History
Beginnings
The Child Trauma Research Program was launched in 1996, when the Chief of Psychiatry at Zuckerberg San Francisco General Hospital (ZSFG) invited Alicia Lieberman to establish a clinical research program with the mission to create science-supported, innovative interventions for trauma-exposed young children as part of the hospital’s role as the designated trauma center for San Francisco and Northern California.
CTRP’s location at the ZSFG trauma center in the heart of San Francisco’s multicultural Mission District enabled us to reach children and families from low-income and disenfranchised cultural backgrounds, whose mental health needs are underserved despite their being disproportionately subjected to traumatic events stemming from adverse life circumstances and lack of access to protective social resources. Alicia partnered with Patricia Van Horn, our program’s associate director until her untimely death in 2014, to develop Child-Parent Psychotherapy, now supported by 5 randomized controlled trials (RTCs) and several community-based clinical studies. Today, CPP is disseminated by 2000+ clinicians in 40+ states and several countries. We continue to pursue our original goal of making state-of-the-art trauma treatment available to young children and families in greatest need.
Foundations of Child-Parent Psychotherapy (CPP):
Building on What Pioneers Taught
CPP is a relationship-focused treatment because traumatized young children often live in families that experienced severe adversity and hardship across multiple generations. The CPP model holds that protecting children begins with helping parents repair the impact of trauma on themselves. When parents grow in their self-compassion, they can move from fear and anger to a more protective loving stance towards their children.
Our approach is rooted in attachment theory and the metaphor of “ghosts in the nursery”, the term used by the infant mental health pioneer and psychoanalyst Selma Fraiberg in the 1970’s to describe painful memories of parents’ childhood experiences which are enacted in their current inability to offer their infants the nurturing care all babies need to thrive. Selma created a two-generation approach that she called “infant-parent psychotherapy” to help parents alleviate their own sources of pain as the roadmap to understand and respond to their baby’s needs.
CPP has expanded this two-generation approach in two major ways:
- We address the entire early childhood span from birth through age 5. Our focus on early trauma called on us to include not only infants but also toddlers and preschoolers, who are routinely overlooked in the mental health field due to the misconception that young children “don’t notice” or “recover quickly” from traumatic events.
- We widened the clinical lens to alleviate historical and social sources of trauma that affect the entire family. Child maltreatment and domestic violence are often the family enactment of the social violence disproportionately affecting marginalized racial, ethnic, religious, and cultural groups – including community violence, traumatic migration, and hate crimes.
Hurt parents can unwittingly hurt their children. The universal hallmarks of trauma are fear, blame, aggression, and blame. We guide parents and small children to express their hurt and anger using words, play, and creative activities. We aim to replace the destructive impact of “ghost memories” of trauma with “angel memories” of safe intimacy that are created during treatment and then extend to everyday life.
Creating Scientific Evidence: It Works!
Decades of research demonstrate that Child-Parent Psychotherapy supports healthy development in infants and young children exposed to trauma as well as their caregivers. For example, compared to families who do not receive CPP, children and caregivers who receive CPP have stronger, more secure relationships and lower levels of mental health problems, including post-traumatic stress symptoms. Children show better cognitive functioning, and caregivers report lower levels of parenting stress. Improvements in the caregiver-child relationship have long-lasting impacts, translating to higher-quality peer relationships and reduced problem behavior in children measured eight years after they received CPP.
Recent interdisciplinary research suggests that some of these effects may occur because CPP helps reduce the biological effects of chronic stress. Findings show that CPP leads to healthier patterns of cellular aging in children and better stress-system functioning in mothers, which may contribute to long-term improvements in health.
Scaling Evidence-based Treatment: CPP Dissemination
Lack of access to services is a major obstacle in meeting the national mental health crisis affecting children of all ages. The American Academy of Child and Adolescent Psychiatry has estimated that preventing and treating childhood trauma would eliminate a significant source of mental health problems across the lifespan into adulthood. From our beginnings, we have made training of excellent clinicians a major focus of our work. In 2001 we became a center of the federally funded National Child Traumatic Stress Network, a Congressional initiative directing the Substance Abuse and Mental Health Services Administration (SAMHSA) to fund this network of programs with the mission of increasing access and raising the standard of trauma care for children, families and communities across the country. Our uninterrupted funding over the past 25 years has enabled us to train thousands of mental health providers who in turn have provided state-of-the-art trauma treatment to tens of thousands of young children and their families locally and nationally. We also have an international reach as government institutions and universities in a growing number of countries engage us in bringing CPP to their countries.
Extending Our Work into Community Partnerships: Sustaining Trauma-Informed Practice Beyond the Hospital
Alongside our efforts to increase access to evidence-based trauma treatment through training and dissemination, we also began developing new approaches to bring our clinical and scientific expertise into community settings serving children and families facing the greatest barriers to care. Beginning in 2008, we partnered with Tipping Point Community to co-develop an innovative hospital–philanthropy-community mental health model aimed at addressing barriers faced by families impacted by poverty, violence, and structural inequity. In response to concerns from community-based organizations that unmet mental health needs were limiting families’ ability to access essential resources, our clinicians were embedded directly within trusted agencies providing food, housing, childcare, employment, and other concrete supports. This approach brought trauma-informed, evidence-based mental health services into the settings where families already sought help, strengthening coordination of care and dramatically improving engagement in treatment.
Over time, a strategic emphasis on broadening reach and supporting sustainable, long-term impact led the partnership to evolve from a primary focus on direct clinical care to a complementary emphasis on system-level workforce development. Training, consultation, and reflective support for frontline staff and organizational leadership became central strategies for strengthening trauma-informed practice within community-based agencies. This evolution laid the foundation for establishing our Community Partnerships arm at CTRP, which extends our longstanding commitment to translating UCSF’s hospital-based clinical excellence, scientific rigor, and training expertise into sustainable, community-embedded mental health practice.
A New Home: Expanding Horizons, Lasting Partnerships
In 2022 we started a new chapter of our history when we moved to the Nancy Friend Pritzker Building, the new home of the UCSF Department of Psychiatry and Behavioral Sciences. While maintaining our commitment to the children and families served by ZSFG, our present co-location with Developmental Pediatrics and Center for Health and Community enables us to forge new clinical, research, and training partnerships that continue to expand the scope of our reach.