View source for Medicine:Dyadic developmental psychotherapy

'''Dyadic developmental psychotherapy''' is a [[Medicine:Psychotherapy|psychotherapeutic]] treatment method for families that have children with symptoms of emotional disorders, including [[Medicine:Complex post-traumatic stress disorder|complex trauma]] and disorders of [[Medicine:Attachment disorder|attachment]].<ref name="Becker-Weidman, A. 2008 pp.329-337">{{cite journal | author = Becker-Weidman A., Hughes D. | year = 2008 | title = Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment | journal = Child & Adolescent Social Work | volume = 13 | issue = 3 | pages = 329–337 | doi = 10.1111/j.1365-2206.2008.00557.x }}</ref> It was originally developed by Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers.<ref name="hughes2003">{{cite journal | author = Hughes D | year = 2003 | title = Psychological intervention for the spectrum of attachment disorders and intrafamilial trauma | journal = Attachment & Human Development | volume = 5 | issue = 3 | pages = 271–279 | doi = 10.1080/14616730310001596142 | pmid = 12944222 | s2cid = 33776982 }}</ref><ref name="hughes2004"/> Hughes cites [[Philosophy:Attachment theory|attachment theory]] and particularly the work of [[Biography:John Bowlby|John Bowlby]] as theoretical motivations for dyadic developmental psychotherapy.<ref name="hughes2004">{{cite journal|author= Hughes D|year= 2004|title= An attachment-based treatment of maltreated children and young people|journal= Attachment & Human Development|volume= 6|issue= 3|pages= 263–278|doi= 10.1080/14616730412331281539|pmid= 15513268|s2cid= 44452582|url= http://www.attachmentcoalition.org/DDP.pdf|url-status= dead|archive-url= https://web.archive.org/web/20110725022654/http://www.attachmentcoalition.org/DDP.pdf|archive-date= 25 July 2011|df= dmy-all}}</ref><ref name="Bretherton, I., 1992">{{cite journal | author = Bretherton I | year = 1992 | title = The origins of attachment theory | journal = Developmental Psychology | volume = 28 | pages = 759–775 | doi = 10.1037/0012-1649.28.5.759 }}</ref><ref name="Holmes, J., (1993)">Holmes, J.(1993) John Bowlby and Attachment Theory, London:Routledge {{ISBN|0-415-07729-X}}</ref>

Dyadic developmental therapy principally involves creating a "playful, accepting, curious, and empathic" environment in which the therapist attunes to the child's "subjective experiences" and reflects this back to the child by means of eye contact, facial expressions, gestures and movements, voice tone, timing and touch, "co-regulates" emotional affect and "co-constructs" an alternative autobiographical narrative with the child. Dyadic developmental psychotherapy also makes use of [[Medicine:Cognitive therapy|cognitive-behavioral]] strategies. The "dyad" referred to must eventually be the parent-child dyad. The active presence of the primary caregiver is preferred but not required.<ref name="hughes2004"/>

A study by Arthur Becker-Weidman in 2006, which suggested that dyadic developmental therapy is more effective than the "usual treatment methods" for [[Medicine:Reactive attachment disorder|reactive attachment disorder]] and [[Medicine:Complex post-traumatic stress disorder|complex trauma]],<ref name="bw1">Becker-Weidman. ''Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy'', Child and Adolescent Social Work Journal. 23(2), April 2006</ref><ref name="bw3">Becker-Weidman, A., (2006b). Dyadic Developmental Psychotherapy: a multi year follow-up. in Sturt, S., (ed) New Developments in Child Abuse Research. NY: Nova</ref> has been criticised by the American Professional Society on the Abuse of Children (APSAC). According to the APSAC Taskforce Report and Reply, dyadic developmental psychotherapy does not meet the criteria for designation as "evidence based" nor provide a basis for conclusions about "usual treatment methods".<ref name="Chaffin et al." >{{cite journal | doi = 10.1177/1077559505283699 | volume=11 | title=Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems | year=2006 | journal=Child Maltreatment | pages=76–89 | author=Chaffin M| issue=1 | pmid=16382093 | s2cid=11443880 }} |</ref><ref name=Reply>{{cite journal | author = Chaffin Mark, Hanson Rochelle, Saunders Benjamin E | year = 2006 | title = Reply to Letters | journal = Child Maltreat | volume = 11 | issue = 4 | pages = 381–386 | doi = 10.1177/1077559506292636 | s2cid = 145525137 }}</ref> A 2006 research synthesis described the approach as a "supported and acceptable" treatment,<ref name= "Craven">{{cite journal | author = Craven , Lee  | year = 2006 | title = Therapeutic Interventions for Foster Children: A systematic Research Synthesis | journal = Research on Social Work Practice | volume = 16 | issue = 3 | pages = 287–304 | doi = 10.1177/1049731505284863 | s2cid = 143942564 }}</ref> but this conclusion has also proved controversial.<ref name="Pignotti & Mercer"/> A 2013 review of research recommended caution about this method of therapy, arguing that it has "no support for claims of effectiveness at any level of evidence" and a questionable theoretical basis.<ref name="mercer2014">{{cite journal | author = Mercer Jean | year = 2014 | title = Examining Dyadic Developmental Psychotherapy as a Treatment for Adopted and Foster Children: A Review of Research and Theory | journal = Research on Social Work Practice November | volume = 24 | issue = 6| pages = 715–724 | doi = 10.1177/1049731513516514 | s2cid = 144696855 }}</ref>

