love you very much, and I really want us to be closer.” At first, Kayla looked doubtful, but she

instinctively moved nearer to Susan on the sofa and snuck a peek at her mother’s face, just enough to see the

softening in Susan’s eyes that accompanied the softening of her voice. Kayla’s face then began to soften, too, as she

mirrored Susan’s caring expression. “Me, too, Mom,” she whispered, without the slightest trace of teenage disdain.

There was still much work to be done—this kind of interaction would need to happen again and again. But in that

moment, Jon, Susan, and Kayla all shared a wordless sense of hope.

Perhaps the real lesson in all this is that all of us---children, adults, and even aging therapists---are, to one degree or

another, creatures of our limbic systems. All of us respond better to an approach encompassing playfulness,

acceptance, curiosity, and empathy, conveyed with genuine smiles, soft eyes, gentle voices, an open posture, and a

figurative hand held out in support. Few of us respond well to closed faces, defensive posturing, annoyed voices, or

judgmental eyes. But as therapists, we have the responsibility to consciously rise above our limbic systems, to

become the adults---even the parents---in the room, until we’ve managed to help our clients access their own better,

more adult, more parental selves.



PARENTAL COMPASSION AND ATTACHMENT FOCUSED TREATMENT: Why it is crucial to help parents resolve their ambivalence toward the mistrusting child5

The key to helping children with blocked trust learn to trust when they come “into care” is having

new caregivers (and therapists) who deeply understand blocked trust and can use this understanding to

resolve what otherwise can easily become chronic ambivalence towards the child. This ambivalence is

a natural tension between an adult’s initial loving intentions towards the child and the inevitable

feelings of disappointment and discouragement that come along with the experience that “love is not

enough” to promote a quick shift in the child from core mistrust to trust. It’s not enough that the

adults avoid “blocked care”. They have to be able to sustain a robust level of compassion towards the

child if they are going to provide the child with the kind of relational experiences over time that can

scaffold the child’s journey from mistrust to trust.

Therapists working with carers (caregivers) and children with blocked trust need to deeply understand

the dynamics of blocked care and know how to help adults work through and resolve their

ambivalence towards the child. Neuroscientists have shown that our emotional brain, our limbic

system, and very specifically our amygdala, responds strongly to ambiguous facial expressions and

incongruities between the literal meaning of words and emotional qualities of another person’s voice.

The amygdala reacts to incongruities in social signals because part of its job in our brains is to launch

a process of “disambiguation” to quickly figure out what we should do about the “thing” that is

sending ambiguous messages. The human amygdala evolved to be especially sensitive to ambiguous

social messages because our communication is complex, especially when our words don’t match our

nonverbal signals.

Children with blocked trust have hypersensitive amygdalae and are very biased towards appraising

anything ambiguous in another person’s communication as negative, as threatening. This is what

neuroscientists call the “negativity bias”, a form of the brain’s survival mechanism, as in “better safe

than sorry”. Children exposed to threatening environments early in life were typically exposed to high

levels of ambiguity in which they were confronted with conflicting combinations of positive and

negative facial expressions and tones of voice and gestures from adults. They had to use their young

brains to learn to disambiguate these mixed messages in milliseconds in order to “decide” what to do,

whether to approach or avoid, engage or defend. This means that a crucial aspect of blocked trust is

the child’s bias towards automatically treating ambiguity in other people’s communication as a threat.

The child’s social defense system, grounded in the neuroceptive process of reading social cues within

a tenth of a second to determine the level of threat or safety in these cues, leads the child to

reflexively, mindlessly mistrust an adult who is sending ambiguous, incongruous signals.

When the caregiver is having very mixed feelings towards the child based on an internal conflict

between good intentions and negative feelings stemming from the child’s mistrust, the caregiver

inevitably gives the child “mixed messages”, ambiguous messages in the form of fleeting negative

facial expressions or tones of voice that belie the content of loving words (“trust me”, spoken with

sounds of defensiveness or anger). In turn, the child’s mistrusting brain automatically responds more

strongly to the negative parts of the ambiguous message than to the positive aspects of the adult’s

communication. Consequently, the adult’s ambivalence promotes further mistrust, reinforcing the

child’s preexisting negativity bias and making it even harder for the child to learn to trust the adult.

