Child-Parent Psychotherapy (CPP) - Promising Futures

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.

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