==Theoretical basis==

Dyadic developmental psychotherapy is based on the theory that maltreated infants not only frequently have [[Philosophy:Attachment in children|disorganized attachments]] but also, as they mature, are likely to develop rigid self-reliance that becomes a compulsive need to control all aspects of their environment. Hughes cites Lyons-Ruth & Jacobvitz (1999) in support of this theory. Caregivers are seen as a source of fear with the result that children endeavour to control their caregivers through manipulation, overcompliance, intimidation or role reversal in order to keep themselves safe. Such children may also suffer intrusive memories secondary to trauma and as a result may be reluctant or unwilling to participate in treatment. It is anticipated that such children will try to actively avoid the exposure involved in developing a therapeutic relationship and will resist being directed into areas of shame and trauma. Hughes proposes that an attachment based treatment may be more effective for such foster and adoptive children than traditional treatment and parenting interventions.<ref name="hughes2004"/>

It is stated that once an infant's safety needs are met (by attachment) they become more able to focus on learning and responding to the social and emotional needs of caregivers. (Schore, 2003ab). Hughes posits that this 'affective attunement', described by Stern (1985) is crucial in the development of both a secure attachment as well as a positive, integrated sense of self. Attunement is a primarily a non-verbal mode of communication between infant and carer, and synchrony in the degree of arousal being expressed, as well as empathy for the child's internal experience. Hughes states "Whether it is a motivational system separate from attachment as is suggested by Stern (2004), or a central aspect of a secure attachment dyad, it remains vital in the child's overall development."<ref name="hughes2004"/>

The therapy attempts to replicate this or fill in the gaps in a maltreated child's experience.

==Methods==

Firstly the therapist becomes 'non-verbally attuned' with the child's affective state. The therapist then attempts to explore 'themes' with the child whilst remaining attuned. Whilst this is done, the therapist then 'co-regulates' (helps the child to manage) the child's emerging affective states with 'matched vitality affect', and develops secondary affective/mental representations of them which is co-constructed with the child for purposes of integration (the therapist tries to help the child gain a coherent narrative about their experiences and an awareness of the positive aspects of themselves). According to Hughes "The therapist allows the subjective experience of the child to impact the therapist. The therapist can then truly enter into that experience and from there express her/his own subjective experience.  As the therapist holds both subjective experiences, the child experiences both.  As the child senses both, the child begins to integrate them and re-experience the event in a way that will facilitate its integration and resolution."<ref name="hughes2004"/> In the anticipated frequent disruptions, due to the child's traumatic and shaming experiences, the therapist accepts and works with these and then 'repairs' the relationship.

