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Parent-Child Interaction Therapy With At-Risk Families
Issue Brief

Author(s):  Child Welfare Information Gateway

Year Published:  2007

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You are in section: Table of Contents 1 - What Makes PCIT Unique 2 - Key Components 3 - Effectiveness of PCIT 4 - What to Look for in a Therapist 5 - Conclusion 6 - Resources 7 - References

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Key Components

PCIT is typically provided in 14 to 20 sessions, each lasting about 1 hour. Occasionally, additional treatment sessions are added as needed.

The PCIT curriculum uses a two-phase approach addressing: 

(1) Relationship enhancement
(2) Discipline and compliance

Initially, the therapist discusses the key principles and skills of each phase with the parents. Then, the parents interact with their children and try to implement the particular skills. The therapist typically observes from behind a one-way mirror while communicating with the parent, who wears a small wireless earphone. Although not optimal, clinicians who do not have access to a one-way mirror and ear bug may provide services using in-room coaching. Specific behaviors are tracked on a graph over time to provide parents with feedback about the achievement of new skills and their progress in positive interactions with their child.

Phase 1:  Relationship Enhancement (Child-Directed Interaction)

The first phase of treatment focuses on improving the quality of the relationship between the parent and the child. This phase emphasizes building a nurturing relationship and secure bond between parent and child. Phase I sessions are structured so that the child selects a toy or activity, and the parent plays along while being coached by the therapist. Because parents are taught to follow the child's lead, this phase also is referred to as child-directed interaction (CDI).

During Phase I sessions, parents are instructed to use positive reinforcement. In particular, parents are encouraged to use skills represented in the acronym “PRIDE”: 

• Praise. Parents provide praise for a child's appropriate behavior—for example telling them,  “good job cleaning up your crayons”—to help encourage the behavior and make the child feel good.
• Reflection. Parents repeat and build upon what the child says to show that they are listening and to encourage improved communication.
• Imitation. Parents do the same thing that the child is doing, which shows approval and helps teach the child how to play with others.
• Description. Parents describe the child's activity (e.g., “You're building a tower with blocks”) to demonstrate interest and build vocabulary.
• Enthusiasm. Parents are enthusiastic and show excitement about what the child is doing.

Parents are guided to praise wanted behaviors, like sharing, and to ignore unwanted or annoying behaviors, such as whining (unless the behaviors are destructive or dangerous). In addition, parents are taught to avoid criticisms or negative words—such as “no,” “don't,” “stop,” or “quit”—and instead concentrate on positive directions.

In addition to the coached sessions, parents are given homework sessions of 5 to 10 minutes each day to practice newly acquired skills with their child. Once the parent's skill level meets the program's identified criteria, the second phase of treatment is initiated.

Phase II: Discipline and Compliance (Parent-Directed Interaction)

The second phase of PCIT concentrates on establishing a structured and consistent approach to discipline. During this phase, also known as parent-directed interaction (PDI), the parent takes the lead. Parents are taught to give clear, direct commands to the child and to provide consistent consequences for both compliance and noncompliance. When a child obeys the command, parents are instructed to provide labeled, or specific, praise (e.g., “Thank you for sitting quietly”). When a child disobeys, however, the parents initiate a time-out procedure. The time-out procedure typically begins with the parent issuing the child a warning and a clear choice of action (e.g., “put your toys away or go to time-out”), and may advance to sending the child to a time-out chair or time-out room as needed.

Parents are coached in the use of these skills during a play situation where they must issue commands to their child and follow through with the appropriate consequence for positive and negative behaviors. In addition, parents are provided with strategies for managing challenging situations outside of therapy (for example, when a child throws a tantrum in the grocery store or hits another child).  Parents also are given homework in this phase to aid in skill acquisition.

Assessments

In addition to clinical interviews, PCIT uses a combination of observational and standardized assessment measures to assess interactions between parent and child, child behaviors, and parental perception of stress related to being a parent, as well as parents' own perceptions of the difficulty of their child's behaviors and their interactions with their child. Assessments are conducted before, during, and after treatment.

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You are in section: Table of Contents 1 - What Makes PCIT Unique 2 - Key Components 3 - Effectiveness of PCIT 4 - What to Look for in a Therapist 5 - Conclusion 6 - Resources 7 - References

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Updated on October 9, 2009