Programs

Child-Parent Psychotherapy (CPP)

Type of Approach:

  • Mixed

Provider Education Level:

  • Unspecified

Length:

  • Greater than 12 weeks

Trauma Type:

  • Child Abuse
  • Community Violence
  • Disrupted Attachment
  • Domestic Violence
  • Gang Violence
  • Homicide/Familicide
  • Multiple
  • Other
  • Sexual Abuse
  • Terrorism

Trauma Symptom:

  • Anxiety
  • Attachment
  • Depression
  • Externalizing Behaviors
  • Internalizing Behaviors
  • PTSD

Setting:

  • Home
  • Hospital-based

Notes:

Type of service:

Weekly, joint child-parent sessions guided by child-parent interactions and child’s free play with developmentally appropriate toys selected to elicit trauma and foster social interaction. Initial assessment includes individual sessions with mother to discuss emerging assessment findings, agree on course of treatment, and plan how to explain treatment to child.

Program setting:

Hospital/clinical; may include home visits

Number of sessions:

Ranging from 12-40 sessions depending on need

Type(s) of trauma addressed:

Domestic violence, child physical and sexual abuse, traumatic grief, community violence, war and terrorism, medical trauma

Additional Information:

Child-parent sessions are interspersed with individual sessions with the mother as clinically indicated.

CPP helps to change maladaptive behaviors, support developmentally appropriate interactions, and guide the child and mother in creating a narrative of the trauma together while working towards resolution.

Unique/Innovative Characteristics
  • Focus on prenatal trauma and impact of trauma on infants and young children
  • Focus on child-parent relationship as focus of treatment
  • Adaptations of CPP include Perinatal CPP and a co-parenting model that involves fathers
  • A CPP curriculum has been developed for domestic violence advocates

Information for this summary was abstracted from the NCTSN publication, Trauma-Informed Interventions: Clinical and Research Evidence and Culture-Specific Information Project and other publications.

Date Added/Updated:

6/15/12

Age:

  • 0-5 (Early Childhood)

Language:

  • English
  • French
  • Portugeuese
  • Spanish

Ethnic Racial Group:

  • American Indian, Alaska Native, Other Indigenous
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Immigrant or Refugee
  • Native Hawaiian or other Pacific Islander
  • Unspecified
  • White

Caregivers Included:

  • Father
  • Mother
  • Other

Population Adaptations:

Age range of children:

Prenatal through 5 years old

Parent/adult caregiver included in intervention:

Child-parent psychotherapy includes the parent in the treatment; in most cases, the non-offending parent. Offending parents are included in the intervention if an initial assessment shows that treatment can be offered safely and is likely to be effective.

Ethnic/racial and other groups served:

All ethnic/racial groups depending on linguistic capacity. In one randomized control trial, all children were Latinos; in two trials the majority of mothers were African American. The program has linguistic expertise in Spanish and Portuguese and a high proportion of the children and families served are monolingual Latinos.

Specific cultural adaptations:

The program cultivates cultural competence by becoming informed about values, childrearing practices, gender and role expectations, religious and spiritual beliefs, and other culturally specific dimensions influencing the functioning of the families.

Languages available:

English, Spanish, Portuguese, French

Foundation:

Theoretical basis:

Integrative approach rooted in psychodynamic and attachment theory that also incorporates premises and practices from trauma clinical research, developmental psychopathology, cognitive-behavioral therapy, and social learning theory.

Evaluation Studies:

In a randomized controlled trial, 75 multiethnic (38.7% mixed ethnicity, 28% Latino, 14.7% African American, 9.3% white, 6.7% Asian) preschool-age child-mother dyads were randomized to CPP or case management plus community referral for individual treatment. The child-mother dyads randomized to CPP attended 60-minute sessions for 50 weeks (mean number of sessions attended was 32.09).

Six months after the one-year treatment period ended, children who participated in CPP had significantly fewer behavior problems and their mothers had significant improvement in severity of psychiatric symptoms compared to children and mothers who received case management and community referrals (control group).

Lieberman, AF, Ghosh Ippen, C, Van Horn, PJ. Child-Parent Psychotherapy: Six month follow-up of a randomized control trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2006; 45(8):913-918.

Results for the randomized controlled trial described above at the end of the one-year intervention were:

  • Children who received CPP had fewer total behavior problems, decreased traumatic stress symptoms, and were less likely to be diagnosed with traumatic stress symptoms compared to children in the control group
  • Mothers receiving CPP showed fewer posttraumatic stress avoidance symptoms compared to mothers in the control group

Lieberman, AF, Van Horn, PJ, & Ghosh Ippen, C. Toward evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry. 2005; 44(12):1241-1248.

Other randomized trials and clinical trials of CPP include:

  1. *Cicchetti, D, Rogosch, FA., & Toth, SL. Fostering secure attachment in infant maltreating families through preventive interventions. Development and Psychopathology. 2006; 18: 623-650.
  2. *Cicchetti D., Toth S.L., Rogosch F.A. The efficacy of toddler-parent psychotherapy to increase attachment security in offspring of depressed mothers. Attachment and Human Development; 1999; 1: 34-66.
  3. Lieberman, Weston, & Pawl. Preventive intervention and outcome with anxiously attached dyads. Child Development. 1991; 62:199-209.
  4. *Toth SL, Maughan A, Manly JT, Spagnola M, Cicchetti D. The relative efficacy of two interventions in altering maltreated preschool children’s representational models: Implications for attachment theory. Developmental Psychopathology. 2002; 14: 877-908.
  5. *Toth, S.L, Rogosch, FA, & Cicchetti, D. The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomized preventive trial. Journal of Consulting and Clinical Psychology. 74;6:1006-1016.
Other publications:

Book describing conceptual framework, intervention modalities, and case examples:

Lieberman, AF & Van Horn, P. 2008. Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: The Guilford Press.

Program Replication:

Over half the randomized controlled trials were conducted by a second independent research team (see * on references provided above).

Rated/Reviewed by Evidence Based Registries:

NREPP: SAMSHA’s National Registry of Evidence-Based Programs and Practices
California Evidence-Based Clearinghouse for Child Welfare
Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases
National Child Traumatic Stress Network Empirically Supportive Treatments and Promising Practices

Training Contact:

Disseminated through the National Child Traumatic Stress Network (www.nctsn.org); e-mail Nick Tise at ntise@psych.duhs.duke.edu

Training Notes:

Training manuals/protocols:

Manual for Child-Parent Psychotherapy:
Lieberman AF, & Van Horn P. 2005. Don’t hit my mommy: A manual for child parent psychotherapy with young witnesses of family violence. Washington, DC: Zero to Three Press.

Guidebook, Adaptation of CPP for Traumatic Bereavement:
Lieberman, AF, Compton, NC, Van Horn, P, Ghosh Ippen, C. 2003. Losing a parent to death in the early years: Guidelines for the treatment of traumatic bereavement in infancy. Washington D.C.: Zero to Three Press.

Training availability:

Yes

Cost of training:

Varies

Languages:

English, Spanish. Primary manual translated into French and Italian

Program Contact