The aim is for the child to be able to construct a new and coherent autobiography that enables the child to be in touch with their inner feelings. "As the therapist gives expression to the child's subjective narrative, s/he is continuously integrating the child's nonverbal responsiveness to the dialogue, modifying it spontaneously in a manner congruent with the child's expressions. The dialogue is likely to have more emotional meaning for the child if the therapist, periodically, speaks for the child in the first person with the child's own words." (Hughes 2004 p18)<ref name="hughes2004"/> The active presence of one of the child's primary caregivers is considered to greatly enhance psychological treatment. However Hughes considers that attachment based treatment can be undertaken with just the therapist.(Hughes 2004 p25)<ref name="hughes2004"/>

==Controversy==
DDP has been criticised for the lack of a comprehensive manual or full case studies to provide details of the process. Its theoretical basis has also been questioned.<ref name="mercer2014" /> Although non-verbal communication, communicative mismatch and repair, playful interactions and the relationship between the parents' attachment status and that of a toddler are all well documented and important for early healthy emotional development, Hughes and Becker-Weidman are described as making "a real logical jump" in assuming that the same events can be deliberately recapitulated in order to correct the emotional condition of an older child.<ref name="Pignotti & Mercer">{{cite journal | author = Pignotti M., Mercer J. | year = 2007 | title = Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions: A systematic research synthesis revisited | journal = Research on Social Work Practice | volume = 17 | issue = 4| pages = 513–519 | doi = 10.1177/1049731506297046 | s2cid = 143261269 }}</ref>

Similarities to certain [[Unsolved:Attachment therapy|attachment therapy]] practices have also provoked controversy.<ref name="mercer2014" /> It has been suggested that the therapy appears to use age regression and holding techniques—features of attachment therapy not congruent with [[Philosophy:Attachment theory|attachment theory]].<ref name="Pignotti & Mercer"/> Becker-Weidman cites Daniel Hughes's 1997 book "Facilitating Developmental Attachment", which contains sections on the use of age regression and holding therapy, as a source document for dyadic developmental psychotherapy.<ref name="bw1"/> The advocacy group Advocates for Children in Therapy include dyadic developmental psychotherapy in their list of "attachment therapies by another name", and continue to list Hughes as a proponent of attachment therapy, citing statements of his that appear to endorse [[Unsolved:Attachment therapy|holding therapy]].<ref>[http://www.childrenintherapy.org/proponents/hughes.html Advocates for Children in Therapy - Daniel Hughes].</ref> In particular, they cite material from Hughes's website about the use of physical contact in therapy.<ref name="Hughes 1997">Daniel A. Hughes (1997). [https://web.archive.org/web/20070205224739/http://danielahughes.homestead.com/fdaintro.html Facilitating Developmental Attachment: The Road to Emotional Recovery and Behavioral Change in Foster and Adopted Children]. Publisher Jason Aronson Inc. Retrieved 30 November 2014.</ref> However a recent academic study found that, "Such practices were not reported by any of the parents" who took part in the study, "and indeed many identified DDP as being child-led, meeting the needs of their family with good results and in a climate of safety."<ref name="Wingfield and Gurney-Smith, 15">Wingfield M, Gurney-Smith B. (2018). [https://doi.org/10.1177%2F1359104518807737 Adoptive parents’ experiences of dyadic developmental psychotherapy]. Clin Child Psychol Psychiatry. 2019;24(4):661-679. doi:10.1177/1359104518807737</ref>

The APSAC Taskforce report on attachment disorder, reactive attachment disorder and attachment therapy, published in 2006, places Hughes and Becker-Weidman within the attachment therapy paradigm and indeed specifically cites Becker-Weidman for, amongst other things, the use of age regression, though not for coercive or restraining practices (p.&nbsp;79). They also describe DDP as an attachment therapy in their November 2006 Reply to Letters.<ref name="Chaffin et al."/><ref name="Chaffin Reply">Mark Chaffin, Rochelle Hanson and Benjamin E. Saunders "Reply to Letters ''Child Maltreat'' 2006; 11, 381 {{doi|10.1177/1077559506292636}} "Dr. Becker-Weidman is cited three times in the body of the report, none of which refer to coercive techniques. The first citation references his Web site's assertion that traditional therapies are either ineffective or harmful (p. 78). The second citation references his recommendation that children be encouraged to regress to an earlier age as part of treatment (p. 79). The third citation references his assertions, which we believe are unsupported, about practicing an evidence-based treatment (p. 85)."</ref> Becker-Weidman had stated in his letter to the Taskforce that it was essential to treat a child at its developmental rather than chronological level, but the Taskforce in its November 2006 Reply to Letters disagreed (p.&nbsp;382).<ref name="Chaffin Reply2">{{cite journal | author = Chaffin Mark, Hanson Rochelle, Saunders Benjamin E | year = 2006 | title = Reply to Letters | journal = Child Maltreat | volume = 11 | issue = 4 | pages = 381–386 | doi = 10.1177/1077559506292636 | s2cid = 145525137 }}</ref><ref name="Becker-Weidman Letter">{{cite journal | author = Becker-Weidman Arthur | year = 2006 | title = Letter to the Editor | journal = Child Maltreat | volume = 11 | issue = 4 | pages = 379–380 | doi = 10.1177/1077559506292632 | pmid = 17043325 }}</ref>

