On an Amazon comment page, a mother recently wrote of her concern for her 9-year-old daughter, who had much difficulty coping with frustration and responded with lengthy tantrums to everyday problems. The mother sought suggestions for treatments focused on attachment, and stated that she was now aware that her own behavior was partially responsible for her daughter’s situation (although she did not comment on how she knew this or what she felt about her conclusion).
In response to the mother’s comment, the following appeared:
“Arthur Becker-weidman says:
DDP would be most helpful for you as it is an evidence-based and empirically validated treatment. See the California Evidence Based Clearinghouse for Child Welfare for their independent review of this and many other approaches.
For those who have not encountered Becker-Weidman before, I should point out that he is a clinical social worker who was at one time associated with Dyadic Developmental Psychotherapy (DDP) as promulgated by Daniel Hughes. Becker-Weidman and Hughes published several papers in which they claimed, incorrectly, that there was an acceptable evidence basis for DDP. The British DDP website, which Hughes now runs together with Kim Golding, no longer refers to Becker-Weidman’s work, but acknowledges that there is currently no published evidentiary foundation for DDP.
So, let’s have a look at the claims Becker-Weidman is making on Amazon.
1. He points to the California Evidence Based Clearinghouse for Child Welfare (www.cebc4cw.org), an organization that posts information about child mental health treatments that are used or marketed in California. I looked into CEBC in some detail for a presentation at a conference last September and found the following:
The information posted is obtained by asking developers of treatments to supply materials that can be used in rating each treatment. Programs are evaluated and rated according to the following scale (for further details, see www.cebc4cw.org/files/OverviewOfTheCEBCScientificRatingScale.pdf).
1. Well-Supported by Research Evidence
2. Supported by Research Evidence
3. Promising Research Evidence
4. Evidence Fails to Demonstrate Effect
5. Concerning Practice
NR. Not able to be Rated on the CEBC Scientific Rating Scale
CEBC lists descriptions and findings about 286 programs, primarily for children and adolescents. Of listed programs, 26 were “non-responders” to inquiries about empirical support. Programs are rated according to stated criteria from 1 (excellent supportive evidence; 21 programs) to 5 (concerning; 0 programs, despite connections of some listed programs with adverse events), or Not Rated when supportive material is insufficient (77 programs). Seventy programs were rated “promising”.
To be rated 3, promising research evidence, as DDP was, requires only one nonrandomized study that compares outcomes for treated individuals to outcomes for some other group. This is a good deal lower bar than even the 2 rating, which requires one randomized controlled trial; treatments are properly described as evidence-based only when two independent randomized controlled trials have shown significant benefit from a treatment.
Incidentally, CEBC was responsive to my query about a program, Circle of Security, that was listed as “well-supported” although published research reports did not agree with this evaluation. CEBC took down the existing statements about Circle of Security and a representative said that further material would be requested from the program developers. When I have time, I need to comment to CEBC about the difficulties with research on DDP that I will come to in a moment.
2. The material Becker-Weidman (or someone) may have provided to CEBC has serious problems beyond its relatively weak design. As other authors and I have pointed out in professional publications, the treatment used in one study and a follow-up published by Becker-Weidman does not appear to have been DDP as it is presently described by Hughes. The original study, done in the late ‘90s, appears to have a number of features that are closely associated with holding therapy (HT), an intrusive and dangerous unconventional treatment. Becker-Weidman cites in his papers recommendations to parents to learn and use methods associated with HT, especially those suggested by the foster parent/dog trainer Nancy Thomas. Given the likelihood that DDP today does not use those methods, and that Becker-Weidman’s version did use those methods, it appears that Becker-Weidman did not do outcome research on DDP, but instead did it on DDP plus some other treatments, making it impossible to generalize from Becker-Weidman’s conclusions to current DDP as practiced by Hughes and Golding. A rival hypothesis about this situation is that Becker-Weidman and Hughes do still use the HT methods but do not disclose the fact; if true, that would earn DDP the CEBC rating of 5, concerning practice.
As I said earlier, the Hughes and Golding website no longer references Becker-Weidman’s publications. They would certainly do so if they thought the work provided evidentiary support for DDP. Becker-Weidman, however, seems to retain his conviction that “what I tell you three times is true”.