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Child Abuse Research Education and Service Institute

Combined Parent-Child Cognitive Behavioral Therapy

Empowering Families At-Risk for Physical Abuse to Develop Healthy Outlooks and Positive Environments

Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT) empowers parents to use effecftive, positive parenting skills, assists children in overcoming the trauma of physical abuse and strengthens parent-child relationships.

Can CPC-CBT help your family?

CPC-CBT is an evidence-based practice designed to address the needs of children and families at-risk for Child Physcial Abuse (CPA). Developed by Dr. Melissa K. Runyon, in collaboration with Dr. Esther Deblinger,  CPC-CBT is grounded in cognitive behavioral theory and incorporates elements from empirically-supported CBT models for families who have experienced trauma (e.g., trauma narrative and processing, positive reinforcement, timeout, behavioral contracting), 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.

Children (ages three - 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 Therapy

  • Help children heal from their abusive experiences.
  • Empower parents to effectively parent their children in a non-coercive manner.
  • Strengthen parent-child relationships.
  • Enhance the safety of all family members.

What to Expect

CPC-CBT is a treatment model consisting of approximately 16 sessions offered over the course of 16-20 weeks in either individual (90-minute sessions) or group (two-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.

Families who have not been substantiated for CPA may still benefit for CPC-CBT. This therapy can be used as a preventitve measure, so that coercive interactions in the family do not escalate to physically abusive interactions.

Skills Emphasized During Therapy Sessions

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.

  • Provide 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.
  • Provide education about child development and age appropriate expectations for children’s behavior.
  • Empower parents to be effective by working collaboratively to develop adaptive coping skills (i.e., anger management, relaxation, assertiveness, etc.) that will assist them in remaining calm while interacting with their children.
  • Develop non-violent conflict resolution skills.
  • Develop a variety of problem-solving skills related to child-rearing, and non-coercive child behavior management skills.

Help 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 offer parents practice with active listening, communication skills, and positive parenting with children. Clinicians participate in these sessions, coaching parents with positive reinforcement and corrective feedback to enhance the skills.

Teach children a variety of positive coping skills, particularly assertiveness and anger management skills training. Children who are exposed to physical violence are much more likely than other trauma populations to present with aggression, so the development of coping mechanisms is imperative to their treatment.

Develop a family safety plan to help identify when parent-child interactions are escalating and the need to take a cool down period in order to enhance safety and communication in the family. During joint parent-child sessions, parents and children rehearse the implementation of the family safety plan.

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.

It is important for children to feel comfortable when they need to communicate information related to their bodies. Review our Body Safety Document Here.