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Child-Parent Psychotherapy

Evidence rating
3
Cost rating
NA
Review: Foundations for Life, July 2016

Child-Parent Psychotherapy (CPP) is a psychoanalytic intervention targeting mothers and preschool children (aged three to five) who may have experienced trauma or abuse (eg domestic violence), or are otherwise at risk of an insecure attachment and/or other behavioural and emotional problems.

Specifically, CPP aims to improve children’s representations of their relationship with their parent and reduce maternal and child symptoms of psychopathology.

Mothers and their child attend weekly sessions for a period of 12 months or longer. The sessions are delivered by practitioners with a Masters (or higher) qualification in psychology or social work. During each session, the practitioner uses empathic, non-didactic support to help the mother reflect on her childhood experiences and differentiate them from her current relationship with her child. 

Parent sessions are interspersed with sessions involving the child where the mother, therapist and child jointly engage in structured play aimed at eliciting trauma-related feelings and behaviours. This allows the therapist to help the mother and child develop a joint narrative around the traumatic events and bring them to their resolution. Mothers also receive support in appropriate discipline and an increased awareness of their child’s moods and emotional states.

EIF Programme Assessment

Evidence rating
3

Child-Parent Psychotherapy has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.

What does the evidence rating mean?

Level 3 indicates evidence of efficacy. This means the programme 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.

This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants. 

What does the plus mean?

The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.

Cost rating
NA

NA indicates that the information required to generate a cost rating is not available at this time.

Child outcomes

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Supporting children's mental health and wellbeing

Improved representations of the mother-child relationship - based on study 1

Improved expectations of the mother-child relationship - based on study 1

Reduced depressive symptoms - based on study 2

Reduced PTSD symptoms - based on study 2

Preventing crime, violence and antisocial behaviour

Improved behaviour - based on study 2

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Child-Parent Psychotherapy

Key programme characteristics

Who is it for?

The best available evidence for this programme relates to the following age-groups:

  • Preschool

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Individual

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Home
  • Children's centre or early-years setting
  • Primary school
  • Secondary school
  • Sixth-form or FE college
  • Community centre
  • In-patient health setting
  • Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted indicated

Where has it been implemented?

United States

UK provision

This programme has not been implemented in the UK.

UK evaluation

This programme’s best evidence does not include evaluation conducted in the UK.

Child-Parent Psychotherapy

About the programme

What happens during delivery?

How is it delivered?
  • CPP is delivered in 32 sessions of approximately 1 to 1.5 hours’ duration each by one clinical practitioner with QCF-7/8 qualifications (and 92 hours of programme training).
What happens during the intervention?
  • CPP is delivered by a practitioner with a Masters (or higher) qualification in psychology or social work.  Mothers and their child attend weekly sessions for a period of 12 months or longer.
  • During each session, the practitioner uses empathic, non-didactic support to help the mother reflect on her childhood experiences and differentiate them from her current relationship with her child.
  • Parent sessions are interspersed with sessions involving the child, where the mother, therapist and child jointly engage in structured play aimed at eliciting trauma related feelings and behaviours. This allows the therapist to help the mother and child develop a joint narrative around the traumatic events and bring them to their resolution.
  • Mothers also receive support in appropriate discipline and an increased awareness of their child’s moods and emotional states.

What are the implementation requirements?

Who can deliver it?
  • The practitioner who delivers this programme is a Masters level clinical practitioner with QCF-7/8 qualification.
What are the training requirements?
  • The practitioners have 92 hours of programme training (seven days' face-to-face training with 36 hours of phone consultation). Booster training of practitioners is recommended.
How are the practitioners supervised?
  • Practitioners are supervised by one host-agency supervisor with QCF-level 7/8, who provides clinical, skills and case-management supervision.
What are the systems for maintaining fidelity?

Not available

Is there a licensing requirement?

There is no licence required to run this programme.

How does it work? (Theory of Change)

How does it work?
  • Positive and sensitive parent/child interactions increase the likelihood of a secure parent/child attachment relationship.
  • Parents experiencing multiple hardships and/or an insecure attachment relationship in their own childhood are less likely to develop positive representations of their child, reducing their ability to respond sensitively and appropriately to their child’s behaviour.
  • Parents receive therapeutic support to improve their ability to form positive representations of their child and provide an appropriately nurturing and sensitive caregiving environment.
  • In the short term, parents develop positive representations of their child, their sensitivity increases and the child experiences greater attachment security.
  • In the longer term, children will develop positive expectations of themselves and others, demonstrate improved mental health and be at a reduced risk of child maltreatment.

Contact details

Chandra Ghosh
University of California San Francisco
chandra.ghosh@ucsf.edu
www.ucsf.edu/

Child-Parent Psychotherapy

About the evidence

CPP’s most rigorous evidence comes from two RCTs, both of which were conducted in the USA.

Study 1

Citation: Toth et al (2002)
Design: RCT
Country: United States
Sample: 155 mother-child (aged four) pairs, 112 where there was a known incident of child maltreatment
Timing: -
Child outcomes: Improved representations of the mother-child relationship
Improved expectations of the mother-child relationship
Other outcomes: None measured

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.

Available at
http://europepmc.org/abstract/med/12549708

Study 2

Citation: Lieberman et al (2005); Lieberman et al (2006); Ghosh et al (2011)
Design: RCT
Country: United States
Sample: 75 mother-child (aged three to five) pairs who have witnessed trauma or domestic violence
Timing: -
Child outcomes: Reduced depressive symptoms
Reduced PTSD symptoms
Improved behaviour
Other outcomes: Reduced symptoms of PTSD
Reduced symptoms of PTSD (maintained for high-risk group at six-month follow-up)
Reduced depressive symptoms (maintained for high-risk group at six-month follow-up)

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.

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.

Ghosh Ippen, C., Harris, W.W., Van Horn, P. l., & 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.

Available at
http://www.jaacap.com/article/S0890-8567(09)62235-8/fulltext?refuid=S0890-8567(10)00082-1&refissn=0890-8567&mobileUi=0
http://www.jaacap.com/article/S0890-8567(09)61891-8/abstract
http://www.sciencedirect.com/science/article/pii/S0145213411001499

Published March 2017   |   Last updated April 2017