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Toddler-Parent Psychotherapy

Evidence rating
2
Cost rating
NA
Review: Foundations for Life, July 2016

Toddler-Parent Psychotherapy (TPP) is a psychoanalytic intervention targeting mother-infant dyads that may be at risk of an insecure attachment.

Specifically, the programme aims to prevent or shift an insecure to a secure attachment, as measured by Ainsworth’s Strange Situation. Mothers identified as being depressed, anxious, traumatised or at risk of maltreating their child attend weekly sessions with their infant (approximately 20-months old at the beginning of the programme). The sessions are delivered by practitioners with a Masters (or higher) qualification in psychology or social work.

During each session, the practitioner helps the mother reflect on her own 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 infant, 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 dissociate negative feelings informed by her own childhood from her interactions with her infant, and appropriately interpret her infant’s behaviours.

EIF Programme Assessment

Evidence rating
2

Toddler-Parent Psychotherapy has preliminary evidence of improving a child outcome, but we cannot be confident that the programme caused the improvement.

What does the evidence rating mean?

Level 2 indicates that the programme has evidence of improving a child outcome from a study involving at least 20 participants, representing 60% of the sample, using validated instruments. 

This programme does not receive a rating of 3 as its best evidence is not from a rigorously conducted RCT or QED evaluation.

What does the plus mean?

The plus rating indicates that a programme’s best available evidence is based on an evaluation that is more rigorous than a level 2 standard but does not meet the criteria for level 3. 

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

Attachment security - based on study 1

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.

Toddler-Parent Psychotherapy

Key programme characteristics

Who is it for?

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

  • Toddlers

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:

  • Children's centre or early-years 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

UK evaluation

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

Toddler-Parent Psychotherapy

About the programme

What happens during delivery?

How is it delivered?
  • TPP is delivered in 32 sessions of approximately one to 1.5 hours’ duration each by one clinical practitioner with QCF-7/8 qualifications.
What happens during the intervention?
  • TPP is delivered by a practitioner with a Masters (or higher) qualification in psychology or social work. Mothers and their toddler 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 toddler.
  • The practitioner also engages jointly with the mother and infant, 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 dissociate negative feelings informed by her own childhood from her interactions with their infant and appropriately interpret her infant’s behaviours.

What are the implementation requirements?

Who can deliver it?
  • The practitioner who delivers this programme is one clinical practitioner with QCF-7/8 qualifications (and 92 hours of programme training).
What are the training requirements?
  • Practitioners have 92 hours of programme training. Booster training for practitioners is recommended.
How are the practitioners supervised?
  • It is recommended that practitioners are supervised by one host-agency supervisor (qualified to QCF-7/8 level) with 92 hours of programme training. 
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 develop a secure attachment relationship. 
  • 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

Toddler-Parent Psychotherapy

About the evidence

TPP’s most rigorous evidence comes from an RCT conducted in the USA.

Study 1

Citation: Cicchetti et al (1999), Toth et al. (2006), Peltz et al (2015)
Design: RCT
Country: United States
Sample: 201 mothers at risk of depression with a 20-month infant
Timing: -
Child outcomes: Attachment security
Other outcomes: Increased relationship satisfaction

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.

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.

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, Advanced on-line publication: http://dx.doi.org/10.1037/fish00000149.

Available at
http://www.tandfonline.com/doi/abs/10.1080/14616739900134021
http://psycnet.apa.org/psycinfo/2006-22003-003
http://psycnet.apa.org/journals/fsh/33/4/372/

Published March 2017   |   Last updated April 2017