Parent Child Interaction Therapy

Parent-Child Interaction Therapy (PCIT)

Children are born with different temperaments; some are easy going and some have more difficulty adjusting to the rhythms of everyday life. Parents often find that “common sense” child-rearing practices for children with easier temperaments may not work for a child with behavior problems. The result is increasing frustration and tension between parent and child, as well as decreasing effectiveness with tantrums, defiance, and misbehavior. Parent-Child Interaction Therapy (PCIT) is a research-supported program that aims to improve parent-child relationships and child behavior by working with both parents and children together.

 What is PCIT?

This program is a scientifically supported treatment for 2- to 7-year-old children with significant disruptive behaviors. PCIT gives equal attention to the parent-child relationship and to parents’ behavior management skills. The goals of the program are to increase positive feelings and interactions between parents and children, to improve child behavior, and to empower parents to use consistent, predictable, effective parenting strategies.

PCIT is unique as it is based on teaching and coaching parents in positive parenting skills from within a supportive environment. Unlike most therapies in which skills are taught in the office yet practiced outside in the “real world,” PCIT offers skills practice with real-time therapist guidance and support.

What happens during PCIT sessions?

PCIT consists of weekly, hour-long sessions, typically over a period of 12 weeks. Teaching sessions involve introduction, modeling, and role-playing of very specific skills. Subsequent sessions involve review of home practice and live coaching of parent-child interactions. Through a one-way mirror and an audio transmitter worn in the parent’s ear (a “bug-in-the-ear”), the therapist gives ongoing coaching, advice, and encouragement while the parent interacts with the child. New skills are thus practiced, reviewed and mastered in the office. Home practice sessions of 5 to l5 minutes a day are a critical part of the treatment.

What do parents learn in the sessions?

Parents learn to increase their positive attention when their child’s behavior is appropriate and to use differential attention to reduce minor negative behaviors. Parents also learn a specific time-out procedure to use when their child does not comply with a command or demonstrates other rule-breaking behaviors (e.g., back talking, hitting a sibling).

How does the PCIT program involve both parents and children in the treatment?

PCIT is structured in two phases: the Child-Directed Interaction and Parent-Directed Interaction phases. At the beginning of each phase, a teaching session with parents and without the child is held to introduce the skills that will be the focus of that phase. Remaining sessions, or “coaching” sessions, include the child and involve live practice with the parent and child, with assessment and coaching of skills by the clinician.

How is progress determined?

Before beginning each session, parents are asked to complete a behavior rating scale: the Eyberg Child Behavior Inventory (ECBI). This scale provides information on the frequency, severity, and impact of their child’s disruptive behavior. Parents must master specific criteria to progress from the Child-Directed Interaction phase to the Parent-Directed Interaction phase (from CDI to PDI to graduation.) Skills are coded, tracked, and reviewed with families each week to inform them of their progress. Families graduate from PCIT after demonstrating CDI and PDI mastery, reporting an average amount of disruptive behavior, and expressing confidence in their ability to manage their child’s behavior in real-life settings.

 Have the effects been examined long-term?

Research suggests that gains made in PCIT are largely maintained at least 6 years after treatment completion.