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Child-Parent Psychotherapy (CPP)


Delivery Approach:
  • Individual
  • Dyadic
Delivery Format:
  • In-Person
  • Virtual
  • Hybrid
Provider Requirements:
  • No Provider Requirements
Type of Experience Addressed:
  • Domestic Violence
  • Child Abuse 
  • Sexual Abuse
  • Community Violence
  • Neglect 
  • Family Separation
  • Homicide/Familicide 
  • Substance Abusing Caregiver 
  • Natural Disasters 
  • Grief/Bereavement 
  • Criminal Victimization 
  • Refugee/Immigration
  • Reunification
  • Medical Trauma
  • Homelessness
  • Verbal/Emotional abuse
  • Mental Health Issues/Concerns
  • Mass shootings
  • Hate Crimes
  • Systemic/Interpersonal Racism
  • Historical trauma
  • Homophobia/Transphobia
  • Other type of experience addressed:
    • Perinatal trauma, Intergenerational trauma, Attachment challenges
Engagement Methods:
  • Somatic
  • Arts based
  • Dance/Theater based
  • Talk-Based
  • Experiential
  • Play Based
  • Culturally Grounded
  • Other Engagement Methods
    • Attachment-based, Trauma-informed
Level of Intervention:
  • Intervention
  • Greater than 12 weeks
  • School
  • Home 
  • Hospital-based
  • Domestic Violence Shelter
  • Homeless Shelter
  • Headstart and Early Education Programs
  • Day Care
  • Family service agencies
  • Health Services 
  • Foster Care 
  • Mental Health Setting
  • Community-based agency
Program Details:
Type of service:

Weekly, joint child-parent sessions guided by child-caregiver interactions. Interventions often include dyadic play with developmentally appropriate toys selected to strengthen the caregiver-child relationship and foster dialogue about potentially traumatic experiences as a way to make meaning of these experiences and restore a sense of safety. Initial assessment includes individual sessions with caregiver to discuss emerging assessment findings, agree on course of treatment, and plan how to introduce treatment to the child.

Program setting:

Hospital/clinical; home; schools; community settings;

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-caregiver sessions are interspersed with individual sessions with the caregiver as clinically indicated.

Goals of CPP include: 1) Enhancing child and family real and perceived safety; 2) Strengthening emotion regulation and body-based regulation capacities; 3) Enhancing caregivers’ reflective capacities and ability to make meaning of their child’s behavior; 4) Strengthening caregiver-child relationship and supporting developmentally appropriate interactions; 5) Supporting child and caregiver in making meaning of potentially traumatic experiences and placing these experiences in perspective; 6) Changing maladaptive behavior patterns.

Unique/Innovative Characteristics
  • Focus on impact of trauma on infants and young children
  • Focus on intergenerational and historical trauma as well as family and cultural strengths as a way to break intergenerational cycles of violence
  • Focus on child-caregiver relationship as focus of treatment
  • Applications of CPP include Perinatal CPP


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:


Population Served

  • Pre-natal
  • 0-5 (Early Childhood)
Population Language:
Ethnic Racial Group:
  • Indigenous People – American Indian/Native American, Alaskan Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or other Pacific Islander
  • White
  • Child and Non-abusive Parent/Caregiver
  • Child
  • Family
  • Grandparents
  • Parent who uses Violence
  • Survivor parent
  • Foster/Adoptive Parents
  • Other Client/Audience:
    • Relative Caregiver
Population Adaptations:
Age range of children:

Prenatal through 5 years old

Parent/adult caregiver included in intervention:

Child-parent psychotherapy includes the caregiver 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 a high proportion of the children and families served are monolingual Spanish speakers.

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. The treatment model incorporates a focus on historical and sociocultural trauma and the ways these have and continue to affect the family’s sense of safety and well being.

Languages available:
Multiple languages. Please visit the CPP roster:


Theoretical basis:

Integrative approach rooted in psychodynamic and attachment theory that also incorporates premises and practices from trauma theory, developmental psychopathology, cognitive-behavioral theory, 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:

California Evidence-Based Clearinghouse for Child Welfare
Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases
The National Traumatic Stress Network Treatments and Practices, Trauma Interventions 

Training & Resources

Training Language:
  • English
  • Spanish
Training Available:
  • Yes
Training Details:
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.

Book describing the conceptual framework underpinning CPP:

Lieberman, A.F. & 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.

Guidebook: Application 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.

Guidebook: Application of CPP to the Perinatal Period:

Lieberman, A. F., Diaz, M. A., Castro, G., & Bucio, G. O. (2020). Make room for baby: Perinatal child-parent psychotherapy to repair trauma and promote attachment. Guilford Publications.

Cost of training:

Varies (typically $2500 per person for the 18 month training period. Please see the budget spreadsheet at the bottom of the Learning Collaborative page of the website for costs to train a group)


Primary manual translated into French and Italian

Training Contact:

Visit the Child-Parent Psychotherapy website

Program Contact

Child Trauma Research Program, University of California San Francisco
675 18th Street, Room 2250
San Francisco, CA 94107
628 206-5979