Implications for Attachment Focused Treatment: Parent Work, PACE, and Conflict Resolution.

With an understanding of the effects of parental ambivalence on the child’s mistrusting brain, it is

clear that therapists need to help parents address and resolve their natural ambivalence. This means

making it safe for the parents to reveal their mixed feelings to the therapist so there can be a safe

enough process for “working through” this ambivalence.

5 A brief paper written for the DDP Network Library by Jonathan Baylin, PhD, July 2015



DDP Informed Resources

Books:

Baylin, J. & Hughes, D. A. (2016) The Neurobiology of Attachment-Focused Therapy: Enhancing Connection

& Trust in the Treatment of Children & Adolescents (Norton Series on Interpersonal Neurobiology). New York:

W.W. Norton

Bomber, L. M. & Hughes, D. A. (2013) Settling to learn. Settling troubled pupils to learn: why relationships

matter in school. London: Worth Publishing Ltd.

Hughes, D.A. (2007). Attachment-focused family therapy. New York: WW Norton.

Hughes, D.A. (2009). Attachment-focused parenting. New York: W.W. Norton.

Hughes, D.A. (2011) Attachment focused family therapy: the workbook. New York: WW Norton.

Hughes, D. A. (2012) It was that one moment. Dan Hughes poetry and reflections on a life of making

relationships with children and young people London: Worth Publishing Ltd.

Hughes, D.A. (2017). Building the Bonds of Attachment, Awakening love in deeply troubled children. 3rd. Ed.

Lanham, MD: Jason Aronson.

Hughes, D. & Baylin, J. (2012) Brain-Based Parenting: The Neuroscience of Caregiving for Healthy

Attachment New York: W.W. Norton

Hughes, D. A.; Golding, K.S. & Hudson, J. (2018) Healing relational trauma with attachment-focused

interventions: Dyadic Developmental Psychotherapy with children and families NY: W. W. Norton & Co, Inc

Golding K. S. (2008) Nurturing Attachments. Supporting Children who are Fostered or Adopted. London:

Jessica Kingsley Publishers.

Golding, K. S. (2014) Nurturing Attachments Training Resource. Running Groups for Adoptive Parents and

Carers of Children Who Have Experienced Early Trauma and Attachment Difficulties London: Jessica Kingsley

Publishers

Golding, K. S. (2014) Using stories to build bridges with traumatized children. Creative ideas for therapy, life

story work, direct work and parenting. London: JKP

Golding, K. S. et al (2013) Observing children with attachment difficulties in preschool settings/school. A tool for

identifying and supporting emotional and social difficulties, London: Jessica Kingsley Publishers

Golding, K. S. et al (2015) Observing adolescents with attachment difficulties in educational settings. A tool for identifying

and supporting emotional and social difficulties. London: JKP

Golding K. S. (2017) Foundations for attachment training resource. The six-session programme for parents of traumatized

children. London: Jessica Kingsley Publishers

Golding K. S. (2017) Everyday parenting with security and love. Using PACE to provide Foundations for Attachment.

London: Jessica Kingsley Publishers.

Golding, K. S. & Hughes, D. A. (2012) Creating Loving Attachments. Parenting with PACE to nurture confidence and

security in the troubled child. London: Jessica Kingsley Publishers

Chapters:

Hughes, D. (2006). Creating PLACE: parenting to create a sense of safety. In Adoption Parenting: Creating a

toolbox, building connections. MacLeod, J. & Macrae, S.(Eds.). NJ: EMK Press. Pp.57-61.

Hughes, D. A. An attachment focused treatment for foster and adoptive families (2007) In K. S. Golding (Ed)

Briefing Paper: Attachment Theory into Practice. The Faculty for Children & Young People of the Division of

Clinical Psychology, The British Psychological Society

Hughes D.A. (2009) The communication of emotion and the growth of autonomy and intimacy within family

therapy. In D. Fosha; D.J. Siegel; & M Solomon (eds) The healing power of emotion. Affective neuroscience,

development and clinical practice. NY: W. W. Norton & Co, Inc. 280-303.

