Toddler-Parent Psychotherapy (TPP) is a therapeutic intervention for mother–toddler pairs who may be at risk of an insecure attachment. 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. The practitioner also engages jointly with the mother and infant to model sensitive caregiving behaviour and suggest positive explanations for the child’s behaviour.
The information above is as offered/supported by the intervention provider.
1 to 2 years old
Individual
Toddler-Parent Psychotherapy is one of three variations of the Lieberman model of child–parent psychotherapy for families with a child between 18 months and 3 years who may be at risk of an insecure attachment. This risk may be due to difficulties with the parent–child relationship stemming from the parent’s own attachment history, complexities in the family’s life, including parental mental health problems, or specific risks associated with child abuse and neglect.
Mothers identified as being depressed, anxious, traumatised, or at risk of maltreating their child attend weekly sessions with their infant for a period of 12 months or longer. The sessions are delivered by practitioners with a master’s (or higher) qualification in psychology or social work.
During each session, the practitioner helps the mother reflect on her childhood experiences and differentiate them from her current relationship with her child through empathic, non-didactic support. The practitioner also engages jointly with the mother and toddler, so that they can model sensitive responding and suggest positive explanations for the child’s behaviour. As the therapeutic relationship develops, the mother learns to appropriately interpret her child’s behaviours and dissociate any negative attributions of her child from her own history of being parented.
18 months to 3 years
Families where the toddler is at risk of an insecure attachment because the parent is experiencing mental health problems or other complex circumstances, or there are concerns about child abuse.
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Attachment security lays the foundation for children to develop positive expectations about themselves and others. Positive and sensitive parent–infant interactions support the development of a secure attachment relationship.
Science-based assumption
Sensitive parenting behaviours are supported by positive representations of the child. Negative parental representations of the child place the attachment relationship at risk.
Science-based assumption
Parents experiencing multiple hardships and/or an insecure attachment relationship in their own childhood are less likely to develop positive representations of their child.
Intervention
Parents receive therapeutic support to improve their ability to form positive representations of their child
Parents learn how to respond more sensitively to their child’s needs and create a nurturing and predictable caregiving environment.
Short-term
Parents develop positive representations of their infant
Parents are less likely to negatively attribute their child behaviour
Parents become more sensitive to their child’s needs.
Medium-term
Improved parent–infant interaction
Reduced risk of an insecure attachment relationship.
Long-term
Child develops positive expectations of themselves and others
Children are at less risk of mental health problems
Children are a less risk of child maltreatment.
Families with a toddler at risk of an insecure attachment because of the parents’ attachment history, complex family circumstances (including parental depression), or specific, child maltreatment risks.
TPP is delivered in 32 sessions of approximately 1 to 1.5 hours’ duration each by a single practitioner over the course of a year.
A TPP therapist with a master’s qualification or higher in counselling, psychology, or social work.
Practitioners receive 92 hours of TPP 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 with 92 hours of TPP training 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.
Toddler-Parent Psychotherapy’s (TPP) most rigorous evidence comes from a single RCT conducted in the United States consistent with Foundations’ Level 2+ evidence strength criteria.
The studies observed statistically significant increases in infant’s attachment security in comparison to children whose mothers did not receive the treatment.
Toddler-Parent Psychotherapy has preliminary evidence of improving a child outcome, but we cannot be confident that the intervention caused the improvement.
| Identified in search | 1 |
| Studies reviewed | 1 |
| Meeting the L2 threshold | 1 |
| Meeting the L3 threshold | 0 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 0 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 201 sample total: 131 depressed mothers with a 20-month old toddler; additionally, 70 non-depressed mothers served as a super control. |
| Race, ethnicities, and nationalities | 93% European American |
| Population risk factors | Maternal depression; otherwise families were chosen specifically because they were low risk. |
| Timing |
|
| Child outcomes | Increased attachment security |
| Other outcomes | Improved maternal marital satisfaction |
| Study rating | 2+ |
| Citations | Study 1a: Toth, S. L., Rogosch, F. A., Manly, J. T. & Cicchetti, D. (2006) The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomised preventive trial. Journal of Consulting and Clinical Psychology. 74, 1006–1016. Study 1b: Cicchetti, D., Toth, S. L. & Rogosch, F.A. (1999) The efficacy of toddler-parent psychotherapy to increase attachment security in off-spring of depressed mothers. Attachment and Human Development. 1, 34–66. Study 1c: Peltz, J. S., Rogge, R. D., Rogosch, F. A., Cicchetti, D. & Toth, S. L. (2015) The benefits of child-parent psychotherapy to marital satisfaction. Families, Systems and Health. 33 (4), 372–382. |
No other studies were identified for this evidence assessment.
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.
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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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