2. Child Parent Psychotherapy
Strength-based Strategies in Working with Traumatized Children and their Families
Melony Williams, LMHC, Good Beginnings of Sullivan County
Erin Barnett, PhD, Dartmouth and West-Central Behavioral Health

3. Effects of Trauma on Very Young Children: Attachment Relationships
Loss of sense of mother/father as reliable protectors
Disturbed mental representations of who is safe and who is dangerous
Loss of capacity to sustain representations of mother/father as secure base
Intense emotions coexist and serve a defensive function in relation to one another
Lieberman & Van Horn, 1998

4. Effects of Trauma on Very Young Children: Social and Emotional Development
Social development: Outgrowth of attachment impaired attachment processes with caregivers.
Socially immature, withdrawn, or aggressive
Emotional development: Difficulty identifying and managing strong emotions (numbness, out of control feelings and behavior)
Other milestones: delayed, regressed development of milestones such as bottle, thumb, potty-training
These difficulties occur as a result of changes in brain pathways and chemicals that interfere with healthy development (Schore)

5. Effects of Trauma on Very Young Children: Later functioning
Associated with:
Substance use/abuse
Adult mental health problems
School problems
Risk taking behaviors

6. Child Parent Psychotherapy Model
A model of psychotherapy that focuses on the relationship between parent and child.
Client is not the child or the parent but the relationship between the two. Focus is on attachment.
Different than many traditional models of psychotherapy.
Focus is on young children. Therapy done with newborns to 6 y.o. and a caregiver

8. Development of CPP Created by Alicia Lieberman and Patricia Van Horn
Another pioneer of the work is Dr. Joy Osofsky of LSU who leads a team of CPP clinicians there and helped to launch a comprehensive family intervention program that includes CPP in Miami.

9. Applications of CPP
Designed to help families who have experienced a trauma that has affected the parent child relationship. Typically the trauma is domestic violence, but this is not always the case.
Treatment ideally occurs weekly for one year.

10. Focus of Treatment parental responsiveness, attunement
increasing parental capacity for nurturance and protection
assistance with emotional/behavioral regulation
developmental guidance- getting children back on normal developmental trajectory
looking at ghost and angels from parents past and how those effect parenting choices- prevention of intergenerational transmission of abuse
resolution of traumatic experiences within the context of the parent child relationship.

11. CPP and Protective Factors
Parental Resilience
Social Connections
Knowledge of Parenting and Child Development
Concrete Support in Times of Need
Social/Emotional Development

12. Theoretical Roots of CPP
Based in attachment theory but also integrates psychodynamic, developmental, trauma, social learning, and cognitive behavioral theories.
Most of the work is done through play.

13. Setting for Treatment
Much of the treatment provided in NH is office based.
Patricia Van Horn’s team at UCSF does home based work
Safety considerations must be addressed but home based work often reduces many barriers to treatment such as lack of transportation, child care for other children in the home, reluctance to go to a mental health facility.
Meeting families where they are at.

14. Course of Treatment

15. Session 1 Focus on building an alliance Assessment of relationship
Gathering a rich history of parent’s childhood, child’s development and relationships among family members
Share details of CPP
Safety

16. Session 2 Parenting Stress Index Child Behavior Checklist
Crowell Assessment

20. Modified Parent Child Relationship Assessment (Crowell & Fleishmann, 1993)
Videotaped
Variety of age appropriate activities used to assess the relationship between mother and child under different circumstances
Free play, clean-up, bubbles, developmentally appropriate tasks, separation/reunion
Use information gained to build on strengths of parent, child and dyad and develop goals to address challenges

21. Consultation after Assessment
After questionnaires and Crowell completed, information and video brought to CPP and group determines if family is a good fit for program.
At third session this information is shared with the family and then the parent is asked if they feel that CPP would fit well for them and if they are willing to make the commitment to treatment.
If CPP is not a good fit, referrals for further services are made.
Assessments repeated at midpoint and termination

23. Specific strength-based strategies within CPP
Strength-based aspects of observational relationship assessment (Crowell)
Mutual positive engagement
Awareness of developmental needs

24. Using video clips strategically to “build up” and “hold” parent in positive light
From Crowell video or session video; have also used photos

25. Focus on identifying and processing “Angels” from caregiver’s childhood
Ghosts and angels
Moments of nurturance, safety to draw from

26. “Catch them being good”
Particularly useful with families involved in child welfare system

27. CPP Implementation: Training Outcomes
To date, over 20 therapists have been trained in three counties across six settings
Claremont Good Beginnings, West Central
Lebanon West Central
Concord and Franklin Riverbend
DHMC
Expert training and consultation followed by internal consultation groups
Over 70 families in NH have begun treatment with CPP, a substantial proportion of referrals come from DCYF and family courts
Stakeholders requesting more training and presentations

28. CPP Implementation: Client outcomes
Mid-treatment outcomes (after 13 sessions) for first 15 cases for which mid-treatment data was available
Significant improvements in clinician-reported parent-child relationship quality PIRGAS
Significant improvement in parent-reported TOTAL CBCL scores – child emotional and behavioral problems
No changes in parent-reported stress or clinician rated relationship quality based on Crowell

29. CPP Case Example

30. Treatment Process and Protective Factors
Parental Resilience
Social Connections
Knowledge of Parenting and Child Development
Concrete Support in Times of Need
Social/Emotional Development

33. Questions