Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom

Introducing the revised framework for developing and evaluating complex interventions: A challenge and a resource for nursing research

This invited discussion paper highlights key updates in the MRC/NIHR's revised framework for the development and evaluation of complex nursing interventions and reflects on the implications for nursing research.

Adoptive parents' experiences of dyadic developmental psychotherapy

Dyadic developmental psychotherapy (DDP) is an attachment-focused therapy frequently used with adoptive and foster families. While the evidence base for DDP is building, national guidance has called for further trials and qualitative evidence. This study aimed to understand the experience of adoptive parents who have completed DDP therapy. Semi-structured interviews with 12 adoptive parents were analysed using interpretative phenomenological analysis. Four superordinate themes were identified: (1) increased understanding, (2) 'It's a different method of parenting generally', (3) the DDP journey and (4) 'It's a shared kind of experience you go through and come out together'. Parents felt they had increased insight into their child's mind and how to better support their child. They felt DDP was a good fit to their unique situations and it appeared to promote acceptance. The DDP journey started with parents feeling uncertainty and questioning the effectiveness of DDP. However, generally parents became committed to the therapy once they saw change and expressed fear and sadness at ending. Parents acknowledged the dyadic nature of DDP, feeling it helped build trust and security and supported co-regulation. Parents also acknowledged the therapist's role in conveying the core DDP principles. Further implications for practice and research are highlighted.

The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy

BACKGROUND

Maltreated children have significant and complex problems which clinicians find difficult to diagnose and treat. Previous US pilot work suggests that Dyadic Developmental Psychotherapy (DDP) may be effective; however, rigorous evidence from a randomised controlled trial (RCT) is lacking. The purpose of this study is to establish the feasibility of an RCT of DDP by exploring the ways that DDP is operating across different UK sites and the impacts of current practice on the potential set-up of an RCT.

METHODS

Qualitative methods (interviews, focus groups and teleconferences) were used to explore trial feasibility with therapists and service managers from teams implementing both DDP and possible control interventions. Data were analysed thematically and related to various aspects of trial design.

RESULTS

DDP was commonly regarded as having a particular congruence with the complexity of maltreatment-associated problems and a common operating model of DDP was evident across sites. A single control therapy was harder to establish, however, and it is likely to be a non-specific and context-dependent intervention/s offered within mainstream Child and Adolescent Mental Health Services (CAMHS). Because a 'gold standard' Treatment as Usual (TAU) does not currently exist, randomisation between DDP and TAU (CAMHS) therefore looks feasible and ethical. The nature of family change during DDP was regarded as multi-faceted, non-linear and relationship-based. Assessment tools need to be carefully considered in terms of their ability to capture change that covers both individual child and family-based functioning.

CONCLUSIONS

An RCT of DDP is feasible and timely. This study has demonstrated widespread interest, support and engagement regarding an RCT and permissions have been gained from sites that have shown readiness to participate. As maltreated children are among the most vulnerable in society, and as there are currently no treatments with RCT evidence, such a trial would be a major advance in the field.