Child-Parent Psychotherapy (CPP) is a therapeutic intervention for parents with a child between 3 and 5 years old who may have experienced trauma or abuse (including domestic abuse). Practitioners with a qualification in psychology or social work meet with individual families on a weekly basis for a period of 26 to 52 weeks. Parents receive support for their symptoms of trauma alongside advice aimed at supporting the needs of the child.
The information above is as offered/supported by the intervention provider.
3 to 5 years old
Individual
CPP is one of three variations of the Lieberman model of child-parent psychotherapy for families with a child aged between 3 and 5 years who has experienced trauma or abuse. The intervention aims to improve children’s representations of their relationship with their parent and reduce parent and child symptoms of mental health.
CPP is delivered by a master’s-level or higher clinical psychologist or social worker to parents and children individually through 32 weekly sessions over the course of 26 to 52 weeks. Typically, the parent and child attend sessions at an outpatient health setting, although the intervention can also be delivered in the home or a women’s shelter.
A primary aim of CPP is to stop the intergenerational transmission of family violence by helping the custodial parent to understand how it is negatively impacting the child. Therapists accomplish this by forming a strong therapeutic alliance at the start of the intervention, which then creates the context in which parents are better able to fully attend to their child’s needs.
During each session, the practitioner uses empathic, non-didactic support to help the parent reflect on their childhood experiences and differentiate them from their current relationship with her child. Parent sessions are interspersed with sessions involving the child, where the parent, therapist, and child jointly engage in structured play aimed at eliciting trauma-related feelings and behaviours. This allows the therapist to help the parent and child develop a joint narrative around the traumatic events and bring them to their resolution. Parents also receive support in appropriate discipline and an increased awareness of their child’s moods and emotional states.
3 to 5 years old
Disadvantaged families with concerns about their child’s behaviour.
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Experiences of maltreatment, trauma and ongoing family stress during the early years increases the risk of poor outcomes in childhood and adolescence.
Science-based assumption
Sensitive parenting reduces the risk of child maltreatment and increases children’s resilience to family stress and traumatic events in early childhood.
Science-based assumption
Parents experiencing high levels of stress or unresolved trauma are more likely to have difficulty responding sensitively to their child’s needs.
Intervention
Parents are supported to manage their stress
Parents are supported to respond sensitively to their child’s needs.
Short-term
Reduced parental stress
Improved parental mental health
Increased parental sensitivity
Improved parent–child relationship.
Medium-term
Improved child language
Improved child behaviour
Reduced child maltreatment risk.
Long-term
Child remains safely with the family
Improved child wellbeing at home and at school.
Families with a child between 3 and 5 years old who have experienced trauma through abuse or neglect or has witnessed domestic abuse.
CPP is delivered in 32 sessions of approximately 1 to 1.5 hours’ duration each by a single practitioner with 92 hours of intervention training.
A CPP therapist with a master’s qualification or higher in counselling, psychology, or social work.
Practitioners receive 92 hours of CPP training (seven days’ face-to-face training with 36 hours of phone consultation). Booster training is recommended.
Practitioners are supervised by one host-agency supervisor who provides clinical skills and case-management supervision.
Contact person: Tuesday Ray
Organisation: UCSF Department of Psychiatry, Child Trauma Research Program
Email address: Tuesday.Ray@ucsf.edu
Website: https://childparentpsychotherapy.com/
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
CPP’s most rigorous evidence comes from one RCT conducted in the United States consistent with Foundations’ Level 3 evidence strength criteria. The study identified statistically significant reductions in children’s symptoms of trauma, as well as improved child behaviour which persisted six months post treatment. The intervention is also supported by one RCT that fulfils Foundations’ Level 2+ evidence strength criteria.
CPP can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome, as well as at least one more RCT or QED.
Reduced traumatic stress disorder symptoms
Immediately after intervention.
Improvement index
Interpretation
Study
Improved child behaviour
Immediately after intervention.
Improvement index
Interpretation
Study
Improved child behaviour
Six months after intervention completion
Improvement index
Interpretation
Study
| Identified in search | 2 |
| Studies reviewed | 2 |
| Meeting the L2 threshold | 2 |
| Meeting the L3 threshold | 1 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 0 |
| Study design | RCT |
| Country | United states |
| Sample characteristics | 75 families living in the San Francisco Bay area with a child between 3 and 5 years who have experienced trauma or domestic abuse. |
| Race, ethnicities, and nationalities |
|
| Population risk factors | All mothers and child participants had been exposed to domestic abuse, physical abuse or community violence. Public assistance was received by 23% of the families and 41% had incomes below the federal poverty level. |
| Timing |
|
| Child outcomes | Post intervention
Six-month follow-up
|
| Other outcomes | Post-intervention
|
| Study rating | 3 |
| Citations | Study 1a: Lieberman, A. F., van Horn, P. & Ghosh Ippen, C. (2005) Toward evidence-based treatment: Child-parent psychotherapy with pre-schoolers exposed to marital violence, Journal of the American Academy of Child and Adolescent Psychiatry. 44, 1241–1248. Study 1b: Lieberman, A. F., Ghosh Ippen, C. & van Horn, P. (2006) Child-parent psychotherapy: 6-month follow-up of a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry. 45, 913–918. Study 1c: Ghosh Ippen, C., Harris, W. W., Van Horn, P. & Lieberman, A. F. (2011) Traumatic and stressful events in early childhood: Can treatment help those at highest risk? Child Abuse and Neglect. 35, 504–513. |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 155 at-risk families with a child aged between 3 and 5 years (average age 4 years) living in the vicinity of Rochester, New York. |
| Race, ethnicities, and nationalities | None reported, although 76% of the retained sample were from a minoritised ethnic background. |
| Population risk factors | 112 of the participants had a documented history of child abuse and neglect. All families were receiving welfare benefits. |
| Timing |
|
| Child outcomes | Supporting children’s health and wellbeing
|
| Other outcomes | None |
| Study rating | 2+ |
| Citations | Toth, S. L., Maughan, A., Manly, J. T., Spagnola, M. & Cicchetti, D (2002) The relative efficacy of two interventions in altering maltreated preschool children’s representational models: Implications for attachment theory. Development and Psychopathology. 14, 877–908. |
No other studies were identified for CPP.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing obesity and promoting healthy physical development: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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