Home Program

Child-Parent Psychotherapy (CPP)

Topic Areas
Scientific Rating
Child Welfare Relevance
Domestic/Intimate Partner Violence: Services for Victims and their Children
2  — Supported by Research Evidence
High
Infant and Early Childhood Mental Health (Birth to 5)
2  — Supported by Research Evidence
High
Trauma Treatment - Client-Level Interventions (Child & Adolescent)
2  — Supported by Research Evidence
High

About This Program

Target Population: Children age 0-5, who have experienced a trauma, and their caregivers

For children/adolescents ages: 0 – 5

For parents/caregivers of children ages: 0 – 5

Program Overview

CPP is a treatment for young children aged 0-5 who have experienced a traumatic event and/or are experiencing mental health, attachment, and/or behavioral challenges. Typically, the child is seen with their primary caregiver in a dyadic format. CPP examines ways that the caregiver-child relationship and the child’s developmental trajectory may be affected by: 1) the child’s trauma history, 2) caregiver’s trauma history, 3) caregiver’s relational history, 4) contextual factors including culture, socioeconomic status, sociocultural trauma, and immigration experience. Targets of the intervention include caregivers’ and children’s maladaptive representations of themselves and each other along with interactions and behaviors that interfere with the child’s mental health and the emotion regulation capacities of both child and caregiver. For children exposed to trauma, caregiver and child are guided to create a joint narrative of the traumatic event and to identify and address traumatic triggers that generate dysregulated behaviors and affect.

Program Goals

The goals for Child-Parent Psychotherapy (CPP) are:

For children:

  • Enhance physical safety
  • Enhance perceived safety
  • Strengthen family relationships
  • Strengthen affect regulation capacities with their parent

For parents:

  • Enhance physical safety
  • Enhance perceived safety
  • Strengthen family relationships
  • Strengthen affect regulation capacities with their child
  • Strengthen body-based regulation with their child
  • Learn about meaning of behavior
  • Learn about the traumatic response
  • Learn how to acknowledge the impact of the trauma
  • Learn how to differentiate between then and now
  • Learn how to put the traumatic experience in perspective

Logic Model

The program representative did not provide information about a Logic Model for Child-Parent Psychotherapy (CPP).

Essential Components

The essential components of Child-Parent Psychotherapy (CPP) include:

  • Dyadic therapy offered by a Masters-level mental health clinician
  • Reflective supervision for the mental health provider
  • Treatment involves three phases
    • Foundational Phase: Incorporates comprehensive assessment to support understanding about the family’s:
      • Needs and challenges
      • Strengths and values
      • History and experiences including child and caregivers’s experience of stressful or traumatic events
    • Core Intervention Phase: Typically involves weekly dyadic sessions and collateral parent meetings with the key intervention goals determined jointly based on the information learned during the foundational phase and the case conceptualization. Common intervention goals include:
      • Support and strengthen the caregiver-child relationship as a vehicle for restoring and protecting the child’s mental health
      • Foster dyadic affect regulation, including body-based regulation
      • Create a context where the caregiver can resume the rightful role as the child’s historian, protector, guide, and nurturer
      • Help the family make meaning of traumatic experience and understand how they may be impacted by the trauma
      • Restore children’s developmental progress in the domains of: affect regulation, trust in relationships, joy in exploration and learning, and constructive engagement in society
    • Closing Phase: Typically includes assessment and dialogue with caregivers to understand changes made during treatment, to support sustainability of treatment gains, and to consider any next steps or additional services.

Program Delivery

Child/Adolescent Services

Child-Parent Psychotherapy (CPP) directly provides services to children/adolescents and addresses the following:

  • Posttraumatic stress symptoms, depression, emotion dysregulation, internalizing and externalizing behaviors, disorganized attachment, relationship disturbance, cognitive functioning, exposure to trauma, placement disruptions

Parent/Caregiver Services

Child-Parent Psychotherapy (CPP) directly provides services to parents/caregivers and addresses the following:

  • Negative attributions about the child, problems in the parent-child relationship, parenting stress and emotion dysregulation, maladaptive parenting strategies, capacity to provide physical and emotional safety to the child, parental symptoms including PTSD symptoms (avoidance, intrusion, and hyperarousal), depression, anxiety, and general distress
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: CPP therapists often engage caregivers not directly involved in treatment including other parents who may not be fully participating in treatment, relatives in the home, and resource caregivers. In addition, CPP therapists partner with providers in the educational system (e.g. daycare, preschool, and kindergarten), child welfare workers, and medical providers. These partnerships enable the therapist to coordinate care, enhance stabilization, and enhance the child’s safety in other settings by having grown-ups who understand their experience and can better support their regulatory needs.

