Child-Parent Psychotherapy
Child-Parent Psychotherapy (CPP) is an intensive therapy model that aims to support family strengths and relationships, help families heal and grow after stressful experiences, and respect family and cultural values. CPP typically progresses in three stages. During the first stage, providers administer questionnaires and meet with parents/caregivers to familiarize themselves with the family’s needs and create a plan for treatment. During the second stage, providers help children express their feelings through play, strengthen parent-child relationships, and deepen 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 needs moving forward.
CPP 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: Oct 2021
Sources
The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: the program or service manual, the program or service developer’s website, the California Evidence Based Clearinghouse for Child Welfare, and the studies reviewed.
Date Program/Service Description Last Updated: Oct 2021
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 download the Handbook of Standards and Procedures, Version 1.0
Target Population
CPP is designed for children ages birth through 5 and their parents/caregivers.
Dosage
CPP therapy sessions are typically delivered weekly for 20 to 32 weeks. Therapy duration is based on clinical need. Sessions are typically 60 to 90 minutes.
Location/Delivery Setting
Recommended Locations/Delivery Settings
CPP sessions are typically delivered in the participants’ home or in an outpatient clinic.
Location/Delivery Settings Observed in the Research
- 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). Several organizations offer endorsed CPP internship programs, which are structured as 1- to 2-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
CPP Training Models and Learning Components
For More Information
Website: http://childparentpsychotherapy.com/
Contact form: https://childparentpsychotherapy.com/about/contact/
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Child-Parent Psychotherapy |
|---|---|
| Identified in Search | 6 |
| Eligible for Review | 4 |
| Rated High | 1 |
| Rated Moderate | 1 |
| 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
24 |
2 (5) | 141 |
Favorable:
2 No Effect: 3 Unfavorable: 0 |
| Adult well-being: Parent/caregiver mental or emotional health |
0.46
17 |
1 (8) | 69 |
Favorable:
1 No Effect: 7 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
24 |
2 (5) | 141 |
Favorable:
2 No Effect: 3 Unfavorable: 0 |
- |
| Study 10557 - IPP vs Community Standard Treatment as Usual (Cicchetti, 2006) | |||||
| Strange Situation Attachment: Secure (%) |
1.79
46 |
- | 64 | - | 1 |
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group (Ghosh Ippen, 2011) | |||||
| Semistructured Interview for Diagnostic Classification: Co-occurring Diagnoses |
0.25
9 |
- | 62 | - | 0 |
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group (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 |
| Study 10557 - IPP vs Community Standard Treatment as Usual (Stronach, 2013) | |||||
| Strange Situation Attachment: Secure (%) |
0.76
27 |
- | 76 | - | 13 |
| Adult well-being: Parent/caregiver mental or emotional health |
0.46
17 |
1 (8) | 69 |
Favorable:
1 No Effect: 7 Unfavorable: 0 |
- |
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group (Bernstein, 2019) | |||||
| IFEEL: Maternal Fear Labels |
0.53
20 |
- | 69 | - | 0 |
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group (Ghosh Ippen, 2011) | |||||
| Symptoms Checklist-90 Revised: Global Severity Index- Depression |
0.58
21 |
- | 49 | - | 6 |
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group (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 |
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group (Lieberman, 2006) | |||||
| Symptoms Checklist-90 Revised: Global Severity Index |
0.50
19 |
- | 50 | - | 6 |
*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.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 10561 - CPP vs. Case Management and Community Referral for Treatment Comparison Group | ||||||
| Characteristics of the Children and Youth | ||||||
| San Francisco, CA, USA | 1996 | Mean age: 4.1; Age range: 3-5 |
39% Mixed ethnicity (predominately Latino/white) 28% Latino 15% African American 9% White 7% Asian 3% Another ethnicity |
-- | 19% of families were involved with Child Protective Services at referral | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| San Francisco, CA, USA | 1996 | Mean age of mothers: 31.5 years |
37% Latina 15% African American 13% Mixed or other ethnicities 11% Asian |
-- | 100% Mothers |
$1,817 Mean monthly family income 41% Incomes below the federal poverty level according to the Department of Health and Human Services Guidelines (2004) |
| Study 10557 - IPP vs Community Standard Treatment as Usual | ||||||
| Characteristics of the Children and Youth | ||||||
| -- | -- | Mean age: 13.3 months | -- | 55% Female | 100% Infants in maltreating families | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| -- | -- | Mean age of mothers: 27.7 years | 78% Minority race/ethnicity | -- | 65% Never married or no longer married | $18,034 Total income |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated High
Study 10561Lieberman, A. F., Van Horn, P., & Ippen, C. G. (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., Ippen, C. G., & 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-Oarent Psychotherapy. Journal of Family Violence, 34(4), 309-320. doi:10.1007/s10896-019-00041-7
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Moderate
Study 10557Cicchetti, 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/S0954579411000307
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 was not conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Low
Study 10555Toth, 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.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.
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
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
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).