The Taskforce in their ''Reply to Letters'' describe Hughes as "a leading [[Unsolved:Attachment therapy|attachment therapist]]" and cite Hughes (together with Kelly and Popper) as examples of attachment therapists who have more recently developed their practices away from the more concerning attachment therapy techniques (p.&nbsp;383).<ref name="Chaffin Reply3">"Hughes went on to describe how his own practice of attachment therapy has changed during the years, specifically in terms of less emphasis on parental victory in power struggles, less use of holding techniques, and rejection of cathartic or dysregulated ventilation of past trauma in favor of approaches that sound very similar to well-supported gradual exposure techniques. Along with this, he offered some discussion of how he came to reconsider some of his own past attachment therapy practices."</ref>

The Kansas University/SRS ''Best Practices Report'' (2004) considered that dyadic developmental psychotherapy as described by Becker-Weidman, appeared to be somewhat different from that as described by Hughes. They state that in 2004 Becker-Weidman's claim that dyadic developmental psychotherapy was "evidence based" cited studies on [[Unsolved:Attachment therapy|holding therapy]] by Myeroff, Randolph and Levy from the Attachment Center at Evergreen.<ref name="Becker-Weidman/Kansas">Becker-Weidmann, A. (3/7/2004). Dyadic Developmental Psychotherapy, retrieved
3/20/2004 from http://www.center4familydevelop.com/developmentalpsych.htm</ref><ref name="Uta et al.">Uta M. Walter, U., M. and Petr, C. Best Practices in Children's Mental Health: "Reactive Attachment Disorder: Concepts, Treatment and Research" Produced by the University of Kansas School of Social Welfare in conjunction with Kansas Social Rehabilitation Services pp 10-18</ref> Hughes' model is described as more clearly incorporating researched concerns about 'pushing' children to revisit trauma (as this can re-traumatize victims) and as having integrated established principles of trauma treatment into his approach. Avoiding dysregulation is described by Hughes as a primary treatment goal.<ref name="Uta et al."/>

Prior and Glaser state that Hughes's therapy 'reads' as good therapy for abused and neglected children, though with 'little application of attachment theory', but do not include it in their section on attachment therapy.<ref name="Prior 2006">Prior, V., and Glaser, D. (2006). ''Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice'', Jessica Kingsley Publishers, Child and adolescent mental health series. | p268 | {{ISBN|1-84310-245-5}}.</ref>

Trowell, while admiring Hughes's clinical skills, stated that "Parents and carers need their own specific parent work and the children and young people need specific work tailored to their needs ... parents with their own unmet attachment needs from childhood may significantly inhibit their ability to speak frankly with, and feel supported by professionals aiming to help their children".<ref>{{cite journal | author = Trowell J | year = 2004 | title = Reflections on 'an attachment-based treatment of maltreated children and young people' | journal = Attachment & Human Development | volume = 6 | issue = 3| pages = 279–283 | doi = 10.1080/14616730412331281566 | pmid = 15513269 | s2cid = 26974869 }}</ref> Referring to the use of facial expressions in attempts at attunement, Trowell noted, "although the therapist may look and feel sad, the young person may see this as a provocation-- either hit out or the therapist may be perceived to be triumphant (the facial expression may be misread)" (p.&nbsp;281). Trowell emphasized the value of many of Hughes's ideas for clinical work, but she concluded that "There is a need for caution. Experienced, well-trained clinicians can, with supervision, take these ideas forward into their clinical practice. But the ideas in [Hughes's 2004 paper] do not provide a sufficient basis for a treatment manual, and are not to be followed uncritically."

