CPP helps enhance the caregiver-child relationship and teaches parents strategies for decreasing problems within the relationship.
It’s a commonly held belief that attachment between parents and their children just happens naturally. Society likes to pretend that humans are born with an innate desire to love and rely upon their parents, and that parents instinctively know how to love, protect, and bond with their children.
The truth is much more complicated than that. Attachment can be disrupted or impaired for a variety of reasons, and parents and children alike can both struggle to form healthy bonds.
This is unfortunate because
The good news is, child-parent psychotherapy (CPP) can help.
Liora Hoffman, PhD, is an assistant clinical professor of medical psychology and program clinical director at New York-Presbyterian Hospital and Columbia University Medical Center. She describes CPP as an evidenced-based treatment plan best suited for children ages 0 to 5 years and their caregivers.
“Typically, families seek out CPP treatment following the experience of a traumatic event or due to concerns regarding their child’s mental health, behavior, or attachment relationships,” Hoffman explains.
There is ample research on the benefits of CPP in improving attachment between a child and their caregivers.
“CPP is a dyadic therapy, so it typically involves a therapist meeting with a child and caregiver together,” Hoffman said. “CPP clinicians like to say that the caregiver-child relationship is the ‘client’ as opposed to the child or caregiver alone.”
Working together with the parent and child, a CPP clinician strives to enhance the caregiver-child relationship and to teach parents strategies for decreasing any problems that may exist within the relationship.
“This is done through the use of play, developmental guidance, emotional support, and case management,” Hoffman says.
Child-parent psychotherapy is a well-known treatment plan in foster and adoptive parent circles. This is because it’s often used to treat early disruptions in a caregiver-child bond.
“Although it can be applicable for a range of other childhood mental health-related reasons including behavior problems and high family conflict,” she explains, “At the core of CPP is the idea of a child’s attachment to [their] primary caregiver, usually the mother.”
Webber says the goals of CPP typically include:
- strengthening the attachment between the child and parent
- improving the overall mental health of the child and parent
- providing both the child and parent with coping skills
- increasing the sense of safety and security in the child-parent relationship
“Most of the literature around CPP pertains to exposure to abuse and violence, such as in domestic violence situations,” Weber explained.
A CPP treatment plan can vary widely depending on the reasons for treatment and the age of the child.
“For babies and toddlers, CPP will provide help in engaging in developmentally appropriate play and help to understand the child’s development,” Hoffman says. “CPP will also explore the caregiver’s own history as it impacts their parenting of the child.”
For children this young, treatment may also be referred to as infant-parent psychotherapy (IPP).
When treatment involves children over the age of 2 years, she explains that CPP usually consists of a lot of play between the child, caregiver, and therapist.
“Children tend to express themselves through play at a young age, and play will be used to understand the internal experience of the child,” Hoffman says. “CPP will help the caregiver understand how their and their child’s experience may affect the child’s functioning and development.”
An average CPP session lasts 45 to 60 minutes and involves both the parent and child, as well as other members of the family on occasion. Hoffman says sessions usually happen weekly and can last for about a year, although there is no set time limit, and therapy generally continues until improvements in the parent-child attachment are made.
Weber explains how CPP differs from other therapy approaches.
“Treatment may be in a therapist’s office or in the family’s home,” she says. “Unlike cognitive behavioral therapy (CBT), which promotes skills-building and emphasizes the identification and challenging of maladaptive or distorted thought patterns, CPP is an integrated approach based in psychodynamic psychotherapy and attachment theory that pulls in elements of CBT and social learning and is trauma-informed.”
The main focus, she says, is often on the relationship between the child and mother.
“The therapist will focus on how parent and child interact, making observations and encouraging changes to improve trust and foster adaptive coping skills,” she explained.
According to Weber, there are several ways the attachment between a child and their caregiver may be disrupted or impaired, including:
- domestic violence
- parental mental health-related issues (e.g., maternal depression)
- other traumatic events
“The optimal attachment style is referred to as a ‘secure’ attachment, meaning a child of this age (up to 5 years) feels safe and secure in leaving the primary caregiver for short periods of time, has practice returning to the caregiver as a ‘secure base,’ as [they know] where [their] caregiver is, and is assured that the caregiver will react in a warm and welcoming way when they do return.”
In an ideal environment, CPP should help that level of attachment to develop.
“This is a process of learning,” Weber says. Throughout that learning process, she explains, the child should come to see their caregiver as reliable, predictable, and warm.
“[This] not only reassures the child and prevents an acute anxiety response or a disorganized way of interacting with the caregiver, but also acts as a model for future relationships for the child,” she explains.
Of course, achieving these goals, and improvement in the child-parent relationship, requires the full commitment and involvement of the child’s caregiver. Without that, CPP will not be successful.
CPP is only suited for families in which the parents are open to full participation, Weber says.
“Even though treatment may be started due to the child’s behavioral or other mental-health-related issues, this is psychotherapy based in the parent-child dyad, and both participants must be fully and equally involved,” she explains.
Some families may find this difficult, especially in cases where childhood trauma on behalf of the parent is unearthed and worked through.
“It can be difficult for caregivers to acknowledge their own role in unhealthy interaction patterns or to have to relive their own experience of a particular trauma,” Weber says.
But therapists are trained in helping caregivers work through this process, and the result can be healing for both the parent and child when a caregiver is fully committed.
“Rest assured providers who are well-trained in CPP will be supportive and validating along the way,” Weber says.
Parents should know that early CPP sessions will typically occur between them and the provider alone, so that the therapist may learn more about the parent-child relationship as well as the overall family history.
“The therapist will speak with the caregiver about their reasons for seeking out CPP, so it may be helpful to write down what is bringing you and your child to therapy,” Hoffman says. “Then, the therapist can work with the caregiver to make collaborative treatment goals.”
She explains that the CPP therapist will also provide the parent with tips and ideas for talking to the child about CPP sessions and preparing them for what to expect.
“Typically, the first session with the child may include some observation of the child and caregiver playing together,” Hoffman says. “Children typically enjoy CPP sessions as it is an opportunity for special time with their caregiver.”
Resource for preparing your child for therapy
It may be difficult for your child to understand what therapy is and why it may be needed. Our article “A BIG Help for BIG feelings” is intended to be read with your child. It explains in easy-to-understand language why therapy may be needed and what may happen during a session. We encourage you to use it as a guide to help your child prepare for their first CPP session with you.
If you’re a caregiver of a child who has dealt with childhood trauma, or if you’re simply a parent who feels the attachment between yourself and your child has been disrupted in some way, child-parent psychotherapy may be a good solution for you and your family.
You can usually start by discussing your concerns with your child’s pediatrician or with your own therapist. Either of these professionals should be able to make recommendations and referrals to a CPP practitioner in your area.
The most important thing to know is that by seeking ways to improve the attachment between yourself and your child, you’re already taking the first steps and proving your desire to have a healthy relationship with your little one. Reaching out for help can be scary, but it’s an indication of your commitment as a parent — and that’s a great thing!
Both you and your child deserve to have a healthy attachment style, and your entire family will benefit because of your dedication to that goal.