We were thrilled at the outpouring of interest in our last blog post: Why Traditional Parenting Fails Children with Trauma. In that post, our Director of Family Works, Anne Zink, discussed Dyadic Developmental Psychotherapy (DDP), the only evidence-informed therapy for children with complex trauma between the ages of 2-21.
As Anne discussed in the last post, DDP is not just a therapeutic model, it’s a way of being. DDP uses the principles of “PACE,” which stands for Playfulness, Acceptance, Curiosity, and Empathy. Staying PACEful is key to building trust and openness in our relationships with children who have trauma and attachment issues.
The number one question we received after Anne’s blog was, “This sounds great, but how do I actually do this?” To answer that question and dig deeper into what this model looks like in practice, I sat down with Anne the other day to learn more about how we can be PACEful in our daily lives.
Kyle: How long has your team been working with the DDP model?
Anne: It’s been about two and a half years now. The entire Family Works team is fully certified in DDP Levels 1 & 2. Knowing that children need to grieve beyond weekly 50 minute therapy sessions, we wanted to infuse the model into their everyday lives by empowering their parents and caregivers with the foundations of DDP. We adapted the DDP clinical intervention model, which revolves around a therapist working with the parents and child, and reoriented it so that we’re coaching the parent to be the center of the child’s healing on a 24/7/365 basis. Dr. Dan Hughes, who developed the model, actually helped us redesign Family Works to be DDP-informed. While in St. Louis providing us with a training, Dr. Hughes spent a few hours with Family Works going over our program model, really talking through our ideas and clarifying our questions. Receiving his endorsement and validation told us we were on the right path.
Kyle: So how much of a shift is this for your team? Is it a major change from models they might have been trained on or used previously?
Anne: It’s night and day. But the reasons people reach out to us for help are always the same. Human beings want relief. Every family our team works with is, by definition, struggling. And when you get into a struggling family that wants relief, the first thing they want is for the behavior to stop. The behavior could be anything, but it’s bad, and they want it to stop. They have most often decided the only way forward is for the child to change, to change quickly, and for an outside professional to come in and work “magic.”
The old way of doing business (and the way many programs continue to operate) can make behaviors stop and stop quickly. These methods use behavior reinforcement, consequences and punishments. These interventions will make behaviors go away for a short while; however, they will return with a vengeance because the cause of the behavior has not been addressed; it has only been suppressed. The insight DDP brings is that changing behavior does not change the child’s pain (shame, humiliation, powerlessness, loss, fear…), and their pain is what necessitates their behavior.
In fact, when we punish a child who has complex, developmental trauma, we suppress their problematic behaviors at the expense of our relationship with them. They developed those behaviors to protect themselves emotionally and physically. It’s no wonder children and caregivers see their relationships deteriorate when we strip those protective behaviors away before they’ve healed. The parents/caregivers do not feel respected or effective and the children do not feel safe. DDP is about healing trauma through relationships, so, first and foremost, any intervention that used behavior modification techniques had to be eliminated from the program.
Kyle: These negative behaviors are a symptom of trauma, so behavior modification is just treating the symptom. How does DDP and being PACEful get us beyond that?
Anne: DDP works on creating a safe relationship that can become the foundation for healing. One of the things Dr. Hughes talks about is experiencing and expressing delight in your child. Do they know you think they’re funny? Do they feel unique? Have you lost sight of all that is wondrous about them? We often slip into parenting as policing – focusing on catching children doing wrong and correcting them. To be PACEful is to catch them doing right. Parent in the positive. The families struggling the most are those who have been fighting against one another for months or even years. They view each other as antagonists. There’s so much resentment. Dr. Hughes and Dr. Baylin refer to this as blocked care; both sides have essentially checked out of the relationship.
Kyle: That sounds insurmountable, honestly. How do you unblock care?
Anne: First, we focus on the parent, not the child. We wrap them in support and validation, acknowledging just how hard and painful it’s been, how hopeless they may feel. It feels like failing as a parent. It feels so lonely. We help them understand how they got to that place, to accept it is not a moral failing but a natural human response to repeated rejections and hurts presented by the child. When they believe we are not judging them and they understand we do know how bad it truly has been, we start to build hope. We’re as PACEful with the parent as we will teach them to be with their child. Once we’ve got hope, we can join with them to recommit to their child, their family and their child’s healing.
Kyle: Where do you go from there?
Anne: We need to build safety and trust first and we work on that through education on complex developmental trauma, brain development, and attachment. We need the parent to understand misbehavior as an expression of the child’s trauma. An expression s/he paid dearly for, and for the time being, needs to rely on to be safe. For example, if he lies, he may likely be protecting against your disappointment and possible removal from the home.
Another example: you get a call from the school telling you your child got into a verbal fight with the math teacher and has received in-school suspension. He walks in the door after school and you are waiting near the door. You immediately ask, “Anything you want to tell me?” He might lie. “He may say, “No.” You might go on asking, giving more and more hints (“Anything about math class?” “No.” “Anything about getting an in-school suspension?” “No.”) He probably knows that you know, but he can’t face it. Because if he admits he couldn’t control himself at school today, he may fear you’ll decide you’re going to call his caseworker and have him removed. Or his shame at being “a problem, again” is too much to admit to when confronted so directly.
Our kids have a negativity bias that is bone deep. They have had low self-worth drilled into them since they can remember. We have to connect with them and assure a sense of safety before we correct. Every single time. There are consequences. They may need to look very different for these kids.