==Evidence==
Two research reports by Becker-Weidman, the second being a four-year follow-up of the first, are the only empirical examination of dyadic developmental psychotherapy.<ref name="mercer2014" /> They reported DDP to be an effective treatment for children with [[Medicine:Complex post-traumatic stress disorder|complex trauma]] who met the DSM IV criteria for [[Medicine:Reactive attachment disorder|reactive attachment disorder]].<ref name="bw1"/><ref name="bw3"/> The first report concluded that children who received dyadic developmental psychotherapy had clinically and statistically significant improvements in their functioning as measured by the [[Social:Child Behavior Checklist|Child Behavior Checklist]], while the children in the control group showed no change one year after treatment ended.  The study also used the [[Unsolved:Attachment therapy|Randolph Attachment Disorder Questionnaire]] as a measure,<ref name="bw1"/> which has not been empirically validated for reactive attachment disorder.<ref name="mercer2015" /> Statistical comparisons were performed using multiple t-tests rather than an [[Analysis of variance|analysis of variance]]; this has been criticized because t-tests increase the chance of finding any significant differences.<ref name="mercer2015">{{cite journal | author = Mercer J | year = 2015 | title = Revisiting an Article About Dyadic Developmental Psychotherapy: The Life Cycle of a Woozle | journal = Child and Adolescent Social Work Journal | doi  = 10.1007/s10560-015-0399-z | volume = 32 | issue = 5 | pages = 397–404| s2cid = 145079126 }}</ref>

The treatment group comprised thirty-four subjects whose cases were closed in 2000/01. This was compared to a "usual care group" of thirty subjects, who were treated elsewhere. The published reports on this work do not specify the nature of "usual care" or clarify why the "usual care" group, who were assessed at Becker-Weidman's clinic, did not have treatment there. Treatment consisted of an average of 23 sessions over eleven months.  The findings continued for an average of 1.1 years after treatment ended for children between the ages of six and fifteen years.  There were no changes in the usual care-group subjects, who were re-tested an average of 1.3 years after the evaluation was completed.

In the follow-up study the results from the original study were maintained an average of 3.9 years after treatment ended. There were no changes in the usual care-group subjects, who were re-tested an average of 3.3 years after the evaluation was completed.

Becker-Weidman's first study was considered by the APSAC Taskforce in their November 2006 Reply to Letters following their main report on attachment therapy.<ref name="Chaffin Reply2"/> The Taskforce had in their original report criticised Becker-Weidman for claiming an evidence base to his therapy, and indeed for claiming to be the only evidence based therapy, where the Taskforce considered no evidence base existed.<ref name="Chaffin et al."/> Becker-Weidman responded to this with an open letter citing his study.<ref name="Letter to the Editor">Arthur Becker-Weidman | Letter to the Editor | Child Maltreat 2006 No 11 | p379 | 
</ref> The Taskforce examined the (2006) study, criticized the methodology and stated that although the study was an important first step towards learning the facts about DDP outcomes, it fell far short of the criteria that must be met before designating a treatment as evidence based.<ref name="Reply p3">"In our estimation, DDP still does not meet criteria as an evidence-based treatment, although the published findings do raise hopes that DDP may be promising. Examining the study, it shares many of the same limitations noted in the Task Force's evaluation of the Myeroff study (p. 85). For example, the study used a small convenience sample, participants were self-selected into treatment versus comparison conditions, the age range of participants was very broad (5-16), there was no direct statistical analysis of differential group change over time, outcome data were not collected by blind or impartial reporters, and the study utilized completer only rather than intent-to-treat methods. Of course, no study is without limitations; however, the fact remains that a single study with these sorts of major limitations, although a first step, is far short of the criteria that must be met before designating a treatment as evidence based. In general, we believe that designating a treatment as evidence based is a job for an independent treatment review panel (e.g., American Psychological Association, Substance Abuse and Mental Health Services Administration [SAMHSA], Office for Victims of Crime Task Force, Cochrane Collaborative, etc.) applying accepted and established scientific review criteria. None has listed DDP as meeting accepted criteria. Thus, it is our opinion that practitioners should not characterize or advertise DDP as an evidence-based practice at this time." Reply to Letters p3.</ref>

