All opinions expressed in the following piece belong to the author(s).
I thought I knew how to help troubled children, then I met Dan!
I have just retired following nearly fifty years as a clinical psychologist working with children and families and eighteen years of practicing DDP. I say ‘practicing’ because, despite being a consultant, I don’t believe we ever can truly become an ‘expert’ in this exceptionally powerful tool. The children and families that we meet have such amazing and diverse strengths and resources that have enabled them to survive the most appalling of experiences, that we can never ‘know’ what to do to help them. We can only learn how to be curious about their innermost world and how they interpret it, and try to create enough safety for the children, young people and their grown ups to be curious about that too.
DDP was the most difficult form of ‘therapy’ I have ever attempted. My psychotherapy training was supervised by Harry Guntrip, an associate of Carl Jung (yes I’m that old). This was quickly followed by personal construct psychotherapy, systemic family therapy, group therapy and play therapy. I never really got on with behaviour therapy (probably at least partially, due to being traumatised as a young student by having to watch gay men being horrendously abused in the guise of aversion therapy), but did learn the benefits of using CBT. None of these challenged me like DDP.
Early in my career my work was highly influenced by John Bowlby and attachment theory. It has underpinned my understanding of human development, functioning and relationships throughout. This taught me how our very early experiences, trauma and neglect in early life have extreme effects on our emotional, psychological and neurological development and guide our expectations as to how we interpret the world and relate to others throughout our lives. To be fair, before DDP, I think I did help adopters and foster carers understand their children a little better and to stop seeing them as ‘naughty’, leading to more realistic expectations from them. I also helped the ‘parents’ cope with the extreme feelings of loss that they experienced regarding the child they had in their mind, (rather than the child they had in reality) and their own occasional periods of disregulation with the child they had. Relationships in the family did seem to improve. But no, my work was not responsible in any way for change and resolution for the little ones. In my arrogance I thought it had to be enough, but then I met Dan Hughes.
I admit that I was very skeptical about Dan at first. He had been associated (some ten years earlier) with some people in the USA whose work I had great difficulty accepting. But I heard that someone I had an inordinate amount of respect for (Geraldine Casswell of course) had gone to the States to see him, and so I said to myself, “Pam stop being a closed minded idiot and go and see what the man has to say”. I did Level One at Family Futures and my world turned upside down. I realised very quickly that Dan had developed the most amazingly simple yet powerful way of doing what I had previously thought was impossible: to create sufficient safety for the children to look at their own internal world and start to allow the emotional experiences that would help them develop emotionally. He had found a way of helping children reflect about their own conceptual processes and why they thought and felt the way that they did. (Is this not what Peter Fonagy would describe as ‘Mentalization’ in adults, the only evidence based effective treatment for severe Personality Disorder in adults?) Dan had found a way of giving the children resolution.
Level One was followed by Level Two in Maine, and then Level Three again at Family Futures in London (this was in the early days of DDP in the UK and yes there were three levels). Dan agreed to supervise my work and I started to put the theory into practice. No of course I didn’t. I really really struggled. In DDP there is no process to follow. All of my previous training and experience was not helping at all: and not just clinical, all the other stuff too. You don’t need the people management skills that I learned through developing and managing two district psychology services. You don’t need the negotiation skills that led to the creation and development of the Hull and Sheffield University’s Clinical Psychology Doctorate courses. You don’t need the teaching and training skills that took me all over England teaching High Court Judges and the legal profession about the consequences on infant and child development of domestic violence, before the change in the law. No, indeed, I had to actively unlearn just about everything I had previously held as sacrosanct. Eventually I twigged, and just concentrated on finding ways of establishing the rhythm, and gradually the rest followed.
I think I have now practiced DDP with about two hundred children over the years. They have taught me an inordinate amount about the strength of human survival and resilience. I never cease to be in awe of them. Some of the children I treated in the early days have kept in touch and have contacted me as adults when they have had their own children, so I have been lucky enough to see them develop further. I think I have also learned a thing or two about DDP from them, which I would like to share with you.
