Parent-Child Cognitive Behavioral Therapy:
Empowering Families At-Risk for Physical Abuse to Develop Healthy Outlooks and Positive Environments
What Is Combined Parent Child Cognitive Behavioral Therapy (CPC-CBT)?
Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT) is an evidence-based practice designed to address the needs of children and families at-risk for CPA developed by Melissa K. Runyon, PhD in collaboration with Esther Deblinger, PhD. CPC-CBT is grounded in cognitive behavioral theory and incorporates elements (e.g., trauma narrative and processing, positive reinforcement, timeout, behavioral contracting) from empirically supported CBT models for families who have experienced sexual abuse, physical abuse, and/or domestic violence, as well as elements from motivational, family systems, trauma, and developmental theories. CPC-CBT has been included on SAMHSA’s National Registry of Evidence Based Practices and Programs (NREPP) website.
What Population Does CPC-CBT Effectively Serve?
Children (ages 3-17) and their parents who are at-risk for or who have already engaged in physically abusive behavior towards their children are appropriate referrals. At-risk may be defined as those families who have had multiple referrals to Child Protective Services (CPS) with no substantiation, as well as those families who report using excessive physical punishment with their children. It may also include parents who experience high levels of stress, perceive their children’s behavior as extremely challenging, and fear they are going to lose their temper with their children.
Goals of CPC-CBT include helping children heal from their abusive experiences, empowering parents to effectively parent their children in a non-coercive manner, strengthening parent-child relationships, and enhancing the safety of all family members.
To date, research has demonstrated that CPC-CBT helps children and families recover from the negative effects of excessive physical discipline/CPA. This supports the promise of CPC-CBT to reduce parental use of corporal punishment, improve positive parenting skills, reduce children’s PTSD symptoms, and strengthen parent-child relationships. Click here for a summary of research findings to support CPC-CBT.
What Are the Skills of CPC-CBT?
CPC-CBT is a manualized treatment consisting of 16 sessions offered over the course of 16-20 weeks in either individual (90-minute sessions) or group (2-hour sessions) format. Every session begins with the parent and child meeting individually with the clinician and concludes with the parent, child and clinician together. The amount of time spent jointly with the parent, child and clinician increases as therapy progresses. By the end of the course of treatment, the majority of the session is spent jointly with parent, child and clinician. The treatment consists of the following phases: Engagement, Skill Building, Family Safety Planning, and Abuse Clarification.
Some of the skills emphasized in the structured therapy sessions include:
Engagement Strategies/Motivational Interviewing
- The use of engagement strategies, motivational interviewing/consequence review, and individualized goal setting to engage and to motivate parents who are often not contemplating changing their parenting style or interactions with their children.
Psychoeducation: Violence, Child Development, Processing Parent’s Relationship with Own Parents
- Providing parents with information concerning emotional and behavioral effects on children of severe corporal punishment and CPA as well as processing the impact on their childhood experiences particularly if they experienced abuse themselves.
- Providing education about child development and age appropriate expectations for children’s behavior
Enhancing Positive Coping Skills in Parents
- Empowering parents to be effective by working collaboratively with them to develop adaptive coping skills (i.e., anger management, relaxation, assertiveness, etc.) to assist them in remaining calm while interacting with their children, to develop non-violent conflict resolution skills, to develop a variety of problem-solving skills related to child rearing, and non-coercive child behavior management skills.
Enhancing Family Communication Skills and Positive Parenting Skills
- Helping families develop effective communication skills to increase family members’ feelings of validation and cooperation with one another. Over the course of treatment, joint parent-child sessions involve having parents practice implementation of active listening, communication skills, and positive parenting with children while the clinicians coach them by offering positive reinforcement and corrective feedback to enhance the skills.
Enhancing Positive Coping Skills in Children
- Teaching children a variety of positive coping skills, particularly assertiveness and anger management skills training, given that children who are exposed to physical violence are much more likely than other trauma populations to present with aggression.
Family Safety Planning
- Developing a family safety plan that involves learning how to identify when parent-child interactions are escalating and taking a cool down period in order to enhance safety and communication in the family. Joint parent-child sessions involve having parents and children rehearse the implementation of the family safety plan.
Abuse Clarification Process
- During the last phase of treatment when improvements have been reported in parent-child interactions, positive parenting, and children’s fear, clarification involves the clinician encouraging the children to write about or share their abusive experiences while focusing on their thoughts and feelings associated with the abuse. While the child is developing this trauma narrative, the clinician also assists parents in processing their own thoughts and feelings while writing and revising a "clarification" letter to their children to enhance their empathy for their children and to demonstrate that they take full responsibility for their abusive behavior. The clarification letter also serves to alleviate the child of blame, respond to the child's questions and/or worries, and correct the child's cognitive distortions concerning the abuse. The parents and children share the clarification letter and trauma narrative in joint segments, unless this process is contraindicated. However, in most cases, this process enhances the parent's empathy for the child and is a powerful therapeutic tool that strengthens the parent-child relationship.