Recommended Intensity:

Weekly 1 to 1.5-hour sessions

Recommended Duration:

Average range: 20-32 sessions depending on multiple factors including safety concerns, system's involvement, and complexity of trauma exposure and trauma-related symptoms.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Public Child Welfare Agency (Dept. of Social Services, etc.)
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)
  • Shelter (Domestic Violence, Homeless, etc.)
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

This program does not include a homework component.

Languages

Child-Parent Psychotherapy (CPP) has materials available in languages other than English:

Hebrew, Norwegian, Spanish, Swedish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

No specific room requirements are needed as the program is often implemented through a home-visiting model. However, a private space is necessary in order to create safety to process past traumatic experiences.

Toys that encourage symbolic or narrative play for children under 5.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

  • Practitioners: Master's level training
  • Supervisors: Master's degree plus minimum of 1 year training in the model

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

Supplemental manuals:

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

There are a number of different training models. The Learning Collaborative is the most common, but there are also agencies and internship sites that are able to offer implementation-level CPP trainings. CPP Learning Collaboratives are typically arranged with an organization (an agency, foundation, or state entity). Training can be requested through the CPP website (link listed above).

Number of days/hours:

A CPP Learning Collaborative (LC) involves 18-months of training that includes: 1) an initial 3-day didactic workshop; 2) two bi-annual (every 6 months) 2-day core competency focused workshops; and 3) twice-monthly hour-long group case consultation calls to support case-based learning as practitioners implement CPP with children aged 0-5 who have experienced a trauma. A CPP LC may also include supervisor calls to focus on ways that supervisors support and scaffold CPP learning and systems calls to think about agency alignment with CPP and any implementation challenges.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Child-Parent Psychotherapy (CPP) as listed below:

The Readiness to Implement CPP self-assessment allows agencies to determine what structure supports they have in place and/or need to obtain in order to obtain training in CPP for their clinical staff and to implement CPP as part of their services. This tool is also used as part of the application process for agencies new to the CPP model who want to be trained. https://docs.google.com/document/d/1nWvqwJhmSvYd3ADsBD3qBg-8fos0BwtmtMG8Lz1PL9c/edit?usp=sharing

Formal Support for Implementation

There is formal support available for implementation of Child-Parent Psychotherapy (CPP) as listed below:

As noted above, CPP training occurs through a Learning Collaborative, which includes 18 months of ongoing consultation, use of fidelity instruments, and assistance with implementation challenges.

In addition, the CPP Dissemination Team at the Child Trauma Research Program provides technical and clinical support through consultation calls with agency administrators and supervisors. Formal support is available depending on the needs of the agency. Support offered can include fidelity monitoring and reporting, agency implementation technical support, supervisor coaching, and sustainability planning.

Fidelity Measures

There are fidelity measures for Child-Parent Psychotherapy (CPP) as listed below:

CPP has fidelity forms for each phase of treatment. The forms assess therapist fidelity on 6 CPP Fidelity Strands. All forms are available for download from the website.

As part of a CPP learning collaborative, practitioners are required to complete the CPP Fidelity tools on two cases, a high challenge and a low challenge case, and to review the forms with their supervisor or team member. Aspects of the tool are also shared and used during the CPP consultation calls. Each practitioner presents a minimum of two times during the learning collaborative and shares components of the fidelity tool as part of their presentation. https://childparentpsychotherapy.com/providers/tools-and-resources/fidelity/

Fidelity Measure Requirements:

Fidelity measures are required to be used as part of program implementation.

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Child-Parent Psychotherapy (CPP).

Implementation Cost

There have been studies of the costs of implementing Child-Parent Psychotherapy (CPP) which are listed below:

Hoagwood, K. E., Richards-Rachlin, S., Baier, M., Vilgorin, B., McCue Horwitz, S., Narcisse, I., Diedrich, N., & Cleek, A. (2024). Implementation feasibility and hidden costs of statewide scaling of evidence-based therapies for children and adolescents. Psychiatric Services, 75(5), 461-469. https://doi.org/10.1176/appi.ps.20230183

Washington State Institute for Public Policy. (2023). Child-Parent Psychotherapy: Benefit cost results. https://childparentpsychotherapy.com/wp-content/uploads/2024/05/Child-Parent-Psychotherapy-WSIPP-Benefits-Cost-Analysis.pdf

Research on How to Implement the Program

Research has been conducted on how to implement Child-Parent Psychotherapy (CPP) as listed below:

CPP and Telehealth

  • Clemmons, N. G., Coates, E., & McLeod, A. (2024). Understanding the benefits of child-parent psychotherapy delivered via telehealth during the COVID-19 pandemic. Children's Health Care, 53(1), 41–59. https://doi.org/10.1080/02739615.2023.2179489
  • Fogarty, A., Savopoulos, P., Seymour, M., Cox, A., Williams, K., Petrie, S., Herman, S., Toone, E., Schroeder, K., & Giallo, R. (2022). Providing therapeutic services to women and children who have experienced intimate partner violence during the COVID-19 pandemic: Challenges and learnings. Child Abuse & Neglect, 130, Article 105365. https://doi.org/10.1016/j.chiabu.2021.105365

CPP Effectiveness in a Culturally Diverse Population of Families Involved with a WrapAround Foster Care Program

  • Weiner, D.A., Schneider, A., & Lyons, J.S. (2009). Evidence-based treatment for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31(11), 1199–1205 https://doi.org/10.1016/j.childyouth.2009.08.013

CPP with Court-Involved Families

  • Hazen, K. P., Carlson, M. W., Cartwright, M. L., Patnode, C., Cole‐Mossman, J., Byrns, S., Hauptman, K., & Osofsky, J. (2021). The impact of Child‐Parent Psychotherapy on child dependency court outcomes. Juvenile and Family Court Journal, 72(1), 21–46. https://doi.org/10.1111/jfcj.12191

CPP Effectiveness when Conducted in 20 Sessions

  • Hagan, M. J., Brown, D. T., Sulki, M., Ghosh Ippen, C., Bush, N., & Lieberman, A. F. (2017). Parent and child trauma symptoms during Child-Parent Psychotherapy: A prospective cohort study of dyadic change. Journal of Traumatic Stress, 30(6), 690–697 https://doi.org/10.1002/jts.22240

CPP Acceptability and Feasibility in Australia

CPP Dissemination in Israel

  • David, P., & Schiff, M. (2015). Learning from bottom-up dissemination: Importing an evidence-based trauma intervention for infants and young children to Israel. Evaluation and Program Planning, 53, 18–24. https://doi.org/10.1016/j.evalprogplan.2015.07.012

CPP Feasibility in Sweden

  • Norlén, A., Thorén, A., & Almqvist, K. (2021). Implementing Child–Parent Psychotherapy (CPP) in Sweden: A qualitative study exploring experiences by caregivers taking part of the intervention with their child. Journal of Infant, Child, and Adolescent Psychotherapy, 20(2), 152–168. https://doi.org/10.1080/15289168.2021.1925001

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Safety and Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Child-Parent Psychotherapy are summarized below:

Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive interaction and outcome with anxiously attached dyads. Child Development, 62, 199–209. https://doi.org/10.1111/j.1467-8624.1991.tb01525.x

Type of Study: Randomized controlled trial
Number of Participants: 93 mother-child dyads

Population:

  • Age — Children: 11–14 months; Adults: 21–39 years
  • Race/Ethnicity — Children: Not specified, Adults: 100% Mexican and Central American
  • Gender — Children: 44% Male; Adults: 100% Female
  • Status — Participants were mothers who were recent immigrants and their children with low socioeconomic status (SES) and recruited from pediatric clinics.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of Infant-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in mother-infant pairs who were anxiously attached. Participants were randomly assigned to either the Infant-Parent Psychotherapy intervention group or a nonintervention control group. Measures utilized include the Strange Situation, the Maternal Attitude Scale, and the Life Event Inventory. A second control group was also formed, consisting of pairs who were found at baseline to be securely attached. Results indicate that intervention group pairs had higher scores in empathic responsiveness and goal-corrected partnership and lower scores on angry behavior by the child than anxious control pairs. The intervention group did not differ from the anxious control group on attachment security, although intervention children were less likely to show proximity avoidance and contact resistance. Both the intervention group and anxious control group improved in maternal child-rearing attitudes over time. Although the secure control group still had higher secure attachment scores at the follow-up than the intervention group, the two groups did not differ significantly on other outcomes at the end of the intervention. Limitations include small sample, lack of postintervention follow-up, and lack of generalizability.

Length of controlled postintervention follow-up: None.

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 & Human Development, 1(1), 34–66. https://doi.org/10.1080/14616739900134021

Type of Study: Randomized controlled trial
Number of Participants: 108 mother-child dyads

Population:

  • Age — Children: Mean=20.4 months (approx. 1.7 years); Adults: 22–41 years
  • Race/Ethnicity — Children: Not specified; Adults: 95% Caucasian
  • Gender — Children: 50% Male and 50% Female; Adults: 100% Female
  • Status — Participants were depressed mothers with at least a high school education recruited through media and referrals from mental health professionals or mothers who lived in the vicinity of these mothers that were screened to create the nondepressed control group.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of Toddler-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in depressed mothers of young children. Participants were randomly assigned to receive Toddler-Parent Psychotherapy or to a nonintervention control group. There was also a second control group of mothers from the same community who did not have any prior diagnosis of a mental disorder. Measures utilized include the Diagnostic Interview Schedule (DIS-III-R), the Beck Depression Inventory (BDI), and the Attachment Q-set (AQS). Results indicate that both the intervention and depressed control groups had a higher proportion of insecurely attached children than the nondepressed control at baseline. At follow-up, the intervention group's proportion of insecurely attached children had decreased to the point that it was no longer significantly different from that of the nondepressed control group, while the depressed control group experienced an increase in insecure attachment. Limitations include the decision to omit mothers from low socioeconomic groups, the use of a more subjective method of classifying children's attachment, small sample size, lack of postintervention follow-up, and lack of generalizability.

