Child-Parent Psychotherapy

Mental Health Promising

Child-Parent Psychotherapy (CPP) is an intensive therapy model serving children birth through age 5 years and their parents/caregivers. CPP aims to support family strengths and relationships, to help families heal and grow after stressful experiences, and to respect family and cultural values. CPP therapy sessions are typically delivered weekly over the course of 20 to 32 weeks or more, depending on clinical need. Each session is 60 to 90 minutes and is delivered at home or in an outpatient clinic. The CPP program typically progresses in three stages. During the first stage, providers use questionnaires and meetings with parents/caregivers to familiarize themselves with the family’s needs and create a plan for treatment. During the second stage, sessions focus on helping children to express their feelings through play, strengthening parent-child relationships, and deepening parents’ understanding of their child’s experiences and behaviors. In the third stage, providers celebrate progress with the family and discuss what supports the family will need moving forward. All CPP providers must have experience as mental health professionals and fulfill training requirements.


Child-Parent Psychotherapy is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome.


Date Research Evidence Last Reviewed: Mar 2020


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, the program or service manual, and the studies reviewed.

 

Program/Service Description Updated: Week of August 24, 2020


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

CPP serves children birth to 5 years and their parents/caregivers.

Dosage

CPP therapy sessions are typically delivered weekly over the course of 20 to 32 weeks or more, depending on clinical need. Sessions are typically 60 to 90 minutes. 

Location/Delivery Setting
Recommended Locations/Delivery Settings

Services are typically delivered at home or in an outpatient clinic.

Location/Delivery Settings Observed in the Research

  • Home
  • Hospital/Medical Center

Education, Certifications and Training

All CPP providers must have experience as mental health professionals and participate in required training. CPP offers three types of training models: (1) CPP Learning Collaborative (LC), (2) CPP Agency Mentorship Program (CAMP), and (3) Endorsed CPP internship. In CPP LC, teams of trainees attend an initial 3-day didactic training, participate in two competency building workshops (6 and 12 months after the initial training), provide CPP and receive feedback through supervision, and consult calls over an 18-month period. After an agency has completed the CPP LC, they may apply for CAMP, in which they identify a team of CPP trainers within their agency to train new CPP providers (with oversight from CPP mentors). Finally, several organizations offer endorsed CPP internship programs, which are structured as one to two year training programs for students in a mental health field who have completed their graduate coursework.

Program or Service Documentation
Book/Manual/Available documentation used for review

Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2015). Don’t hit my mommy: A manual for Child-Parent Psychotherapy with young children exposed to violence and other trauma (2nd ed.). Zero to Three.

Available languages

The CPP manual is available in English.

Other supporting materials

Training Overview

Training Model Learning Components

Psychotherapy with Infants and Young Children: Repairing the Effects of Stress and Trauma on Early Attachment

