On Monday I had the privilege of a phone interview with Dr. Becker-Weidman. He has been practicing family therapy for 25 years in the New York area. He is also the adoptive parent of a daughter he and his wife adopted from China 14 years ago. He has written over a dozen scholarly papers and has presented and trained all over the world. He founded the Center For Family Development. He recently co-authored with Debra Shell the book Creating the Capacity for Attachment. He has a blog with a vast amount of information.
These are not exact quotes.
Me: Please tell me about the treatment you use for treating children with RAD.
Dr. Becker-Weidman: We use a method called Dyadic Developmental Psychotherapy.
It was developed by Daniel Hughes. It is an attachment focused family therapy. It different than traditional therapy. It follows along the lines of the Circle of Security. It provides a playful, accepting, curious, and empathic environment for the child. The therapist models for the mother new ways of interacting with the child that are therapeutic.
Me: What 3 things do you think are most important for a mom of a child with RAD to know?
Dr. Becker-Weidman: First I do complete evaluation of each child that comes in. There are many other disorders that resemble the behavior seen with RAD. It is important to have the correct diagnosis.
1. Children with RAD are developmentally younger than their physical age. Treat your child as though they are the that developmental age. In other words, if a child is 8 but acts only 3, you need to have the expectations of a 3 year old for him.
2. Treat the cause not the symptom. Look at the underlying factor driving the behavior. That fear or sadness is what needs to be addressed.
3. Parents must develop the ability to be sensitive to the child's need. They need empathy and attunement. Think of your child as relationship phobic. When you work to develop emotional intimacy they will attempt to take you back to a level where they feel more comfortable.
Me: What if there is no Attachment Therapist in your area?
Dr. Becker-Weidman: Consider driving further. It doesn't make sense to get ineffective therapy. Locate a therapist who is willing to learn and drive to Attachment Therapy a couple of times. Some Attachment Therapists do 2 week intensives and you bring your therapist with you. We have done that one several cases. I can come to your area and do a master class for therapists. Check with the local health center that train therapists and see if they can have a training for therapists in your area.
On your initial call to an Attachment Therapist ask questions. See if it is a good fit. Many therapists have websites now. Ask for this and go and do some reading.
Me: Thank you Dr. Becker-Weidman.
Dr. Becker-Weidman has many resources available to us. Thank you Dr. Becker-Weidman for you time. Thank you for helping families!
2 comments:
Wow how exciting!!!
The new book, Treating Complex Traumatic Stress Disorder, edited by Christine Courtois and Julian Ford, The Guilford Press, NY, 2009, supports the various elements, principles, and techniques of Dyadic Developmental Psychotherapy. The chapter on family therapy approaches states, "Meta-analytic studies have found family based treatments to be more effective than treatment as usual (TAU)...The strongest evidence for the efficacy of family therapy for traumatic stress disorders is provided by studies with families of traumatized toddlers and preschool- or early elementary school-aged children." pp394-395.
The book describes the importance of affect regulation, focusing on attachment relationships in treatment, attention to developmental level and processes, emotional regulation, titrated exposure to traumatic memories, therapeutic alliance, intersubjectivity, and other topics that are core principles and methods of Dyadic Developmental Psychotherapy. It is heartening to find additional support for the use of DDP in the treatment of attachment and trauma disorders.
The book describes practice principles for treating children with complex traumatic stress disorder which are quite consistent with previous material published about DDP over the last several years:
1. Safety First
2. A relational bridge must be developed to engage, retain, and maximally benefit the child and caregiver(s).
3. Diagnosis, treatment planning, and outcome monitoring are always relational.
4. Diagnosis, treatment planning, and outcome monitoring are always strengths-based.
5. All phases of treatment should aim to enhance self-regulation competencies.
5a. Emotional regulation.
5b. Attention, memory, decision making (information processing).
5c. Self-regulation of consciousness and motivation.
5d. Bodily self-regulation.
5e. Relational self-regulation.
6. Determining with whom, when, and how to address traumatic memories.
7. Preventing and managing relational discontinuities and psychosocial crises.
from pages 67-78.
As described and elaborated in the book, these principles have also been previously described and elaborated on in various publications about DDP (several books and journal articles).
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