Length of controlled postintervention follow-up: None.

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. https://doi.org/10.1017/S095457940200411X

Type of Study: Randomized controlled trial
Number of Participants: 122 mother-child dyads

Population:

  • Age — Children: Mean=48.14 months (approx. 4.0 years); Adults: Not specified
  • Race/Ethnicity — Children: 76% Minority and 28% Nonminority; Adults: Not specified
  • Gender — Children: 68 Male and 54 Female; Adults: 100% Female
  • Status — Participants were families with a documented history of maltreatment recruited from the Department of Social Services or randomly recruited from families receiving Temporary Assistance to Needy Families (TANF) and screened for history of maltreatment.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of Preschooler-Parent Psychotherapy (PPP) [now called Child-Parent Psychotherapy (CPP)]. Participants were randomly assigned to the PPP, psychoeducational home visitation (PHV), or community standard (CS) groups. A comparison group (NC) of low-income mothers and children with no history of maltreatment was also included. Measures utilized include the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R). Results indicate that children in the PPP intervention evidenced more of a decline in maladaptive maternal representations over time than PHV and CS children and displayed a greater decrease in negative self-representations than CS, PHV, and NC children. Also, the mother–child relationship expectations of PPP children became more positive over the course of the intervention, as compared to NC and PHV participants. Limitations include constructs that might be expected to improve more dramatically in the PHV model (e.g., improved parenting skills and knowledge of child development) could not be addressed, small sample size, and lack of postintervention follow-up.

Length of controlled postintervention follow-up: None.

Lieberman, A. F., Van Horn, P., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44(12), 1241–1248. https://doi.org/10.1097/01.chi.0000181047.59702.58

Type of Study: Randomized controlled trial
Number of Participants: 75 mother-child dyads

Population:

  • Age — 3–5 years; Adults: Not specified
  • Race/Ethnicity — Children: 39% Mixed Ethnicity, 28% Latino, 15% African American, 9% White, 7% Asian, and 3% Other; Adults: 37% Latina, 24% White, 15% African American, 13% Mixed or Other, and 11% Asian
  • Gender — Children: 39 Female and 36 Male; Adults: 100% Female
  • Status — Participants were referred by court, Child Protective Services (CPS), or other community services after child witnessed marital violence.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the treatment outcomes for preschool-age children exposed to marital violence, comparing the efficacy of Child-Parent Psychotherapy (CPP) with case management plus treatment as usual in the community. Participants were randomly assigned to either the CPP treatment group or to a comparison group receiving case management and referral to individual treatment in the community for mother and child. Measures utilized include the Child's Exposure to Community Violence: Parent Report Version, the Child Behavior Checklist (CBCL), the Semistructured Interview for Diagnostic Classification DC: 0-3 for Clinicians, the Life Stressor Checklist, the Clinician Administered PTSD Scale, and the Symptoms Checklist-90. Results indicate that CPP group children showed a significant decline in posttraumatic stress disorder (PTSD) symptoms and behavior problems at the conclusion of the study, while comparison group children did not. Mothers in the CPP group showed significant reductions in avoidant symptoms and there was a moderate effect on general distress and PTSD symptoms. Limitations include a small sample, lack of postintervention follow-up, and reliance on maternal report.

Length of controlled postintervention follow-up: None.

Cicchetti, D., Rogosh, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623–649. https://doi.org/10.1017/S0954579406060329

Type of Study: Randomized controlled trial
Number of Participants: 189 mother-child dyads

Population:

  • Age — Children: Mean=13.3 months; Adults: Mean=28.67 years
  • Race/Ethnicity — Children: Not specified; Adults: 74% Minority Race/Ethnicity
  • Gender — Children: 101 Female and 88 Male; Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the treatment outcomes for preschool-age children exposed to marital violence, comparing the efficacy of Infant Parent Psychotherapy (IPP) [now called Child-Parent Psychotherapy (CPP)] with case management plus treatment as usual in the community. Participants were randomly assigned to receive IPP, psychoeducational parenting intervention (PPI), or to a community standards control group (CS). An additional comparison group (NC) from low-income nonmaltreating families was also included. Measures utilized include the Childhood Trauma Questionnaire (CTQ), the Perceptions of Adult Attachment Scale (PAAS), the Maternal Behavior Q-Set (MBQ), the Adult-Adolescent Parenting Inventory (AAPI), the Social Support Behaviors Scale (SSBS), the Parenting Stress Inventory (PSI), and the Strange Situation. Results indicate that mothers in the maltreatment group, relative to the nonmaltreatment group mothers, reported greater abuse and neglect in their own childhoods, more insecure relationships with their own mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support, and they were observed to evince lower maternal sensitivity. Infants in the maltreatment groups had significantly higher rates of disorganized attachment than infants in the NC group. At postintervention follow-up at age 26 months, children in the IPP and PPI groups demonstrated substantial increases in secure attachment, whereas increases in secure attachment were not found for the CS and NC groups. Moreover, disorganized attachment continued to predominate in the CS group. Limitations include lack of postintervention follow-up and inconsistent maternal engagement in the intervention.

Length of controlled postintervention follow-up: 1 month.

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(8), 913–918. https://doi.org/10.1097/01.chi.0000222784.03735.92

Type of Study: Randomized controlled trial
Number of Participants: 50 mother-child dyads

Population:

  • Age — Children: 3–5 years; Adults: Not specified
  • Race/Ethnicity — Children: 38% Mixed Ethnicity, 28% Latino, 16% African American, 12% White, 4% Asian, and 2% Other; Adults: 37% Latina, 24% White, 15% African American, 13% Mixed or Other, and 1% Asian
  • Gender — Children: 28 Male and 22 Female; Adults: 100% Female
  • Status — Participants were referred by court, Child Protective Services (CPS), or other community services after child witnessed marital violence.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Lieberman et al. (2005). The purpose of the study was to examine the durability of improvement in child and maternal symptoms 6 months after termination of Child-Parent Psychotherapy (CPP). Participants were randomly assigned to either the CPP treatment group or to a comparison group receiving case management and referral to individual treatment in the community for mother and child. Measures utilized include the Child Behavior Checklist (CBCL) and the Global Severity Index (GSI). Results indicate that in a comparison of baseline and 6-month follow-up scores, the CPP treatment children showed significant reductions in problem behaviors while the control group did not. Intent-to-treat analyses revealed similar findings for children’s behavior problems but were not significant for maternal symptoms. Similarly, only the CPP group mothers showed a significant improvement in distress levels at 6 months. Limitations include small sample size and reliance on maternal report.

Length of controlled postintervention follow-up: 6 months.

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 randomized preventive trial. Journal of Consulting and Clinical Psychology, 74(6), 1006–1016. https://doi.org/10.1037/0022-006X.74.6.1006

Type of Study: Randomized controlled trial
Number of Participants: 198 mother-child dyads

Population:

  • Age — Children: Mean=20.34 months (approx. 1.65 years); Adults: Mean=31.68 years
  • Race/Ethnicity — Children: Not specified; Adults: 93% European American
  • Gender — Children: 53% Male and 47% Female; Adults: 100% Female
  • Status — Participants were mothers who had experienced major depressive disorder (MDD) since their child’s birth and were of non-low socioeconomic status recruited through mental health professionals and the media, or mothers who lived in the vicinity of these mothers that were screened to create the nondepressed control group.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Cicchetti et al. (1999). The purpose of the study was to test the efficacy of Toddler-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in depressed mothers of young children. In addition to the Cicchetti et al. 1999 sample the current study includes 55 additional dyads. Participants were randomly assigned to Toddler-Parent Psychotherapy (DI) or the nonintervention (DC) groups. A control group of nondepressed mothers (NC) was also created by directly contacting families. Measures utilized include the Diagnostic Interview Schedule (DIS-III-R), the Beck Depression Inventory (BDI), and the Strange Situation. Results indicate that both groups with depressed mothers showed insecure attachment at baseline. At postintervention, the rate of secure attachment in the DI group was higher than both the NC and DC groups. Limitations include lack of generalizability to higher risk populations, small sample size, and high attrition.

Length of controlled postintervention follow-up: None.

