Child–Parent Psychotherapy (CPP) is a dyadic, relationship-based treatment for parents and young children, which aims to help restore normal developmental functioning in the wake of domestic violence and trauma. CPP concentrates on restoring the attachment relationships that are negatively affected by violence, establishing a sense of safety and trust within the parent–child relationship and addressing the co-constructed meaning of the event or trauma shared by parent and child. The treatment is also known as Infant–Parent Psychotherapy (IPP), which is an adaption for infants, and Child–Parent Psychotherapy for Family Violence, which is available for families who experience multiple forms of familial violence.
Originally designed to use with parents and children who witness domestic violence, CPP and IPP are based on psychoanalysis and attachment theory, but they combine and integrate principles from multiple theories (developmental, trauma, social learning, psychodynamic, and cognitive–behavioral theories) to help parents and their children recover from exposure to violence and other traumatic stressors.
CPP sessions concentrate on parent–child interactions to support and foster healthy coping, affect regulation, and increase appropriate reciprocity between parent and child. The initial assessment session of CPP is to provide individual sessions with the mother to discuss the emerging assessment findings, agree on the course of treatment, and plan how to explain the treatment to the child. Weekly joint child–parent sessions are conducted while the mother continues individual sessions. The sessions concentrate on changing maladaptive behaviors, supporting developmentally appropriate interactions, and guiding the child and mother to create a joint narrative of the traumatic events while working toward their resolution.
Although the goals of CPP may be pursued through various therapeutic modalities, the emphasis of the therapy sessions is always on the parent–child interaction. When the family structure is threatened with disruption (such as possible removal of the children from the home), crisis intervention, case management, assistance with problems of living, and advocacy with the social system and agencies that can provide assistance to maintain the family’s well-being are also provided.
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Lieberman, Van Horn, and Ippen (2005) found significant differences on measures of child functioning and maternal symptoms between the treatment group that received Child–Parent Psychotherapy (CPP) and the comparison group.
Children in the CPP group had a significant reduction in the number of traumatic stress disorder (TSD) symptoms from intake to posttreatment, whereas the comparison group did not. The CPP group also showed significant reduction in behavior problems from intake to posttreatment as measured by the Child Behavioral Checklist Total scores.
The clinical significance of treatment effects was measured by comparing the percentage of children in each group who met the criteria for a diagnosis of TSD. At intake, there was no group difference (50 percent of children in the CPP group and 39 percent of the children in the comparison group met the criteria). At posttest, there was a statistically significant difference between the groups. Only 6 percent of the children in the CPP group met the criteria for TSD, whereas 36 percent of the children in the comparison group met the criteria.
Scores from the CAPS showed a significant reduction in avoidance symptoms for mothers in the CPP group only. However, there were no significant treatment effects found for re-experiencing and hyperarousal symptoms. The total CAPS scores showed a significant reduction from intake to posttreatment for mothers in both the CPP and comparison groups. Analysis of the Global Severity Index scores, which is considered the best single indicator of current distress, showed that mothers in the CPP group showed a significant reduction, whereas the comparison group showed a trend in this direction but it was not statistically significant.
The clinical significance of treatment was determined by comparing the percentage of mothers in each group who were diagnosed with PTSD. At intake, there was no difference between the groups (47 percent of mothers in the CPP group and 46 percent of mothers in the comparison group met the PTSD criteria). At posttest, there was a decline in PTSD diagnosis for mothers in both groups. Twelve percent of CPP mothers and 27 percent of comparison mothers met the PTSD criteria. The difference was not statistically significant.
Intent-to-treat analyses—in which scores from intake or 6-months were used in place of missing posttest scores—resulted in similar results as those described above for both children and mothers.
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