Hughes, D.A. (2009) Principles of attachment and intersubjectivity. In A. Perry(ed) Teenagers and Attachment.

Helping adolescents engage with life and learning. London: Worth Publishing 123-140.



Hughes, D. (2009). Attachment-Focused Treatment for Children. In Kerman, M. (Ed.) Clinical pearls of

wisdom. New York: Norton. 169-181.

Hudson, J (2006 ) Chp 8 Being Adopted. Psychological Services for Adopting In K. S. Golding, H. R. Dent, R.

Nissim, & E. Stott (Eds) Thinking psychologically about children who are looked after and adopted. Space for

Reflection. John Wiley & Sons Ltd.

Papers:

Andrew E, Williams J and Waters C (2014) Dialectical Behaviour Therapy and attachment: vehicles for the

development of resilience in young people leaving the care system. Clinical Child Psychology and Psychiatry

19(4): 503–515.

Boyer, N. R. S.; Boyd, K. A.; Turner-Halliday, F.; Watson, N.; & Minnis H. (2014) Examining the feasibility of

an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated

psychiatric problems in the United Kingdom. BMC Psychiatry 14:346

Casswell, G.; Golding, K. S.; Grant, E.; Hudson, J. & Tower P. (2014) Dyadic Developmental Practice (DDP):

A framework for Therapeutic intervention and Parenting. The Child & Family Clinical Psychology Review, No

2., 19 - 27

Hughes D.A (2003) Psychological interventions for the spectrum of attachment disorders and intrafamilial

trauma. Attachment and Human Development, 5,3, 271-277

Hughes, D.A. (2004) An Attachment-based treatment of maltreated children and young people. Attachment &

Human Development, 6, 263-278

Hughes, D. (2014) DDP: Toward a comprehensive trauma-informed treatment for developmental trauma

disorder. The Child & Family Clinical Psychology Review, No 2., 13 - 18

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

Hughes, D.; Golding, K. S.; & Hudson, J. (2015) Dyadic Developmental Psychotherapy (DDP): the

development of the theory, practice and research base. Adoption & Fostering, 39, 356 – 365

Selwyn J.; Golding, K.; Alper, J.; Gurney Smith, B.; Hewitt, O. (2016) A quantitative and qualitative evaluation

of the nurturing attachments group programme.

http://www.adoptionplus.co.uk/userassets/12763_AdoptionPlus_Summary_Report_Digital917144.pdf

Hewitt, O.; Gurney-Smith, B. & Golding, K. (2018) A qualitative exploration of the lived experiences of

adoptive parents attending ‘Nurturing Attachments’, a dyadic developmental psychotherapy informed group.

Clinical Child Psychology and Psychiatry https://doi.org/10.1177/1359104517753511 | First Published January

22, 2018

Wingfield, M. (submitted) Adoptive parents’ experiences of Dyadic Developmental Psychotherapy.

DVD & CD

http://danielhughes.org/Dan/20Hughes/20Web/20Pages/booksdvd.html

Dan Hughes and Jan Koomar SAFE PLACE: Parenting strategies for facilitation attachment and sensory

integration.

Dan Hughes Building the bonds of attachment

Dan Hughes Developing attachment family therapy examples

http://www.dyadicdevelopmentalpsychotherapy.org/bookspub.html

Dan Hughes A Videoed Conversation: Integrating Neurobiology into DDP – 15 years on

https://www.familyfutures.co.uk/product/dan-hughes-videoed-conversation-integrating-neurobiology-ddp-15-

years/

Michael Trout The hope filled parent http://danielhughes.org/Dan/20Hughes/20Web/20Pages/booksdvd.html