Kyle: What would be a PACEful approach to that situation you just described?
Anne: Sure, let’s try this:
The parent lets the youth get settled for 15 minutes after school and then gently approaches with a soft voice and relaxed face. “Hey bud, I heard you had a tough day today. Maybe in math class? You might’ve said some stuff to your teacher? I’m going to grab a cup of tea and we can talk about it in fifteen minutes. Cam I bring you a soda or milk? Does that sound good to you?”
The whole time your affect needs to be calm and understanding. You need to be emotionally regulated. He knows he’s in trouble, his defenses are up. He probably has a pretty strong fear that you’re going to reject him. He might already be feeling that rejection, preemptively. We have to demonstrate, through our words and our body language, that it is okay, that you are curious and empathetic and accepting of him as a person. You are communicating that you will need to talk about it, but you have assured safety first.
Kyle: One of the questions I’m sure you get all the time is, “Where are the consequences for his actions, then?” How do you like to answer that?
Anne: Consequences may look different, but they’re definitely still there. You need to connect first though. As we talk to kids about what they did and why they did it, we can let them know we understand. For instance:
“You must have been really upset to have called her that name. What was happening? Oh, you forgot to put your name on your test again and she called you out on it in front of the whole class? I bet it made you feel kind of humiliated to be called out in front of the class. It probably felt like she was calling you dumb. I guess I would feel kind of embarrassed too. I don’t like feeling like that.”
Once you both understand why it happened, AND he understands that you get why he reacted as he did (note: understanding does not equal agreement!), AND he knows you get it and that you get him and that you accept him, THEN you can begin to discuss different responses he could have chosen. Then you can decide on the consequences. Absolutely, he needs to know his reaction wasn’t acceptable or effective, but that’s not the first thing he needs to know.
Kyle: What do children take from a more confrontational, traditional approach to misbehavior? What are the risks if we continue in that style?
Anne: We know the results because traumatized kids grow into dysfunctional adults. We have several decades of research based on interviews with adults who grew up in the same situations our kids are in now. To them, everything is a threat, they’re insecure about their relationships. They felt – and feel – damaged and useless. They say things like, “That’s why mom beat me, that’s why she let those men use me.”
You have to protect your child’s self-worth. You have to challenge the messages they receive from others about themselves. You have to challenge the messages they tell themselves about themselves. They do not expect that from adults because they have never had anyone but themselves to rely on for emotional safety.
Kyle: And being PACEful helps them build self-worth?
Anne: Yes! What we know about neurobiology and brain development is that humans need a steady stream of good experiences to build trusting, positive relationships. Neurotransmitters and hormones like dopamine and oxytocin, which make us feel happy and safe, release when we have small moments of connection. Something as simple as touching your child’s shoulder, winking across the dinner table, or complimenting the way they spoke respectfully to an adult all release a quick burst of dopamine or oxytocin that lingers for several minutes. In addition to building trust and connection, dopamine and oxytocin protect us from the kinds of negative emotions which drive trauma behaviors.
Kyle: This seems like it’s really realigning how you behave toward kids.
Anne: Exactly. It is more about being and less about doing, especially in the early stages of developing and cementing trust.
Kyle: I’ve seen parents and even professionals react to the impact being PACEful has on our kids. But sometimes they actually seem to get discouraged. I remember one mom saying, “Well, I’m just not like that. It’s not how I was raised. I don’t know that I can be that playful and understanding and perfect all the time.” Lots of variations on that theme. What do you think about that?
Anne: Some people, those who are naturally expressive in nonverbal ways or through their tone, they might have a leg up on the rest of us. But no one is perfect. No one has a monopoly on every piece of PACE.
The key is finding your strengths. Maybe playfulness isn’t your thing, and you come off as more naturally serious. You can make up for that with curiosity or empathy. Figure out where you’re most comfortable first, then build up and out. Once you find what you’re good at, you’ll feel more confidence and the rest will grow. You can build your expressiveness through something as simple as listening to a storyteller podcast, or an audiobook. Becoming comfortable reading children’s books using different voices for various characters could be good practice. Watching videos of Dr. Hughes on YouYube or asking a Family Works staff to roleplay with you would be other ways to gain additional exposure to PACE.
And keep in mind the value of playfulness; the point of being playful is not to be goofy or silly (although that has its place too!). While playful, we are able to neurologically disrupt the child’s anxiety or stress response. The human brain cannot be engaged in both stress and playfulness simultaneously. Therefore, by engaging with a little wistfulness, we can help the child become less stressed, less self-protective and more open and engaged to our connections with them. Once they’re open, we can help them begin to trust and heal.
DDP, and being PACEful, is the best tool we have for helping parents reach into the inner experiences of these kids, to build a path allowing them a space to join and build healthy, resilient relationships. The parents who we’ve worked with through Family Works love it. We have a no-show rate near zero, which is unheard of for in-home services. Many are hungry for more learning, about half attend our support groups to further build their PACE skills. They truly are the best ambassadors for this model. No matter how much my team and I talk about it, results speak louder.
The Coalition is looking for opportunities to infuse DDP deeper into the metropolitan area. Recently, we partnered with Missouri Foundation for Health to begin creating a DDP training collaborative specifically for foster, adoptive, and guardianship parents. It should be transformative, and we’re excited to be at the forefront of this.
If you would like to learn more about the DDP, you can find resources at the DDP Network (https://ddpnetwork.org/resources/)