Ippen, C. G., 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 & Neglect, 35(7), 504–513. https://doi.org/10.1016/j.chiabu.2011.03.009

Type of Study: Randomized controlled trial
Number of Participants: 75 mother–child dyads

Population:

  • Age — Children: 3–5 years; Adults: Mean=31.48 years
  • Race/Ethnicity — Children: 39% Mixed Ethnicity, 28% Latino, 15% African American, 9% White, 7% Asian, and 3% Other; Adults: 37% Latina, 24% White, 15% African American, 13% Mixed or Other, and 11% Asian
  • Gender — Children: 39 Female and 36 Male; Adults: 100% Female
  • Status — Participants were referred by court, Child Protective Services (CPS), or other community services after child witnessed marital violence.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Lieberman et al. (2005). The purpose of the study was to reanalyze data from a randomized controlled trial to examine whether Child–Parent Psychotherapy (CPP) is efficacious for children who experienced multiple traumatic and stressful life events (TSEs). Participants were randomly assigned to either the CPP treatment group or to a comparison group receiving case management and referral to individual treatment in the community for mother and child. Children with 4 or more TSEs were assigned to the high risk group; children with fewer than 4 TSEs were assigned to the low risk group. Measures utilized include the Child's Exposure to Community Violence: Parent Report Version, the Child Behavior Checklist (CBCL), the Semistructured Interview for Diagnostic Classification DC: 0-3 for Clinicians, the Life Stressor Checklist, the Clinician Administered PTSD Scale, and the Symptoms Checklist-90. TSEs were calculated through acestudy.org. Results indicate that for children in the 4 or more risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of cooccurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with less than 4 TSEs showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4 or more TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group. Limitations include a small sample, reliance on maternal report, and dichotomizing children into only two TSE risk groups.

Length of controlled postintervention follow-up: 6 months.

Stronach, E. P., Toth, S. L., Rogosch, F., & Cicchetti, D. (2013). Preventive interventions and sustained attachment security in maltreated children. Development and Psychopathology, 25(4pt1), 919–930. https://doi.org/10.1017/S0954579413000278

Type of Study: Randomized controlled trial
Number of Participants: 137 mother-child dyads

Population:

  • Age — Children: Mean=13.3 months; Adults: Mean=26.9 years
  • Race/Ethnicity — Children: 60% African American, 18% White, 6% Latino, 16% Biracial/Other; Adults: 54% African American, 25% White, 12% Latino, 9% Biracial/Other
  • Gender — Children: Not specified; Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Cicchetti et al. (2006). The purpose of the study was to evaluate the relative efficacy of Child-Parent Psychotherapy (CPP) and psychoeducational parenting intervention (PPI) in supporting the maintenance of secure attachment and predicting behavioral functioning in maltreated children 12 months after the end of treatment. Participants were randomly assigned to one of three intervention conditions: CPP, PPI, and a control group involving standard community services (CS). A fourth group of infants from nonmaltreating families and their mothers comprised a nonmaltreated comparison (NC) group. Measures utilized include the Strange Situation paradigm, the Attachment Organization in Preschool Children: Procedures and Coding Manual, the Childhood Trauma Questionnaire—Short Form (CTQSF), the Diagnostic Interview Schedule—Version IV (DIS-IV), and the Child Behavior Checklist/2–3 (CBCL). Results indicate that at follow-up, children in the CPP group had higher rates of secure and lower rates of disorganized attachment than did children in the PPI or the CS group. Rates of disorganized attachment did not differ between the CPP and the NC groups. Intention to treat analyses also showed higher rates of secure attachment at follow-up in the CPP group relative to the PPI and the CS groups. However, groups did not differ on disorganized attachment. At follow-up on the CBCL there were no significant differences on internalizing, externalizing, or total problems scales among the four study groups. Both primary and intention to treat analyses demonstrated that maternal-reported child behavior problems did not differ among the four groups at the follow-up assessment. Limitations include generalizable only to maltreating, multiproblem families willing to participate and agree to random assignment; study results may not be replicated in circumstances under which clinicians are not provided adequate time for training, supervision, and client outreach; and treatment decliners were grouped with dyads who were randomly assigned to the CS condition for the primary data analyses.

Length of controlled postintervention follow-up: 1 year.

Toth, S. L., Sturge-Apple, M. L., Rogosch, F. A., & Cicchetti, D. (2015). Mechanisms of change: Testing how preventative interventions impact psychological and physiological stress functioning in mothers in neglectful families. Development and Psychopathology, 27(4pt2), 1661–1674. https://doi.org/10.1017/S0954579415001017

Type of Study: Randomized controlled trial
Number of Participants: 157 mother-child dyads

Population:

  • Age — Children: Mean=13.3 months; Adults: Mean=26.9 years
  • Race/Ethnicity — Children: 60% African American, 18% White, 6% Latino, and 16% Biracial/Other; Adults: 54% African American, 25% White, 12% Latino, and 9% Biracial/Other
  • Gender — Children: Not specified; Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Cicchetti et al. (2006). The purpose of the study was to evaluate the relative efficacy of Child-Parent Psychotherapy (CPP) and psychoeducational parenting intervention (PPI) in supporting the maintenance of secure attachment and predicting behavioral functioning in maltreated children 12 months after the end of treatment. Participants were randomly assigned to one of three intervention conditions: CPP, PPI, and a control group involving standard community services (CS). A fourth group of infants from nonmaltreating families and their mothers comprised a nonmaltreated comparison (NC) group. Measures utilized include the Strange Situation paradigm, the Attachment Organization in Preschool Children: Procedures and Coding Manual, the Childhood Trauma Questionnaire—Short Form (CTQSF), the Diagnostic Interview Schedule—Version IV (DIS-IV), and the Child Behavior Checklist/2–3 (CBCL). Results indicate that at follow-up, children in the CPP group had higher rates of secure and lower rates of disorganized attachment than did children in the PPI or the CS group. Rates of disorganized attachment did not differ between the CPP and the NC groups. Intention to treat analyses also showed higher rates of secure attachment at follow-up in the CPP group relative to the PPI and the CS groups. However, groups did not differ on disorganized attachment. At follow-up on the CBCL there were no significant differences on internalizing, externalizing, or total problems scales among the four study groups. Both primary and intention to treat analyses demonstrated that maternal-reported child behavior problems did not differ among the four groups at the follow-up assessment. Limitations include generalizable only to maltreating, multiproblem families willing to participate and agree to random assignment; study results may not be replicated in circumstances under which clinicians are not provided adequate time for training, supervision, and client outreach; and treatment decliners were grouped with dyads who were randomly assigned to the CS condition for the primary data analyses.

Length of controlled postintervention follow-up: 1 year.

Guild, D. J., Toth, S. L., Handley, E. D., Rogosch, F. A., & Cicchetti, D. (2017). Attachment security mediates the longitudinal association between Child-Parent Psychotherapy and peer relations for toddlers of depressed mothers. Development and Psychopathology, 29(2), 587–600. https://doi.org/10.1017/S0954579417000207

Type of Study: Randomized controlled trial
Number of Participants: 130 mother-child dyads

Population:

  • Age — Children: Mean=9.77 years; Adults: Mean=31.68 years
  • Race/Ethnicity — Children: 119 White, 5 Black, 4 Hispanic, and 2 Other; Adults: 93% European American
  • Gender — Children: 53% Male and 47% Female; Adults: 100% Female
  • Status — Participants were children and their mothers with a history of major depressive disorder (MDD) since giving birth to their child.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Toth et al. (2006). The purpose of the study was to examine postintervention attachment status as a mediator of the association between Child Parent Psychotherapy (CPP) for depressed mothers and their offspring and subsequent peer relations among offspring. The study examined follow-up data of teachers’ reports on participants’ competence with classroom peers when they were approximately 9 years old. Participants were randomly assigned to CPP or to a depressed control condition in which no intervention was provided. Measures utilized include the Diagnostic Interview Schedule, Version III, Revised (DIS-III-R), the Beck Depression Inventory (BDI), the BDI-Second Edition (BDI-II), the Strange Situation, and the Teacher Checklist of Peer Relationships (TCPR). Results indicate that children who received CPP were more likely to show evidence of secure attachments at postintervention, which in turn was associated with more positive peer relationships at age 9. However, analysis controlling for child gender and age at the 9-year-old follow-up indicated that the main effect of baseline group assignment on peer relations was nonsignificant. Limitations include concerns about generalizability to children and mothers of different racial/ethnic backgrounds or lower socioeconomic strata, reliance on a single measure of peer relationships, and high attrition rates at the follow-up time point.

Length of controlled postintervention follow-up: Approximately 7.5–8 years.

Bernstein, R. E., Timmons, A. C., & Lieberman, A. F. (2019). Interpersonal violence, maternal perception of infant emotion, and Child-Parent Psychotherapy. Journal of Family Violence, 34(4), 309–320. https://doi.org/10.1007/s10896-019-00041-7

Type of Study: Randomized controlled trial
Number of Participants: 113 mother-child dyads

Population:

  • Age — Children: Average=4.15 years (Range=2–6 years); Adults: Average=31.00 years (Range=19–46 years)
  • Race/Ethnicity — Children: 38% Mixed Ethnicities, 29% Latino, 14% African American, 11% White, 6% Asian, and 2% Other; Adults: 40% Latina, 24% White, 15% African American, 11% Asian, 7% Mixed Ethnicities, 3% Other, and 1% Native American
  • Gender — Children: 59 Male and 54 Female; Adults: 100% Female
  • Status — Participants were mothers of children ages 2 to 6 years old who were exposed to interpersonal violence (IPV).