A day with Dan Hughes, Falkirk 2009 http://www.adoptionuk.org/s/shopcategory/100516/100534/audiovisual/

http://www.adoptionplus.co.uk/userassets/12763_AdoptionPlus_Summary_Report_Digital917144.pdf

https://doi.org/10.1177/1359104517753511


http://www.dyadicdevelopmentalpsychotherapy.org/bookspub.html

https://www.familyfutures.co.uk/product/dan-hughes-videoed-conversation-integrating-neurobiology-ddp-15-years/

https://www.familyfutures.co.uk/product/dan-hughes-videoed-conversation-integrating-neurobiology-ddp-15-years/


http://www.adoptionuk.org/s/shopcategory/100516/100534/audiovisual/



Additional Reading List

Attachment Theory Bowlby J (1988/1998) A secure base. Clinical applications of attachment theory. London: Routledge

Clarke A.M. and Clarke A.D.B. (2000) Early Experience and The Life Path. London: JKP

Howe D. (2005) Child Abuse and Neglect. Attachment, development and intervention. Palgrave

Siegal D.J & Hartzell M (2003) Parenting from the inside out. NY: Tarcher/Putnam

Trauma Porges, S. W. (2017) The pocket guide to the polyvagal theory. The transformative power of feeling safe. NY: W.W.

Norton & Co.

Solomon M.F. & Siegel D.J. (2003) Healing trauma. Attachment, mind, body and brain. London: W.W Norton & Co.

Siegel, D. J. (2007) The Mindful Brain. NY: W.W. Norton & Co.

Shame Kaufman G (1996) The Psychology of Shame. Theory and treatment of shame-based syndromes. NY: Springer Publ Co.

2nd ed. (1st ed: 1989).

Tangney, J. & Dearing, R. (2002). Shame and guilt. NY: Guilford Press.

Education

Bombèr L. M. (2007) Inside I’m hurting. Practical strategies for supporting children with attachment difficulties in

schools. London: Worth Publishing Ltd.

Bombèr L. M (2011) What about me? Inclusive strategies to support pupils with attachment difficulties make it through

the school day. London: Worth Publishing Ltd.

Forbes, H. T. (2012) Help for Billy. A beyond consequences approach to helping challenging children in the classroom.

Boulder, Colarado: BCI

Residential Care

Barton, S.; Gonzalez, R. & Tomlinson, P. (2012) Therapeutic residential care for children and young people.

An attachment and trauma-informed model for practice. London: Jessica Kingsley Publishers

Parenting and Interventions Jernberg A & Booth P.B. (2001) Theraplay: Helping parents and children build better relationships through attachment-

based play (2nd Ed) Jossey-Bass.

Marvin R; Cooper G; Kent H & Powell B (2002) The Circle of Security Project: Attachment-based intervention with

caregiver-pre-school child dyads. Attachment & Human Development. 4, 1, 107-124

Norris, V. & Rodwell, H. (2017) Parenting with Theraplay® Understanding attachment and how to nurture a closer

relationship with your child. London@ JKP

Dozier M. (2003) Attachment-based treatment for vulnerable children. Attachment & Human Development, 5,3, 253-257

Elliott, A. (2013) Why can’t my child behave? Empathic parenting strategies that work for adoptive and foster families.

London: Jessica Kingsley Publishers

Lacher D.B, Nichols T & May J.C. (2005) Connecting with kids through stories. Using narratives to facilitate attachment

in adopted children. London/Philadelphia Jessica Kingsley Publishers.

Lloyd, S. (2016) Improving sensory processing in traumatized children, Practical ideas to help your child’s movement, co-

ordination and body awareness. London: Jessica Kingsley Publishers

Adolescence Allen J. P & Land D. (1999) Attachment in Adolescence. In Cassidy & Shaver (eds) Handbook of Attachment, Chapter

15, Guilford Press

Downes C (1992) Separation revisited. Adolescents in foster family care Surrey: Ashgate Publishing

Siegel, D. J. (2014) Brainstorm. An inside-out guide to the emerging adolescent mind, ages 12 – 24. London: Scribe

Staff, R. (2016) Parenting adopted teenagers. Advice for the adolescent years. London: Jessica Kingsley Publishers

Taylor, C. (2010) A practical guide to caring for children and teenagers with attachment difficulties. London: JKP.

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