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Book Review: Healing Relational Trauma with Attachment-Focused Interventions

For a young child, traumatic experiences can lead to a pattern of mistrust, anticipation of further trauma, avoidance, and difficulty relating to others. Their development can be compromised. Their sense of self can become fractured, and their lives become merely an expression of their trauma.

Helping children like this requires a deeply sensitive clinical approach that begins with the children’s relationships.

“When children develop patterns of survival that involve them relying on themselves, not others, they do so out of a profound mistrust that others will meet their needs and will do what is best for them,” write Daniel A. Hughes, Kim Golding, and Julie Hudson.

In their new book, Healing Relational Trauma With Attachment-Focused Interventions, the authors present Dyadic Developmental Psychotherapy (DDP) as a theory and use rich case studies to demonstrate how it can restore connection, trust, safety, and secure relationships where they have been most damaged.

“Dyadic developmental psychotherapy was developed to provide therapeutic, healing relationships with children who do not trust their caregivers, teachers, therapists, and wider community. It relies on principles taken from our knowledge of attachment, developmental trauma, and the intersubjectivity to inform the development of the therapeutic relationship between the therapist and the child,” write the authors.

Using their presence, empathic response, and acceptance, DDP therapists help children move beyond their traumas to a place where they can begin to create new stories.

The authors write, “From these jagged stories of shame and terror that arose from relational trauma, DDP is creating stories of connection, strength, and resilience.”

Children who experience relational trauma learn to relate to others in ways that disrupt their attachment. Some may become avoidant and learn to minimize their emotional experiences. Some may become dependent and learn to not have confidence in themselves. Others will become overwhelmed in the process of learning to relate to others and will be disorganized in their responses.

These patterns continue long after the trauma has ended. The authors write, “Children who have experienced developmental trauma are at high risk of not resolving the impact of the trauma even when they are no longer living with their parents who caused the trauma.”

As the purpose of secure attachment is to provide a safe base from which the child can explore the world, when it is absent, children experience difficulty not only in relationships but in coping with the variety of stresses the world presents.

“As social mammals, the socio-emotional world of relationships and learning about self and other through relationships is the primary world that young children are exploring,” write the authors.

The foundation of secure attachment begins with playfulness, acceptance, curiosity, and empathy (PACE), and is also the central therapeutic stance and relational attitude of DDP.

Through affective-reflective dialogue, interactive repair, synchronized verbal and nonverbal communication, and the creation of stories that integrate a sense of self into a narrative of safety in relationships, DDP therapy begins the process of weaving together the many narrative threads both within the therapeutic relationship and outside of it into one consistent story.

The authors describe the case of Jonathan, who after having had his 8th birthday, and managing it well, returns to attention-needing behaviors, along with being moody and sulky. His father, in thinking through Jonathan’s responses, is able to identify that, for Jonathan, returning to normalcy after his birthday triggered fears of not being good enough anymore. By staying emotionally regulated himself, Jonathan’s father is able to respond to him with empathy.

They write, “Regulation enhances reflective function: Parents who can stay regulated or can notice the loss of this and bring themselves back to a regulated state will be more consistently present to the child.”

A central theme of DDP is the ability to preserve the sanctity and safety of the parent-child relationship — something that the authors emphasize is the parent’s responsibility.

Setting limits and using discipline are necessary for healthy development of the child, however, without also providing relationship repair when necessary, the child can begin to experience fear, shame, and anticipation of abandonment.

At the heart of DDP is acceptance, and many parents upon using this approach identify what was missed in their child’s early life. What emerges is a new way to help. Instead of simply trying to “fix” traumatized children, parents learn to see their need for trust and safety, to create a safe environment for them to express themselves, and to use emotional regulation to respond to their needs — however they are expressed.

It is hard to imagine any clinician who will not encounter relational trauma at some point in their career. What Healing Relational Trauma offers is a new way to understand what relational trauma is, how it fractures a child’s sense of safety and trust, and most important, how to restore the essential connection and attachment needed to begin the process of healing. It is a book that should be required reading for all clinicians.

Healing Relational Trauma with Attachment-Focused Interventions

W.W. Norton & Company, 2019

Hardcover, 302 Pages

Book Review: Healing Relational Trauma with Attachment-Focused Interventions

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Claire Nana

Claire Nana is a regular contributor and book reviewer for Psych Central.

APA Reference
Nana, C. (2019). Book Review: Healing Relational Trauma with Attachment-Focused Interventions. Psych Central. Retrieved on October 30, 2020, from
Scientifically Reviewed
Last updated: 11 May 2019
Last reviewed: By a member of our scientific advisory board on 11 May 2019
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