Contact Information for Developers

Website: http://childparentpsychotherapy.com/

Results of Search and Review Number of Studies Identified and Reviewed for Child-Parent Psychotherapy
Identified in Search 7
Eligible for Review 5
Rated High 1
Rated Moderate 2
Rated Low 2
Reviewed Only for Risk of Harm 0
Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Behavioral and emotional functioning 0.64
23
2 (4) 128 Favorable: 3
No Effect: 1
Unfavorable: 0
Child well-being: Cognitive functions and abilities 0.34
13
1 (3) 97 Favorable: 0
No Effect: 3
Unfavorable: 0
Adult well-being: Parent/caregiver mental or emotional health 0.09
3
3 (11) 266 Favorable: 1
No Effect: 10
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size
and Implied Percentile Effect
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Child well-being: Behavioral and emotional functioning 0.64
23
2 (4) 128 Favorable: 3
No Effect: 1
Unfavorable: 0
-
Cicchetti, 1999
Attachment Q-set: % with Secure Attachment 0.77 *
27
- 63 - 0
Ghosh Ippen, 2011
Semistructured Interview for Diagnostic Classification: Co-occurring Diagnoses 0.25
9
- 62 - 0
Lieberman, 2005
Semistructured Interview for Diagnostic Classification: Traumatic Stress Disorder 0.86 *
30
- 65 - 0
Child Behavior Checklist: Total Problem Behavior 0.57 *
21
- 65 - 0
Child well-being: Cognitive functions and abilities 0.34
13
1 (3) 97 Favorable: 0
No Effect: 3
Unfavorable: 0
-
Cicchetti, 2000
Wechsler Preschool and Primary Scales of Intelligence-Revised: Full Scale IQ 0.39
15
- 97 - 0
Wechsler Preschool and Primary Scales of Intelligence-Revised: Verbal IQ 0.40
15
- 97 - 0
Wechsler Preschool and Primary Scales of Intelligence-Revised: Performance IQ 0.23
9
- 97 - 0
Adult well-being: Parent/caregiver mental or emotional health 0.09
3
3 (11) 266 Favorable: 1
No Effect: 10
Unfavorable: 0
-
Bernstein, 2019
IFEEL: Maternal Fear Labels 0.53
20
- 69 - 0
Cicchetti, 2000
Diagnostic Interview Schedule-III-R: Any New Major Depressive Episode -0.06
-2
- 97 - 0
Ghosh Ippen, 2011
Symptoms Checklist-90 Revised: Global Severity Index- Depression 0.58
21
- 49 - 6
Lieberman, 2005
Clinician Administered PTSD Scale: Reexperiencing 0.34
13
- 65 - 0
Clinician Administered PTSD Scale: Avoidance 0.62 *
23
- 65 - 0
Clinician Administered PTSD Scale: Hyperarousal 0.19
7
- 65 - 0
Clinician Administered PTSD Scale: Total Symptoms 0.48
18
- 65 - 0
Symptoms Checklist-90 Revised: Global Severity Index 0.44
16
- 65 - 0
Lieberman, 2006
Symptoms Checklist-90 Revised: Global Severity Index 0.50
19
- 50 - 6
Toth, 2006
Diagnostic Interview Schedule-III, Revised: Subsequent Depressive Episode 0.01
0
- 100 - 1
Beck Depression Inventory: Depressive Symptoms -0.18
-7
- 100 - 1

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers.

Studies Rated High

Study 10561

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.

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 & Adolescent Psychiatry, 45(8), 913-918.

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 & Neglect: The International Journal, 35(7), 504-513.

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. doi:10.1007/s10896-019-00041-7


Studies Rated Moderate

Study 10556

Cicchetti, D., Toth, S. L., & Rogosch, F. A. (1999). The efficacy of Toddler-Parent Psychotherapy to increase attachment security in offspring of depressed mothers. Attachment & Human Development, 1(1), 34-66.

Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2000). The efficacy of Toddler-Parent Psychotherapy for fostering cognitive development in offspring of depressed mothers. Journal Of Abnormal Child Psychology, 28(2), 135-148.

Study 10559

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.

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 & Health: The Journal Of Collaborative Family Healthcare, 33(4), 372-382. doi:10.1037/fsh0000149

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. doi:10.1017/S0954579417000207


Studies Rated Low

Study 10557

Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development And Psychopathology, 18(3), 623-649.

Cicchetti, D., Rogosch, F. A., Toth, S. L., & Sturge-Apple, M. L. (2011). Normalizing the development of cortisol regulation in maltreated infants through preventive interventions. Development And Psychopathology, 23(3), 789-800. doi:10.1017/S095457941100

Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2011). The effects of child maltreatment and polymorphisms of the serotonin transporter and dopamine d4 receptor genes on infant attachment and intervention efficacy. Development And Psychopathology, 23(2), 357-372. doi:10.1017/S0954579411000113

Stronach, E. P., Toth, S. L., Rogosch, F., & Cicchetti, D. (2013). Preventive interventions and sustained attachment security in maltreated children. Development And Psychopathology, 25(4 Pt 1), 919-930. doi:10.1017/S0954579413000278

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(4), 1661-1674. doi:10.1017/S0954579415001017

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.
Study 10555

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(4), 877-908.

This study received a low rating because it did not meet design confound standards.


Studies Not Eligible for Review

Study 10560

Hagan, M. J., Browne, D. T., Sulik, 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. doi:10.1002/jts.22240

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10562

Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive intervention and outcome with anxiously attached dyads. Child Development, 62(1), 199-209.

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).