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Child-Parent Psychotherapy:

A relationship-based treatment for


traumatized young children
Alicia F. Lieberman, Ph.D.
alicia.lieberman@ucsf.edu
Chandra Ghosh Ippen, Ph.D.
chandra.ghosh@ucsf.edu

A Developmental Approach to Treatment


Young children develop in relationships
Young children use relationships with
caregivers to
Regulate physiological response
Form internal working models of
relationships
Provide secure base for exploration and
learning
Model accepted behaviors

Impact of Trauma on Caregiver-Child


Relationship
Either partner may develop new negative
attributions based on trauma experience
Changes in the way they perceive each other
Traumatic expectations
Caregiver and child may serve as traumatic
reminders for one another
(Pynoos, 1997)

Young Children Need to Be Seen in the


Context of Their Relationships

Child-Parent Psychotherapy
Goals
Encouraging normal development: engagement
with present activities and future goals
Maintaining regular levels of affective arousal
Establishing trust in bodily sensations
Achieving reciprocity in intimate relationships

Child-Parent Psychotherapy
Trauma-related goals
Increased capacity to respond realistically to threat
Differentiation between reliving and remembering
Normalization of the traumatic response
Placing the traumatic experience in perspective

Multi-Theoretical Approach to Treatment

Developmentally Informed
Attachment
Trauma
Psychoanalytic
Social Learning
CognitiveBehavioral
Culturally informed

Child-parent Psychotherapy
Intervention Modalities
1.
2.
3.
4.
5.
6.

Promote developmental progress through play,


physical contact, and language
Unstructured/reflective developmental guidance
Modeling protective behaviors
Interpretation: linking past and present
Emotional support
Concrete assistance, case management, crisis
intervention

Randomized Trial

Treatment children show greater improvements than comparison group


children

Traumatic stress symptomatology


Diagnosis of Traumatic Stress Disorder
Behavior problems

Treatment mothers show greater improvement

Avoidant symptomatology
Total PTSD symptomatology
General symptomatology
(Lieberman, Van Horn, & Ghosh Ippen, 2005;
Lieberman, Ghosh Ippen, & Van Horn, in press)

10

Maternal Symptomatology:
PTSD (CAPS)
25

P<.001

20
15

Tx Post

Comp Pre
H
yp
er
ar
ou
s

Av
oi
d

R
ee
xp
e

al

an
ce

Tx Pre

rie
nc
in
g

10

Comp Post

12

Maternal Symptomatology:
PTSD (CAPS Total Score)
60
50
40

P<.05

30

Tx
Comp

P<.001

20
10
0
Pre

Post

13

Child Behavior Problems:


Total Problems (CBCL)

62
61
60

Tx

59

Comp

58

p<.01

57
56
55
54
Pre

Post

14

Child Traumatic Stress Disorder

9
8
7
6
5
4
3
2
1
0

p<.001

Pre

Treatment
Comparison

Post

15

Child Diagnosis:
Traumatic Stress Disorder
80
70
60
50
40
30
20
10
0
Treatment

Comparison

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