Between the Taskforce report and Reply to Letters, Craven & Lee (2006) undertook a literature review of 18 studies of interventions used for foster children and classified them under the controversial Saunders, Berliner, & Hanson (2004) system.<ref name= "Craven"/><ref name="Saunders 2004">Saunders, B.E., Berliner, L., & Hanson, R.F. (Eds.). (2004). Child Physical and Sexual
Abuse: Guidelines for Treatment (Revised Report: 26 April 2004). Charleston, SC: National
Crime Victims Research and Treatment Center. {{cite web |url=http://academicdepartments.musc.edu/ncvc/resources_prof/ovc_guidelines04-26-04.pdf |title=Archived copy |access-date=2007-08-02 |url-status=dead |archive-url=https://web.archive.org/web/20070701080502/http://academicdepartments.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf |archive-date=1 July 2007 |df=dmy-all }} Quote "''Category 1'': Well-supported, efficacious treatment; ''Category 2'': Supported and probably efficacious; ''Category 3'': Supported and acceptable; ''Category 4'': Promising and acceptable; ''Category 5'': Novel and experimental; and ''Category 6'': Concerning Treatment"</ref><ref name="Gambrill">{{cite journal | author = Gambrill E | year = 2006 | title = Evidence-based practice and policy: Choices ahead | journal = Research on Social Work Practice | volume = 16 | issue = 3 | pages = 338–357 | doi = 10.1177/1049731505284205 | s2cid = 16407858 }}</ref> They considered only two therapies aimed at treating disorders of attachment, each of which was represented by a single study: dyadic developmental psychotherapy and holding therapy.<ref name="Becker-Weidman 2004">Becker-Weidman, A. (2004). Dyadic developmental psychotherapy: An effective treatment for children with trauma-attachment disorders. Retrieved 10 May 2005 from http://www.Center4familyDevelop.com</ref><ref name=Myeroff>{{cite journal | author = Myeroff  | display-authors = etal | year = 1999 | title = Comparative effectiveness of holding therapy with aggressive children | journal = Child Psychiatry and Human Development | volume = 29 | issue = 4 | pages = 303–313 | doi = 10.1023/a:1021349116429 | pmid = 10422354 | s2cid = 20560678 }}</ref> They placed both in Category 3 as "supported and acceptable". This classification means that the evidence basis is weak, but that there is no evidence of harm done by the treatment. The Craven & Lee classification report has been criticized as unduly favourable.<ref name="Pignotti & Mercer"/> This critique noted the absence of a comprehensive manual giving details of the dyadic developmental psychotherapy intervention—one of the necessary criteria for assessment using the Saunders et al. guidelines, and one without which no outcome study can be placed in any of the available categories. Craven and Lee rebutted this paper in a reply that concentrated on holding therapy rather than dyadic developmental psychotherapy.<ref name="Craven & Lee 2007">{{cite journal | author = Lee R.E., Craven P. | year = 2007 | title = Reply to Pignotti and Mercer: Holding Therapy and Dyadic Developmental Psychotherapy are not supported and acceptable social work interventions | journal = Research on Social Work Practice | volume = 17 | issue = 4| pages = 520–521 | doi = 10.1177/1049731506297043 | s2cid = 144651333 }}</ref>

It appears from the reports that attachment therapy techniques may have been used in addition to standard DDP. The therapist in Becker-Weidman's study instructed parents to use the "[[Unsolved:Attachment therapy#Parenting techniques|attachment parenting methods]]" of two authors who are described by Jean Mercer as advocating "coercive and intimidating approaches to children in treatment", specifically physical restraint and withholding of food and drink. Because of this deviation from the modern presentation of DDP, Mercer argues that the study cannot be considered a test of DDP in its current form.<ref name="mercer2014" /> Mercer cites Becker-Weidman's research as an example of the [[Woozle effect]], in which "flawed, limited, or exaggerated data" is uncritically repeated and republished until it achieves popular acceptance.<ref name="mercer2015" />

==See also==
*[[Medicine:Attachment disorder|Attachment disorder]]
*[[Philosophy:Attachment in children|Attachment in children]]
*[[Philosophy:Attachment theory|Attachment theory]]
*[[Unsolved:Attachment therapy|Attachment therapy]]
*[[Medicine:Attachment-based therapy (children)|Attachment-based therapy (children)]]
*[[Medicine:Complex post-traumatic stress disorder|Complex post-traumatic stress disorder]]
*[[Medicine:Reactive attachment disorder|Reactive attachment disorder]]

==References==
{{reflist|2}}

{{Attachment theory}}
{{Humandevelopment}}

[[Category:Psychotherapy]]

{{Sourceattribution|Dyadic developmental psychotherapy|1}}