A family found themselves struggling with the behavior of their 3-and-a-half year old daughter. She would become easily frustrated by changes in routine, and struggle to self-regulate her behavior She would become inconsolable at times when separated from her mother, which then turned into aggression to anyone that would intervene. She would throw objects, push her sibling, bite, stomp her feet, yell and scream, and fall on the floor when not getting her way. Behaviors would occur at home, but also when transitioned into pre-school/daycare. Her parents were exhausted and overwhelmed as they struggled to manage their daughter’s behaviors amid the constant tantrums. Finally they sought help through Parent Child Interaction Therapy, or PCIT.
What is PCIT?
Parent Child Interaction Therapy is a proven short-term approach to improve the relationship of caregivers and children. PCIT works in a simple, clear, and strengths-based approach to reduce negative attention-seeking behaviors, improve role model self-regulation, and increase positive communication. PCIT is provided with consistent support and guidance from a trained professional in an office setting while being available for phone support between sessions and after treatment completion.
PCIT consists of weekly sessions conducted in two treatment phases:
InChild-Directed Interaction (CDI), caregivers are taught the PRIDE skills: Praise,Reflect, Imitate, Describe and Enjoyment.
o Praise: Tell the child exactly what you like: “I love how you are sharing the toys with me.”
o Reflect: Repeating what your child says to improve their speech. If the child says “Kitty has a black nose,” the parent says “The cat’s nose is black.”
o Imitate: Copying what the child is doing with the toys showing your child you approve as well as teaching child how to take turns. As the child is drawing a tree, the parent says, “I’m drawing a tree just like you.”
o Describe: Saying what the child is doing that is appropriate to increase attention: “You are making a tower with the blocks.”
o Enjoy the Interaction: Parents practice these skills after being taught one-to-one by therapist and encouraged to do daily at home with child as well as during all PCIT sessions.
InParent-Directed Interaction (PDI),caregivers learn to use effective commands and discipline procedures (time-out chair and time-out room). The therapist is able to provide support to caregivers as they learn to manage their child’s behaviors in many settings. PCIT time-out procedure is very detailed and uses specific wording and time limits. Time-out sequences uses a time-out chair that the child is instructed to sit quietly at when the child does not comply with a command. A time-out room is used as a back-up whenever the child does not stay on the time-out chair.
How does PCIT work?
PCIT was developed by Dr Sheila Eyberg, taking two aspects of authoritative parenting as identified by Baumrind and focusing on the nurturance (CDI phase of treatment) and limit-setting styles (PDI phase of treatment). Research Into the influence of parents/caregivers on young children’s behavioral and emotional development shows that while some parenting practices may intensify a child’s problems, other practices have enormous potential to influence children’s behaviors in a positive way. PCIT is designed to help parents learn and implement these new skills.
One aspect that distinguishes PCIT from other approaches is that it provides live direct coaching to parents; the therapist observes the caregiver and child together, and then works with the caregiver to manage challenging child behaviors as they occur in real time. Live coaching also allows the therapist to support caregivers as they gain confidence in managing their child’s behaviors and mastering the specialized PCIT skills.
During the course of treatment, the child engages in appropriate creative play with parent(s) at the weekly therapy sessions, and daily five minutes of play as well. Children love the positive attention from their parents and will start to make changes to their behaviors almost immediately. Many families see improvements in behaviors in the first few weeks.
After a good foundation of skills is developed by caregiver/parent(s), they move into a second phase of treatment allowing the parent take the lead and provide direct commands. Children learn to comply to commands with the use of labeled praise for compliance or time out for non-compliance. Children learn that if they comply immediately, they will get to continue to do more pleasurable activities such as play.
Parents are able to carry these skills from the therapy session, into the home and into public places as the skills are applied across all areas. During the course of treatment, parent(s) track the child’s behaviors to see progress allow graduation from PCIT treatment. PCIT research has also showed that its effects were maintained for 1-6 years following treatment.
Who is PCIT for?
Families with children ages 2.5 to 7 years who display any or all of the following:
- Difficulty staying seated
- Difficulty taking turns
- Difficulty playing alone or quietly
- Refusal and defiance of adult requests
- Purposeful annoyance of others
- Temper tantrums
How effective is PCIT?
Research shows PCIT is effective in reducing children’s behavior problems while decreasing parent distress. It has been shown to reduce the risk of child abuse occurring within the home and/or reports of child abuse. PCIT improves parenting skills and attitudes with their child building on the bond and reducing criticism. Children’s negative behaviors are less frequent and less intense per parent(s) reports while in PCIT treatment and beyond.
PCIT has also been shown to be effective in treating multiple issues such as adjustment with parental divorce, attention deficit hyperactivity disorder, separation anxiety, depression and many others. Additionally, PCIT has shown to be adaptable across a variety of populations (genders and ethnic groups). Feedback from participating families includes:
- “We communicate better and have a stronger bond now…
- I am proud of myself and being able to handle situations with my son…
- She is now allowing me to come into her world…
- This program has basically saved my relationship with my child.”
As for the parents mentioned earlier, they participated in teach sessions and weekly one-hour coaching sessions, while practicing the skills they learned daily while playing with their daughter at home. They incorporated them throughout their daily lives to gain the biggest improvements in the child’s behaviors and their relationship. After just 11 weeks of treatment, they saw a dramatic improvement in their daughter’s behavior and they felt more confident and knowledgeable on how to address any attention-seeking behaviors.
Reflecting on the effectiveness of PCIT, the girl’s father said:
The respect I gained from her in understanding what she goes through during our interactions has helped me work on better, clear, concise, and descriptive commands. And the quality one-on-one time that was spent with her and working on our relationships has proven to be invaluable!!”
Her mother also found the experience worthwhile:
“The program and our outcomes have been life changing for our family. We have gone from multiple melt-downs – child AND Parent – daily to minimal events. Our daughter is more confident and I feel better in the way we now handle conflict.”
Where can I get more information about PCIT?
To find a PCIT-certified therapist in your area, visit the PCIT website www.pcit.org/united -states and search by state. (If you’re in the Allentown. PA area, you can call KidsPeace’s Green Street Outpatient Services at 610-799-8910 to learn more.)
Source: Parent-Child Interaction Therapy, Second Edition, C.B. McNeil and T.L. Hembree-Kigin (2011)
