Child Parent

Psychotherapy

Denise Jaimes-Villanueva,MA &

Caitlin Lepore, LCSW
February 22, 2012

Agenda
Vignette
Background
Clients
Theory

/ Framework
Objectives
Role of Assessment
Structure / toys
Principle Components
Ports of entry
Ghosts & Angels in the
Nursery
Reflective Supervision

Vignette

Lenny, age 3 , has been expelled from day care because he bit another
child for the fourth time and other parents have complained that he is a
danger for their children. During the assessment, Lennys mother, Mrs.
OBrian, describes extensive domestic violence perpetrated by Lennys
father. She reports that Lenny was home when the abuse took place, though
she does not believe that he was aware of it because it was mostly at night
and he was asleep in the other room when it occurred. Lennys father is now
out of the home and has an unpredictable pattern of visits with Lenny on
approximately a monthly basis. Mrs. OBrian is worried about these visits
because she believes that her husband is using them to turn Lenny against
her. She says that Lenny has prolonged tantrums when he returns from visits
with his father, refuses to be comforted by her, and hits her and kicks her
when she tries to hold him. Bedtime is also a major struggle and sometimes
it will take two hours of fighting him before he will get to sleep. He
will run out of the bed and around their apartment, knocking over furniture
and throwing toys when she is trying to get him to bed. Eventually it
culminates in a temper tantrum where he is so exhausted he will fall asleep
while he is crying. After eliciting a detailed account of present
circumstances, the clinician asks: What were things like for you when you
were growing up? Mrs. OBrian says that her parents divorced when she was
a baby and she never knew her father. She adds: I have been thinking of
going back with my husband because I dont want Lenny to grow up without a
father, like I did.

Background
Extension

of Infant-Parent
Psychotherapy
Selma Fraiberg & Ghosts in the Nursery
Alicia Lieberman
IPP focuses on treating parents
psychological conflicts expressed through
attitudes and behaviors toward child
IPP focused on 0-3. CPP extends to work with
parent-child relationship up through age 6
Both focus on attachment and relationship as
basic premise to promote improvement in
child

CPP Appropriate
Clientele
Children

ages 0-5 & their

caregiver(s)
Exposure to trauma
IPV, abuse, neglect, grief and loss
Currently experiencing
emotional/behavioral problems

Theory / Frame
Attachment

Theory
Trauma Theory
Psychoanalytic/
Psychodynamic Theory
Developmentally
informed
Culturally informed
Cognitive Behavioral
Social Learning

Therapeutic Objectives

Encourage normal development

Engagement with present activities and

future goals

Think about the meaning of the childs

behavior
Maintain regular levels of affective
arousal
Establish trust in bodily sensations
Awareness and understanding of bodys
reactions
Comfort with physical contact

Achieve reciprocity in intimate

relationships

Respond in contingent ways to behavior

Engage in goal-corrected partnership with
awareness of the perspective (feeling,
motives, plans, goals, needs) of the other)

*slide from
Chandra
Ghosh Ippen
(2010)

Assessment examples
Child

Trauma History & Symptoms

Traumatic Events Screening Inventory (TESI)

Trauma Symptom Checklist for Young Children
(TSCYC)
Child Behavior Checklist (CBCL)

Parent

Trauma History & Symptoms

Life Stressors Checklist

Adverse Childhood Experiences (ACE)

Relationship

Parent Stress Index (PSI)

Crowell Procedure

Strengths

session

and Needs / Goals setting

Structure / Toys
Introduce

the reason for treatment

60-90 minute weekly sessions
Average length of treatment is 1 year
Collateral meetings with caregivers
outside of sessions as needed
Home- or office-based
Toys: Animal families, dollhouse, families,
dinosaurs, phones, emergency vehicles, food
and dishes, art supplies, fences, puppets,
baby doll w/ bottle and blanket, blocks,
medical kit, bubbles, play doh, puzzles,
board games, superheroes
Trauma triggering/prompting toys

Principle Components
1.

Sessions consist of joint

and individual/couple
collaterals w/
caregiver(s)
Joint sessions focus on
play and spontaneous
child-parent interactions
Collateral sessions used
to discuss content, focus
on parents experience

Principle Components
2.

Therapist translates
Developmental and emotional
meaning of childs behavior
Promotes parental understanding
and positive parenting practices
Therapists job is to facilitate
the parents confidence to be in
the role as the one to guide their
child through life and the trauma

Principle Components
Targets of CPP
Maladaptive child behavior
Punitive & developmentally
inappropriate behaviors
Patterns of parentchild
interaction that reflects
mistrust and misunderstanding
3.

Principle Components
Focus on joint activities that
foster:
Mutual pleasure
Positive parental attributions
to child
Childs trust in parent
4.

Principle Components
5.

Interventions tailored to needs of parent

and child
Play, language, physical activity, &
physical affection to promote development
Developmental guidance
Role modeling of protective interventions
Addressing traumatic reminders
Evoking memories of the past to restore
self-esteem and hope (angels and ghosts)
Insight oriented interpretation
Emotional support
Crisis intervention
Concrete assistance

Principle Components
Start simple
When simple and direct
strategies do not result
improvement more complex
interventions should be used
6.

Ghosts in the Nursery

Intergenerational

transmission of trauma

Experiences from a caregivers

past may influence their parenting
relationship

Caregivers

reflect on their
attachment history and
childhood experiences in
order to gain insight into
their own parenting &
caregiver-child relationship

Fraiberg S, Adelson E, Shapiro V (1975).Ghosts in

the nursery. A psychoanalytic approach to the
problems of impaired infant-mother relationships.
Journal of the American Academy of Child &
Adolescent Psychiatry, 14(3), 387-421.

Angels in the
Nursery
Focus is on resiliency and

strengths

Promotes the caregivers

ability to
identify with the role of
protector

Can bring up parents unmet

needs and
wishes

Ports of Entry

Child and parents behavior

Child/parent interaction
Childs representation of self or parent
Parents representation of self or child
Mother/father/child interaction
Inter-parental conflict (and conflict w/
siblings)
Child/therapist relationship
Parent/therapist relationship
Child/parent/therapist relationship

Osofsky, J., (2009)Using Child-Parent Psychotherapy to Treat Young Children Exposed to Trauma [Power Point slides].
Retrieved from http://www.throughtheeyes.org/files/Osofsky%20Online%20Docs/Core%20Competencies.pdf

Vignette
In

your seventh session with Lenny and his

mother, he takes out the animals. He takes
out a large dinosaur, a smaller baby
dinosaur, and a sheep. He begins to hit the
big dinosaur and the sheep together
aggressively, and scrunches up his nose in
concentration as he slams them together,
grunting. Mrs. OBrian stares off into space
for a moment and then comments softly,
Lenny, stop. Mrs. OBrian turns to you and
says, You know, Lennys dad has been coming
around more and he says he stopped drinking.

Reflective Supervision
Enables

the therapist to become

more aware of self and others
Reveals countertransference
issues
Promotes:
Interpersonal growth
Positive parallel process
Calmness and focus

Reflective
One

Supervision:
model

20 minutes a presenter tells the case to the

listening partner
2 minutes of silence
13 minutes the reflecting team talks among
themselves about what they have overheard,
keeping the focus on the presenter
10 minutes the presenter responds in
conversation w/ the listening partner; the
listener helps the presenter focus on what
has been overheard from the reflecting team
15 minutes the boundary is removed so all can
join the conversation

Hester, R. & Walker-Jones, K (2009). Know your story and lead

with it: the power
of narrative in clergy leadership.

Thank you!
Questions
Thoughts
Feelings