Wendie Klapper, director of the Parent-Infant Center at Mt. Sinai-St. Luke’s, explains how therapy can help parents and very young children build a stronger relationship. Strengthening that bond early on, she says, can benefit children throughout their lives.

Q: What is Child-Parent Psychotherapy?

A: Child-Parent Psychotherapy is therapy for parents and their young children, ages 0-5. The parent and child meet with the therapist together, and the therapy focuses on how the parent and child interact, think and feel about each other.

Parents and children spend one hour a week with a therapist focusing on their relationship through play. One of the main ways very young children express themselves is through play.

We ask parents to observe their child playing and imagine what the child is thinking or feeling. If a child is behaving in destructive ways, the therapist can help a parent learn new strategies to deal with a child’s behavior. But the therapist also encourages the parent to empathize with the child. When children feel that their parents understand them and are curious about them, they feel less anxious and they grow calmer.

During the week, parents work on dealing with things like tantrums or bedtime routines. During the session, the parent and therapist talk about what works, what doesn’t work, and they problem solve together. Therapists listen carefully to what parents say, because parents are the experts on their child. No one knows that child better.

Q: How do you see families grow?

A: We have a young mother in our program now whose 1-year-old was removed from her care. The mother was alleged to be verbally and emotionally abusive. As a child, she herself had been physically and sexually abused and spent time in foster care.

Through individual therapy, she made a lot of gains in understanding how her own trauma history impacted her relationship with her child. For example, she wasn’t nurturing her child or being consistent, maybe because of how she was treated as a child. She and her individual therapist also developed strategies for her to calm herself down when she became very upset.

In Child-Parent Psychotherapy, she was able to focus on changing her relationship with her child. She understood better how her tone of voice and body language might feel threatening to her child. She also recognized that her child’s severe temper tantrums might be a reaction to being placed in foster care.

As this mom became less angry and felt less helpless as a mother, she also began to play with a lot of enjoyment. Play became a wonderful experience she and her child shared. At the beginning, we weren’t sure whether this mother would be able to reunite with her child, but her child is scheduled to return home soon.

Q: What is the role of the therapist?

A: Very often, when families are under stress, that stress breaks down trust between parent and child and damages a child’s sense of safety with the parent—what we call attachment. The goal of Child-Parent Psychotherapy is to strengthen that attachment and restore trust and feelings of safety.

Therapists also help parents discuss difficult topics with their children, even very young children. For instance, the therapist can help the parent find ways to answer, “Why don’t I live with you, Mommy?” It’s important for parents to reassure children that the problems the family is facing are not the child’s fault.

We also talk about parents’ own experiences with play. Many parents don’t know how to play, because they weren’t given the opportunity to play themselves as children. That can create a lot of anxiety. Therapists help parents develop age-appropriate activities to do with their children, and provide reading materials to help parents become experts on child-rearing. Parents also develop insight into how their own childhood impacts how they raise their children. That insight is very important to the parent-child relationship.

Many parents also go to individual therapy. When parents have been through so much, individual therapy provides a really important opportunity to work through their own feelings.

Q: Who can Child-Parent Psychotherapy help?

A: Child-Parent Psychotherapy was developed to help parents and children heal from the devastating impact of domestic violence. We also see families that have been impacted by physical or sexual abuse, neglect, the loss of a child, a child’s placement in foster care, or mental health problems, like severe depression or post-traumatic stress. We can even work with mothers who are pregnant, and continue working with them after their child is born. The therapy usually lasts anywhere from several months to two years.

Parents also come to us who are struggling with their children’s behavior. Some children may be born with sensory issues, like sensitivity to being touched, which makes it hard to comfort them. Other children may have speech delays, which makes it hard to communicate and leads them to act out. As parents understand more about what their children are trying to communicate by their behaviors, they can help children communicate in positive and effective ways.

We focus on the parent-child relationship at such a young age because we know from years of research that if parents and children are able to develop an emotionally supportive relationship early on, it helps both the child and parent continue to build a healthy relationship throughout the child’s life. Having a safe and trusting relationship also leads to other positive outcomes for children, including improved school performance, positive relationships with peers, and decreased substance abuse.