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Lieberman et al. (2006). The purpose of the study was to examine four interrelated hypotheses. The first two hypotheses test whether IPV-exposed mothers show bias toward fear or anger in interpreting infants’ facial expressions, and whether this bias is related to child symptoms. The second set of hypotheses examines whether bias can be changed by Child-Parent Psychotherapy (CPP) and whether this change mediates treatment gains. Participants were randomly assigned to either the CPP treatment group or to a comparison group. Measures utilized include the IFEEL Picture System (IFP), the Clinician-Administered PTSD Scale (CAPS), and the Child Behavior Checklist (CBCL 2/3 and 4/18). Results indicate that IPV-exposed mothers exhibit a perceptual bias toward fear, but not anger. Bias toward fear was linked to greater child internalizing symptoms while bias toward anger was linked to greater child externalizing symptoms. Participation in CPP resulted in decreased bias toward fearful faces. The treatment-related changes in mothers’ perceptions of children’s facial expression did not emerge as the mechanism by which CPP reduces children’s symptoms. Limitations include the stimuli in the IFEEL task depict 12-month-old infants, whereas the sample included mothers of slightly older (2- to 6-year-old) children; the study did not include a behavioral measure of parental sensitivity or proxy for parent-child relationship quality; and limited generalizability due to socioeconomic status, geographic location, racial/ethnic background, and exposure to traumatic stressors.

Length of controlled postintervention follow-up: None.

Guild, D. J., Alto, M. E., Handley, E. D., Rogosch, F., Cicchetti, D., & Toth, S. L. (2021). Attachment and affect between mothers with depression and their children: longitudinal outcomes of child parent psychotherapy. Research on Child and Adolescent Psychopathology, 49(5), 563–577. https://doi.org/10.1007/s10802-020-00681-0

Type of Study: Randomized controlled trial
Number of Participants: 135 mother-child dyads

Population:

  • Age — Average=20.34 months; Adults: 21–41 years (Mean=31.68 years)
  • Race/Ethnicity — Children: Not specified; Adults: 93% White, 4% Black, 2% Hispanic, and 2% Other
  • Gender — Children: 47% Female; Adults: 100% Female
  • Status — Participants were mothers of non-low socioeconomic status recruited through mental health professionals and the media, or mothers who lived in the vicinity of these mothers that were screened to create the nondepressed control group.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Toth et al. (2006). The purpose of the study was to examine the longitudinal effects of Child-Parent Psychotherapy (CPP) for a subset of toddlers and their mothers with depression on a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Participants were randomized to either a depressed intervention condition (DI), in which dyads received CPP, or a depressed control condition that did not receive an intervention (DC). Participants without depression or other history of major mental illness (NC) were also recruited to serve as an additional comparison group. Measures utilized include the Diagnostic Interview Schedule (DIS-III-R), the Beck Depression Inventory (BDI), and the Strange Situation. Results indicate that toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 (36 months old) displayed higher levels of maternal warmth at T3 (9 years old) and lower levels of child anger and problem behavior at T3. Limitations include the sample was restricted to middle-class mothers; findings may not generalize to children and mothers of different racial and ethnic backgrounds, or to those from lower socioeconomic strata; it is possible that additional services sought and/or the use of psychotropic medication may have contributed to children’s improved social functioning; the absence of data on intervening events post-intervention presents the possibility that alternative unmeasured variables, and not treatment effects may explain maternal and child outcomes at T3; and CPP was compared to a non-intervention control condition rather than another active treatment.

Length of controlled postintervention follow-up: 16 months and approximately 6 years.

Additional References

Chu, A. T., Ippen, C. G., & Lieberman, A. F. (2021). It’s all about the relationship: The role of attachment in Child-Parent Psychotherapy. Research on Child and Adolescent Psychopathology, 49(5), 591-593. https://doi.org/10.1007/s10802-020-00741-5

Ghosh Ippen, C. & Lieberman, A.F. (2024). Child–Parent Psychotherapy: Acknowledging ruptures in safety and rebuilding the protective shield. In J. D. Osofsky, H. E. Fitzgerald, M. Kiren, & K. Puura (Eds). WAIMH handbook of infant and early childhood mental health. Volume 2: Cultural context, prevention, intervention, and treatment in infant mental health (pp. 293–312). Springer Nature.

Lieberman, A. F., Hernandez Dimmler, M., & Ghosh Ippen, C. (2018). Child-Parent Psychotherapy: A trauma-informed treatment for children and their caregivers. In C. Zeanah (Ed.). The Handbook of Infant Mental Health (4th ed., pp. 485–499). Guilford Press.

Contact Information

CPP Dissemination Team
Agency/Affiliation: University of California, San Francisco, Child Trauma Research Program
Website: childparentpsychotherapy.com
Email:

Date Research Evidence Last Reviewed by CEBC: June 2024

Date Program Content Last Reviewed by Program Staff: June 2024

Date Program Originally Loaded onto CEBC: May 2006