I started practicing DDP as an independent practitioner before the Adoption Support Fund. Local Authorities would only fund a finite amount of treatment per child. The number of sessions allowed was limited. I was at a loss as to what to do, so, as usual when faced with extreme uncertainty in DDP, I asked Dan. He told me that the most change seemed to happen in the first twelve weeks of therapy, and suggested that I try twelve two hour sessions, followed by a break of a few months and then another twelve sessions. All sessions needed to last up to two hours because it took that long with the children I was seeing. This pattern seemed to work really well. The children did make major changes in the first set of sessions, and seemed to use the break to consolidate those changes. The parents didn’t become exhausted and could give their all in those sessions. DDP is of course totally non-directive, but a pattern did appear to evolve. Within the first set of sessions the children grieved the loss of their birth parents or foster carers and started to attach to their adopters. The second set of sessions seemed to deal with their traumatic memories. I suppose it makes sense, we can’t resolve trauma until we’re safe. For those in the DDP community who have to face similar restrictions in funding, this pattern of working may well be worth a try.
I saw a recording of Dan acting a young boy who was desperately trying to relate to his schizophrenic mum, who was played by a Family Futures staff member wearing a white china mask. The film was really powerful emotionally. So I started using something like this in the second set of sessions with some of the children. They would sit in between their parents and would be in charge of the camera and be the director in our film all about them. We would then decide how many scenes we needed and who would play what. I would always act them when they were tiny and suffering abuse. I would maintain eye contact with them as I was acting their early experiences and afterwards check with the child that I had acted their early life correctly. There was only one child who said that I had got it wrong. I asked her what that was, and she told me that my dress was too clean. The parents and sometimes the child themselves would act them at significant times in their future lives, for example when they won the British Grand Prix, became a teacher, computer wiz, and just had a happy life as an adult. The snippets of film would then be edited and reconfigured into a special news program about the life of this wonderful person. A DVD was then prepared which we would watch together in the next session and the child would then take home. This film seemed to help the children make sense of their early lives and all of the children experienced enormous delight in seeing their parents acting them as successful and happy people at different times in their future lives.
I have found DDP to be a really intensive form of treatment. It reaches the parts other therapies don’t touch. As a therapist and expert witness I had heard and known of many ways that people abuse children, but I had never heard the things I heard through DDP. I am sure that this may well happen to you too, so please have someone you can talk to about it. Secondary trauma is an exceptionally negative side effect for the practitioner.
DDP teaches us all humility. A couple came to see me four years after they had adopted three children. They were very defended and had been following a way of working, which I think is about the antithesis of DDP. Mum acknowledged that she had been badly abused herself as a child. They only had funding for work that included the children. So I explained DDP to them and asked them to read ‘Building the Bonds of Attachment’, and made an appointment to see them together with their eldest child the following week. My thoughts at that time were that it wouldn’t work and I just had to be careful that the experience wasn’t difficult for the child. I would then use that knowledge to get the family appropriate funding. Those parents were the best DDP co-therapists I have ever had. They did amazing work with all of their exceptionally traumatised children. All of my assumptions were proved groundless.
It’s getting late and I have to pick up my grandchildren, (my new and best ever job), but before I go I want to share with you one little girl’s story of DDP.
I first met her when she was just two years old and I was assessing her for Care Proceedings. She was the most ‘frozen’ child I had ever met. She eyes were unblinking as she stared without moving any part of her body. She had no speech and never uttered a sound. She just watched for a period of over one hour.
I met her again when she was seven and came to see me with her adoptive mum. She still didn’t talk much and was pretty unresponsive verbally. After a while she started to play with the dolls house and Playmobil. So I just began to make the dolls be playful, accepting and empathic with hers, whilst I was really curious about how her dolls made sense of what was happening. She was sitting within her mum’s arms throughout most of this. We did this for many weeks.
Eventually she let her mum play as well and shortly afterwards started to speak.
We ‘played out’ many exceptionally abusive memories in these sessions, until she told me that she didn’t need the dolls any more. Our sessions then became more akin to traditional DDP, if there is such a thing.
Towards the end of our work we were chatting and she revealed that she had seven imaginary friends, all of whom had different personalities and had met different needs of hers throughout her life. One was funny and cheered her up. One was cuddly and would tell her that everything would be alright when the bad stuff was happening. One was really frightened and her job was to comfort that one so the bad stuff couldn’t get either of them. Another one was always strong and angry and would say the stuff she couldn’t. They were all very different.
I asked her if they were there then. She looked at me askance and said,
“Pam! Herummph! Of course not! I don’t need them any more, I’ve got my mum”.
So Dan and the DDP Community, on behalf of this little girl, and the many other children I have seen, I would like to thank you sincerely for giving me the skills and support to help them and their families. Keep up the very good work!
I have to dash, its 2.40 pm and I have the school run.
With warmest wishes, Pam
Publisher: DDP Network (Jun 2021)
Article Copyright © Pam Tower, 2021